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Flashcards in General cutaneous surgery Deck (31)
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1

Define an abscess

a localised collection of pus

2

Abscesses are nearly always...

secondary to a bacterial infection, pus is full of bacteria and dead bacteria within white blood cells

3

What are sterile abscesses?

No bacteria are involved but an accumulation of dead and dying cells and tissues with a fibrous capsule

4

Describe a malar abscess

Associated with dental disease. Extraction of the offending tooth is required, usually the carnassial tooth.

5

Describe an anal sac abscess

Impactions of anal gland secretions can lead to abscess formation.



The abscess normally ruptures out of the skin around the anus.

6

Describe a cat bite abscess (CBA)

Canine teeth penetrate deep into the skin leaving only a small entry wound. The wounds quickly heals over sealing bacteria beneath the skin

7

Describe penetrating wounds

- as with CBA, the skin is penetrated and heals over quickly leaving bacteria to multiply beneath the skin e.g. thorn, nail etc

8

Describe foreign bodies

an object e.g. grass seed, wood splinter penetrates the skin; the entry hole quickly heals over sealing the foreign body within the tissues

9

Describe a rabbit abcess

rabbits get recurrent abscesses in the submandibular and cheek area

the pus within is much thicker and is difficult to drain and remove

commonly related to tooth root problems and/or nasolacrimal disease

10

What are the clinical signs of an abscess?

Local swelling

Local pain

Warmth and erythema of the overlying skin

Systemic signs – pyrexia, depression, anorexia, tachycardia

discharge

11

Describe treatment of abscesses

Cold (sterile) abscesses can form if antibiotics are given without lancing and releasing the encapsulated pus

Lance an abscess where it begins to ‘point’ (soft spot)

Warm compresses can encourage an abscess to point and even rupture

GA or sedation is normally needed to lance an abscess

Prepare the site surgically and lance with a scalpel blade (FNA first to confirm)

Express pus and flush cavity out well

Daily flushing and cleaning of the site, prevent a scab from forming

Abscesses need to heal from the inside out

Surgical resection of some abscesses. Rabbit abscesses best treated this way.

12

Describe problems that tumours can cause

The physical mass of the tumour can press on other structures in the body and cause pain or loss of function

Rapidly growing tumours can use up energy resources and cause the animal to feel unwell and depressed

Cytokines released by a tumour can cause distant physiological effects. E.g. anal adenocarcinoma and lymphosarcoma can cause hypercalcaemia, which can cause polydipsia, polyuria and renal failure.

The tumour may spread to vital organs e.g. the heart, kidneys, lung, liver resulting in loss of function and clinical signs.

13

Describe a benign tumour

Usually have a well developed capsule and remain in one site

14

Describe a lipoma

Adipose (fatty) tissue tumour

15

Describe a histiocytoma

Commonly seen in dogs under the age of three years, occasionally in older animals



Commonly spontaneously regress without treatment

16

Describe an adenoma

Benign tumour of the glandular tissue e.g. anal adenoma, adenoma of the thyroid gland

17

Describe a papilloma

‘Warty’ growths found on the skin, occasionally the bladder, arising from the epithelial tissue

18

Describe a malignant tumour

Often show ulceration, local infiltration and metastasis

19

Describe a carcinoma

Produced from the epithelium e.g. squamous cell carcinoma, mammary tumours (adenocarcinomas)

20

Describe a malignant melanoma

Strictly should be called a melanocarcinoma

21

Ideally, before removal, any tumour...

should be FNAed to give an indication of the type of tumour before removal so the surgical margin adjusted as needed. Skin grafts may be required
to close the deficit

22

Describe a pedicle graft

A pedicle graft or skin flap is a partially detached segment of skin and subcutaneous tissue



The base or pedicle of the flap maintains circulation to the skin during transfer to a recipient location



This location can be local or distant, advanced or rotated

23

Describe a Single Pedicle Advancement flap

A flap is undermined to the side of the defect and advanced over the wound



The defect and the sides of the flap are then sutured

24

Describe a Bipedicle Advancement Flap
(H-plasty)

As a single pedicle advancement but skin is undermined from both sides of the wound



The skin is then advanced on both sides to meet in the centre and cover the defect

25

Describe a rotational flap

A curved lesion is made adjacent to the wound



The length of the incision usually needs to be about four times the width of the wound



Used where the skin can only be mobilised from one side of the wound e.g. around the anus

26

Describe a Transposition Flap (90˚)

Transposition flaps are developed at angles of up to 90˚



They tend to be moved from the thoracic or abdominal skin to cover wounds affecting proximal limbs

27

Describe skin free grafts

Segments of skin are completely detached from one area of the body to ‘resurface’ another area lacking epithelial surface



No vessel attachment at all

28

Describe the survival of free skin grafts

Survival of the graft in the first 48 hours is by absorbing tissue fluid from the recipient bed

Later on new blood vessels grow into the graft

Post operative care is therefore vital to graft survival

Accumulation of material (blood, pus) under the graft or movement delays or prevents revascularization and often leads to non-adherence and graft necrosis

29

Describe a punch graft

Grafts usually taken with a punch biopsy and pushed into ‘holes’ in the granulation tissue

30

Describe a stamp/strip graft

Small squares or strips of skin laid onto granulation tissue with gaps between the grafts