BCSE
Surgery
Surgical Principles – BCSE Study Guide
March 28, 2026
30 min read
33 views
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. |
You've been studying hard
Create a free account to keep reading
Free accounts get 5 articles/day + daily practice questionJoin 14,000+ vet students already studying with NavleExam.
No credit card needed — free account takes 30 seconds.
Create Free Account — Keep Reading Already have an account? Log inor skip signup — just get daily questions
No spam. One question per day. Unsubscribe anytime.
BCSE Exam Prep Platform
Everything you need to pass the BCSE
✓
10,000+ Practice Questions
Exam-style with full explanations
✓
Past Exam Papers
Real previous exam questions
✓
Flashcard Mode
Species & topic quick review
✓
High-Yield Study Guides
What's actually on the exam