General Surgery: Sutures, Bowel Anastomosis, and Post-Operative Care

This set covers surgical sutures, needle types, bowel anastomosis methods, post-operative complications like fever and wound dehiscence, SSI classifications, and perioperative hygiene protocols.

Purse string sutures

A suturing technique used in rectal prolapse surgery ($\text{Thiersch wiring}$), cervical cerclage, and to bury the appendicular stump.

Swaged end

The specific end of a surgical needle where the thread is attached.

Round body (RB) needle

A needle with a rounded cross-section used for delicate structures, specifically the bowel, bladder, common bile duct ($\text{CBD}$), and blood vessels.

Cutting needle

A needle with a triangular cross-section used for tough structures including the skin, sheath, fascia, and scalp.

Needle holding rule

The needle should be held at $\frac{1}{3}^{rd}$ from the swaged end and $\frac{2}{3}^{rd}$ from the pointed end.

Suture Numbering

No. $1$ is the thickest suture, while No. $11-0$ is the finest suture.

Catgut

A natural absorbable suture made from sheep mucosa that undergoes enzymatic degradation over $90$ days.

Vicryl (Polyglactin)

A braided, synthetic absorbable suture absorbed through hydrolysis in $60-90$ days, commonly used for the bowel, bladder, and $\text{CBD}$.

PDS (Polydioxanone)

A synthetic absorbable suture with an absorption time of $180$ days.

Prolene (Polypropylene)

A synthetic monofilament non-absorbable suture used for rectus sheath closure (where suture length is $4 \times$ wound length) and vascular repair.

Suture removal: Face

Non-absorbable sutures on the face should be removed within $3-5$ days.

Submucosa

The strongest layer encountered in bowel anastomosis.

Linear Stapler

A surgical stapler used for bowel anastomosis, sleeve gastrectomy, and Zenker's diverticulum surgery.

Post-Op Fever Day 1

The most common ($\text{m/c}$) cause is atelectasis, which is prevented by chest physiotherapy (incentive spirometer), pain control, and cessation of smoking $4-6$ weeks prior to surgery.

Salmon fluid sign

The oozing of serous fluid from the surgical site, identifying a burst abdomen or abdominal wound dehiscence, usually occurring on post-operative day ($\text{POD}$) $6$.

ASEPSIS and Southampton

Two distinct scoring systems used for the assessment and categorization of Surgical Site Infections ($\text{SSI}$).

Clean wound

A wound from a procedure like thyroid surgery or CABG where the GI/GU system is not entered, carrying a $1-2\%$ $SSI$ rate with antibiotic prophylaxis.

Dirty wound

A wound involving pus, peritonitis, or fecal contamination, with a $20-40\%$ $SSI$ rate without antibiotic prophylaxis.

Hand washing missed areas

The most frequently missed areas are the thumb and finger tips, while interdigital areas are less frequently missed.

Prophylactic antibiotics

Medication given ideally $30$ to $60$ minutes before surgery (during induction); a repeat dose is required if surgery is prolonged beyond $4$ hours.

OT Temperature and Humidity

Optimal operating theater conditions are a temperature of $18-21^{\circ}C$ and humidity of $50-60\%$.

MUST tool

The Malnutrition Universal Screening Tool used to assess overall risk by scoring $BMI$, weight loss, and acute disease effects.