Surgical Operations Quiz

General Principles of Surgical Operations

• Suture Materials are classified into absorbable and non-absorbable categories.

Types of Absorbable Sutures

• Natural Absorbable Sutures:

  • Plain Catgut: Derived from sheep's intestine, absorbed within one week by phagocytosis; limited use due to severe reactions.
  • Chromic Catgut: Modified with chromium salt, less irritant; absorption time extended to three weeks.

• Synthetic Absorbable Sutures:

  • Dexon (Polyglycolic Acid): Multifilamentous, good tensile strength; absorbed in four months.
  • PDS (Polydioxanone): Monofilamentous, ideal for contaminated wounds; absorbed in six months.
  • Vicryl (Polyglactin): Multifilamentous, used for gastrointestinal anastomosis; absorbed in four months.
  • Monocryl (Polyglecapron 25): Monofilament with high tensile strength; absorbed in three to four months.

Non-Absorbable Sutures

• Natural Non-Absorbable Sutures:

  • Surgical Silk: Multifilamentous, rich in protein causing significant tissue reaction; requires removal if infection occurs.

• Synthetic Non-Absorbable Sutures:

  • Nylon (Ethilon): Polyamide, available in mono or multifilament, good tensile strength.
  • Prolene (Polypropylene): Monofilamentous, strong tensile strength, difficult to knot.
  • PTFE: Minimal tissue response with good handling.
  • Others: Recently introduced staplers, adhesive tapes, and stainless steel.

Suture Characteristics

• Monofilament Sutures: Single strand, less organism harboring, suitable for vascular surgery.
• Multifilament Sutures: Composed of several filaments, greater tensile strength.
• Tensile Strength: Required strength to keep tissues in proper apposition.

Types of Stitches

• Simple Stitch
• Mattress Stitch: Vertical and transverse (horizontal) variants.
• Lembert Suture: Second row inverting sutures.
• Tension Sutures: Include simple overhead, blanket, quilted, Lembert's, and Connell's (loop on mucosa).

Suture Removal Times

• Face: 5-7 days
• Scalp: 10 days
• Trunk & Upper Extremities: 10-14 days
• Lower Extremities: 14-21 days
• Early removal reduces risk of marks, infection, and tissue reaction.

Suture Removal Process

• Clean and sterilize skin.
• Elevate suture gently with forceps.
• Cut one side and grasp the knot, pulling towards the suture line.

Alternative Closure Methods

• Steri-Strips
• Staplers
• Tissue Adhesive
• Barbed Sutures

Types of Suture Needles

• Straight Needles: Used for superficial structures, e.g., skin.
• Curved Needles: Variants include 3/8, 1/2, 5/8 circles.

Needle Variants

• Rounded Needle: Circular cross-section, suitable for organs and mucosa.
• Cutting Needle: Triangular cross-section, sharp edges for skin sutures.
• Eyeless Needle: Threaded within; common in plastic, vascular, neuro-surgery.
• Eyed Needle: Traditional, with a small opening, limited reuse.

Surgical Techniques

• General Anesthesia: Used for various surgical procedures.
• Incisions: Specific techniques based on anatomy, e.g., transverse for neck, vertical for axilla.

Abscess Management

• Important Sites: Parotid, breast, pulp, peri-anal abscesses require immediate intervention.
• Cold Abscess Treatment: Use anti-T.B. drugs, prefer aspiration over drainage unless secondary infections or impending rupture occurs.

Surgical Drains

• Classification: Open, closed, active, passive.
• Uses: Withdrawal of fluids and tissue apposition to remove potential spaces via suction.