Surgical Wound Management and Suture Techniques, Exams of General Surgery

Download Surgical Wound Management and Suture Techniques and more Exams General Surgery in PDF only on Docsity! Surgical Technology Lecture # 7 Test What is a wound? - Any tissue that has been damaged by surgery (intentional) or trauma (accidental) What is incisional? - Cutting into tissue to expose underlying tissue What is excisional? - Removing tissue How is classification of surgical wounds done? - • It is done according to their degree of microbial contamination • A wound is not classified until the end of the case because of the possible factors What are the 4 types of surgical wound classification? - 1. Class I - Clean 2. Class II - Clean Contaminated 3. Class III - Contaminated 4. Class IV - Dirty/Infected What is Class I wound classification? - • Surgery was performed under IDEAL CONDITIONS • No breaks in sterile technique • PERFECT SURGICAL PRODUCEDURE - everything works fine What is Class II wound classification (Clean Contaminated)? Give 2 examples - • This is a case that HAS THE POTENTIAL TO BECOME CONTAMINATED OR INFECTED • We have controlled entry into the genitourinary (GU) tract, biliary tract • There is also a minor break in technique • Examples: • Appendectomy - this case has the potential to become contaminated if during the case there is leakage from the appendix while removing it • Cholecystectomy - gall bladder removal (cholecystis = gall bladder). There is potential for the gall bladder to leak during the case What is Class III (Contaminated) wound classification? Give 2 examples - • This case is CONTAMINATED • MAJOR BREAK IN STERILE TECHNIQUE • Examples: • The gall bladder has ruptured during the procedure and bile leaked into the peritoneal cavity. There is spillage from the intestines • A gunshot wound (outside object breaks the skin and enters a body cavity) What is Class IV (Dirty infected) wound classification? - • INFECTION IS PRESENT • Open infected wound • TRAUMA WOUND WITH PERFORATED VISCERA (organs and body tissues) • Patient comes into the OR with infection • Examples: • Peritonitis: serious condition where the covering of the stomach, intestines and nearby organs become swollen and infected • Diverticulitis: inflammation of abnormal sacs of the intestine • Tumor • Abscess What is thermal wound? - How long does the Maturation Phase last? What are the symptoms? - • Begins on the 14th postoperative day and lasts until the wound is completely healed (up to 12 months) • Key word is COLLAGEN DENSITY INCREASES • CICATRIX (Scar) FORMS What is second intention (granulation) wound healing? - • These wounds have MUCH TISSUE LOSS and cannot be sutured closed and heal by granulation • GRANULATION tissue is new connective tissue and tiny blood vessels that form on the surfaces of a wound during the healing process. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size • It is common for a HERNIATION (weakness in muscle where viscera or tissue can protrude through the wound) to occur with this type of wound • GRANULATION is also referred to as "Proud Flesh" What is third intention (delayed primary closure) would healing? - • THE WOUND IS LEFT OPEN irrigated and packed with lap pads (depending on facility) and CLOSED 4-6 DAYS LATER • This wound is INFECTED What factors affect wound healing? - 1. Physical conditions of the patient 2. Intra-operative tissue handling 3. Application of the principles of asepsis through the use of sterile technique What 7 physical conditions of the patient affect wound healing/ - 1. Age - older patients take longer to hear 2. Nutrition 3. Obesity 4. Disease 5. Smoking 6. Radiation exposure - like the one cancer patients are exposed to 7. Immunocompromised/immunosuppressed patient - such as HIV patients, those with diabetes, cancer patients who smoke, etc. What 8 intra-operative tissue handling techniques affect wound healing? - 1. Length and direction of the incision 2. Dissection technique 3. Length of surgery 4. How much the tissue was handled 5. Hemostasis technique 6. Tissue approximation 7. Elimination of dead space 8. Secure wound closure What is the 3rd consideration in wound healing? - • Was there any break in sterile technique? • Any microbial contamination of the wound could lead to an infection, causing an increase in morbidity or mortality What is dehiscence? - • Partial or total separation of a layer or layers of tissue after closure What is friable tissue? - • Weak tissue that is easily torn • Seen in older and pediatric patients What is eviseration? - • Viscera (tissue or organs) protrude through the incision site • Emergency situation that requires immediate surgical intervention to replace the viscera and close the wound What is hemorrhage? - • Severe bleeding • Usually occurs in the first few hours of a wound closure What is an infection? - • This occurs when the microbial count increases What is an adhesion? - • When the surface of two or more structures stick together when normally they are not attached • Happens frequently with patients who have had many surgeries What is a herniation? - • Occurs when the incision or muscles weaken and cause the viscera to protrude • Commonly it is the intestines which protrude What is a fistula? - • Abnormal or surgically made passage between a hollow or tubular organ and the body surface or between two hollow or tubular organs What is a sinus tract? - • An abnormal tract between two surfaces where ONLY one end is open and contains abnormal drainage What is a keloid scar? - • Hypertrophic (increase in bulk) scar, which are raised and thick What sutures are used in smaller vessels? - • 6-0 and 7-0 What sutures are used in the eyes? - • 8-0 to 10.0 What suture gauge is used to close the dura? (crani) - • 4-0 What suture gauge is used to do a sub-q closure? - • 4-0 What is tensile strength? - • Amount of force or pull that a suture strand can withstand before breaking What 8 pieces of information are displayed on suture packages? - 1. Surgical application 2. Product code # 3. Suture length and color 4. Suture size and length 5. Photo of the size and shape of the needle 6. Needle point 7. Lot # 8. Expiration date What are ligature or ties? - • They are used to occlude and retract vessels and ducts What are the 4 types of ligating methods? - 1. Free tie 2. Ligature reel 3. Instrument tie (Tie-on-a-Pass) 4. Suture ligature (Stick tie) What is a free tie? - • This type of suture is handed as a single strand • The surgeon puts his hand out straight palm down; hold the suture at both ends and place in his palm What is the ligature reel? - • Used on superficial bleeders • The ligareel is radiopaque; the suture strand is wrapped around the reel • You pull the suture to make a 2" tail, hand the reel with tail to surgeon What is an instrument tie (Tie-on-a-Pass)? - • This is used to occlude deeper vessels • Single strand of suture is clamped to the tip of a clamp - Adson, Mixter and handed to the surgeon • You pass the instrument the same way as usual, and hold the tip of the suture with your other hand What is a suture ligature (stick tie)? - • This is used to occlude deeper vessels • There is a swaged needle attached What is a swaged needle? - • A suture that is firmly attached to the needle itself What are the 3 parts to a needle? - 1. Point 2. Body (shaft) 3. Swaged end Who determines the type of suture to be used in a procedure? - • The surgeon When do you open a suture? - • Do not open sutures until they are requested Can sutures be sterilized once opened? - • No, they have to be discarded How are sutures placed on the sterile field? - • You can flip the suture onto the field or open and let the STSR take it How should you load a suture? - • The needle should be clamped 1/3 of the swaged end of the needle How do you handle chromic gut and plain sutures? - • Do not stretch to reduce their memory because handling with rubber gloves weakens the suture How do you handle nylon sutures? - • Nylon sutures are held between gloved hands to remove the memory, not by pulling it when it is on the needle holder In what procedure are nylon sutures used? - • Neuro • Commonly used for skin When is a side cutting or spatula needle used? - • Eye procedures What is a tapered needle? - • Do not have a cutting edge • Penetrate tissue by puncturing it • Commonly used on the GI tract's delicate tissue because they will do the least amount of trauma What is a blunt needle? - • It has a round shaft and a blunt tip • Commonly used on the kidney and liver - delicate friable tissue What is a Keith needle? - • Straight needle • Comes free or swaged Give 5 characteristics of a plain gut suture - 1. Absorbable natural 2. Monofilament 3. From beef or sheep intestines 4. Packaged in alcohol 5. Treated with salt solution Give 5 characteristics of a chromic suture - 1. Absorbable natural 2. Monofilament 3. From beef or sheep intestines 4. Packaged in alcohol 5. NOT treated with salt solution What suture provides the longest duration of wound support? - • Polydioxanone - PDS II What suture can be used in the presence of an infection? - • Polyglactin 910 • Also called Vicryl What suture is commonly used for tendon repair (strong)? - • Polyethylene • Also called Ethibond Describe 5 characteristics of a polypropylene suture - 1. Also called praline 2. Non-absorbable 3. Inert in tissue 4. Suture of choice for vascular 5. Can be used in the presence of an infection besides steel Describe 4 characteristics of a stainless steel suture - 1. The most inert in tissue 2. Can be used in the presence of infection 3. Has the highest tensile strength 4. Worst handling qualities Describe 3 characteristics of surgical silk suture - 1. Commonly used on the serosa of the GI tract 2. Must be used dry 3. Cannot be used in the presence of infection Name common suture codings used - • C / CV - Cardiovascular • CTX - Circle Taper Extra Large • FS - For Skin • KS - Keith Straight • RB - Renal Artery Bypass • OS - Orthopedic surgery • CP - Cutting Point • CE - Cutting Edge In what 3 situations are hypodermic needles used? - 1. To inject medications into tissue and IV tubing 2. To withdraw medications into a syringe from a vial held by a circulator 3. To withdraw fluids from tissues • They come in various sizes and lengths Name the 7 types of non-suture needles - 1. Hypodermic 2. Arterial or venous/cannula 3. Intravenous 4. Irrigation 5. Biopsy 6. Insufflation 7. Spinal What is an arterial or venous/cannula needle? - What is a subcuticular suture? - • Stitches are hidden under the skin layer • The suture runs along the tissue below the skin • There is no visible suture (don't have to be removed) • Steri-strips or dermabond are used to reinforce the wound What is a pursestring suture? - • This is a draw string suture around a tubular structure • Commonly used on the cecum following an appendectomy What is an interrupted suture? - • Used on tissues under tension and infected tissue • There are 3 variations: • Simple Interrupted • Interrupted Horizontal • Interrupted Vertical What is a figure 8 stick tie? - • This is when the surgeon clamps off a bleeder and he prefers to use a stick tie instead of a ligareel to tie off the tissue • The STSR holds the clamp showing the surgeon the tip, and he runs a suture through the tissue and ties a knot, as he is tightening the knot, the STSR releases the clamp and the bleeder is sealed • Tissue or vessel to be tied is held in a hemostat; first throw is a surgeon's knot; suture is then passed back and forth through the tissue around the two sides of the clamp in a figure-8 fashion and the suture is tied What is a buried suture? - • The knot of the suture is buried under the tissue layer and not sticking out What are traction sutures? - • They are used to retract tissue or structure that may not be easily retracted with a conventional retractor instrument • Commonly used on the eye, heart, tongue and common bile duct (CBD) What are retention sutures? - • These are large sutures, non absorbable, interrupted that are placed through all layers of tissue when there is an indication that the wound may not heal properly • Used for wound reinforcement • These wounds are nasty What are bridges or bolsters? - • These are used with the retention suture to prevent the heavy suture from cutting into the patient's skin • They are tubular pieces of plastic or rubber tubing What are endoscopic sutures? - • Used in laparoscopic procedures • When performing suturing techniques in this type of surgery there are two types of tying knots • Extra-corporal - the knot is tied outside the body and slipped back in • Intra-corporal - the suture is tied outside the body • The endoloop and endostitch are two types of suture used What are 8 alternative skin closure methods? - 1. Wound zipper 2. Dermabond 3. Fibrin glue 4. Button suture 5. Umbilical tape 6. Vessel loop 7. Suture anchors 8. Adhesive skin closure tape What is the wound zipper? - • Leaves no suture holes What is dermabond? - • Cyanoacrylate • Liquid glue • Used on kids What is fibrin glue? - • Biological adhesive • It can be used on deep tissues • Approximates wounds • Helps control bleeding What is a button suture? - • Used on tendon repair • The button helps eliminate tissue damage What is umbilical tape? - • It was originally used to tie off the umbilical cord on an infant • It is now used for retraction • It is like a shoe lace • Must be counted • 3 to a pack What is a vessel loop? -