Introduction to Surgery

Question 1

What is wound dehiscence?

Answer 1

Surgical complication in which a wound ruptures along a surgical suture

Question 2

What is the expected infection rate of all surgical wounds?

Answer 2

5%

Question 3

Describe the levels of sterilization.

Answer 3

• Critical
  
  • For Equipment or implants entering the body below the skin or mucous membranes
  • Requires sterlization and sterile technique
• Semi-critical
  
  • For Equipment that contacts the skin or mucous membranes only for surgical purposes without penetration of the body
  • Requires cleaning and disinfections
• Non-critical
  
  • For equipment that contacts mucous membranes or intact skin not directly associated with surgery
  • Requires cleaning and disinfection

Question 4

What is catgut suture? Describe its key characteristics.

Answer 4

• Suture prepared from sheep intestinal submucosa or cattle interstitial serosa
• Causes significant inflammatory response
• Rate of absorption variable depending on site and wound conditions
• Loses tensile strength rapidly and unpredictably
• treated with chromium salt solution to resist body enzymes and slower the absorption process thus supporting the wound for longer period
• Has a tendency to swell and weaken when wet
• Considerably weakened by knotting, but ties good ligatures
• Continues to be a popular choice of suture material despite many drawbacks and risk of TSE infection because it is cheap

Question 5

What is Poliglecaprone 25 (Monocryl)? Describe its key features.

Answer 5

• Synthetic monofilament
• Co-polymer of glycolide and carprolactone
• Absorbed by hydrolysis
• Virtually memory free
• Handles well knots securely
• Has the highest initial tensile strength of any monofilament absorbable

Question 6

What is Polyglactin 910 (vicryl)? Describe its key characteristics.

Answer 6

• Braided synthetic absorbable (glycolic acid and lactic acid)
• Coated to reduce tissue drag and improve knotting characteristics
• Absorbed by hydrolysis and therefore shows predictable loss of tensile strength
• Vicryl rapide has quick absorption

Question 7

What is Polydioxanone (PDS). What is its key feature?

Answer 7

Monofilament degraded by hydrolysis at a slow rate

Question 8

What is nylon suture? What are its key features?

Answer 8

• Monofilament (multifilament)
• High tensile strength
• High memory
• Poor knot security
• Poor handling
• Main use for skin sutures
• Permanent material

Question 9

What is Polypropylene? What are its key features?

Answer 9

• Monofilament polymer of propylene
• With careful tying, strands flatten at knot to enhance holding
• High memory and poor handling makes good knots difficult to tie
• Virtually inert in tissues
• Not to be used in infected areas

Question 10

What are the advantages/disadvantages of naso-oesophageal (NO) intubation and its contraindication?

Answer 10

• Advantages
  
  • Easy to place
  • Ability to eat and drink around tube
  • Removal at any time
• Disadvantage
  
  • Small tube size
  • Risk of tracheal placement
  • Risk of premature removal
• Contraindications: vomiting/regurgitation

Question 11

For what condition is oesophagostomy indicated? What are the advantages/disadvantages of using an oesophagostomy tube? What are the contraindications for its use?

Answer 11

• Indicated for disorders of oral cavity/pharynx with functional distal GIT
• Contraindicated for
  
  • Oesophageal disorder
  • Post-oesophageal surgery
  • Oesophagitis
  • Megaoesophagus
• Advantages
  
  • Easy to place
  • Well-tolerated
  • Large-bore tubes
  • Ability to eat/drink around the tube
  • Removal at any time
• Disadvantages
  
  • Require general anaesthesia (GA) for placement

Question 12

For which conditions is Gastrostomy tube feeding indicated? What are the advantages/disadvantages of its use?

Answer 12

• Indicated for patients with a functional stomach /distal GIT but surgery of oral cavity, larynx, pharynx, oesophagus
• Advantages
  
  • Ease of placement
  • Well-tolerated
  • Large-bore tubes
  • Ease of feeding and tube care
  • Oral feeding can still occur
• Disadvantages
  
  • General anaesthetic required for placement
  • Specialist equipment required
  • Entry into peritoneal cavity
  • Needs 7-14 days for stoma to form prior to removal
  • Severe complications if early removal

Question 13

What are some possible complications of using a gastrostomy tube?

Answer 13

• Peritonitis
  
  • With premature removal
  • With over-feeding of large-breed dogs
• Vomiting
• Peri-stomal infection
• Migration of feeding tube tip into pylorus

Question 14

For what condition is enterostomy tube feeding indicated?

Answer 14

Indicated for gastric, intestinal, pancreatic disease and biliary tract surgery with distal functional intestine as it bypasses dysfunctional stomach/duodenum