Surgical Technology Chapter 22

Absorbable suture

Suture material that is broken down and metabolized by the body.

Adhesion

Scar formation of the abdominal viscera.

Anastamosis

The surgical creation of an opening between two blood vessels, hollow organs, or duct

Approximate

to bring tissue together by sutures or other means.

Autotransfusion

Also called blood salvaging. A method of retrieving blood lost at the operative site, reprocessing it, and infusing it back to the patient.

Capillary action suture

The ability of suture material to absorb fluid.

Contracture

Scar tissue that lacks flexibility, causing constriction and pain.

Debridement

Chemical or mechanical removal of necrotic or nonviable tissue and foreign bodies after infection or trauma.

Dehiscence

Separation of the edge of a surgical wound during healing.

Evisceration

The protrusion of abdominal viscera through a wound or surgical incision.

Fistula

A complication of wound infection in which one or more hollow, skin-lined tracts form at the wound site and continue to drain pus and fluid.

Hematoma

A blood-filled space in tissue, the result of a bleeding vessel.

Hemostatic agent

Substance applied to bleeding tissue in order to enhance clotting.

Inert

Causing little or no reaction in tissue or with other materials

Interrupted sutures

A technique of bringing tissue together by placing individual sutures close together.

Ligate

To place a loop or tie around a blood vessel or duct.

Non absorbable suture

Suture material that resists breakdown in the body.

Primary intention

The wound-healing process after a clean surgical repair.

Running suture

A method of suturing that uses one continuous suture strand for tissue approximation.

Serosanguineous fluid

Exudate or discharge containing serum and blood.

Swage

The area of an atraumatic suture where the suture strand is fused to the needle.

Tapered needle

A suture needle that has a round body that tapers to a sharp point.

Tensile strength

The amount of force or stress a suture can withstand before breaking.

Throw

A loop that forms a knot.

Tie on a passer

A strand of suture material attached to the tip of an instrument

What is the role of the surgical technologist in wound management?

The surgical technologist must remain alert to the condition of the wound and the progress of the surgery in order to anticipate both routine and unexpected requirements on the field.

What type of needles have cutting point

A cutting needle

What types needles have rounded pointed

A blunt needle

Ligation

The act of ligating, esp. of surgically tying up a bleeding artery.

What type of forceps are used on vessels?

DeBakey "Scored insert at the working tip

What type of forceps are used on intestines?

Adson without teeth or Dressing forceps "smooth without teeth

What typeof forceps are used on the liver?

Adson without teeth or Dressing forceps "smooth without teeth

What suture is used to close the appendix?

Purse-string suture

Retension suture

A type of interrupted technique used to provide additional support to wound edges in abdominal surgery.

Interrupted suture

An individually placed, knotted, and cut technique

What is the difference between skin staples and hemoclips?

Skin staplers are used to close a skin incision and hemoclips are used to close down and occlude a vessel or a duct.

Indermil

Tissue adhesive is indicated for the closure of topical skin incisions including laparoscopic incisions, and trauma-induced lacerations in areas of low skin tension that are simple, thoroughly-cleansed, and have easily approximated skin edges.

Dermabond

A synthetic cyanoacrylate, used to close the skin. It is fast setting with high strength; nonabsorbable.

3 phases of wound healing

1st phase: Inflamatory phase
2nd phase: Proliferative phase
3rd phase: remodeling

Excess inflamation and discharge from a wound are signs of what?

Surgical SIte Infection

What is the material used under a pneumautic tourniquet?

Flat cotton bandaging material {Webril or Soft Roll} that conforms to the shape of the extremities as it is wrapped.

What is used to exsanguinate the estremity

Esmarch bandage

How does one decide where to place the tourniquet?

The cuff location should be selected such that as much tissue as possible lies between the cuff and any nerves or vascular structures that could be subject to damage.

free tie

Lengths of suture without a needle

stick tie

Suture with a needle (suture lig)

double armmed

Needle is swaged at each end

Clean wound

Uninfected. No inflammation. Closed primarily [all tissue layers sutured closed]. Respiratory, gastrointestinal, genital, and uninfected urinary tracts were not entered. May contain closed drainage system. [Infection rate 1% to 5%].

clean contaminated wound

Respiratory, gastrointestinal, genital, or urinary tracts were entered without unusual contamination. No evidence of infection or major break in aseptic technique. [Infection risk 3% to 7%]

contaminated wound

Open, fresh accidental wound. Major break in aseptic technique occurred during the surgical procedure. Gross spillage from the gastrointestinal tract occurred. Presence of acute, nonpurulent inflammation. [Infection risk 10% to 17%]

dirty wound

Old traumatic wounds with devitalized tissue. Existing clinical infection. Perforated viscera [Infection risk >27% ]

common names for non absorbable

Plain gut, Cromic gut, Vicryl, Monocryl, PDS

common names for absorbable

Silk, Nylon, Prolene, Stainless steel, Ethilon, ethibond, Mersilene, Pronova Neurolon

What type of dressing prevents or limits movement of the surgical wound?

Supportive dressings are used to prevent or limit movement of the surgical wound during healing.

What type of suture is designed to release?

De-tach or Control-release

Retention suture

A type of interrupted technique used to provide additional support to wound edges in abdominal surgery.

Continuous suture

Has a knot at the beginning and one at the end. It is composed of one continuous strand of suture. The needle is alternated from one side of the tissue edge to the other.

Tie on passer

One end of the tie is clamped in a hemostat or tonsil clamp

What are Halstead's principles of surgery?

1. Handle tissues gently
2. Control bleeding as efficiently as possible
3. Preserve blood supply
4. Observe strict aseptic technique
5. Minimize tissue tension
6. Eliminate dead space

Hemostasis

Controlling bleeding by mechanical means; such as sutures, sponges, surgical instruments, and electrosurgery, and by biochemical means using drugs or other pharmaceutical agents.

Homeostasis

To maintain a balanced or constant internal state; the regulation of any aspect of body chemistry, such as blood glucose, around a particular level

Allograft

A tissue graft derived from human tissue. These types of grafts are tested for infectious disease and infection before distribution from the tissue bank.

Autologous autograft

Tissue obtained from the patient's body and implanted in another site, such as a bone graft taken from the hip for implantation in the spine.

Bovine graft

Tissue graft of beef origin.

Epithelialization

The migration of epithelial cells, into the wound during healing.

Implant

Any type of tissue replacement or device placed in the body.

Porcine graft

Graft taken from pig tissue.

Wound cover

Tissue used to cover large defects in skin, usually a result of burns, trauma, or infection.

Xenograft

A graft derived from animal or synthetic source.

Autologous grafts

Grafts made from the patient's body.

Allogeneic grafts

Grafts made from nonliving cadaver bone.

Composite grafts

Grafts made of a combination of cadaver bone, morcellated allograft bone, and marrow.

Demineralized bone matrix [DBM]

A processed material made from collagen, protein, and growth factors. It is used as granules, chips, putty, or gel.

Ceramic materials

These provides structural support only.

Graft composites

Grafts that contain combinations of DBM and marrow, ceramic-collagen, and ceramic-autograft-collagen combinations.

Classification of wounds

1. Primary intention
2. Secondary intention
3.Third intention

Secondary intention healing

The wound-healing process when a wound is not sutured. This type of wound heals from the base.The healing process involves filling the tissue gap with granulation tissue. It is much slower, and the resulting scar can be quite large compared to primary int

Third intention healing

is a process in which an infected or a contaminated wound is treated and the wound space is packed to prevent serum accumulation and to protect it against environmental exposure. When sufficient granulation tissue has filled in the wound, it is sutured.

What is the difference between capillary action and tensile strength?

Capillary action sutures are made of multifilament strands that absorb moisture and hold body fluids (called wicking or Capillary action). The stability of a suture is what enables it to withstand the forces connected with the healing process, and is bett