Q)In preop evaluation before placing skin graft over wounded area…bacterial colony count must be less than a) 10000 b) 100000 c) 1000000 d) 10000000
ans b) 10 raise to the power 5
Prerequisites for skin grafting: The recipient site should be assessed for potential bacterial load, blood supply, presence of devitalized tissue, and exposed vital structures. Donor site availability Perform recipient site tissue culture if history or concern for infection (counts <105 CFU/g tissue for most pathogens required before grafting). Presence of group a beta heamolytic streptococci is absolute contraindication for skin grafting [/bg_collapse]
a) Highly selective vagotomy divides the vagus nerves supplying the acid-producing portion of the stomach
b) Incidence of postoperative complications is lower.
c) The criminal nerve of Grassi should be severed
d) Crow's feet nerves are severed till below the GE junction
This Question discusses the concept of criminal nerve of Grassi and features of HSV
Highly Selective Vagotomy (HSV) only divides the last part of the nerves which supply the part of stomach which produces acid.
Anterior and posterior nerves of Latarjet are found and their terminal branches are severed from 7 cm proximal to the pylorus to 5 cm above the GE junction
Motor function of the stomach is not affected
Criminal nerve of Grassi is branch of posterior Vagus. It should be sought and cut. This nerve derives its name from the common mistake done during vagotomy. This nerve is often missed and responsible for recurrence of symptoms of Peptic ulcer disease.
Ref sab 2oth page 1206
Vagus Nerve branches
Anterior trunk: Gives
Branch to liver GB and Bile duct and goes along the lesser curvature as the anterior nerve of Latarjet
Sends branches to the celiac plexus and continues along the posterior aspect of the lesser curvature as the posterior nerve of Latarjet.
Criminal Nerve of Grassi: The first branch of the posterior trunk, innervates the gastric fundus. Failure to divide this nerve during an acid-reducing surgery can lead to recurrent ulcers
Crows Foot: The most distal branches of the anterior and posterior trunks and provides innervation to the antro-pyloric region. These branches are spared in a highly selective vagotomy (HSV)
Parasympathetics are vagally mediated using acetylcholine as the primary neurotransmitter