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Sx Skills - Lab Manual Info

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drraythe's version from 2016-05-05 09:53

Lab Manual

Question Answer
Which suture material should you NOT do surgeons knots on?Cat gut - can cz fraying
When might you want to use surgeons knots?May be used when ligating thick vascular pedicles, pedicles under tension or where there is tension along wound edges
When are hand ties useful to do?Useful in confined spaces but uses more suture than instrument ties;
Also useful when sutures have been preplaced (i.e. thoracotomy)
How does Two-hand tie compare to one-hand tie?2 HAND: allows for good control & accuracy but difficult to perform in confined spaces
1 HAND: useful in deep cavities & confined spaces
How is knot security related to diameter of suture material?Inversely related (bigger diameter, less security)
The knot should be as small as possible. Use appropriate small gauge suture. Cut suture ends (“tags”) short (How short?)-exception is what, why?3mm short tags. Exception is surgical gut (6mm, due to swelling)
Make the final throw as close to _________ as possibleHorizontal
Pros & cons of an interrupted patternPRO: more secure than continuous pattern → failure of a single interrupted suture is often not of serious consequence. Also enables adjustment of tension along suture line
CONS: less time efficient & uses more suture material than continuous patterns
Effect on incision edge → appositional → indicated when, what is it good for?Indicated when there is no tension on incision edges. Enables best anatomical approximation
Effect on incision edge → inverting → indicated when, what is it good for?Indicated for use in larger-lumen hollow organs. Serosa-serosa apposition provides water-tight seal & inversion ↓ exposure of suture minimizing risk of adhesion formation
Effect on incision edge → everting → indicated when, what is it good for? Downside?Indicated for suturing skin edges under tension. There will be a longer healing time, tho
Effect on incision edge → tension relieving → indicated when, what is it good for? Exs?Used to ↓ tension on suture line. Can also be used in tissues w/ slow healing time. inclds everting patterns such as the mattress patterns, but also inclds Mayo-mattress, walking sutures & near-far patterns
*Applications for simple interrupted? Advantages?Very commonly used suture pattern for skin, closure of the rectus sheath following a ventral midline incision & other tissue types. Advantage: each suture is independent, therefore if 1 fails, the integrity of the closure should not be significantly affected
*Applications for cruciate? Useful in?Helps to resist tension while preventing eversion of the skin edges → is NOT the most ideal pattern in areas where tension is of real concern! Useful in closing stumps (i.e. tail & digit amputation sites)
*Applications for the vertical mattress?Can be used when incision edges are under tension, best used w/ stents to reduce risk of suture tearing through the incision edge. Less effect on local blood supply than horizontal mattress. Degree of eversion is dependent upon how tightly the suture is tied
*Applications for horizontal mattress?Can be used when incision edges are under tension. Best used w/ stents to reduce risk of suture tearing through the incision edge. Degree of eversion is dependent upon how tightly the suture is tied. Greater risk of complications from effect on local blood supply than vertical mattress
Which has greater risk of complications from effect on local blood supply-vertical or horizontal mattress?Horizontal compromises blood supply more
***What is the most appropriate pattern for closure of incisions/wounds subjected to considerable tension???Surgeon's stitch (near far, far near)
Applications for the surgeons stitch?Most appropriate pattern for closure of incisions/wounds subjected to considerable tension. Resists tension w/o causing excessive stress directly on incision/wound edges
**Always begin/end continuous suture patterns where???~5 mm beyond each end of the incision
What are the applications of the simple continuous?Used commonly to close subcutaneous layer of ventral abdominal incision, but can also be used for other applications & in a variety of tissue types (i.e. hollow organs). Can be placed more rapidly than a series of simple interrupted sutures Ensure good knot security to avoid suture failure. Creates good tissue apposition & more water-tight seal versus a simple interrupted pattern
In what regard is a simple continuous better than a simple interrupted?A continuous Creates good tissue apposition & more water-tight seal versus a simple interrupted pattern
Applications of a ford interlocking?Advantage of this pattern is stability in the event of knot failure. Suture pattern commonly used in bovine, but can be used to close skin in small animals
Advantage of which (continuous) pattern is stability in the event of knot failure?Ford interlocking
What are the applications of a continuous horizontal mattress?Can be used when incision edges are under tension. Best used w/ stents to reduce risk of suture tearing through the incision edge. Can be placed more rapidly than interrupted horizontal mattress.
What are the applications of the Subcuticular (intradermal) w/ buried knot?W/ good apposition, it will look good & leave minimal visible scar formation. Good pattern for animals who are unlikely to return for suture removal
Which pattern is good for animals who are unlikely to return for suture removal?Subcuticular (intradermal) w/ buried knot?
Currently, the most commonly used suture patterns for most hollow organ procedures?Appositional-simple interrupted/continuous
*What are the applications of the lembert pattern?Closure of large-lumened hollow organs (colon, bladder, stomach, rumen). Can be used in a single-or double-layer closure; if used in a double-layer closure, can be used as either 1st or 2nd layer
Which is full thickness - Cushing or Connell?Connell
*If doing a Cushing or Connell, where do you want to start suturing?Begin pattern on right side of the incision for right-handed surgeons (or left side of incision for left-handed surgeons)
Applications for a Cushing pattern?Can be used as the inner or outer layer of a double-layer closure on hollow viscera
Applications for a Connell pattern?May only be used as the 1st (inner) layer of a two-layer closure  can be followed by a Cushing or Lembert
What are some applications of a purse-string suture?Used to stabilize indwelling cannulae (tubes), close defect in hollow organ wall, temporarily close anus during perineal surgical procedures, help to maintain rectal prolapse reduction, close ends of intestine during intestinal resection & anastomosis (old technique)
What are the applications of the Chinese Finger Trap?Used to secure indwelling tubes (i.e. feeding tubes) to PTx
**The likelihood of a ligature failing is related to what?The volume it encloses (the more stuff it has to be around, the more likely it is to fail)
How many throws in a ligature knot should be tightened thumb-to-thumb?The 1st 2 throws of every knot
When should you be flashing while tying a ligature?1st 2 throws
*Applications for a circumferential ligature?Vascular hemostasis, Ligation of ovarian or testicular pedicle
Benefit the transfixing ligature has over the circumferential?↓ risk of slipping
*Applications of transfixing ligature?Vascular hemostasis, Ligation of ovarian or testicular pedicle
Millers knot → for use in ligations, especially in circumstances where ...Pedicle is under tension
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