BCSE
Surgery
Surgical Principles – BCSE Study Guide
📅 March 28, 2026
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BCSE study guide for Surgical Principles. High-yield review with exam-focused content and practice questions.
| Method |
Description |
When Used |
| Closed Gloving |
Hands remain inside gown cuffs until gloves are completely on. Lowest contamination risk. |
Primary method after initial gowning. Best practice for preventing contamination. |
| Open Gloving |
Bare hands touch only inside of gloves. Higher contamination risk. |
When not wearing gown or replacing contaminated gloves intraoperatively. |
| Assisted Gloving |
Sterile team member holds glove open for another to insert hand. |
Assisting gowning of other team members or regloving during surgery. |
| STERILE Areas |
NON-STERILE Areas |
| Gown front from chest to sterile field level |
Neckline, shoulders, underarms |
| Sleeves from 5 cm below elbow to cuff |
Sleeve cuffs (collect moisture) |
| Draped instrument table (top surface only) |
Back of gown (cannot be observed) |
| Draped patient within surgical field |
Anything below table level |
| Antiseptic |
Properties |
Considerations |
| Chlorhexidine |
Broad spectrum, residual activity, effective in organic matter |
Avoid eyes, ears (ototoxic), mucous membranes |
| Povidone-Iodine |
Broad spectrum including fungi and spores |
Inactivated by organic matter, may cause tissue toxicity |
| Alcohol (70%) |
Rapid bactericidal, no residual activity |
Fire hazard with electrosurgery, dries skin |
| Blade # |
Shape and Use |
Handle |
| #10 |
Curved, belly blade - most common for skin incisions |
#3 |
| #11 |
Pointed, triangular - stab incisions, draining abscesses |
#3 |
| #12 |
Hooked/sickle shape - specialized (ophthalmology) |
#3 |
| #15 |
Small curved - precise/small incisions, declaws |
#3 |
| #20 |
Large curved - large animal skin incisions |
#4 |
| Type |
Characteristics |
Primary Use |
| Mayo Scissors |
Heavy, sturdy blades. Straight or curved. |
Cutting dense tissue, fascia, suture material |
| Metzenbaum Scissors |
Long handles, short delicate blades. Usually curved. |
Delicate tissue dissection (fat, muscle fascia) |
| Operating/Suture Scissors |
Multipurpose, moderate weight |
Cutting suture material only (preserves sharpness) |
| Type |
Tip Configuration |
Tissue Application |
| Adson Forceps |
Fine teeth (1x2 or 2x3) at tip |
Skin, delicate tissue handling |
| Brown-Adson |
Multiple fine teeth (7x7 or 9x9) |
Skin with minimal trauma |
| Rat-Tooth Forceps |
Interlocking teeth (1x2) |
Dense tissue, skin when good grip needed |
| DeBakey Forceps |
Atraumatic serrations |
Vascular tissue, delicate viscera |
| Type |
Jaw Pattern |
Use |
| Mosquito (Halsted) |
Small, delicate. Fine serrations entire length. |
Small vessels, delicate tissue |
| Kelly |
Medium. Transverse serrations on distal HALF only. |
Medium vessels, tissue bundles |
| Crile |
Similar to Kelly. Serrations extend FULL length. |
Similar to Kelly, provides better grip |
| Carmalt |
Longitudinal grooves with cross-hatching |
Crushing large tissue pedicles (ovarian) |
| Rochester-Pean |
Heavy, transverse serrations full length |
Heavy tissue bundles, large vessels |
| Retractor |
Type |
Primary Application |
| Senn |
Hand-held |
Skin and superficial muscle. Three-pronged end and flat blade end. |
| Army-Navy |
Hand-held |
General soft tissue retraction. Flat blades at 90 degrees. |
| Hohmann |
Hand-held |
Orthopedic - retracts muscle from bone. |
| Gelpi |
Self-retaining |
Superficial tissue. Sharp points anchor into tissue. |
| Weitlaner |
Self-retaining |
Muscle and fascia. Multiple blunt or sharp prongs. |
| Balfour |
Self-retaining |
Abdominal surgery. Center blade retracts cranially. |
| Finochietto |
Self-retaining |
Thoracic surgery. Heavy-duty rib spreader. |
| Type |
Features |
| Mayo-Hegar |
Most common. Available in multiple lengths. Simple jaw design. |
| Olsen-Hegar |
Has built-in scissors for cutting suture. Convenient but requires experience. |
| Castroviejo |
Spring-loaded, fine. For ophthalmic and microsurgery. |
| Classification |
Category 1 |
Category 2 |
| By Absorption |
Absorbable (loses strength within 60 days) |
Non-absorbable (retains strength beyond 60 days) |
| By Structure |
Monofilament (single strand) |
Multifilament/Braided (multiple strands) |
| By Origin |
Natural (gut, silk, cotton) |
Synthetic (nylon, PDS, Vicryl) |
| Material |
Structure |
Absorption |
Tensile Strength |
Common Uses |
| Chromic Gut |
Mono, Natural |
10-40 days |
50% at 7-10 days |
Fast-healing tissue, mucosa |
| Polyglycolic Acid (Dexon) |
Braided, Synthetic |
60-90 days |
50% at 14-21 days |
Subcutaneous, fascia |
| Polyglactin 910 (Vicryl) |
Braided, Synthetic |
56-70 days |
50% at 21 days |
General closure, ligation |
| Poliglecaprone 25 (Monocryl) |
Mono, Synthetic |
90-120 days |
50% at 7-14 days |
Subcuticular, intradermal |
| Polydioxanone (PDS) |
Mono, Synthetic |
180-210 days |
50% at 28 days |
Slow-healing tissue, fascia |
| Material |
Structure |
Properties |
Uses/Notes |
| Silk |
Braided, Natural |
Excellent handling, poor knot security, high tissue reaction |
NOT in infected wounds. Actually absorbs over 2 years. |
| Nylon (Ethilon) |
Mono, Synthetic |
Good strength, low reaction, poor knot security |
Skin closure. Needs extra throws (5-6). |
| Polypropylene (Prolene) |
Mono, Synthetic |
Inert, maintains strength, minimal tissue drag |
Skin, vascular, where permanent strength needed. |
| Polyester (Mersilene) |
Braided, Synthetic |
Excellent strength, some tissue drag |
Cardiovascular, where permanent strength needed. |
| Stainless Steel |
Mono/Twist, Metal |
Strongest, inert, difficult to handle |
Orthopedic, sternotomy. Rarely used in soft tissue. |
| Needle Type |
Design |
Tissue Application |
| Taper Point |
Round body, sharp tip penetrates by spreading |
Viscera, muscle, fascia (friable tissue) |
| Cutting |
Triangular cross-section, sharp cutting edges |
Skin, dense tissue, sternum |
| Reverse Cutting |
Cutting edge on outer curve (away from wound) |
Skin - reduces cut-through. Most common for skin. |
| Side Cutting (Spatula) |
Flat, cutting edges on sides |
Ophthalmic surgery |
| Pattern |
Description |
Advantages/Uses |
| Simple Interrupted |
Individual sutures, each knotted separately |
Tension adjustable per suture. If one fails, others remain. Most versatile. |
| Simple Continuous |
Running suture, knots only at beginning and end |
Faster, even tension distribution. Less suture material. If fails, entire line fails. |
| Ford Interlocking |
Continuous with loop-lock after each bite |
More secure than simple continuous. Good for skin when slight tension exists. |
| Intradermal/Subcuticular |
Continuous within dermis, buried |
Excellent cosmesis, no external sutures. No suture removal needed. |
| Pattern |
Description |
Uses |
| Cushing |
Continuous pattern through serosa and muscularis only |
GI surgery, bladder. Does not penetrate lumen. |
| Lembert |
Interrupted or continuous, serosa and muscularis only |
Oversewing GI closures for added security. |
| Connell |
Continuous, full-thickness penetrating lumen |
First layer GI closure (followed by inverting pattern). |
| Purse-String |
Circumferential suture around an opening |
Closing stab incisions, securing catheters, cecal inversion. |
| Pattern |
Description |
Uses |
| Horizontal Mattress |
Two parallel bites connected beneath wound. Suture parallel to wound edge. |
Tension relief, everting wound edges. |
| Vertical Mattress |
Far-far-near-near bites. Suture perpendicular to wound edge. |
Combines deep and superficial closure. Strong eversion. |
| Cruciate (X-pattern) |
Figure-8 pattern crossing over wound |
Closing linea alba. Distributes tension. |
| Method |
Mechanism |
Application |
| Digital Pressure |
Direct compression occludes vessels |
Immediate control of bleeding. Temporary. |
| Hemostatic Forceps |
Clamps vessel for ligation or electrocoagulation |
Isolating vessels for permanent occlusion. |
| Vascular Clamps |
Atraumatic temporary vessel occlusion |
Large vessels during repair. Bulldog, Satinsky. |
| Sponge Packing |
Compression with surgical sponges |
Diffuse oozing from large surface areas. |
| Tourniquets |
Circumferential limb compression |
Limb surgery, emergency hemorrhage control. |
| Hemoclips |
Metal or polymer clips occlude vessel |
Small to medium vessels. Faster than ligation. |
| Technique |
Description and Use |
| Simple Ligature |
Suture wrapped around clamped vessel and tied. Basic technique for small to medium vessels. |
| Transfixation Ligature |
Needle passes through tissue pedicle before tying. Prevents ligature from slipping off. For large vessels and pedicles. |
| Modified Miller Knot |
Circumferential ligature with locking loop. For pedicles (ovarian). Prevents slipping. |
| Encircling Ligature |
Suture placed around vessel before cutting. For vessels where clamping is difficult. |
| Method |
Mechanism |
Vessel Size Limit |
| Monopolar Electrosurgery |
Current passes through patient to grounding plate. Coagulates by heat generation. |
Up to 2 mm diameter vessels |
| Bipolar Electrosurgery |
Current passes between two forcep tips. More precise, less thermal spread. |
Up to 2 mm diameter. Better for delicate areas. |
| Vessel Sealing (LigaSure) |
Bipolar device denatures collagen/elastin. Seals and cuts in one motion. |
Up to 7 mm diameter vessels |
| Ultrasonic (Harmonic) |
High-frequency vibration generates heat. Coagulates and cuts simultaneously. |
Up to 5 mm diameter vessels |
| Laser Surgery |
Light energy absorbed by tissue generates heat. Precise coagulation. |
Up to 0.5 mm diameter vessels |
| Agent |
Mechanism |
Applications |
| Gelatin (Gelfoam) |
Absorbs blood, provides matrix for clot formation |
Oozing from bone, parenchymal organs. Absorbed in 4-6 weeks. |
| Oxidized Cellulose (Surgicel) |
Low pH activates clotting, physical matrix |
Diffuse capillary oozing. Bacteriostatic. Absorbed in 2-6 weeks. |
| Collagen (Avitene) |
Activates platelets, promotes aggregation |
Capillary bleeding. Rapid hemostasis. Absorbed. |
| Thrombin |
Converts fibrinogen to fibrin directly |
Spray application on oozing surfaces. Often combined with gelatin. |
| Bone Wax |
Physical barrier in bone (not absorbed) |
Bone edges (sternotomy). NOT for use where healing needed. |
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