Surgery I Final Review - Exam 2 Material

SURGERY I EXAM 2 FINAL REVIEW

SURGERY I EXAM 2 FINAL REVIEW

Open Wound Management

Open Wound Management

1. Cover the wound with a clean, dry bandage

2. assess and stabilize the animal

3. clip and aseptically prepare the wound area

4. start debridement and lavage

What are the initial steps in managing open or superficial wounds?

first 6-8 hours post-injury when bacterial levels are typically below 10⁵ CFU/g of tissue

What is the "Golden Period" in wound management, and why is it important?

1. Class 1 (0-6 hrs): Clean, minimal trauma → Primary Closure

2. Class 2 (6-12 hrs): Mild contamination → Delayed Primary Closure

3. Class 3 (>12 hrs): Dirty/infected → Secondary or Third Intention Healing

How are wounds classified and which closure methods are appropriate for each class?

1. Surgical: Fastest, for clearly devitalized tissue

2. Autolytic: Moist environment; slower, gentle

3. Mechanical (bandage): Early/infected wounds; non-selective

4. Enzymatic: For patients unfit for surgery

5. Biosurgical (maggots): Chronic, infected, necrotic wounds

What are the main types of debridement and when are they used?

1. Lavage reduces bacteria and debris.

2. Preferred method: 1L saline in a pressure bag at 300 mmHg via 18G needle (7-8 psi).

3. Avoid sponges and low-pressure tools; they're ineffective and may damage tissue

Why is wound lavage critical, and what methods are most effective?

Principles of SA Reconstructive Surgery

Principles of SA Reconstructive Surgery

1. unequal suture spacing

2. resecting one large or two small triangles of skin

3. resecting an elliptical skin segment

How can "dog ears" at suture lines be prevented or corrected?

1. incisions near a wound to relieve tension

2. used over fibrotic areas or important structures like tendons, vessels, or joints.

What are relaxing incisions and when are they used?

Z-shaped incision to reduce tension and aid closure, with the central limb parallel to lines of tension and limbs at 60° angles

What is a Z-plasty and what is its purpose in wound closure?

1. Benign tumors: ≥1 cm

2. Malignant tumors: ≥2-3 cm and one fascial plane deep

3. Wider margins for infiltrative/aggressive tumors

What surgical margins are recommended for tumor removal?

1. advancement

2. rotational

3. transposition

4. interpolation

5. axial pattern flaps

What are the main types of skin flaps used for wound closure?

1. To close defects from trauma

2. To correct congenital abnormalities

3. To repair surgical wounds after tumor removal

4. To restore function and aesthetics using the most appropriate and cost-effective techniques

What are the main indications for performing reconstructive surgery in veterinary patients?

1. Plasty techniques (e.g., V-to-Y, Z-plasty)

2. Pedicle flaps (partially detached tissue mobilized to cover defects)

3. Grafts (fully detached skin segments transferred to another site)

4. Use of local tissue advancement or distant tissue transfer

What are some key surgical techniques for closing large or irregular skin defects?

1. Make incisions parallel to skin tension lines

2. Use undermining, appropriate suture patterns, and skin-stretching techniques

3. Avoid excessive tension to prevent dehiscence and preserve blood flow

4. Assess elasticity and mobility of surrounding tissue before closure

What are key principles and methods for reducing skin tension during reconstructive surgery?

1. Presuturing (24h before surgery)

2. Adjustable sutures

3. Skin stretchers (noninvasive, effective in 24-96h)

4. Inflatable tissue expanders (gradual expansion over days/weeks)

What methods are used to stretch or expand skin prior to reconstructive closure?

1. Subdermal and walking sutures

2. Vertical mattress sutures placed 1-2 cm from the primary line

3. Pulley sutures (far-near-near-far) and horizontal mattress sutures

4. Use of stents and proper spacing to reduce pressure and skin necrosis

What suture techniques help relieve tension and promote wound healing?

Principles of Trauma Management

Principles of Trauma Management

1. rapid (under 2 minutes) assessment to identify life-threatening issues, prioritizing critical organs

2. helps determine the extent of injury and immediate interventions needed

What is the purpose and time limit of a primary survey in an emergency?

1. M² - Massive Hemorrhage & Muzzle

2. A - Airway

3. R - Respiration

4. C - Circulation

5. H² - Head Injury & Hypothermia

6. E - Evacuation / Pain Management / Antibiotics

What does the acronym M²ARCH²E stand for in Canine Tactical Combat Casualty Care (CTC3)?

1. Check for airway patency: listen for abnormal sounds, observe for masses, swelling, or obstructions.

2. Clear obstructions using techniques like the "2-finger sweep."

3. Be prepared to reposition head/neck or perform a tracheotomy if needed.

List the key steps for assessing and managing a dog's airway.

1. Arterial bleeding: bright red, squirting

2. Venous bleeding: dark red, oozing

3. Apply constant pressure

4. Use tourniquets (e.g. C-A-T, SOF-T)

5. Hemostatic dressings (e.g. Combat Gauze, Chitogauze)

What are signs of massive hemorrhage and how do you control it?

1. Pale, blue, or brick-red mucous membranes

2. Capillary refill time >2 seconds

3. Weak or absent pulse, irregular rhythm

4. Signs of shock include rapid HR and delayed CRT

What are critical signs to check for circulatory compromise in a trauma patient?

SA Pre-Operative Patient Assessment and

Preparation

SA Pre-Operative Patient Assessment and

Preparation

1. Thorough history (signalment, complaint, past treatments)

2. Complete physical exam (including neurologic & orthopedic systems)

3. Laboratory data

4. Evaluation of underlying diseases

5. Patient stabilization

What are the core components of a preoperative assessment in veterinary surgery?

1. Based on patient age, physical status, and procedure risk

2. "Big 4" for young, healthy animals: PCV, Total Protein, Blood Glucose, & BUN

3. Older/systemic patients need CBC, chemistry, urinalysis

How is the extent of preoperative lab work determined and what are the "Big 4"?

1. I: Healthy, elective surgery

2. II: Mild systemic/localized disease

3. III: Severe systemic disease (e.g., pneumonia)

4. IV: Life-threatening disease (e.g., renal failure)

5. V: Moribund, unlikely to survive 24 hrs

6. "E" = Emergency surgery

What is the ASA classification and what does "E" signify?

1. Most SSIs come from endogenous skin flora

2. Preoperative antisepsis is critical (CHG > PVI)

3. Clip just before surgery with a #40 blade

4. Avoid shaving the night before

5. Clean skin properly, flush prepuce in male dogs

What are key points in preventing SSIs in veterinary surgery?

1. Builds trust & sets expectations

2. Must include: diagnosis, options, risks, cost, prognosis, and postoperative care

3. Use clear, honest language about odds (e.g., 50:50 = "I really don't know")

4. Signed consent & cost estimate forms are mandatory

Why is client communication vital and what must it include?

LA Bandaging & Open Wound Management

LA Bandaging & Open Wound Management

1. Granulation tissue: ~Day 5

2. Epithelialization: Between Day 4-6

When do granulation tissue and epithelialization typically appear in equine wound healing?

1. Stop the bleeding

2. Assess blood loss, vitals (HR, RR, MM color, CRT)

3. Evaluate tetanus vaccination status

4. Determine mechanism of injury and time elapsed

5. Consider primary closure if <12 hrs post-injury

What are the critical first steps in managing a wound in a horse?

1. Give tetanus toxoid and tetanus anti-toxin

2. Risk of anti-toxin: Theiler's disease (serum hepatitis)

What tetanus protocol should be followed for a horse with an unknown or outdated vaccine history?

1. Primary closure - <12 hrs, clean wounds

2. Delayed primary - 3-5 days post-injury, mild contamination

3. Delayed secondary - After granulation tissue, excise excess tissue first

4. Second intention - No closure; for large, contaminated, or chronic wounds

What are the four types of wound closure and when are they used?

1. Causes: Distal limb wounds, excessive movement, hypoxia from bandaging, owner ointments

2. Treatment: Sharp debridement, topical steroids, possible skin grafts

What causes proud flesh in horses and how is it treated?

LA Pre-Operative Assessment

and Preparation

LA Pre-Operative Assessment

and Preparation

1. Referring Veterinarian - for history, diagnostics, and case follow-up

2. Owner/Trainer/Agent - to explain risks, costs, post-op care, and outcomes

3. Insurance Company - especially for elective vs emergency anesthesia or euthanasia

What three parties must be communicated with before large animal surgery, and why?

1. Inherent Risk Factors: Signalment, history, body size, foals/geriatrics

2. Variable Risk Factors: Primary disease, surgical urgency (emergency vs elective), extent of surgery, ASA score

What are the main components of pre-operative risk assessment in large animals?

1. ASA III: Severe systemic disease (e.g., dehydration, fever)

2. ASA IV: Life-threatening disease (e.g., sepsis, colitis); increased anesthesia risk

What does an ASA status of III or IV indicate in a horse?

1. Fever or systemic illness (for elective cases)

2. Unstable cardiovascular status

3. Abnormal diagnostics (e.g., electrolyte imbalances, anemia, lung sounds)

Name 3 scenarios when surgery should be delayed in large animals.

1. Clean

2. Clean-contaminated

3. Contaminated

4. Dirty

5. Used to determine antibiotic use and infection risk.

What are the 4 classes of surgical wounds, and why are they important?

Principles of LA Soft Tissue Surgery

Principles of LA Soft Tissue Surgery

1. Tissue is thicker, skin doesn't bruise easily

2. Hemorrhage is usually not a problem

3. Trauma is reduced by using fingers, stay sutures, and atraumatic forceps

How is large animal tissue handling different from small animals?

1. Blood volume = 8% of body weight (~40 L for 500 kg horse)

2. <15% loss (6 L) = No signs

3. 15-20% loss (8 L) = Clinical signs

4. 40% loss (16 L) = Risk of death

How much blood can a horse lose before clinical signs appear?

1. Standing: Avoids recumbency complications & cheaper, useful for select structures (e.g. dorsal)

2. Recumbent: Safer for surgeon, better access to most structures & preferred for control — opposite of cattle

What are the pros and cons of standing vs. recumbent surgery in horses?

1. Swelling → airway obstruction (may need tracheotomy)

2. Nerve damage

3. Improper airway sizing → aspiration or unresolved issue

4. Surgical site infection (URT surgery = clean-contaminated/contaminated)

What are key complications of upper respiratory tract (URT) surgery in horses?

1. Adhesions (↓ fibrinolysis)

2. Peritonitis, hemoabdomen

3. Ileus, diarrhea, endotoxemia

4. Incisional infection

5. Prevention tips: gentle tissue handling, keep moist, use lubricants, flush abdomen, avoid dry gauze

What are common post-operative complications in equine GI surgery?

SA Bandaging and Bandaging Techniques

SA Bandaging and Bandaging Techniques

1. Advantages: Protects wounds & speeds wound healing

2. Disadvantages/Complications: Can result in limb amputation & to patient death if not properly applied

What are the advantages and disadvantages of bandaging in veterinary practice?

1. Primary Layer: Debrids tissue, delivers medication, absorbs exudate

2. Secondary Layer: Absorbs agents, prevents bacterial growth, supports the wound

3. Tertiary Layer: Holds bandage in place, protects from external bacteria

What are the primary functions of a bandage's layers?

1. Patient discomfort

2. Mutilation of bandage or wound by patient

3. Bacterial colonization

4. Ischemic injury

5. GI foreign body obstruction

What are common complications associated with bandages?

1. Adherent: Used for debridement, may be wet or dry

2. Nonadherent: Used for the repair phase, retains moisture, and prevents dehydration

What is the difference between an adherent and nonadherent primary layer?

1. Apply bandage from toes up to avoid swelling

2. Use firm, even pressure during application

3. Expose middle two toes if possible

4. Owner compliance is crucial for success

What are some key rules to remember when applying bandages?

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