Week 1-2 Flashcards by Iseoluwa Ojo

A surgical suture, also known as a stitch or stitches, is a _______ used to __________ and ____________ after an injury or surgery.

medical device

hold body tissues together

approximate wound edges

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There are numerous types of suture which differ by _______ and _______ as well as __________ and characteristics

needle shape and size

thread material

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_________ , or _______, needles with sutures consist of a pre-packed eyeless needle attached to a specific length of suture thread.

Swaged

atraumatic

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The _____ and ______ needle design allows curved needles to be straight enough to be used in laparoscopic surgery, where instruments are inserted into the abdominal cavity through narrow cannulas.

ski and canoe

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Monofilament versus polyfilament threads

Monofilament fibers have less _________ but create less _________ and are more appropriate with ______ tissues where ___________ can be more significant such as _________________.

tensile strength ; tissue trauma

delicate tissues ; tissue trauma

small blood vessels.

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Monofilament versus polyfilament threads

Polyfilament (_________) sutures are composed of multiple fibers and are generally greater in _______ with greater ___________, however, they tend to have greater ____________ and theoretically have more propensity to harbor _________

braided; diameter

tensile strength; tissue reaction

bacteria

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Other properties to consider between a mono or poly filamentous thread

Tensile strength: the ability of the suture to _____________________.

Elasticity: the ability of the suture material to ______________ such as in cases of ________.

Tissue reactivity: ______________ of the surrounding tissue that can cause materials to break down quicker and lose tensile strength.

Knot security: the ability of the suture to __________________

hold tissues in place without breaking

adapt to changing tissues ; edema

inflammatory response

maintain a knot that holds the thread in place

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(Absorbable or Non absorbable?) (natural or synthetic?) suture have the (Absorbable or Non absorbable?) (natural or synthetic?) fibers have the highest rates of tissue reactivity.

Non absorbable synthetic

absorbable natural

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Absorbable sutures are either degraded via ___________ or ___________ and should not be utilized on body tissue that would require greater than ___________ of tensile strength.

proteolysis : hydrolysis

two months

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Absorbable sutures are generally used (internally or externally?) during surgery or to avoid further procedures for individuals with (low or high?) likelihood of returning for suture removal.

Internally ;low

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Natural absorbable

Natural absorbable material includes ___________ , ___________ and ___________ which are all produced from the _____ extracted from ____________.

They are all (mono or poly?) filaments which have different degradations times ranging from ___-____days.

plain catgut, chromic catgut and fast catgut

collagen; bovine intestines

poly; 3–28

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Synthetic absorbable

Synthetic absorbable material includes ________ acid, ________ acid, _________, Polydioxanone and Polytrimethylene carbonate.

Among these are monofilaments, polyfilaments and braided sutures. In general synthetic materials will keep tensile strength for longer due to less local tissue inflammation

Polyglactic

Polyglycolic

Poliglecaprone

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Best used on:

Plain catgut-
Chromic catgut
Fast catgut-

Mucosal tissues
Mucosal, skin, genitalia
Mainly skin, also mucosal

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Non-absorbable

They are appropriate for tissues with a (low or high?) degree of mechanical or shear force (________, certain skin location).

High

tendons

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Sutures

Natural non-absorbable : ______

Synthetic non-absorbable: ______,______,_________

Silk

nylon, polypropylene and surgical steel

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Sutures

Natural non-absorbable : Silk - ____filament

Synthetic: includes nylon, polypropylene and surgical steel all of which are _____filaments

poly

mono

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A Marjolin ulcer is a ___________ that arises in the setting of ____________ skin, _______ scars, and _______ wounds

cutaneous malignancy

previously injured

longstanding

chronic

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_____________________ (ERAS) is a modern approach to help people _______ following surgery

Enhanced Recovery After Surgery

recover quicker

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ERAS PROTOCOL

Pre-Operative

•Ensuring the patient is as healthy as possible prior to surgery, through ______ and ________

•Optimising medical management, including _________ and ________

•__________ prior to surgery to enhance bowel recovery and avoid bowel prep if appropriate

•Solids allowed until _______ pre-operatively (unless contra-indicated)

•Intake of clear fluids until ______ prior to surgery, with some centres moving towards being able to drink clear fluids up to the time of leaving the ward

•Loading with 12.5% _________ within 2 hours of surgery

exercise and weight loss

smoking and alcohol cessation

Altered diet; 6 hours

2 hours

carbohydrate beverage

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ERAS PROTOCOL

Intra-Operative

•Use of multimodal and _______ analgesia, including regional anaesthesia*

•Includes avoidance of ____-acting benzodiazepines in the elderly

•Use of multimodal postoperative __________________ prophylaxis

•Use of _______________ surgery

•Targeting a goal-directed fluid therapy regime, including goal-directed _______ management

opioid-sparing

short; nausea and vomiting

minimally invasive

haemostasis

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Regional anaesthesia includes _______ and ________ anaesthesia, __________ catheters, and _____________ regional blocks

spinal and epidural anaesthesia

rectus sheath catheters

local anaesthetic regional blocks

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ERAS PROTOCOL

Post-Operative

Ensure adequate _________ is achieved to allow for early mobilisation

Early ________ and optimising nutrition

Multi-disciplinary post-operative patient follow-up, including in the post-acute care phase

pain control

oral intake

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There are several parts to the operating theatre:

List them

Scrubbing area

Operating room

Anaesthetic room

Storage area

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There are several parts to the operating theatre:

_____________ – contains sinks and sterile gowns, gloves, and masks/visors etc

___________ – contains the scrub nurse table

Scrubbing area

Operating room

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Storage area also are often sterile T/F

The time it takes for a tissue to no longer require support from sutures will vary depending on tissue type: Days: ____,_______, or ______ Weeks to Months: ________ or ______ Months to Never: ______________

Muscle, subcutaneous tissue or skin Fascia or tendon Vascular prosthesis

The ideal suture is the (smallest or largest ?) possible to produce uniform tensile strength, securely hold the wound for the required time for healing, then _________. It should be predictable, easy to handle, produce minimal reaction, and knot securely.

Smallest be absorbed

_________ sutures are commonly used for deep tissues and tissues that heal rapidly

Absorbable

For the more commonly used absorbable sutures, complete absorption times will vary: Vicryl rapide =___ days Vicryl = ___ days Monocryl = ~____ days PDS = ~_____ days

42 60 100 200

Non-Absorbable Sutures Non-absorbable sutures are used to provide _____-term tissue support, remaining ______ by the body’s ________ (until removed manually if required).

long walled-off inflammatory processes

Non-absorbable sutures Uses include for tissues that heal (rapidly or slowly?) , such as ______ or ______ , closure of __________, or _______ anastomoses.

slowly fascia or tendons abdominal wall vascular

Monofilament vs Multifilament Suture materials can also be sub-classified by their structure: Monofilament suture – a single stranded filament suture (e.g _____,——- *, or prolene). Multifilament suture – made of several filaments that are twisted together (e.g _______ or _______ ).

nylon; PDS braided silk or vicryl

Monofilament vs Multifilament sutures Monofilament suture -(Lower or Higher?) infection risk -(good or poor?) knot security and ease of handling. Multifilament suture -(good or poor?) knot security and ease of handling -(Lower or Higher?) infection risk

Lower; poor Good; Higher

The larger the size ascribed to the suture, the _______ the diameter is, for example a 7-0 suture is ______ than a 4-0 suture.

smaller smaller

When choosing suture size, the _______ size possible should be chosen, taking into account the _______ of the tissue.

smallest natural strength

Commonly, surgical needles are made from _____________ .

stainless steel

Surgical needles are composed of: The _______ end connects the needle to the suture The _________ or ____________ is the region grasped by the needle holder. The _________

swaged needle body or shaft Needle point

Needle bodies can be ______,_______, or _________

round, cutting, or reverse cutting:

Needle bodies can be round, cutting, or reverse cutting: Round bodied needles are used in _____ tissue such as ______ and _____ Cutting needles are ______ in shape, and have _____ cutting edges to penetrate _____ tissue such as the ______ and _______, and have a cutting surface on the con______ edge Reverse cutting needles have a cutting surface on the con_____ edge, and are ideal for ______ tissue such as _______ or ______ sutures, and have reduced risk of cutting through tissue

friable; liver and kidney triangular; 3; tough; skin and sternum;cave Vex; tough; tendon or subcuticular

The needle point acts to pierce the tissue, beginning at the maximal point of the body and running to the end of the needle, and can be either _____ or _______

sharp or blunt

Needle points Blunt needles are used for ________, and in _____ tissue, and can potentially reduce the risk of blood borne virus infection from needlestick injuries. Sharp needles pierce and spread tissues with minimal cutting, and are used in areas where ______ must be prevented.

abdominal wall closure; friable leakage

Allis forceps are _______ surgical instruments, used to grasp ____ tissues (such as _____) Babcock forceps are ______ instruments with a (rough or smooth?) end, allowing for more delicate structures (such as ______) to be held in an _______ manner Dunhill forceps are (small or large?) forceps with _____________ ends, often used to grasp ———- prior to ligation Lane tissue forceps have ______ teeth, allowing the grasping of _____ tissues, such as ______

toothed ; firm tissues ;fascia jawed ; smooth ; bowel; atraumatic manner small ;curved serrated ;vessels interlocking teeth; tough ; fascia

Littlewood forceps have ____ ended teeth, used to grasp ______ tissues, such as ______. They are often used to gain entry via the _________ for _______ surgery. Sawtell forceps are _______ forceps with a ——— end, often used to grasp ———— prior to ligation Available as curved or straight, Spencer Wells forceps can be used to ______ medium to large sized vessels prior to ligation

blunt ;tough ;fascia. ; umbilicus ; laparoscopic curved ; serrated ; vessels clamp

Debakey forceps are _______ forceps used in a wide variety of procedures, importantly can be used to grasp tissues (such as ______ ) without damaging them Lanes forceps are ______ instruments, useful for grasping tissues and are widely used within all surgical specialities (however not to be used to grasp _____) Gillies forceps are (narrow or wide?) ________ forceps, often used to grasp ______ (not to be used to grasp _______)

non-toothed ; bowel toothed ; bowel narrow ; toothed ; skin ; bowel

Mayo scissors are ______ scissors, with _______ ends, often used to cut _______ or ________, either straight or curved McIndoe scissors are used often for cutting or dissecting ______, characteristically have a ______ blade

heavy; semi-blunt; thick tissues or sutures tissues; curved

Rampleys can be used for handle ______ or _______

guaze or sponges

Diathermy is the use of ________ frequency alternate polarity radio-wave ________ to _______ or _____ tissue during surgery.

high frequency electrical current cut or coagulate

Diathermy It allows for ______ to be made with limited ________ and is now used in nearly all surgical disciplines.

precise incisions blood loss

Diathermy uses _______ frequencies

very high

Diathermy Depending on the temperature reached, different results occur: at 60oc, ________ occurs (______), between 60-99oc, _____ occurs and the tissues ______, and at around 100 oc, the tissues ______ (_______).

cell death ; fulgurate dehydration; coagulate vaporise; cutting

Diathermy Cutting uses a __________ waveform with a __________ voltage. Coagulation alternatively uses a __________ waveform with a __________ voltage.

continuous ; low pulsed ; high

abscess is a localised collection of ____ surrounded by __________.

pus granulation tissue

Pus contains ______ tissue with suspended _____________ and ________. It forms when the primary insult is a _______ bacterium and extensive tissue necrosis occurs.

necrotic dead and viable neutrophils dead pathogens pyogenic bacterium

Over time, the acute inflammation will cease and, if not ___________, the abscess will be replaced by ______.

surgically drained scar tissue

An abscess can be a source for _________________ of a pathogen, with the abscess acting as a _______ for the infection. It can also cause continually rising pressures within the tissue, resulting in _____ and _________ of local structures.

systemic dissemination harbour pain; destruction

The basic principles for the management of a wound or laceration are: List all 5

Haemostasis Cleaning the wound Analgesia Skin closure Dressing and follow-up advice

In cases of significant injury or laceration of vessels, steps may need to be taken to reduce bleeding and aid haemostasis. These include ________,_______,________, or _________

pressure, elevation, tourniquet, or suturing.

Wound cleaning is important for reducing infection and promoting healing. There are five aspects of wound cleaning: List all

Disinfect Decontaminate Debride Irrigate Antibiotics

five aspects of wound cleaning: Disinfect the __________ with antiseptic and Avoid getting ________ Decontaminate the wound by _________ Debride any _______ where possible Irrigate the wound with _____ Antibiotics for high-risk wounds or signs of infection

skin around the wound ; alcohol or detergents inside the wound manually removing any foreign bodies devitalised tissue saline

Remember to not use adrenaline with local anaesthetic if administering ________________

in or near appendages (e.g. a finger)

Skin Closure To aid wound healing, the edges of the wound can be manually opposed. There are four main methods of doing so: List all

Skin adhesive strips Tissue adhesive glue Sutures Staples

Skin Closure Skin adhesive strips (e.g. Steri-StripsTM) are suitable if ___________ are present Tissue adhesive glue :a popular choice in ___________ Staples can be used for some ____ wounds

no risk factors for infection paediatrics scalp

When applying a wound dressing to a non-infected laceration, the first layer should be __________ (such as a __________), followed by an __________ to attract any __________, and finally __________ to secure the dressing in place.

non-adherent ; saline-soaked gauze absorbent material ; wound exudate soft gauze tape

Any sutures or adhesive strips should be removed _______ after initial would closure (or ______ if on the head) tissue adhesive glue will naturally slough off after ______.

10-14 days 3-5 days 1-2 weeks

Remove dressings at the same time as the sutures or adhesive strips. T/F

foreign body (________ giant cell) mycobacterium tuberculosis (_______ giant cell) fat necrosis (________ giant cell).

foreign-body Langhans Touton

There are two main types of healing, ________ intention and _______ intention. In both types, there are four stages which occur; _______,________,_______, and ________

primary; secondary haemostasis, inflammation, proliferation, and remodelling.

Any wound made by a scalpel will heal by _________ intention. Surgeons can aid healing by ensuring adequate opposition of the wound edges, through use of surgical glue, sutures, or staples.

primary

When sutures are used to close a wound, ensuring the correct tension of the sutures is essential: Too loose and the _________________, limiting the primary intention healing and reducing wound strength Too tight and the ______________ and lead to tissue necrosis and wound breakdown

wound edges will not be properly opposed blood supply to the region may become compromised

Healing by secondary intention occurs when ___________, therefore healing must occur from the (top or bottom?) of the wound (up or down?)wards.

the sides of the wound are not opposed bottom upwards

Local factors affecting wound healing M I L F S

mechanical factors Infections Location of wound Foreign material Size and type of the wound Radiation damage

Systemic factors affecting wound healing ???

Co-morbidities Obesity Nutrition Increasing Age

Classification of wound contamination ?

Clean Clean contaminated Contaminated Dirty

Classification of wound contamination Clean _____ signs of inflammation, ____ opening of any of the tracts Clean contaminated ___________ case that is otherwise _____. ________ opening of respiratory, GI, biliary, or GU tract with _____ spillage

No; no Urgent or emergency; clean Elective; minimal

Classification of wound contamination Contaminated _____ spillage from GI tract or entry into biliary or GU tract (in the presence of __________). Or a ________ trauma <___ hours old or a ________ wound to be grafted or covered Dirty ________ inflammation (e.g. _____) Preoperative _______ of respiratory, gastrointestinal, biliary, or genitourinary tract, or a penetrating trauma >___ hours old

Gross; infected bile or urine Penetrating; 4; chronic open Purulent; abscess; perforation;4

Fibroadenoma:_______ lesions, _____-defined and ______ on palpation, (pain or painless?) Lipoma:________ and _______ benign adipose tumour Cysts: (rubbery or hard?), (smooth or irregular?) , and (well-defined or indistinct?), (pain or painless?) Nodullarity: (rubbery or hard?) , (smooth or irregular?) , and (well-defined or indistinct?) , (pain or painless?) Carcinoma: (rubbery or hard?) , (smooth or irregular?) , and (well-defined or indistinct?) (painful or painless?)

highly mobile; well; rubbery, painless soft; mobile hard, smooth, and well-defined, either rubbery, irregular, and indistinct, pain hard , irregular, and indistinct, often painless, rarely painful

Adenoma A _______ adenoma is a benign _______ tumour, typically occurring in the _______ female population. Papilloma _________ papillomas are a benign breast lesion that usually occur in females in their ________yrs, most typically occurring in the _________ region Phyllodes tumours* are _________ tumours. They are commonly (smaller or larger?), occur in an ______ age group, and are comprised of both epithelial and stromal tissue.

ductal; glandular; older Intraductal; 40-50; subareolar rare fibroepithelial; larger; older

benign breast lesions can present in a variety of ways. However in general, benign breast lumps tend to be more (mobile or fixed?) and have (smoother or rougher?) borders than their malignant counterparts, which often have ______ surfaces, a _____ consistency, and can be ______ to different layers of tissue.

Mobile; smoother craggy; firm; fixed

Malignant lesions tend to present as a single mass, whilst it is possible to get multiple benign breast lumps. T/F

Differential Diagnosis of Benign breast lump The main differentials to consider include _______,_______, and _______

cysts, abscesses, and malignant lesions.

The mainstay of distinguishing between breast lumps is __________________[.

the Triple Assessment

All suspicious breast lesions should undergo the triple assessment, warranting _________,________,_________

examination, imaging, and histology.

Common benign tumour subtypes include ________,________,________,________ and ___________

Fibroadenoma, Adenoma, Papilloma, Lipoma, and Phyllodes Tumours

Plain catgut is a natural suture material derived from the _________ of _________ or the _________ of _________.

submucosa ; sheep intestine serosa ; cattle intestine.

Chromic catgut is a modification of __________ that is tanned with _________ to improve ________ and delay ________.

plain catgut chromic salts strength; dissolution

Current methods for fighting SSIs involve the use of sutures coated with common antibiotics (________). Unfortunately, these antibiotics have been rendered ineffective due to the _____________________________

triclosan increasing rate of antibiotic resistance.

The cruciate anastomosis is an arterial network located on the ______ surface of the ______________. Some authors refer to it as the ____________________. The cruciate anastomosis is formed by the: _____________________ artery. And ____________ artery

posterior; proximal femur collateral circulation at the hip joint First perforating branch of deep femoral Inferior gluteal

An arthrotomy is a _________ of a ________ , which should include inspection of the _______, ___________ structures, _________, and __________.

surgical exploration of a joint cartilage; intra-articular joint capsule; ligaments

Traumatic brain injury is classified as ______,_________, or ________, based on the __________________.

mild, moderate, or severe Glasgow Coma Scale (GCS) score

Wagner’s classification of Foot ulcers Ulcer grading Description Grade O Grade 1 Grade 2 Grade 3 Grade 4 Grade 5

No ulcer but high-risk foot Superficial ulcer Deep ulcer, no bony involvement or Abscess with bony involvement (as shown by X-ray) abscess Localized gangrene e.g. toe, heel etc Extensive gangrene involving the whole foot