Exam 3: Lecture 23 - Amputations

Question 1

what are the common types of amputations

Answer 1

1. tail
2. ear pinna
3. digits
4. penile
5. thoracic limb
6. pelvic limb

Question 2

what is a caudectomy

Answer 2

amputation of a portion of the tail

Question 3

what are the 2 types of caudectomy

Answer 3

1. cosmetic caudectomy
2. therapeutic caudectomy

Question 4

what is a cosmetic caudectomy

Answer 4

performed to comply with breed standards or traditions

Question 5

why are cosmetic caudectomies considered controversial

Answer 5

ethically, morally, legally

Question 6

what are the reasons for therapeutic cuadectomy

Answer 6

1. trauma
2. infection
3. neoplasia
4. possibly perianal fistula

Question 7

T/F: therapeutic caudectomies require anesthesia after one week of age

Answer 7

true!!

Question 8

what does T3 mean

Answer 8

tail tip trauma

Question 9

T/F: usually if the tail is down to the bone, we can still save it

Answer 9

FALSE! usually cannot save it

Question 10

what are some non-surgical treatments of tail injuries

Answer 10

change the environment, bandage, topical treatment

Question 11

T/F: a caudectomy is a last resort for tail injuries

Answer 11

true

Question 12

when is a tail amputation indicated

Answer 12

when there is a tail tip lesion and bandaging is ineffective or impossible

Question 13

what are the 9 steps of a tail amp

Answer 13

1. make an elliptical incision around base of tail
2. incise SQ tissue to expose muscles
3. separate the attachments of the levator ani, rectococcygeus, and coccygeus muscles to the caudal vertebrae
4. transect tail by disarticulation at 2nd or 3rd caudal vertebrae
5. ligate medial and lateral arteries
6. appose levator ani muscles and lavage
7. appose SQ tissue in a simple interrupted or continuous
8. excise redundant skin if needed
9. appose skin edges with approximating 3-0 nonabsorbable sutures

Question 14

what can we use to prevent tail amps

Answer 14

1. e-collar
2. bite-not-collar
3. bucket
4. adequate pain control

Question 15

what are some tips for tail amps

Answer 15

1. it is a MAJOR procedure in an adult dog
2. dont amputate just the distal tip
3. amputate through the disc space
4. use generous skin flaps
5. hemorrhage control
6. most importantly, PAIN CONTROL

Question 16

what are some complications of a tail amp

Answer 16

1. hemorrhage
2. tension bc flaps are too short
3. wound disruption
4. neuroma formation (rare)
5. tail is too long and interferes with sit respense
6. self-mutilation due to pain

Question 17

what step of a tail amp is this

Answer 17

ligation and purse string

Question 18

what is dr thompson doing in this picture (important)

Answer 18

inserting a needle through the disc space

Question 19

what are 3 indications for thoracic limb amp

Answer 19

1. neoplasia
2. trauma
3. neurological impairment

Question 20

what are the 2 types of neurological impairments we can have in the forelimb

Answer 20

1. radial nerve paralysis
2. brachial plexus injury

Question 21

what are the 2 types of thoracic limb amps

Answer 21

1. forequarter
2. mid-humeral

Question 22

how do we know if a dog is a good candidate for forequarter amputation

Answer 22

1. owner concerns
2. desires functional outcome
3. will the dog stand after
4. relative health of remaining joints/limbs

Question 23

what kind of amputation is being shown in this picture

Answer 23

forequarter amputation

Question 24

T/F: we do not need to block the brachial plexus when we are doing a forequarter amp

Answer 24

FALSE, we DO need to block it!

Question 25

what type of technique is being used for this thoracic limb amp

Answer 25

three forceps transfixation suture technique

Question 26

T/F: we should apply a soft padded bandage after a forequarter amputation

Answer 26

true!!

Question 27

what type of forelimb amp is this

Answer 27

mid-humeral amputation

Question 28

what are the 11 steps of a forequarter amp

Answer 28

1. make a skin incision from the dorsal border of scapula, over scapular spine, and proximal 1/3rd of humerus 2. continue incision around the forelimb 3. transect the trapezius and omotransversarius 4. transect rhomboideus muscle from its attachment 5. elevate the serratus ventralis muscle 6. retract scapula laterally to expose the axillary artery and vein 7. transect brachial plexus 8. transect latissimus dorsi 9. place the 3 forceps transfixation technique 10. transect brachiocehaplicus and deep/superficial pectorals 11. to close, approximate the muscle bellies to cover branchial plexus and close remaining tissues

Question 29

what are the 8 steps to a mid-humeral amputation

Answer 29

1. make incision around the forelimb at level of distal 1/3rd of humerus 2. ABduct the limb and separate the biceps brachii and medial head of the triceps to expose vessels for ligation 3. place 3 forceps transfixation suture technique 4. transect triceps tendon, cut biceps brachii and brachialis muscles at insertion 5. ligate cephalic vein and transect radial nerve 6. osteotomize the humerus ad remove the limb 7. place interrupted sutures in outer muscle sheath 8. close the incision

Question 30

how do we do the three-forceps transfixation suture technique

Answer 30

1. place 3 forceps on the artery and ligate it in the crushed area of the proximal forceps 2. place transfixation ligature distal to the first ligation and cut the vessel between middle and distal clamps

Question 31

what veins and nerves must be transected for a mid humeral amputation

Answer 31

1. brachial artery and vein 2. median nerve 3. ulnar nerve 4. musculocutaneous nerve

Question 32

what are the indications for pelvic limb amputation

Answer 32

1. neoplasia 2. trauma 3. neurologic impairment

Question 33

what type of neurological impairments can lead to pelvic limb amp

Answer 33

1. sciatic nerve injury/impairment 2. femoral nerve injury/impairment

Question 34

what type of pelvic limb amputation is this

Answer 34

coxofemoral disarticulation

Question 35

what are the 11 steps to a coxofemoral disarticulation amputation

Answer 35

1. make a skin incision around the rear limb at level of middle 1/3rd of femur 2. open femoral triangle on medial side by incising between pectineus muscle and caudal belly of sartorius muscle to expose and ligate deep femoral artery and vein 3. transect sartorius, pectineus, gracilis, and aDDuctor muscles 2cm from inguinal crease 4. transect iliopsoas muscle at insertion on lesser trochanter 5. incise the joint capsule and cut ligaments of the head of the femur 6. on lateral side, transect the biceps femoris and tensor fascia lata 7. sever sciatic nerve 8. transect gluteal muscles, semimembranosus, semitendinosus 9. sever external rotator muscles and quadratus femoris 10. elevate rectus femoris muscle 11. remove limb

Question 36

what type of amputation is this

Answer 36

mid-femoral amputation

Question 37

what are the 10 steps to do a mid-femoral amputation

Answer 37

1. make skin incision around the rear limb at the level of distal 1/3rd of femus 2. on medial side transect gracilis muscle and caudal belly of the sartorius at mid-femoral level 3. isolate and ligate femoral vessels, transect pectineus muscle through its musculotendinous junction 4. place 3 forceps transfixation suture technique 5. transect quadriceps proximal to patella 6. transect biceps femoris at level of quadriceps 7. isolate and cut sciatic nerve at level of third trochanter 8. transect semimembranosus, semitendinosus, adductor muscles 9. elevate insertion of adductor muscles from linea aspera of femus 10. cut femur at the junction of the proximal and middle thirds of the diaphysis and remove the limb