CSFA CSFA Hemostasis and Wound Closure 2 — Questions and Answers
Question 1: Gelatin sponge (Gelfoam) achieves hemostasis primarily by which mechanism?
- Releasing vasoconstrictors into tissue
- Providing a scaffold for platelet aggregation and clot formation (Correct answer)
- Directly lysing red blood cells
- Activating the extrinsic coagulation pathway chemically
Correct answer: Providing a scaffold for platelet aggregation and clot formation
Gelfoam acts as a physical matrix that absorbs blood and provides a surface on which platelets aggregate and fibrin polymerizes.
Question 2: Which layer of the abdominal wall is closed with a running or interrupted suture using a heavy delayed-absorbable or permanent suture for fascial strength?
- Subcutaneous fat (Camper's fascia)
- Skin
- Anterior rectus fascia / aponeurosis (Correct answer)
- Peritoneum
Correct answer: Anterior rectus fascia / aponeurosis
The fascial layer (anterior rectus sheath/aponeurosis) bears the primary tension of abdominal closure and requires strong, long-lasting suture material.
Question 3: When using bipolar electrosurgery, what is the key advantage over monopolar electrosurgery?
- Higher temperatures are reached
- Current travels only between the two bipolar forceps tips, limiting tissue spread (Correct answer)
- It can cut tissue as well as coagulate
- A grounding pad is still required
Correct answer: Current travels only between the two bipolar forceps tips, limiting tissue spread
Bipolar current passes only between the two tines of the forceps, confining electrical energy to the grasped tissue and protecting surrounding structures.
Question 4: What is the correct needle holder technique when driving a curved needle through tissue?
- Push the needle in a straight line
- Follow the arc of the needle's curvature with a pronating wrist motion (Correct answer)
- Use pliers-grip with maximum force
- Drive the needle heel-first
Correct answer: Follow the arc of the needle's curvature with a pronating wrist motion
A curved needle must be driven in the direction of its arc; pronating the wrist follows the curve naturally, preventing tissue tearing.
Question 5: Which absorbable suture retains tensile strength the longest, making it suitable for slow-healing tissues like fascia?
- Plain catgut (7–10 days)
- Chromic catgut (10–14 days)
- Polyglactin 910 / Vicryl (2–3 weeks)
- Polydioxanone / PDS (4–6 weeks) (Correct answer)
Correct answer: Polydioxanone / PDS (4–6 weeks)
PDS (polydioxanone) retains approximately 70% tensile strength at 2 weeks and 50% at 4 weeks, making it ideal for fascial repair.
Question 6: Intraoperatively, the surgical first assistant notes persistent oozing from a parenchymal liver surface. Which topical hemostatic agent is most appropriate?
- Bone wax
- Oxidized regenerated cellulose (Surgicel) (Correct answer)
- Vasoconstrictor soaked gauze
- Silver nitrate stick
Correct answer: Oxidized regenerated cellulose (Surgicel)
Oxidized regenerated cellulose (Surgicel) promotes clotting through a low-pH environment and provides a physical mesh; it is commonly used on solid organ surfaces.
CSFA CSFA Hemostasis and Wound Closure 2
Gelatin sponge (Gelfoam) achieves hemostasis primarily by which mechanism?