Chapter 12 - Surgical Techniques

Question 1

1. T/F time in surgery is directly proportional to tissue damage.

Answer 1

• TRUE

Question 2

2. Name all Halsted’s Principles (7)

Answer 2

• Apply strict asepsis during preparation and surgery
• Assure good hemostasis to improve conditions for the procedure and limit infection
• Avoid the formation of dead space
• Minimize tissue trauma through careful handling thereof
• Maintain blood supply
• Avoid undue tension on tissues
• Carefully adapt the corresponding tissue layers

Question 3

3. What are the 3 ways to hold a scalpel handle?

Answer 3

• Pencil grip
• Fingertip grip
• Palm grip

Question 4

4. What is a disadvantage of the pencil grip for scalpel handle?

Answer 4

• The relatively steep angle with which the scalpel is held, thereby decreasing contact of the cutting edge with the skin

Question 5

5. The fingertip grip for the scalpel is ideal for what type of incisions.

Answer 5

• Long straight, curved, or sigmoidal incisions

Question 6

6. Name 4 advantages of the fingertip grip for a scalpel blade

Answer 6

• provides greater cutting surface
• better control of the blade angle
• optimal control of incision depth
• blade movement originates in the shoulder, allowing entire arm to participate

Question 7

7. The cutting action of scissors is most effective at the ________

Answer 7

• tips of the instrument

Question 8

8. The blade near the hinge of scissors should not be used for cutting because it does what to tissue?

Answer 8

• Crushes it more than cuts it

Question 9

9. Straight blade scissors should be used to cut what type of tissue?

Answer 9

• Dense tissues

Question 9

10. What are the 3 methods for holding needle holders?

Answer 9

• Tripod grip
• Palm grip (thenar eminence grip)
• Thenar grip
• Pencil grip

Question 10

11. What is the advantage of the tripod grip for needle holders?

Answer 10

• Allows precision when releasing the needle, preferred when tissue is delicate or when precise suturing is required.

Question 11

12. The palm grip for needle holders is useful for _______ and ______?

Answer 11

• rapid instrument manipulation in closure of tissue where precision is not essential
• robust tissue that requires a strong needle-driving force

Question 12

13. T/F: the suture needle is gripped along its shaft so that the needle is parallel to and near the tip of the instrument.

Answer 12

• F, perpendicular to the instrument

Question 12

14. The needle can be grasped close to the ____ for better precision

Answer 12

• needle tip

Question 13

15. T/F: palm gripping of thumb forceps is less precise and more likely to cause unnecessary trauma to tissue

Answer 13

• True

Question 14

16. What grip is used for hemostat forceps?

Answer 14

• tripod grip

Question 15

17. Name the 5 most commonly used tissue forceps in equine surgery

Answer 15

• towel clamps
• mosquito forceps
• Allis tissue forceps
• Ochsner forceps
• Carmalt forceps

Question 16

18. T/F: Towel clamps and Allis tissue forceps are atraumatic and can be used to retract tissue. Oschners are traumatic and should only be used for tissue that will be removed

Answer 16

• False, all are traumatic, except for towel clamp

Question 17

19. When skin is properly transected, what will the skin edges do?

Answer 17

• retract

Question 18

20. Each time a scalpel leaves and returns to tissue a ____ is created, which adversely affects healing

Answer 18

• jagged edge

Question 19

21. T/F: a stab incision results when the bursting threshold of the tissue being incised is exceeded

Answer 19

• True

Question 20

22. A press cut is used to open what type of structures

Answer 20

• hollow, fluid filled structures such as the bladder

Question 21

23. T/F: lateral heat production during electroincision increases with duration of trigger activation and tissue contact time.

Answer 21

• True

Question 22

24. What speed should an electroincision be made

Answer 22

• 7 mm/s

Question 23

25. How many tissue planes should be cut at a time with electroincision?

Answer 23

- one

Question 24

26. Name 3 undesired effects of a charred electrode on an electroscalpel

Answer 24

- higher power is required to incise tissues - current is dispersed to a larger area of tissue, diminishing control - thermal necrosis of the wound is increased

Question 25

27. Name 2 things that can result in excessive buildup of char at the tip of the electroscalpel

Answer 25

- Power setting may be too high or the cutting speed may be too slow

Question 26

28. Name 3 advantages of electrosurgical incision

Answer 26

- reduction in total blood loss - decreased need for ligatures and reduction in the amount of foreign material left in the wound - reduced operating time

Question 27

29. Name 2 disadvantages of electrosurgical incisions

Answer 27

- delayed wound healing - decreased resistance of wounds to infection

Question 28

30. T/F: electro incisions heal by second intention. There is a definite lag time in reaching maximal strength, therefore skin staples or sutures should be left in place an additional 2-3 days

Answer 28

- F, heal by primary intention

Question 29

32. What is the most atraumatic method of blunt dissection?

Answer 29

- Finger dissection

Question 30

31. Name 4 tissues best excised with a scalpel

Answer 30

- skin - hollow organs - contaminated subcutaneous tissues - neoplastic tissues

Question 31

33. Where is scissor dissection not recommended?

Answer 31

- In deeper dissections ,where vessels or nerves could be severed before they are seen.

Question 32

34. Name 3 general techniques to achieve hemostasis

Answer 32

- mechanical - thermal - chemical

Question 33

35. Name 5 types of mechanical hemostasis

Answer 33

- pressure - ligatures - staples - surgical repair - Esmarch system

Question 34

36. What is the least traumatic means of vascular hemostasis? (only appropriate for small vessels)

Answer 34

- Direct pressure with sterile gauze

Question 35

37. When a hemostat is used for small vessel hemostasis, what processes within the vessel maintain hemostasis once the clamp is removed?

Answer 35

- Vasospasms and intravascular coagulation

Question 36

38. What portion of the hemostat is best used for mechanical hemostasis?

Answer 36

- The tip

Question 37

39. How should mosquito forceps be placed for mechanical hemostasis?

Answer 37

- Perpendicular to the cut surface

Question 38

40. How should larger forceps be applied for mechanical hemostasis?

Answer 38

- Perpendicular to the long axis of the vessel to be ligated

Question 39

41. If double ligation is needed, hemostats should be placed approximately ____ apart

Answer 39

- 2-3mm

Question 40

42. What are 2 techniques for ligation of larger pedicles?

Answer 40

- Divide and conquer - Three-forceps method

Question 41

43. Staples can occlude vessels up to ___ in diameter

Answer 41

- 7mm

Question 42

44. What are the advantages of using staples for mechanical hemostasis?

Answer 42

- Speed and precision

Question 43

45. What does LDS stand for in the stapling system?

Answer 43

- Ligate and Divide Stapler

Question 44

46. How does the LDS stapler system work?

Answer 44

- Applies 2 vascular staples that are crimped around the vessel simultaneously then divides the vessel between the staples (ligate and Divide stapler)

Question 45

47. What are the 2 disadvantages of using stapler systems for hemostasis?

Answer 45

- Expense - Potential failure when used on large vessels

Question 46

48. What are the major holding layers of large vessels?

Answer 46

- Tunica adventitia and tunica media

Question 47

49. What size suture is recommended for suturing a vessel wall defect

Answer 47

- 4-0 to 6-0

Question 48

50. Where should Esmarch or pneumatic tourniquets be placed in relation to the surgical site?

Answer 48

- 10-15cm proximal to the surgical site

Question 49

51. A tourniquet can be left on a limb up to _____.

Answer 49

- 60-90 minutes - (2-3h)

Question 50

52. What is the most common method of thermal hemostasis?

Answer 50

- Electrocoagulation or

Question 51

53. T/F: if the current applied in electrocoagulation is too low, the intracellular fluid boils and the vessel can burst without hemostasis.

Answer 51

- False – too high

Question 52

54. What is the mechanism of action of electrocoagulation?

Answer 52

- Obliterative coagulation

Question 53

55. What type of current produces the best hemostasis in electrocoagulation?

Answer 53

- a partially rectified waveform

Question 54

56. Electrocoagulation can coagulate vessels up to ___ in diameter?

Answer 54

- 2mm

Question 55

57. Defferent electrothermal bipolar or ultrasonic vessel-sealing systems (such as LigaSure) allow safe sealing of vessels up to ______mm diameter.

Answer 55

- 7mm

Question 56

58. What chemicals can be used to achieve hemostasis? (4)

Answer 56

- Epinephrine - Buffered 10% formalin - Ɛ-aminocaproic acid - Tranexamic acid

Question 57

59. Epinephrine works on what receptors and has what effect on vessels?

Answer 57

- α-adrenergic receptors, - peripheral vasoconstriction

Question 58

60. What is the mechanism of action of aminocaproic acid?

Answer 58

- Antifibrinolytic lysine analogue, stops hemorrhage by inhibition of clot breakdown - Inhibit conversion of plasminogen to plasmin

Question 59

61. Name 4 soluble sponge materials that can be used for hemostasis

Answer 59

- gelatin foam - oxidized cellulose - oxidized regenerated cellulose - micronized collagen

Question 60

62. What substance can be placed on bone to control bleeding?

Answer 60

- Bone wax

Question 61

63. What should be used instead of metallic retractors in the case of neurovascular bundles and nerves?

Answer 61

- Penrose drains or umbilical tape

Question 62

64. T/F: reduction of post-operative infection is directly proportional to the volume of irrigation solution in clean and clean contaminated wounds

Answer 62

- True

Question 63

65. Name 3 reasons why irrigation fluids may reduce infection rates

Answer 63

- removal of surface bacteria and debris from contaminated wounds - dislodgement and removal of bacteria and exudate from infected wounds - dilution and removal of toxins associated with infection

Question 64

66. What are the characteristics of the ideal lavage solution?

Answer 64

- Sterile, nontoxic, iso-osmotic, isotonic, and normothermic

Question 65

67. Name 3 examples of fluids that would be considered ideal lavage solutions

Answer 65

- sterile 0.9% physiologic saline - lactated ringer’s solution - plasmalyte

Question 66

68. T/F: adding antibiotics to lavage solutions has been shown to further reduce infection rates

Answer 66

- False

Question 67

69. Name 3 types of suction tips

Answer 67

- Yankauer - Poole - Frazier

Question 68

70. T/F: Normal cortical bone can be removed with a curette

Answer 68

- False