Surgery 101 Lectures- Study for Finals

A knot consists of how many Throws?

2 throws

A secured knot consists of how many throws

4 throws

What are Friction knots used for?

Examples?

Useful for vascular ligation

Miller’s and Strangle knots are better in vitro knot security over a Surgeon’s knot

Complexity of Suture Patterns can be defined as

Simple or Complex

Simple=One pass through tissue on each side of incision

Complex= two passes through tissue on each side of incision(mattress)

Continuity of Suture patterns can be defined as

Interrupted

Continuous

Effect on Incision Edges

Appositional

Everting

Inverting

Tension Relieving 

Appositional

Brings incision edges together- use when no excessive tension on skin

Everting

Incision edges turn upward- use in areas under tension

Inverting

Incision edges turned inward-use on hollow organs to minimize risk of luminal content leakage (serosa-serosa)

What suture material is preferred

What surgical needle 

monofilament

Cutting needle 

Distance between sutures should be 

~5mm

Ligature Applications

Hemostasis-

Vascular ligation

Used for pedicle Ligation (ovarian/testicular)

Circumferential Ligature is applied where

Most proximally on the pedicle 

transfixation Ligature is applied where

Most distally on the pedicle

Friction knots are used for

Fatty pedicles or when there is high tension on the pedicle

What is the Goal of the Three clamp Technique 

Contributes to hemostasis and ligature security by Crushing Tissues within a Vascular Bundle 

Where do you place your hemostats during a ligature

Proximal to the Ovary/Testicle

First ligature in a three-clamp technique is applied

At the site of the most proximal hemostat

Suture is placed at site of crushed tissue once proximal hemostat is removed

Circumferential ligature or friction knot 

Second Ligature in a three-clamp technique is applied

between the 1st ligature and middle hemostat

transfixation Ligature

In a Three clamp technique where do you transect the pedicle

Between middle and distal hemostats

Thumb to Thumb is what

Manually tightening the first Two Throws of all ligatures

What is flashing

Loosening of Hemostatic forceps distal to ligature being applied while first TWO throws of ligature are being secured

Strengths of suture when doing hollow viscera depends on what?

Sutures grasp of the t. submucosa (fibromuscular) layer 

What do you use when suturing hollow viscera

Absorbable monofilament

Tapered swaged needle

Appositional or inverting interrupted or continuous patterns 

What pattern should NEVER be used on Small intestines

Inverting patterns- cause decrease in luminal diameter

Why should you never use everting suture patterns for hollow viscera

Increased risk of leakage for luminal contents

Single Layer Closure of Hollow viscera include

partial thickness or Full thickness

Simple Continuous and simple interrupted 

Double Layer Closure of Hollow Viscera include 

Inner= partial or full thickness

Outer= Partial Thickness ONLY

-not commonly used

Visceral organs heal in how much time

7-10 days post Op

Fibrin clot rapidly laid down sealing closure very soon after surgery

What are some potential complications of Suturing Hollow viscera

Peritonitis

Adhesions

Formation of calculi

When is Finger Trap used

To secure drains to patient

uses a purse string suture