click below
click below
Normal Size Small Size show me how
Surg Seminars
Surgery
Question | Answer |
---|---|
2 basic kinds of suture. | absorbable and nonabsorbable |
4 types of absorbable sutures. | plain gut, chromic gut, Dexon, and Vicryl |
Source of plain and chromic gut sutures. | tough submucosal layer of the hog intestine |
Plain vs chromic gut sutures (tensile strength) | Plain gut is unmodified & loses tensile strength in 1 to 2 wks; chromic gut is soaked in chromic acid salts, retains its strength for 2 to 3 wks |
How long tensile strength is maintained in Dexon and Vicryl | 2 to 3 weeks |
4 groups of nonabsorbable sutures | silk and cotton, braided synthetics, monofilament synthetics, and wire |
3 reasons silk is most commonly used suture material. | Silk is easy to handle, easy to tie, and holds knots well. Silk will stay securely tied if tied with three knots |
Advantages of braided synthetic sutures over silk. | less reactive than silk; good retention of tensile strength; relatively inert in uninfected tissue |
Pos & cons of monofilament sutures. | more difficult to handle and tie and hold knots poorly; very inert & do not shelter bac; heal without stitch abscesses; hold their strength well with time |
Pos & cons of using wire suture. | adapt to tissue more poorly than monofilaments, small open spaces; hard to tie; larger must be twisted (adv in suturing bone); retains its strength well |
Grading system for suture sizes | Largest = 5; smallest = 10-0 |
Absorbable vs. nonabsorbable sutures | use absorbable if continued strength not important, or infxn issue favors absorbable; Nonabsorbable used if need minimal tissue rxn, or continued strength beyond 2-3 wks, or suture will be removed |
4 surgical needle characteristics | eye, shape, point and cross section, and size |
Mayo needle | stout, curved, tapered needle, available in several sizes; often for suturing fascia |
Keith needle | 6 - 7 cm straight cutting needle used on the skin; needle itself is 3-4 times as big as the suture |
French eye needle | fine curved needle in the 1.5 to 2 cm range, has a spring-like eye |
Swaged needle | fastened to the end of the suture during manufacture & needs to be no larger than the suture itself; for CV & intestine surg; for and for nylon or polypropylene sutures |
Taper (atraumatic) | for soft tissues and fascia, the tapered needle, round in cross section is best. |
Conventional cutting needle | puts a small cut in the direction of pull of the suture; easier to pass through the tissue |
Reverse cutting needle | have a flat edge in the direction of pull |
Ground point wire | saber point that has sharp edges, while the body of the needle is round in cross section; sharp enough to penetrate & sew grafts |
Square knot = | Strongest knot; 80-90% of tensile strength of uninterrupted strand. |
Four principles of suturing | Approximate-do not strangulate; use smallest size suture necessary to maintain closure; small sutures placed close together = lg sutures placed farther apart; wound tension is best relieved by using subcutaneous absorbable sutures |
Bite = | amount of tissue taken when placing the suture needle |
Throw = | Each suture knot consists of a series of throws |
Skin closure | Sutures, usually of a nonabsorbable material, placed in the skin with the knot tied on the surface |
Dermal closure | Sutures, usually of an absorbable material, that are placed in the superficial(subcutaneous) fascia and dermis with the knot buried in the wound |
Subcuticular (pull-out) suture | an excellent cosmetic closure because it eliminates the crosshatching caused by suture marks. This technique is limited to straight lacerations less than 2-3 inches long |
Why is layer matching important when closing wounds. | Failure to appose layers meticulously can cause improper healing with an unnecessarily large scar |
Wound edge eversion | sl raised wound edge above plane of normal skin will flatten w/ healing; edges that are not everted will contract into linear pits = noticeable cosmetic defects. |
Define dead space | These spaces tend fill with fluid and can be potential sites for infection |
Problems caused by too much wound edge tension | minimize tension in order to preserve capillary blood flow to the wound edge |
3 techniques to reduce wound edge tension | Dermal (Deep) Closures; Wound Undermining; More Sutures |
Pros of wound taping | Pro: less need for anesthesia, ease of application, even distn of tension across wound, no residual suture marks, elim need suture removal. |
Cons of wound taping | Cons: do not work well near joints, on hair bearing surfaces, wounds under tension, in very young or noncompliant pts, or on wounds that cannot be made free of blood or secretions |
Describe the correct methods to hold forceps | Pencil grip |
most important principle of wound care: | copious irrigation and adequate debridement |
Langers lines | Conn tissue bundles usu follow a predictable course within the dermis; wound closures parallel to these lines remain thin leaving small scars |
Wound closure: if time after injury is <8 hours: | Primary closure |
Contaminated wounds or wounds treated after 6 - 8 hrs: | delayed-primary closure or delayed closure |
Puncture wound: | leave open |
List five causes of shock | cardiac compressive; cardiogenic; hypovolemic; neurogenic; septic |
initial tx: cardiac compressive shock: | correction of the mechanical abnormality. |
initial tx: cardiogenic shock: | cautious fluid administration to increase preload; ACEI, beta blockers |
initial tx: hypovolemic shock: | lg bore IV access; crystalloid infusion; PRBCs? |
initial tx: neurogenic shock: | IV fluids; Peripheral vasoconstrictors? |
initial tx: septic shock: | clear offending infxn (Abx, débride, resect); supportive / resp |
Indications for PRBCs | hypovolemia + anemia; symptomatic anemia |
Indications for platelets | Plts <50,000 (bleeding); Plts <15,000 (asymptomatic) |
Indications for fresh frozen plasma | bleeding & coagulopathy; coumadin reversal |
Indications for cryoprecipitate | Fibrinogen <100 mg/dL |
Risks of transfusion | hemolytic rxn; febrile nonhemo rxn (vs WBCs); dz transmission |
Organisms: skin/scalp | staph epi & staph aureus |
Organisms: nose/sinus | strep & H flu |
Organisms: mouth | strep spp & Eikenella |
Organisms: feet | pseudomonas |
Organisms: cat bite | Pasteurella |
Organisms: dog bite | Strep viridans |
Post-op diarrhea often due to: | C. diff (tx: PO Flagyl) |
Phases of wound healing | inflam (1-10 d); proliferation (5d – 3 wks); remodeling (3 wks-1 yr) |
Ways to handle tissue that minimize risk of infection | Sterile technique; Minimize tissue damage; Prophylactic Abx (peak = same time as skin incision); outcomes clinical research to systematically identify problems |
Infections occurring within 48 hours post-op: | If rapidly spreading: possibly necrotizing fasciitis due to Clostridia or Strep. B |
Most common post-op infxn | UTI |
Post-op infxn <POD3 | pneumonia |
Most common cause of post-op fever | atalectasis |
Post-op infxn POD3 | UTI |
Post-op infxn: usu POD5 | Wound infxn |
Veins for IV: usu first choice | metacarpal veins |