Surgical Suturing Techniques for Small and Large Animals, Exams of General Surgery

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Principles of Surgery Final Exam When prepping your pig, what 2 cleaning agents are used to scrub the incision? - betadine and alcohol alternating between the two When prepping your pig, describe the pattern that you use to scrub the future incision site? - start in center of incision site and move to the outer edges in a circular pattern *never* go back into center after circling out Why do we perform a "dirty scrub" AND a "sterile scrub" if they have the same agents? - DS: to clean off major/large dirt and debris SS: done in cleaner environment help ensure are is close to completely sterile as can be (often done with sterile gloves) What are the boarders for draping your pigs for an abdominal incision? - xyphoid pubis cover most lateral pai of nipples What is knowing the linea alba and rectus abdominis? - linea where incision is made and rectus abdominis has fascia which is the holding layer for the sutures Surgical incisions should be made with what instrument using what grip? - scalpel blade/handle finger tip grip What are Metzenbaum scissors used for? - Cutting/removing delicate tissue like subcu and fat What distance from and length apart should sutures on the body wall of a animal be? - 5-6mm What will not impact the security of an incision? - incision length What is the 30/50 rules for small animal surgery? - dog 30lb use 3-0 dog 30-50lbs use 2-0 dog >50lbs use 0 only applies to fascial/body wall layer *remember convert kg-lbs* A 40 kg dog comes in for surgery, what should you prep as your suture for the abdominal closure? A. 2-0 PDS in a simple interrupted pattern B. 1-0 nylon in a simple continuous pattern C. 1-0 PDS in a simple continuous pattern D. 2-0 nylon in a simple interrupted pattern - C. 1-0 PDS in simple continuous pattern (can close abdomen with interrupted or continuous) Which suture type matters the least when picking a size? A. abdominal wall B. subQ C. Skin - B. subQ The abdominal wall suture size is critically important to withstand the tension of holding the abdomen together. The skin pattern is also somewhat important to create a barrier to the outside world. The sub Q is whatever. We close it to avoid dead space which means the size of suture is whatever you want usually (just don't make it so big that it could cause irriration or make the skin harder to close What is a seroma? - the accumulation of serious fluid in dead space in the region of an incision non-reducible, cool to touch *death space* remains after incomplete closure of surgical wounds permitting accumulation of fluid resulting in delay in healing How does a seroma delay wound healing? - prevent tissue opposition interfering with blood supply to areas inhibiting influx of phagocytic cells to area Should you try to drain a seroma? - *no* How is a seroma treated? - warm compresses Ext. rectus sheath- 2-0 PDS, simple cont/interrupted SQ- 3-0/4-0 monocryl/PDS, simple continuous Skin- 3-0 ethilon/prolene, interrupted, staples List the suture types, sizes and pattern you would use to close a ventral midline incision (specify for each layer) in a 35kg dog. - Ext. rectus sheath- 0 PDS simple cont/interrupted SQ- 3-0/4-0 monocryl/PDS, simple continuous Skin- 3-0 ethilon/prolene, interrupted, staples List the suture types, sizes and pattern you would use to close a ventral midline incision (specify for each layer) in a 450kg horse. - Ext. rectus sheath- 2 or 3 vicryl, simple cont SQ- 2-0 absorbable, simple cont Skin- stainless steel staples, 2-0 (or 0) nonabsorb List the suture types, sizes and pattern you would use to close a ventral midline incision (specify for each layer) in a 100kg foal. - Ext. rectus sheath- 1 vicryl/PDS simple cont SQ- 2-0 absorbable, simple cont Skin- none, 2-0 non- absorbable, staples Which of the following layers must be included to close a celiotomy? a. rectus adominus muscle b. peritoneum c. internal rectus sheath d. external rectus sheath - *d. external rectus sheath* What tissue layer has the most variability when it comes to selecting suture size? a. Linea alba b. SQ c. Skin - a. Linea alba t/f external rectus sheath and linea alba are the same thing - *true* List the suture types, sizes and pattern you would use to close a flank laparotomy (specify foreach layer) in an adult cow. - Layer 1: peritoneum + transversus abdominus, 2-3 absorbable, simple cont. Layer 2: internal/external abdominal oblique, 2-3 absorbable, simple cont Layer 3: skin, 2 non-absorbe, supramid, ford interlocking/simple cont What is a clean surgery? - non-traumatic, non-inflamed operative wounds not enter resp, GI, genitourinary, oropharyngeal tract What is a contaminated sx? - done on traumatic wound w/out purulent discharge spillage of GI contents/infected urine major sterility tech break What is a clean-contaminated sx? - entry into resp, gastrointestinal, genitourinary tracts w.out extreme contamination otherwise clean procedure where drain is placed What is a dirty sx? - done on traumatic wounds with purulent discharge, devitalized tissue or foreign material perforated viscus or fetal contamination What factors might play a role in this increased incidence of infection? - patient prep surgeon procedure/tech/ time environment What glucose value can indicate septic peritonitis post surgery? - glucose will be 20 mg/dL or more lower in the abdominal fluid than the blood cause bacteria present will eat sugar t/f telazol is a class III drug - *true* Is telazol a dissociative/benzo induction agent? - yes What is xylazine? - alpha 2 agonist, for sedation, muscle relaxation, analgesia What is atropine? - Anticholinergic > HR Where is the esophageal diverticulum located in pigs? - immediately dorsal to esophagus What are the areas an ETT can get caught in pigs? - esophageal diverticulum fornix under cricoid cartilage What is the formula for calculating fluid rate per sec on a drip set? - (BW(kg) x fluid rate/3600) * fluid drip set At that anesthetic depth is the eye position ventromedial? - med light - med - med deep At that anesthetic depth is the eye position fixed central? - light or deep How does jaw tone change in the anesthetic depths form light - deep? - L- very tight ML- tight M - moderate MD- mild D- absent What is lidocaine used for in intubating pigs? - *reduce laryngospasm* only need to apply *1-2 drops* per arytenoid How should gauze scrubs be picked up from containers for scrubbing? - pick them up with non-dominant hand transfer gauze to your dominant hand and perform scrub never reach into jar w/dirty hand You are presented with a 6 kg 8-year-old cat that you have diagnosed with a small intestinal obstruction (based on physical exam, radiographs, blood work, etc). You think it is going to be a foreign body but abdominocentesis - degen neutrophils, +/- visible extra/IC bact peripheral blood glucose >20mg/dL than abdominal fluid = septic You are in surgery for a young Labrador retriever that has a small intestinal foreign body obstruction. How do you make the decision to perform an enterotomy versus a resection and anastomosis? (What would you evaluate to help you make this decision?) - *color of bowel*: black, gray, tan, green = bad purple = may recover red = ok *peristalsis*: seg good peristaltic waves - good sign, lack of peristalsis no bad though *bleeding*: nice bright red blood good sign. dark/thick blood concerning *perforations*: if there are present resection/anastomosis *mesenteric pulses* How many minutes of contact time is required for sterilium scrub? - 2 minutes make sure to wash hands/nail pick *completely dry* hands place sterilium on each palm and rep down forearms t/f open gloving uses surgical gown to cover hands before placing gloves on - *false* - that's closed gloving What is open gloving? - when you have no gown and only have sterile gloves on for smaller procedures that require smaller sterile field Which would a open glove be most suite to open gloving: a. joint tap b. splenectomy c. celiotomy - a. joint tap Which would a closed glove be most suited for: a. skin biopsy b. regloving during surgery c. spay surgery - c. spay surgery What is an enterotomy? - incision into the intestine What is a resection and anastomosis? - when remove section of intestines and close up the two edges What are Doyen forceps used for? - to isolate section of bowel you're entering Why do you enter the intestine on the anti-mesenteric side? - to preserve blood supply How long can an enterotomy incision be? - length of the bowel diameter Why does the mucosal inversion of cut intestine need to be trimmed before closing and R&A? - because it messes with the apposition if not done What tool do you use for trimming mucosal eversion? a. scalpel blade b. mayo scissors c. Metzenbaum scissors d. suture scissors - C. metzenbaum scissors Which of the following is true regarding cushing vs appositional suture? A) inverted allows or faster healing B) appositional is less likely to leak C) inverted leaves less suture exposed D) inverted can be used for any size intestine - C) inverted leaves less suture exposed A Dog R&A suture pattern should be A) Single apposition B) Double apposition C) Single inverting D) Double inverting - A) single apposition All of the others (double appositional, any inverting) end up reducing the lumen diameter and in a small animal the lumen is already so small that any reduction can lead to increased risk of impactions What is the intestinal holding layer? - submucosa What direction do you suture in for a resection anastomosis? A) mesenteric -> antimesenteric B) antimesenteric -> mesenteric - A) mesenteric -> antimesenteric Describe the suture you would you use in the small intestine of an 8kg cat? - 4-0 PDS or vicryl For small animals, I wouldn't go above a 3-0 suture. You don't want to leave massive knots in the abdomen and there usually isn't tons of pressure that needs heavy duty suture Describe the suture you would you in the small intestine of an 500kg horse? - 3-0 PDS Even in larger animals, you don't need crazy thick suture and less is more in horses since they love to get adhesions What tissues should reverse cutting needles be used on? - tough tissues avoid use of cutting needles on soft delicate tissues like bowel How is septic peritonitis dx? - *abdominocentesis* showing high WBC, degenerative neutrophils and low glucose compared to blood What are 6 ways you can assess health of intestines? - 1. color 2. wall thickness 3. presence of peristalsis 4. presence of arterial pulsation 5. bleeding when incised ( if not present may still be viable) 6. presence of perforation What needle type has a cutting side on the back of the needle? - cutting needle What needle type makes a smaller hole in the tissue? - taper needle Why might you want to close an enterotomy transversely? - reduces narrowing of lumen