Lets get Knotty
What is the difference between electrosurgery and electrocautery?
Electrosurgery: passage of electrical current from instrument through issues using alternating current
Electrocautery: uses heat generated by direct electric current into a metal wire or probe
Name the 6 things you should include in your dental chart
Calculus score
Gingival score
Periodontal disease score
Abnormalities
Treatments
Tension: when closing a would, it should be _________ to the tension lines
Tell me how long suture can support these structures and why they take that long to heal.
Skin, muscle, subcutaneous tissue - few DAYS
Fascia - few WEEKS
- Tendon and ligaments - few MONTHS
What is the importance of retractors, and what considerations should we keep in mind? BONUS: what should you place in the underlying tissue to protect it?
Improve visualization
Maintain exposure
Potential to cause trauma due to improper handling or poor placement → ischemia/necrosis
BONUS: Moistened lap sponges
YOU GOT A CASE! Case #3
Look at case #3
What are the 2 nerve blocks performed in horses?
Maxillary NB
Mental NB
What is a finger trap and what would you use it for?
A type of suture that secures “-ostomy” tubes and anchor them to skin
This prevents accidental distraction or slippage
How are suture characteristics classified? Big 3, then name the specifics in each.
Behavior in tissue
Absorbable or non-absorbable
Structure
Monofilament or multifilament
Origin
Synthetic, organic, metallic
What is Halsted’s Principle of sx?
H - Handle tissue gently
A - Attenuate all bleeding
L - Leave blood supply intact
S - Strict aseptic technique
T - Tension minimized
E - Edges nicely apportioned
D - Dead space minimized
Name the 2 everting suture patterns.
Horizontal mattress
Vertical mattress
Skin staples
DOG: Name the structures the caudal inferior alveolar NB blocks (ST and teeth)
All teeth: incisors, canine, premolars and molars
Soft tissue: cheek, rostral and lower lip, intermandibular tissues
Name the 4 types of tendon sutures (need to know their name in case she asks what the suture does)
Kessler locking loop
Three-loop pulley
Bunnell-mayer
Krackow
What are the advantages and disadvantages of absorbable vs non-absorbable suture? Be as specific as you can. BONUS: What animals would you place absorbable sutures on?
Absorbable
Advantage
Removal not needed if buried
Minimal tissue reaction
Disadvantage
Need to remove if placed externally
Lose strength over time
Non-absorbable
Advantage
Minimal tissue reaction
Strong
Disadvantage
Need to be removed
Can migrate/fragment
May need to be careful burying some of them - causes inflammatory rxn.
Strength loss over time
BONUS: aggressive animals, or animals you know are not coming back to the clinic
LABEL!! #3
Document
Name the inverting suture patterns. Which of them is the most common one?
Lembert
Cushing
Connell
Utrech
Halstead
Parker-kerr
Purse string
What 2 drugs are used for local blocks in veterinary medicine? Which one lasts longer? Hint: About 3-4hr
Bupivacaine*
Lidocaine
What are the 2 most common types of ligations?
Miller’s knot
Transfixing ligature
YOU GOT A CASE! Case #5
Go to case #5.
What is the purpose of crushing tissue forceps vs. non-crushing tissue forceps? While you’re at it, label them :)
Crushing
Used in tissues that will be excised from the body
Non-crushing
Used in tissues that will remain inside the body
Provides temporary occlusion
Name the 7 appositional patterns and what they hold together.
Simple interrupted
Skin, linea, SQ, viscera
Simple continuous
Intradermal, SQ, linea, fascia, viscera, vasculature
Continuous intradermal
skin
Interrupted intradermal
SQ, fascia, holding layer
Ford interlocking
Thick skin
Cruciate
Skin, muscle, fascia
Modified gambee
Intestinal anastomosis
What is the dog and cat dental formula? BONUS: equine dental formula and explain the premolar situation.
DOG: 3/3, 1/1, 4/4, 2/3
CAT: 3/3, 1/1, 3/2, 1/1
HORSE: 3/3, 1/1, 3-4/3-4, 3/3
Name 5 tension-relieving sutures. For bonus points, tell me what portion is under tension (ex. Skin and fascia under tension).
quilled/stended - skin under tension
Far-near-near-far - skin and fascia under tension
Far-far-near-near - skin and fascia under tension
Walking suture - move skin over defect
DOUBLE THE POINTS!!! Describe what suture AND needle you would utilize for these tissues during surgery:
Skin
Monofilament, non-absorbable, reverse cutting - may use absorbable, but need to be removed
Abdomen
Monofilament or multifilament, absorbable, reverse cutting or taper point (depends on tissue layer being sutured)
Muscle
Monofilament, absorbable, taper point
Tendon
Monofilament, non-absorbable, reverse cutting
Parenchymal organs (liver, spleen, kidney)
Monofilament, absorbable, taper point
Hollow viscous organs (stomach, intestine, bladder)
Monofilament or multifilament, absorbable, taper point
Infected/contaminated locations
Monofilament, absorbable, taper point (organ) or reverse cutting (skin)
Vessels
Monofilament, absorbable or non-absorbable, taper point
Label ;) #4
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