Incision and Wound Closure Flashcards Preview

MRCS A: Pathology II > Incision and Wound Closure > Flashcards

Flashcards in Incision and Wound Closure Deck (32)
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1
Q

Midline incision through linea alba

A

Easy incision to make, creates good access and easily extensible and relatively avascular.
Linea alba thins infraumbilically

Crosses Langer’s line, some vessel damage and can damage the bladder

2
Q

Infra-umbilical incision

A

Paraumbilical hernia repair

Lap port insertion

3
Q

Para-median incision

A

Rarely used, 1.5cm from linea alba and involves cutting through the rectus sheath.

  • Less easy to create
  • Poor cosmetic result
  • Jenkins rule not applicable (Suture length=wound length x 4)
  • Intercostal nerve damage
  • Falciform ligament above umbilicus on right side of patient
4
Q

Pararectal incision

A

Not used

Incisional hernias and nerve damage often result

5
Q

Kocher’s incision

A
Open cholecystectomy (right)
Splenectomy (Left)
3cm below and parallel to the costal margin, from the midline up to the rectus border
Superiorly-sup epigastric vessels
Laterally-intercostal nerves
No caudal/posterior extension
6
Q

Rooftop incision

A

Liver and spleen access

Pancreatic, gastric and adrenal procedures

7
Q

Transverse muscle cutting incision

A

Intercostal nerves

8
Q

McBurney’s/Gridiron incision

A

Classic appendicectomy scar
Perpendicular to McBurney’s line (ASIS-Umbilicus)
ilio-hypogastric, ilio-inguinal nerves
Deep circumflex artery

9
Q

Rutherford Morrison incision

A

Good access to caecum, appendix and right colon

Good extensions possible

10
Q

Lanz incision

A

1/3 distance from ASIS to umbilicus
better cosmesis
Splits ilioinguinal and iliohypogastric nerves causing denervation of the inguinal canal mechanism-increased risk of inguinal hernias

11
Q

Pfannenstiel incision

A

2cm above pubis

Gynaecological, bladder and prostate access

12
Q

Transverse incision

A

Neonate and children use

Less painful, better cosmesis than longitudinal incision but red muscle splitting=more bleeding

13
Q

Loin scar

A

Nephrectomy

14
Q

Wound closure principles (9)

A
Incise along tension lines
Eliminate dead and infected tissue
Gentle tissue handling
Ensure good supply
Eliminate potential spaces for haematoma
Well appositioned tissue
Low wound tension
Appropriate closure technique
Appropriate suture material
15
Q

Mass closure of abdomen

A

Protect abdominal contents e.g. omentum
Non-absorbable suture nylon or slow absorbable e.g. PDS
Jenkins rule: suture length 4xwound length
Jenkins 1cm rule: suture bite 1cm, adjacent sutures 1 cm apart.
Include all layers of the abdomen except skin and subcut fat. Fascia provides wound strength

16
Q

Choosing the right suture

A

Suture size
Characterisitics (Braided vs monofilament-handling vs knotting, absorbable/non-absorbable)
Needle

Absorbable suture for quick healing tissues e.g. bowel
Non-absorable for abdominal wall slower healing
Monofilament for running stitches e.g. vascular surgery
Braided for knotting (ligation)

17
Q

Ideal suture

A
Monofilament
strong
easy handling
Minimal tissue reaction
Holds knot well
Predictable reaction
18
Q

Non-absorbable sutures pneumonic

A

Double ‘S’
Double “P” Double “P”
LC

19
Q

Non-absorbable sutures Double S

A

Silk

  • Natural
  • Braided multifilament
  • May be dyed and have wax coating

Steel

  • Man made
  • May be mono or multifilament
20
Q

Non-absorbable sutures Double P (I)

A

Polyester

  • Man made
  • Multifilament
  • Dyed/undyed
  • Coated/Uncoated

Polyamide

  • Man made
  • Mono or multifilament
  • Dyed/undyed
21
Q

Non-absorbable sutures Double P (II)

A

Polypropylene (Prolene)
-Man made
-Monofilament
Dyed/Undyed

PVDF

  • Man made
  • Monofilament
  • Dyed/Undyed
22
Q

Non-absorbable sutures L

A

Linen

  • Natural
  • Twisted multifilament
  • Dyed/undyed
23
Q

Non-absorbable sutures C

A

Cotton

  • Twisted multifilament
  • Dyed/undyed
  • Uncoated
24
Q

Absorbable sutures PPPP

A

Polyglycolic acid

  • Man made
  • Braided multifilament
  • Dyed/Undyed
  • Coated/uncoated

Polygalactin 910 (Vicryl)

  • Man made copolymer
  • Coated

Polydioxanone sulfate (PDS)

  • Man-made copolymer
  • Monofilament
  • Dyed/Undyed

Polyglyconate
-Man made copolymer
-Monofilament
Dyed/Undyed

25
Q

Needle characteristics

A

Needle shape

  • Straight
  • Curved
  • Circular
  • J-shaped

Needle profile

  • Blunt needle: abdominal closure
  • Round bodied (Spreads rather than cutting tissue-organs)
  • Cutting/Reverse cutting needle-triangular profile-tough fibrous tissue
26
Q

Suture removal

A

Face 4-5 days
Scalp 6-7 days
Hands and Limbs 10 days
Abdominal wounds 10-20 days

27
Q

Surgical drains use

A
  • Drain a collection e.g. subphrenic abscess

Drains may be open or closed, suction and non suction

  • Decompress e.g. pneumothorax
  • Risk of leakage e.g. bowel anastamosis
  • Divert fluid from an obstruction e.g. suprapubic catheter

-Minimise dead space and fluid collections e.g mastectomy

28
Q

Surgical drain examples

A

Suction: Only closed system-Redivac and suction chest drain

Non-suction Open: Penrose and Corrugated drain

Non-suction Closed: Robinson drain, T tube, urinary catheter, chest drain

29
Q

Scar minimisation

A
Langers lines
Wrinkle lines (nasolabial folds, forehead wrinkles)
Natural junctions (Nose and face)
Hidden sites (Eye brow, hair line)
Good appoition
Low tension
Small suture diameter
Suture removal at earliest opportunity
Avoid sun-pigmentation
30
Q

Scar types

A

Hypertrophic scars
Keloid scars
Malignant change in scars

31
Q

Hypertrophic

A

Proliferative phase of scar healing can remain if large area of skin damage e.g. abrasion/burns.
The scar appears red and hard

32
Q

Keloid

A

Excessive scar tissue breaching beyond the wound