Chapter 11 Word Scramble

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Question	Answer
1st century	Celsus and Glaenus ligated vessels
19th century	Sterile technique. Pasteur: Organisms outside the body caused disease. insturments should be boiled and passed through flame. Lister:Infection was a result of "Disease dust". Soaked suture in carbolized oil
20th Century	Suture made of catgut, silk, kangaroo. Fist synthetic suture polyglycolic acid
Tensile strength	Maximum amount of weight it can endure before breaking
Absorbable suture	Capable of being absorbed by the tissue. Should absorb by the time the tissue has healed. Avoid tissue reaction
Nonabsorbable suture	resists enzymatic digestion or absorption by tissue
Monofilament suture	single thread structure, do not harbor bacteria, more difficult to hold knot, ideal suture type if infection present
Multifilament suture	Multiple threads braided or twisted. capillarity, able to harbor bacteria. avoid use when there is infection. great tensile strength. easy passage through tissue. easy handling. secure knots
Capillarity	Capability to harbor bacteria and tissue fluids
Tie on pass	Adson tonsil with suture at tip
Name a chemical, electrical and mechanical way to obtain hemostasis	Chemical: Avitene Electrical:Bovie Mechanical:Suture
Natural suture	cellulose, animal product, animal tissue.Natural absorbable:digested by body enzymes that attack the suture strand
Synthetic suture	polymers from petroleum based products. Synthetic absorbable is hydrolyzed by the body. Water in tissue breaks down synthetic fibers. Minimal tissue reaction
The united states pharmacopeia USP and Brown and Sharp B and S	USP specifies diameter (gauge) for suture. B and S specifies commercial wire gauge numbers largest is 7
Where is absorbable suture used	Areas that do not need continuous support. Subcutaneous tissue and mucosal layer of the intestine
Where is nonabsorbable suture used	where there is need for continuous support. Closed abnormal openings in the heart, dura of the brain, dura over spinal cord, fascia and skin
What are common monofilament absorbable sutures	Plain gut, chromic gut, PDS and monocryl
What are common monofilament nonabsorbable suture	Prolene, surgilene (used on heart with cooleys), Nylon, stainless steel
What are common Multifilament absorbable suture	Vicryl and dexon
What are common multifilament nonabsorbable suture	silk, surgical cotton, braided nylon, mersilene, ethibond (strong used for ortho)
Ligatures	Ties to occlude vessels. Precut lengths (18, 24, 30in). or comes in suture reels. Cut suture shorter than 1/4in if multifilament and cut at 1/4 in for monofilament
Free tie	No needle or needle holder. Place suture in surgeons hand. Monofilament leave 1/4 in tail and multifilament leave 1/8in tail
Suture ligature	Stick tie:Sutures with a swaged atraumatic needle loaded onto a needle holder. Large vessel occlusion to prevent suture slippage.
Reel tie	Occlude superficial bleeders. Radiopaque and include in count
Instrument tie	Tie on a pass: suture is loaded onto an instruement crile, schnidt, adson
List the from first to last the layers of closure	1. Peritoneum 2. Fascia 3. Muscle 4. Subcutaneous 5. Subcuticular 6. skin
Primary suture line	Sutures that approximate wound edges for first intention healing. Ex pursestring, subcuticular
Second suture line	ease tension on the primary. Retention sutures placed lateral to primary sutures
Linear staples	Two parallel rows of staples
Ligating cutters	Two ligating clips side by side then divides the tissue between the clips
Cutting needle	3 cutting edges
Taper points	round shaft without a cutting edge
blunt needle	round shaft that ends in a blunt tip
Shaft	Between the suture stand and the point. Length is determined by the depth of the bite or the tissue to be sutured
Point	Determines the shape of the body. body shapes are round, triangular or flattened. Tapered and blunt needles have round bodies. Cutting needles have triangular bodies
Body	stright or most common is 1/2 circle body. Microsurgical needles are retention suture needles usually 3/8 circle
CDC classifies wounds in what three categories	Clean. Clean contaminated. Contaminated. dirty infected
Inflammation	Injured tissues release histamine. bodies protective response to injury
First intention wound healing	Primary closure. Phase 1 lag phase- inflammatory response. Phase 2 proliferation. Phase 3 maturation-cicatrix forms
Second intention wound healing	granulation-proud fesh-excessive granulation of tissue may form
Third intention of wound healing	delayed primary closure-contaminated or dirty wounds
What are the three main factors that influence wound healing	1 Physical condition 2. Intraoperative tissue handling 3. application of principles of asepsis and sterile technique
Dehiscence	Partial or total separation of tissue after closure
Friable	Easily torn
Evisceration	Protrusion of the viscera through the edges of a separated wound. Emergency
Fistula	Abnormal tract between two epithelium lined surfaces that is open at both ends
Sinus tract	abnormal tract between two epithelium lined surfaces that is open at one end only
Keloid scar	Hypertrophic scar formation
Why does the surgeon try to use the smallest suture for wound closure	1. Minimal tissue trauma 2. minimal foreign material in body
What is 1 and 0 suture most used on	Ortho wounds and abdominal fascia
what is 4-0 and 5-0 suture used on	aortic anastamosis
What is 6-0 and 7-0 suture used on	smaller anastamosis or coronary or carotid arteries
8-0 throught 11-0 suture used on	microvascular and eye procedures
4-0 suture is used on	dural closure
3-0 and 4-0 suture is used on	subcuticular skin
What are factors for choosing suture	1. type of procedure 2. condition of tissue 3. disease processes 4. surgeon preference 5. suture cost 6. availablility of suture
What are disease processes that affect suture closure	DM. immune system diseases, pituitary gland dysfunction, localized infection, systemic infections
Pliability	How easily suture passes through tissue. How easily suture ties knots and knot security
What is the most important information on a suture box	suture size, material, size of needle
What are surgical needles made of and what is the needle eye?	Made of steel. Needle eye is where the suture is attached
Closed eye needle	Round or square holes have to lead suture through. Causes more tissue damage
French eye needle	Pull the taut strand into a V shape. Load quicker than closed eye. More tissue damages than eyeless
Eyeless or swaged needle	Suture inserted into one end of the needle. Single arm attachment or double arm. Permanently attached suture or control release
Conventional cutting needle and reverse cutting needle	Conventional: 3 cutting edges that extend the length of the shaft Reverse: Opposing cutting edges along the shaft
Side cutting needle and tapered point needle	side: opthalamic procedures aka spatula tapered: Round shaft without cutting edges, doesn't cut tissue, used on delicate tissue
Blunt point and ground point wire needles	Blunt: round shaft with blunt tip ground: point with sharp edges and round body
What size circle are microsurgical needles	3/8 circle
Hypodermic needle	Inject medications, withdraw medications into a syringe, draw fluids from tissue. Gauge 12-30. smaller the needle the larger the number
Arterial or venous/cannula needle	employ a needle to introduce a plastic indwelling catheter into a vessel, used to obtain arterial blood gas
Arterial needles	Ex Potts-Cournand, introduc diagnostic or angioplasty guiding catheters into arterial system
Irrigation needles	small ccannulated tube, straight or angled, disposable and non disposable, different lengths
Biopsy needles	Obtain tissue samples from inside the body. Ex dorsey needle, chiba biopsy needle, franklin silverman and trucut biopsy needle
Continuous or running suture	evenly distributed tension. Simple continuous:Long straight edges that easily evert. Continuous running/locking, blanket stitch: suture is locked prior to next throw, reduce skin tension and increase wound edge eversion
Interrupted suture	for Tissue under tension (Halsted method). Interrupted horizontal mattress: 2 bite placed parallel. Interrupted vertical mattress: 2 bite 1st place close to wound edge 2nd placed slightly behind first
Endoscopic suturing: Extracorpeal and Intracorporeal	Extracorporeal: Creating the knot outside the body. Intracorporeal: Internal suturing and tying knot inside the body ex endoloop
Wound Zipper	Noninvasie, atraumatic device for skin closure. Eliminates needle holes and sharps injury, faster than suturing
Cyanoacrylate	Synthetic adhesive for skin closure. ex Dermabond and indermil. Chemical liquid glue, dries in 2 minutes. Flexible, wears off in 7-10days. Can't use if infection is present
Fibrin Glue	Biologic adhesive and hemostat agent. Mix calcium chloride and thrombin. Drawn in two separate syringes and applied at the same time
Bridges	Plastic device that bridge and close the incision. tension can be adjusted
Bolsters	Plastic or rubber tubing on retention suture to prevent retention suture from cutting the skin
Button holes	Tendon suture
Split lead shots	Clipped on ends of subcuticular sutures after skin closure
Umbilical tape	retraction and isolation during surgery
Vessel loops	Isolation and retraction, elasticity. White/yellow=Nerves or ducts. Red=Arteries. Blue=veins
Suture Anchors	Used in ortho for fixing tendons and ligaments to bone
What are the benefits and disadvantages of stapling	Advantage: Less tissue reaction, accelerated wound healing, less operating time, efficiency. Disadvantages: Increased cost, must be preciseley placed
Fascia and skin stapler	Approximate skin edges, single staple per action, close abdominal fascia
Linear staples and linear cutter	2 straight, staggered, evenly spaces, parallel rows of staples used for transection ex TA. Cutter: Staples and cuts tissue ex GIA
Ligating clips and linear dissecting stapler	occlude small structures. Dissecting stapler: 2 ligating clips side by side and then divides the tissue between the clips
Intraluminal stapler	Circular, anastomosis of tubular structures Ex EEA
Synthetic meshes	Pliable, easy to cut, easy to suture, porus
Biological materials	Fascia Lata, Muscle of cattle or muscle from patients thigh. Ingrowth mesh: Sugisis, porcine small intestine

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