Surgery Lecture Exam 1

What is involved in a history?

* Signalment
* Age, breed, gender
* Reason for visit
* Specific history for presenting complaint
* Ask for pertinent details
* Any treatments for problems
* Current medications, vitamins, supplements
* Follow-up history
* Anything else?

Leading Questions vs. Open Ended Questions

* When did you first notice it? vs Has it been there for a long time?
* Has it changed in size? vs Has it gotten bigger?
* Does Rex seem to notice it? vs Is it causing pain?
* Have you noticed any other changes in Rex? vs Is Rex eating less or losing weight?

What is included in a signalment?

* Age
* Gender
* Breed

What does a consent form consist of?

* Identifies the patient
* Specific procedures to be performed
* Preoperative bloodwork
* General anesthesia
* Neuter
* Potential risks
* Veterinarians name
* Estimate
* Signature of the owner of the patient
* Owner contact information

Who can sign consent form?

Must be signed by owner of animal

Who cannot sign consent form?

Persons under the age of 18

Exception to consent form?

If a horse has an agent and the owner has previously discussed with the veterinarian, the agent can sign

Sources of surgical infection:

* Operating room environment
* Operating team
* Surgical instruments and supplies
* \*Patient’s endogenous flora

Before Surgery:

* Eat
* Daily showers/ hair washing
* Keep fingernails short and clean
* No overpowering fragrances
* Clean scrubs

Surgical Attire:

* Clean scrubs with shirt and drawstrings tucked in
* Surgical cap that completely covers hair
* Surgical mask
* Shoecovers over surgery dedicated shoes
* No cellphones

Scrubbing Up:

* Nails no longer than fingertips
* Remove all jewelry
* Clean nails first before starting scrub

3 Types of gloving:

* Open gloving
* Closed gloving
* Assisted gloving

Open Gloving

* Not used for routine surgical gloving
* Used when only hands need to be sterile

Closed Gloving

* Provides assurance against contamination because bare skin is not exposed
* Preferred method for surgical procedures

Assisted Gloving

* Requires 2 people
* Used if a glove is contaminated during surgery

To maintain a sterile environment:

* Continual monitoring of sterile field
* Handling sterile instruments
* Passing sterile instruments
* Sterile light covers

Monitoring Patient:

* Electrocardiography
* Capnography
* Pulse Oximetry
* Temperature
* NO HEATING PADS

Instrument Count

* Before opening body cavity
* Before closing body cavity

Best Instrument Handling:

* Orderly arrangement
* Ring handles closest to the surgeon
* Knowing what the surgeon needs
* Knowing what each instrument does
* Proper passing of instruments

What are the responsibilities of the surgical assistant?

* Maintaining sterile environment
* Monitoring Patient
* Managing Instrument Table
* Instrument Handling
* Maintaining Tissues
* Maintaining hemostasis

Memory:

Inherent capability of suture to return to, or maintain its original gross shape

Drag:

the amount of friction created as suture is pulled through the tissue

Tensile Strength:

a measurement of the ability of material to resist deformation and breakage

Elasticity:

the degree to which suture will deform under stress or load and return to its original form when the load is removed

Plasticity:

the degree to which suture will deform without breaking and will maintain its shape after removal of the deforming force

Pliability:

the ease of handling and the ability of the suture to change shape

Creep:

tendency of a suture to slowly and permanently deform under constant stress

Hydrolysis:

cleavage of chemical bonds by the addition of water

Proteolysis:

breakdown of proteins into peptides and amino acids

Suture Alternatives:

* Surgical mesh
* Tissue adhesive
* Stapling

Surgical Mesh

* used to augment surgical repair of slow healing tissue
* synthetic polymers or biologically derived materials
* Polypropylene
* SIS
* woven or knitted for strength
* Small pore size inhibits ingrown of capillaries and fibroblasts

Tissue Adhesive

* Cyanoacrylate glue
* Liquid monomer form
* Bonds to skin cells and it sloughs when those cells die

Correct Application of Tissue Adhesive

* Pinch skin edges together and apply to surface on top of skin

Stapling

* Skin Staples
* Circular Staples
* Linear Staples
* Vascular Clips

Simple Interrupted Pattern

* Easiest pattern to learn
* Appositional
* Provides secure closure
* Avoid excessive tension on tissue

Simple Interrupted Pattern

Simple Continuous Pattern

* Appositional
* Tied off only at ends
* Saves time and suture materials
* Not generally used for skin
* Avoid over-tightening
* Provides secure closure

Simple Continuous Pattern

Cruciate Pattern

* Appositional
* Too much tension will cause tissue to invert
* Faster than simple interrupted
* Gives a strong closure

Cruciate Pattern

Horizontal Mattress Pattern

* Tension relieving pattern
* Distributes forces away from the incision
* Too much tension will cause tissue to evert and damage blood supply to tissue

Horizontal Mattress Pattern

Buried Patterns

* Absorbable suture material
* Appositional
* Closes dead space
* Skin sutures support this layer of closure
* Knot is always at deepest layer

Buried Patterns

Correct Way to Put on a Blade:

Align the edge of the scalpel blade to the edge of the scalpel handle. As you slide the blade down, it will fall unto the small grooves in the scalpel handle. Keep moving the blade until it clicks into place.

Correct Way to Remove a Blade

To remove the blade, clamp the base with a pair of hemostats. Lift the base of the blade slightly and begin pushing it off the handle. Make sure no one is in front of you as you remove the blade. Once removed, discard the used blade in a sharps container.

Rules for Passing Instruments

* In a ready to use closed position so they can be gripped easily
* Anticipate
* Gentle but firm slap into the hand
* Thumb forceps passed with the points/ teeth pointing down
* Curved instruments passed with the point away from the surgeons palm
* Right handed vs left handed
* Finger rings first

How should Instruments be Arranged on a Table

Bard-Parker Handle and Blades

Mayo-Hegar Needle Holders

No scissors

Olsen-Hegar Needle Holders

Has scissors

Brown-Adson

General forceps used for tissue handling, suturing, cautery

Adson (Rat-Tooth)

Rat-tooth tip, for suturing skin and fascial planes

DeBakey

Delicate forceps which minimize trauma to tissues

Mayo Scissors

* Handle Length Similar to cutting blade length
* Used for tougher thicker tissue

Metzenbaum Scissors

* Longer handle than cutting blade length
* Used for finer tissue dissection
* Abdominal Surgery
* Cystomy
* Gastrotomy

Lister Bandage Scissors

Littauer Suture Scissors

General Operating Scissors

Halsted Mosquito Hemostatic Forceps

* Straight or curved jaws, used to control point bleeders
* Smallest hemostats

Kelly and Crile Hemostatic Forceps

* Straight or curved jaws
* Kelly-transverse grooves only on the distal surface
* Crile- transverse grooves over entire jaw surface

Halsted Mosquito Hemostatic Forceps and Kelly Hemostatic Forceps

Rochester-Carmalt Hemostat

* Used for clamping the ovarian pedicle in spays
* Strength is at the tips

Babcock Tissue Forceps

* Atraumatic organ grasping
* Use bladder, stomach, uterus

Doyen Intestinal Forceps

* Thin bowed jaws, longitudinal grooves, used for intestinal occlusion

Allis Tissue Forceps

* Crushing/ grasping forceps
* Should not be used on live tissue
* If it stays in patient do not use these

Backhaus Towel Clamps

Roeder Towel Clamps

Jones Towel Clamps

Senn Retractors

* Retract skin and superficial muscle layers

Army Navy

Ribbon Malleable

* Various lengths and widths
* Used in abdominal and thoracic surgeries

Gelpi Retractors

* Tips are sharp and angled outward
* Orthopedic/ neurologic

Weitlaner Retractors

* Superficial soft tissue

Balfour Retractors

* Abdomen

Finochietto

* Thorax

Snooks Spay Hook

Yankauer Suction Tip

* For large volumes of fluid

Poole Suction Tip

* For large, pooling volumes (body cavities)

Frazier Suction Tip

* Fine control

Suction Tubing

Suction Reservoir

Orthopedic Wire Twisters

Orthopedic Wire

Pin/ Wire Cutter

Periosteal Elevators

* Freer

ASIF or AO

Rongeurs

* Single Action

Rongeurs

Double Action

Mallet

Osteotome

Hohmann Retractor

Skin Stapler

GIA Stapler

TA Stapler

Monopolar Cautery

Bipolar Cautery

Cautery Unit

Ligasure

* Vessel sealing device
* Up to 7mm diameter vessels

Types of Suture Needles:

* Cutting
* Taper
* Reverse Cutting
* Trocar
* Blunt point
* Straight
* Micropoint
* Spatula