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