WHAT ARE YOU LEARNING?Explain basic principles of surgery,

laceration healing, and surgery considerations

Know Basic

Principles of Surgery

Laceration types etc

Surgical Considerations

Understand• Surgery principle

significance• Laceration healing• How to determine

considerations

Do• Outline surgery

basics• Explain healing

• Compare/Contrast Considerations

Unit EQ: Why is surgery important in vet practices?

Concept : Laceration Healing

Lesson EQ:

How does a wound heal?

Vocab

First Intention Healing, golden period, hemtoma

Concept :Surgical

ConsiderationsLesson EQ:

How are considerations determined?

VocabGDV, Necrotic,

Concept Surgical

PrinciplesLesson EQ:

What is one basic principle of surgery?

VocabSterilization,

Autoclave, Disinfectants

Reminders: Skin and mucous membranes provide

barrier to outside world THEREFORE

Surgery disturbs this barrier and allows for bacterial entry

Prevention of Bacterial Entry through barrier Environment has bacteria everywhere! Aseptic Technique

General practices used to minimize the risk of infection

Must be comprehensive! Includes

Management of facility, patient, surgical site, surgeon and equipment

Disinfectants: Used to clean facility, used on inanimate

objects Normally too harsh for direct skin contact

Sterilization: Tools are potential bacteria

carriers Instruments are cleaned of

debris (tissue etc) Kills all micro-organisms Uses pressure and steam

Autoclave : tools packed in steaming wrap, 15 to 30mins at 275 degrees

Common Procedures Outline Categorize Explain how they work What safety considerations are outlined?

Are they visible to the naked eye? Where is the safety information located?

How to read an MSDS Activity

Common Tools

Scalpel Needle Holder Scissors Tissue forceps Hemostatic Foreceps Retractors Towel Foreceps/Clamps Spay Hook

Provides clean incision Typical designed for single use

Disposal , removal off handle Varying Sizes and Shapes

Holds needle for suturing Teeth provide strong grip Insert replaced as teeth wear out

Various Shapes and Sizes (depends on surgery)

Curved = more maneuverable

Straight= cut through tough tissue

Normally in packs Metzenbaum – delicate

tissue Mayo – tough tissue

Appear like tweezers Tip will vary depending on use

Serrated= delicate tissue holding Heavy teeth= secure grip Ratchet locking grip= secure hold

(prolonged grip) Not used for delicate tissue

“Hemostats” Have a ratchet lock Used to clamp blood vessels (HEMO)

Once clamped, vessel can be ligated (tied off)

Hold tissues to expose surgical area so the surgeon has a better view

Self retaining or held by assistant

Surgical drapes cover animal during surgery

Only area open is surgical site Clamps keep towel in place during

surgery and help prevent contamination

Used to bring uterus through tiny incinsion

Covered in bacteria naturally To prevent spread

Gloves, mask, head cover, gown Wash hands (up to elbows)

with antiseptic soap and scrub brush Scrub should last 5 minutes to

properly clean Hold cleanest part highest

(hands in the air)

Area cleared of general debris

Normally shaved or clipped clean Loose hair is vacuumed off

Scrubbed with antiseptic soap , sometimes iodine Central region scrubbed first

then work outward in a circular motion

“Clean” Healthy skin is entered, healthy tissue is

removed Examples

Spay/Neuter

Choose a typical surgery Spay Neuter Biopsy Intestinal Obstruction Other (explain)

Outline prep procedure, tools typical used and procedure itself including suture Draw tools used

JUST OUTLINE not complete sentences.

Laceration Healing

How does a wound heal?

Understanding healing is essential to surgery and trauma treatment

Hemostasis Phase: Bleeding Begins directly after trauma or surgery breach Bleeding helps to flush the wound Instantly the vessels constrict, blood flow

slows Blood starts to clot

Protects from excessive blood loss Clot dries= scab

Scab allows for protection and for healing underneth

Inflammation Phase: Blood vessels dilate

Bring more white blood cells to the area White blood cells help destroy damaged tissue

and bacteria Dilated vessels increase heat into the region

and produce red area Damaged tissue releases plasma and adds to the

swelling area Signs of inflammation phase

Swelling, heat, redness, pain

Repair/ Proliferation Phase Begins simultaneously with inflammation

process Connective tissue enter the damaged area and

begin to form new fibrous connective tissue Proliferation of cells in the new connective

fibers and matrix Capillaries begin to grow within the area Produces a granular appearance on the skin

Tissue at this stage is called granulated tissue

This tissue fills the gap between the wound edges and sets barrier from infection (Reminder)Rich supply of capillaries

increases amount of white blood cells As the G tissue forms E tissue form

across the edges Cells continue to layer and thicken

Remodeling Phase Gap is closed (Second Intention Healing) Occurs within several weeks of wound, but

can last for years! (scar tissue) Connective tissue w/in the wound becomes

more organized and shrinks (scars shrink) Strength of wound increases over time

Proud Flesh: Common in lower leg wounds in horses Over growth of granulated tissue prevents

epithelial tissue from covering the wound

Illustrate the wound healing process Graphic organizer : Cause Effect Chain

Aseptic Techniques – decrease bacteria Gentle handling during surgery-

decreases inflammation response Appropriate incisions- less disruption of

blood supply = faster healing

Dead space: important to consider Present because of tissue separation Tumor removal leaves a pocket

Types of Accumulation Hematoma – accumulation of blood in the dead

open space Seroma- more puss like Abscess- contains bacteria, white blood cells, dead

tissues Fluid build up= increases tension @ wound site

Two main methods Decrease size of pocket during surgery

Sew together tissues manually Latex tubing

Penrose drain (passive) Active Drain

Outline the steps for suturing a wound. What are the TYPES of sutures What do they look like? How are they sewn? (only do a general

outline for sewing a wound closed) What are important items to consider when

suturing a trauma or surgical wound?

Surgical Considerations

More than one method to a surgery Possible Differences

Approach Order of Steps Tech methods / Tools etc

Aka Ovariohysterectomy Steps:

Animal anesthetized and secured to table Scrubbed Start surgery

Most common Ventral Midline incision

Middle of the stomach Why the midline?

Abdominal muscles naturally have a gap (Linea Alba) Little bleeding , easy access to organs

Locate Uterus (near the spine) Deep in cavity

Use spay hook to contact and begin uterine horn removal

Control blood flow All arteries are ligated by the three-clamp

method Vessels are sutured Clamps releases

Check for leaking

Ligaments cut Ligaments located Ligaments holding the uterus are ligated Uterus is free

Organ removal Ovaries, uterine horns, uterine body all removed

Cavity Check No bleeding in dead space

Suture Sub Q tissue tightened to close dead space Absorbable using a tapered point needle

Close Linea Alba Close epithelial label with NON absorbable

suture (stitches removed later)

Same incision : Ventral Midline Possible findings?

Looped intestine Blood supply cut off from segment Intestine become necrotic (dead) Reposition : If severe, section must be removed

attaching only healthy portions together ( intestinal anastomosis)

AKA gastric dilation- volvulus syndrome (GDV) Occurs in deep chested breeds ( Boxer)

Circulation to the stomach is disrupted Vomiting common symptom (food cannot move

forward, build up of gases) Diagnosis through radiographs / Xrays Treatment:

IV fluids to reduce shock Tube down esophagus to relieve gas pressure

If stomach is twisted surgery is needed

Ventral midline incision along linea alba Bladder brought the surface through

incision Gauze surrounding surgical area to prevent

urine entering abdomen Incision of bladder Stones removed Continuous mattress suture Suture abdomen

Surgical Considerations What procedures are cited? Outline their process What are common complications that occur after surgeries? What is the common approach used? (Common incision used). What is the

location and why is this location used? What characteristic of tumors makes for difficult removal? How do vets

combat this problem? What are the challenges present when working in the chest cavity? How

do vets combat these problems? What is orthopedic surgery? What are common ways to perform repairs

during orthopedic surgery? Summarizing: In 10 sentences or less summarize surgery in veterinary

practice. What might make is more difficult in animals than human surgery? What are basic principles? How does one generally perform surgery based off these principles? How does one perform a surgery correctly?

Define: Aseptic, Disinfectant, Sterilization, Proud Flesh, First Intention Healing, Second Intention Healing, Penrose Drain, Suture, GVD, Ovariohysterectomy

What is the 1st and more important principle of surgery? What is the most common aseptic technique? (We use it in class, and before

surgery) How long should this technique be performed? List the common tools and what they are used for How is the surgeon prepped ? How is the animal prepped? Explain how they are “washed” and why it is

done in this manner What are the phases of wound healing? What ways can wound healing time be minimized? What is a common problem in wound healing in horses? What are the two kinds of drains and how does each drain work? What are the types of sutures (draw them) What are the steps in spaying an animal