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VMD407
operative surgery
| Question | Answer |
|---|---|
| Surgical objectives | preserve or restore function restore structure (anatomic reconstruction) preserve or restore appearance minimize morbidity |
| what % of uncomplicated surgeries result in infection? | 2-5% |
| Halstead's surgical principles | Gentle tissue handling Aseptic technique Hemostasis Anatomic reconstruction Minimize dead space Minimize foreign material Manage concurrent disease |
| key events of surgical injury and healing | hemostasis inflammation proliferation remodeling scar maturation |
| Reasons for dehiscence | loss of tissue integrity loss of suture integrity excessive forces on wound |
| surgical factors contributing to wound complications | excessive tissue inflammation infection necrosis excessive forces |
| suture pullout | the force required to pull a suture out of a tissue (= relative holding strength of the tissue) |
| relative tissue strengths | fascia(3.77Kg) > skin(1.82Kg) > muscle(1.27Kg) > fat(0.2Kg) |
| describe the ideal suture | loses tensile strength at the same rate as the tissue of a healing wound gains tensile strength |
| what are desirable characteristics of a suture | biocompatibility ease of handling knot security non-capillary absorption inhibition of microbial growth |
| absorbable, short lasting, natural suture | Catgut TS = 7-14d Abs = 40-60d |
| absorbable, short lasting, synthetic suture | vicryl rapide TS = 7-14d Abs = 40-60d |
| absorbable, medium lasting, braided suture | Vicryl Braided Dexon TS = 14-28 Abs = 60-90+d |
| Absorbable, medium lasting, monofilament suture | Monocryl Dexon TS = 14-28d Abs = 60-90+d |
| absorbable, long lasting, monofilament suture | Maxon PDSII Biosyn TS >40d Abs = 120-180+d |
| Tensile strength retention vicryl rapide | 50% in 5-6d 0% in 2wks |
| Tensile strength retention Monocryl | 60-70% in 1wk 30-40% in 2wks |
| Tensile strength retention coated vicryl | 50% in 3wks |
| Tensile strength retention PDSII | 50% in 4wks |
| zone of inflammation | ~4mm from incision want sutures beyond this to avoid inflammatory degradation of suture material |
| vicryl rapide TSRP Abs | TSRP = 50% 5-6d Abs = 42d |
| monocryl TSRP Abs | TSRP = 60-70% 1wk; 30-40% 2wks Abs = 90-119d |
| coated vicryl TSRP Abs | TSRP = 50% 3wks Abs = 56-70d |
| PDSII TSRP Abs | TSRP = 50% 4wks Abs = 180-210d |
| What are the most commonly used sized suture needles in veterinary medicine? | 3/8 circle and 1/2 circle |
| name three grips for holding needle drivers | thumb finger - more control thenar - more flexibility palmed - more force applied to needle |
| Different approaches to hemostasis | pressure clamping ligation sealing hemostatic agents |
| Double ligation of vessels | 2 ligatures placed 2-4mm apart may need more than 2 (and placed farther apart) for large vessels |
| Why do you want to minimize dead space? | reduces space for collection of serum serum is a nidus for infection and also puts gravitational tension on suture line |
| What are some techniques for minimizing dead space | apposition of tissue layers (+/- tacking) external pressure bandage drains (active/passive) loose wound packing (with gradual removal) |
| "Clean Wound" | non-tramatic no break in technique no inflammation no GI, genitourinary, respiratory |
| "Clean Contaminated Wound" | minor break in technique GI, genitourinary, but no significant spillage |
| "Contaminated Wound" | Major technique break GI, genitourinary with spillage freshly traumatic wound |
| "Dirty Wound" | acute bacterial inflammation transection clean tissue to access pus traumatic wound, devitalized tissue, foreign body, fecal contamination, delayed treatment |
| How do you calculate risk of surgical site infection? | (Dose of bacterial contamination X virulence of bacteria) divided by resistance of host |
| critical bacterial inoculum | 10^5 microorganisms/gram tissue |
| antimicrobial prophylaxis | procedures > 2hr procedures with implants dental GI Open Fx repair Orthopedics perineal hernia repair |
| when should antimicrobial prophylaxis be given? | <2hr before incision |
| what is the best way to minimize surgical site infection | excellent surgical technique -asepsis -gentle tissue handling -hemostasis -accurate apposition |
| anesthetic drug groups | Parasympatholytics (atropine) Neuroleptanalgesics (acepromazine/ hydromorphone; acepromazine/oxymorphone) Opioids (Morphine) |
| atropine | rapid onset short duration blocks muscarinic effects on heart and glands |
| acepromazine | long onset long duration sedation, antiarrhythmic, cheap hypotension, seizures, no analgesia |
| hydro- and oxymorphone | short onset 4-6hr duration good analgesia (+/- sedation) panting, bradycardia, regurgitation, excitability |
| acepromazine/oxymorphone (or hydro) | good sedation and analgesia lower doses less vomiting panting bradycardia regurgitation |
| morphine | long onset long duration excellent sedation and analgesia vomiting, panting, bradycardia, hypothermia, vasodilation, histamine release |
| what's an advantage of normosol R and plasmalyte? | they don't have Ca |
| When do you give horses prolylactic abx? | Commonly b/c fear risk of respiratory dz After Kelby's mom induces penile abrasions |
| Which abx do you commonly give to dogs in sx? For which bacteria? | Cefazolin - effective against 99% Staph & 90% Ecoli (coagulase + Staph and Ecoli) |
| Which abx do you commonly give to horses in sx? For which bacteria? | Penicillin + aminoglycoside (Gentamicin/amikacin) for Staph & Strep & Enterobacteriacea |
| What are the 4 general recommendations for abx prophylaxis? | -give immediately before incision (<2h) -redose if lengthy procedure -no additional benefit after 24h -if a drain is placed, continue abx for 24h post drain removal -if Kelby's mom has open sores |
| 4 reasons we premedicate | -sedation (gettin' her "in the mood") -preemptive analgesia (before tight backdoor penetrations) -decrease injectable/inhalant (you only have so much in your date-rape kit) -block side effects associated with drugs/procedure (screaming and fighting bac |
| What kind of closure should you use on Kelby's mom's gaping anus? | Trick Question: Let the 5 guys after you worry about the closure |
Created by:
modonnell