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What are the phases of wound healing and time frame of each? (4)
- 1. formation of a fibrin-platelet clot at the injury site (30-60 min)
- 2. recruitment of WBCs to protect the site from infection (60min to 3 days)
- 3. Neovascularization and cell proliferation (3-5 days)
- 4. Tissue remodeling (~7 days)
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Surgical wound healing occurs by...
epithelialization and epithelial seal within 24 hours if there is ideal apposition of SQ, dermis, epidermis.
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What is a species difference b/w cats and dogs in time to surgical wound healing?
cats have lower cutaneous perfusion an reduced wound breaking strength at 1 week post-op...always keep sutures in cats for 2 weeks
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What are advantages (2) and disadvantages (3) of creating a surgical wound with electrocautery and lasers?
- Advantages: hemostasis, lymphatic sealing
- Disadvantages: may result in thermal damage, affects cutaneous perfusion, delays wound healing
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What makes the linea alba?
external leaf of the rectus abdominis sheath
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What are the layers of abdominal closure?
- 1. linea alba
- 2. subQ (dogs only)
- 3. skin
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Describe the holding layer of the ventral abdominal wall and how it should be approached.
external rectus sheath is the holding layer: if you go through entire rectus abdominis muscle, there will be more pain than if you go through just the external rectus sheath….rectus muscle, internal leaf do not provide additional holding strength
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What suture material do you close a ventral abdominal incision with?
- Linea: slowly absorbable monofilament- PDS; size depends on size of patient
- SQ: ALWAYS 3-0!!! rapidly absorbable- catgut
- Skin: ALWAYS 4-0!!! non-absorbable (skin sutures), monofilament absorbable (intradermal)
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What are uses of chromic gut? (2)
- vascular ligations
- SQ closure
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What are sizes of appropriate sutures based on size for spermatic cord, ovarian pedicle, and linea closure?
- >15kg--> 0
- 10-15kg--> 2-0Â
- 1.5-9.9kg--> 3-0
- <1.5kg (pediatric)--> 4-0
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What is the interval b/w sutures when closing the linea?
- 5-8mm, depending on size of animal
- 5mm from incision
- short tags (2-3mm)
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How does your approach to SQ change if you're closing the skin with a percutaneous or cruciate pattern?
perfect skin apposition with the subQ closure is crucial if you're closing with these patterns [not crucial if closing skin with intradermal]
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Purpose of SQ closure. (2)
- close dead space
- relieve tension on skin for skin closure
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Describe the principals of skin closure. (2)
- cosmetic, non-holding layer
- use cutting needle and 4-0 suture
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What are percutaneous suture patterns? (4)
- simple interrupted (rarely used for skin after abdominal closure)
- cruciate
- simple continuous (never really used for skin)
- ford interlocking (large animal)
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What is an appropriate interval when using cruciates to close skin?
- 8-10mm b/w sutures
- 5mm from incision line
- leave long tags (10mm)
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Describe an intradermal closure.
- buried knots
- horizontal mattress in dermal layer
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