Surgical Techniques and Wound Healing: A Comprehensive Guide, Exams of General Surgery

Download Surgical Techniques and Wound Healing: A Comprehensive Guide and more Exams General Surgery in PDF only on Docsity! CSFA Test #1 Principles Surgical Assisting SUR 284 The two-hand tie - gives the best knot security Which of the following methods of suturing should be used to close a deep layer located on the medial edge of a myocutaneous flap closure of a sacral decubitus ulcer? - half-buried mattress suture with 0 PDS FS A. The simple running stitch would lend itself to wound dehiscence. Although the 0 gauge is an appropriate gauge suture, the SH needle is not the optimal needle for closing muscle. Vicryl is a braided stitch that would lead to wicking of postoperative SSI should it occur. B. The Cushing suture is a continuous vertical mattress stitch that closes lumens. The Prolene stitch is not the best choice on muscle because it is non-absorbable. However, the FS needle is an appropriate needle selection for closing this layer. C. The Halstead suture technique is a double-layer closure used on friable tissue, which muscle is not. The 0 gauge suture is an appropriate gauge suture. Vicryl is a braided stitch, which would lead to wicking of postoperative SSI should it occur. The CTX needle is not an appropriate needle selection for closing this layer because the curve is too large for the proximity of the edges of the wound. D. The half-buried mattress (Grey-Turner) method of suture is a series of inverted interrupted horizontal or vertical mattress stitches. In this method, the knot is tied deep to avoid the incision line and prevent irritation. The interrupted status helps to avoid wound dehiscence should a suture fail. PDS has the same qualities of Vicryl, but it is monofilament so it does not lend itself to wicking of possible SSI. The 0 gauge is an appropriate gauge suture. The FS needle is an appropriate needle selection for closing this layer. keloids are - enlarged scar due to formation of excessive amounts of collagen True or False: All of the following are correct tips for holding retractors 1.When holding retractors only use the amount of force necessary for visualization 2.Focus on holding the retractor even if you are holding it for hours- lack of focus will cause the retractor to move and block visualization 3.When holding an Army-Navy type retractor tow-in with the retractor - term refers to placing pressure on the end of the retractor keeping it slightly down while slightly lifting in/up-wards this motion will help keep a blunt retractor from slipping out 4.When holding two retractors you will need to use counter and counter-traction to maintain proper visualization - true If during the course of an operation in which an initially clean wound was made and the pharyngeal cavity was entered, the wound is now: - a clean, contaminated wound Lithotomy position is another modification of the supine position with the patient lying on their back with their legs in stirrups or on leg braces exposing the perineum, vagina, and rectum. Care must always be taken to prevent injury to the Obturator nerve. - true All of the following statements concerning Trendelenburg position are true Except - Trendelburg position is used for procedures of the head and neck Primary intention or First intention wound healing: Refers to the healing process following closure of a clean surgical incision closed with suture material - true Granulation or Second Intention wound healing the Wound is irrigated, nonviable tissue removed and the wound is closed 4 to 7 days latter - false Which of the following physical characteristics of sutures is described as the amount of force necessary to break the suture? - tensile strength All of the following tips for using a crile are Correct: True or False 1.When placing a clamp around a vessel for ligation avoid getting excess tissue in the clamp 2. When holding a clamp on a vessel being tied the assistant must take care not to lift up on the clamp 3.When placing a tie around a clamp take care not to catch the end of the clamp in the suture as you tie 4.When holding the clamp gently show the person tying the vessel the tip of the clamp to help pass the tie around the clamp 5.When ask to flash a clamp gently open the clamp all the way moving up the vessel and then re-clamp the vessel. 6.When ask to buzz a clamp or forceps gently touch the clamp with the Cautery (bovie) with the coagulation button making sure the clamp of forceps is not touching other structures to avoid an accidental burn injury. - false The overgrowth of scar tissue is known as - hypertrophic scar The Surgeon knot - is the same as a square knot has two loops in the first throw is useful because the first throw with the too loops tends to stay in place better than the square knot b and c b and c True or False: The basic definition of a knot (hitch) is a way of joining two threads of suture together by tying the threads together or to itself. In knot tying the first intertwining of the threads is called a half- hitch. It takes a minimum of two half-hitches to form a knot. The technique used to tie surgical knots varies depending on training and preference. The knot preferred in surgery is a square knot or reef knot. - true True or False: A square knot is composed of two half-hitches, made in the same direction of each other. A Surgeons knot consists of two half-hitches in opposite directions followed by the third half-hitch made in the opposite direction of the first two. - false Fibroblasts are: - a connective tissue cell producing collagen Cicatrix is: - a scar True or False: Dr. William Halstead (1852-1922). He is remembered for what became known as Halsted's principles which include: gentle handling of tissues, meticulous hemostasis, strict aseptic technique, sharp dissection of tissue, using the minimal amount of smaller gauge non-irritating suture material during wound closure, never leave a dead space during wound closure and avoid tension during wound closure. - true A type of wound in which the alimentary, oropharyngeal, respiratory, or genitourinary regions are entered is classified as - clean contaminated A. Clean contaminated wounds are operative wounds in which the respiratory, alimentary, genital, or urinary tract is entered under controlled conditions and without unusual contamination. Specifically, operations involving the biliary tract, appendix, vagina, and oropharynx are included in this category, provided no evidence of infection or major break in technique is encountered. B. Clean wounds are uninfected operative wounds in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered. In addition, clean wounds are primarily closed and, if necessary, drained with closed drainage. Operative incisional wounds that follow nonpenetrating (blunt) trauma should be included in this category if they meet the criteria. C. Contaminated wounds include open, fresh, accidental wounds, operations with major breaks in sterile technique or gross spillage from the gastrointestinal tract, and incisions in which acute, nonpurulent inflammation is encountered. D. Dirty or infected wounds include old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera. This definition suggests that the organisms causing postoperative infection were present in the operative field before the operation Dehiscence is: - the separation of the layers of a surgical wound True or False: A Horizontal mattress interrupted suture is An everting stitch often used to reduce tension along wound edges in wounds under high tension. The stitch is used on skin or fascia. - true Control of major vascular bleeding both arterial or venous usually requires: - Hemostatic clamps and ligature Tourniquets should only be applied by properly trained individuals. Tourniquets should be calibrated often and checked for wear. Check the connections; often the small rubber gasket will come off which will cause the tourniquet to leak. Selecting the proper size tourniquet is very important; the tourniquet should overlap the extremity by ? inches, but should not overlap the extremity by ? inches or more - 3 and 5 inches There are a number of antiseptic solutions that can be used for the preoperative skin prep. Patients who have shell fish allergies should not use this product. - Iodophors Chlorhexidine gluconate (Hibiclens): This is a broad spectrum antiseptic that continues to kill microbes following its application. It may be mixed with 70% alcohol. It can cause corneal damage and therefore should not be used for facial preps or in the ear canal as it has been linked with hearing loss - true Which of the following are the MOST important considerations when preventing wound infection in the surgical patient? 1. pathogen transmittal