Surgical conditions of the skin, amputations Flashcards
(84 cards)
1
Q
AVMA position statement on declawing
A
- Surgical declawing is no ta medically necessary procedure for the cat in most cases
2
Q
Inherent risks of surgical procedures
A
- Anesthetic complications
- Hemorrhage
- Infection
- Pain
3
Q
What are alternatives for scratching behavior?
A
- Scratching posts, cardboard boxes, lumber of logs, and carpet or fabric remantns affixed to stationary objects
- APpropriate claw care (trimming claws every 1-2 eeks) should be provided
- Temporary synthetic nail caps are available as an alternative to onychectomy to prevent human injury or damage
4
Q
What should be the housing of declaws cats?
A
- Indoor only and allowed outside only under direct supervision
5
Q
When can surgical onychectomy be considered?
A
- Where scratching behavior is an issue as to whether or not a particular cat can remain as an acceptable household pet in a particular home
6
Q
What is the scientific evidence that declawing leads to behavioral abnormalities compared to cats in control groups?
A
- No scientific evidence that declawing leads to behavioral abnormalities
7
Q
What are veterinarians obliged to provide cat owners?
A
- Complete education about declawing
- It is not just removal of the claw but is a major surgery involving amputation
- Rarely medically necessary
- CDC doesn’t list declawing a a means of preventing disease in either healthy or immunocompromised individuals
- Declawing may warrant consideration as an alternative to relinquishment or euthanasia, but only after extensive education and presentation of other strategies to manage scratching bheavior
8
Q
What is the word for the declaw procedure?
A
- Onychectomy
9
Q
What is removed during onychectomy?
A
- P3 and the nail (dog) or claw (cat)
10
Q
Indications for onychectomy?
A
- Nail bed trauma or infection in cats or dogs
- really questionable whether indoor cats are justified at all with declaw
11
Q
Label the P2, P3, flexor process, and ungual crest on a diagram?
A
- Just do it
12
Q
Anesthesia and analgesia required for onychectomy?
A
- General anesthesia
- Regional block
- Plus other pain medications including a post-op pain plan
13
Q
Preparation for onychectomy
A
- Scrub but do not clip (too traumatic to tissues and will cause more irritation postop)
14
Q
Where do you tourniquet for onychectomy and why?
A
- Tourniquet distal to the elbow to avoid nerve damage
15
Q
How do you perform the amputation for an onychectomy?
A
- Use a laser, scalpel or Rescoe nail trimmers to disarticulate between P2 and P3
- Resco technique tends to leave the flexor process behind
- A scalpel can be used to remove any remaining P3
16
Q
What can lead to postop lameness with onychectomy?
A
- DO not damage P2 or the digital pad
17
Q
Closure options for onychectomy
A
- Single suture, surgical glue, or just a bandage
18
Q
What do you need to do at the end of the onychectomy to make sure all digits have been declawed?
A
- Count at the end
19
Q
What are primary complications with onychectomy?
A
- Hemorrhage
- Leave a part of the ungual crest
- Pad or nerve damage
- Bandage too gith
20
Q
What to do for hemorrhage after onychectomy?
A
- This can be dramatic, especially if the cat is shaking its foot and gets the bandage off
- Cats should be kept in the hospital for 1-2 nights postop so if this happens, it’s not in the client’s home and you can address it promptly
21
Q
What happens if a part of the ungual crest remains?
A
- Nail re-growth
- SQ keratinized tissue –> inflammation –> abscessation
- Treatment requires removing the nail and the ungual process remnant, leaving hte open wound to drain, and antibiotics
22
Q
What happens with pad or nerve damage?
A
- Lameness (usually transient)
23
Q
What happens if the bandage is too tight?
A
- Ischemic necrosis, feet can slough
- Very serious
24
Q
Treatment options if you get sloughing of the feet?
A
- Debride, lavage, amputation
- Often need a graft
25
Which digit is the dewclaw?
- Digit 1
| - May lack P1 and P2
26
What are the indications for dewclaw removal?
- Dewclaw prone to injury - dangling (often P3 only), active outdoor/hunting dog
- Risk of dewclaw avulsion, clipper trauma in dogs groomed frequently
- Breed standards (some breeds should have it)
27
When is neonate dewclaw removal done?
3-5 days old
28
Why is neonate dewclaw removal done at 3-5 days old?
- Hemorrhage is more significant past that age
29
Procedure for neonate dewclaw removal
- Local anesthesia +/- sedation
- Amputate with Mayo scissors, scalpel blade, or laser
- Hemostasis with pressure, stryptic powder, AgNO2, band-aid
- Approximate skin with a single suture, skin glue, or allow to heal on its own (i.e. second intention)
30
When is non-neonate dewclaw removal done?
12 weeks or older
31
What is the anesthesia for non-neonate dewclaw removal?
- general anesthesia
32
Describe the procedure for non-neonate dewclaw removal
- Make an elliptical incision for ease of closure, dissect the SQ, ligate arteries, disarticulate Metacarpophalangeal or metatarsophalangeal joint with scalpel blade and suture SQ and skin closed
- Bandage and E-collar are essential - assume dogs will lick these surgery sites
33
What is a hygroma?
- Fluid-filled pseudocyst
34
What causes a hygroma?
- Repeated trauma over a boney prominence in heavy dogs leading to the formation of a connective tissue capsule filled with fluid
35
Which breed of dogs tends to get hygromas?
- Heavy, giant/large breed dogs
36
Most common site for hygroma?
- Elbow
37
What is the best treatment for hygroma?
- Eliminate the cause!!
- NO SURGERY
- Donut bandage so that pressure goes on the healthy tissue around the hygroma and not the hygroma itself
- Well padded surface to lie on
38
What should you not do with a hygroma?
- ASPIRATE it
- It's just going to come back, and in the meantime you may have introduced bacteria that will love to grow in the pocket of fluid
39
Surgery for hygroma
- ONLY FOR SURGEONS
- Last resort
- High risk of dehiscence, infection, and recurrence
40
What causes the irritation with skin fold pyoderma?
- Normal skin secretions, moisture, and debris accumulate in the skin fold leading to intertriginous irritation
41
Signs of skin fold pyoderma
- Pruritus, viscous exudate, foul smell
42
What is the first line of treatment for skin fold pyoderma?
- Medical treatments!
| - Keep clean and dry
43
What are common sites for skin fold pyoderma?
- Lip fold (Spaniels, St Bernard, Bulldogs)
- Nasal fold (brachycephalics, Bulldogs)
- Vulvar folds (obese dogs, Bulldogs)
- Body folds (Shar Pei, bulldogs)
- Tail folds (Bulldogs
44
What is surgery to correct the lip fold called?
- Cheiloplasty
45
What is surgery to correct the nasal fold called?
- Nasoplasty
46
What is surgery to correct the vulvar fold called?
- Episioplasty or vulvoplasty
47
How do you surgically correct the skin fold pyoderma?
- Excise via elliptical incision around the affected fold
48
What is a screwtail, and which breed gets it?
- TIghtly wound tail that is buried in folds of skin (most commonly in the bulldog)
49
Surgery for screwtail
- Treatment requires surgery
| - Give an owner with a bulldog a heads up about these potentially being an issue
50
What are three indications for amputation of the tail (caudectomy)?
- Trauma, infection, or neoplasia that cannot be medically resolved
51
How should you plan incisions for amputation?
- Plan them in each layer so that each can be closed without tension after the appendage is amputated
52
Fill in the blank: Leave soft tissues (SQ, muscle) LONGER or SHORTER than bone.
- Longer
53
Fill in the blank: Leave skin LONGER or SHORTER than soft tissues.
- Longer
54
What about vessels for caudectomy?
- Know where they are located so you can pre-emptively ligate before cutting
55
When should e-collar always be recommended?
- For tail and digit surgery always
56
AVMA position statement on ear cropping and tail docking
- Opposes ear cropping and tail docking of dogs when done solely for cosmetic purposes
- AVMA encourages the elimination of ear cropping and tail docking from breed standards
57
AAHA ear cropping/tail docking statement
- Opposed to ear cropping and/or tail docking in pets for cosmetic regions
- Vets should counsel and educate pet owners that these procedures should not be performed unless medically necessary
58
Caudectomy procedure
- Make a duckbill incision so as to create dorsal and ventral flaps that extend distal to transection site between vertebrae
- Disarticulate between 2 vertebrae after ligating vessels and cutting tendons, ligaments, and joint capsule
- Close in >1 layer
- Place an E-collar!
59
For best cosmetic results, should the dorsal or ventral flap for a caudectomy be longeR?
- Dorsal flap longer than the ventral one so that the incision will be on the ventral side of the tail
- This also shields the incision from trauma caused by the wagging tail hitting against something
60
What are three indications for toe amputation
1. Infection
2. Trauma
3. Neoplasia
That cannot be medically resolved
61
Differentials for a subungual mass in a dog?
- SCC
- MCT
- Malignant melanoma
62
Differentials for a subungual mass in a cat?
- Think metastasis from primary pulmonary neoplasia
| - Make sure you have three view chest radiographs
63
What are the primary weight bearing digits?
- III and IV
64
What would be the consequence of removing one of the primary weight bearing digits?
- May have more significant impact on the use of limb postop than removing other digits
65
What might you want to consider when doing a toe amputation for a neoplastic lesion?
- Will you be able to get clean margins, or is another treatment (e.g. limb amputation, radiation therapy) a better choice?
66
What is an Esmarch bandage, and what is it sued for?
- Sterile vet wrap is tightly wrapped from the tips of the toes to midway up the antebrachium (staying distal ot the elbow), with some extra 180 degree twists proximally
- This abandage milks the blood out of the limb and keeps it out
- The vet-wrap over the surgery site is CAREFULLY cut away (bandage is tight, so it can be easy to accidentally cut the skin)
- This is to help act as a tourniquet during vascular surgery
67
Maximum time for Esmarch bandage?
- Not definitively known, but not more than 1.5 to 2 hours is advised, since this is how long it takes to deplete ATP stores
- Before closing the surgery site, the bandage is removed, so that any areas of bleeding can be addressed
68
Procedure for digit amputation
a. Plan incision to allow tension-free closure; can use webbing in-between toes in the closure
b. Ligate vessels; cut tendons/ligaments/joint capsule to disarticulate. Lavage, then change gloves and instrument if it's a neoplastic lesion.
c. Close in >1 layer
d. Bandage/E-collar
e. Submit for histopath if amputating for mass, even if you have a pre-op biopsy
69
What needs to be done pre-op to make sure a dog will do okay on 3 legs (befoer limb amputation?
- Do a complete orthopedic and neurologic exam
70
How soon do most dogs walk after amputation?
- Most dogs walk within 24 hours
71
Why don't you leave a long stump instead of amputating the limb?
- Could be damaged
72
What is the most common type of amputation done with forelimb amputation?
- Forequarter amputation
| - Remove the entire forelimb, including the scapula
73
Advantages for the forequarter amputation including removal of the scapula?
- No bone to cut
- Good margins if the tumor is not in the scapula
- Cosmetic (if ou leave the scapula, there is scapular muscle atrophy and you will see the outline of the boney scapula)
74
Hindlimb options for amputation
- Opinions differ on which is more cosmetic and/or easier
- You could cut at the level of the proximal 1/3 of femur (only if no neoplasia in the femur)
- Coxofemoral diarticulation
75
What is required for the amputation procedure in private practice?
A. Reviewing anatomy before you go to surgery so that you know where major vessels and nerves are and which muscles need to be cut (e.g. for forequarter amputation, only have cut muscles that go from the body wall to the scapula/limb; don't have to cut triceps, which goes from scapula to ulna since both bones are coming out)
b. Injecting nerves with bupivacaine prior to cutting them (common for muscles supplied by that nerve to jerk when you cut the nerve)
C. ligating major vessels
d. Cutting muscles with cautery (will twitch) to decrease bleeding
e. Closing dead space well (Seromas are common post-op)
76
Where do vessels come into the forelimb?
- Via the axillary region
77
Other properties of silk
- Non-absorbable
| - multifilament
78
Do you ligate the artery of the vein first? Why?
- ARTERY
| - will continue filling with blood if you don't
79
How many sutures do you place on the artery and vein?
- 2 in the animal and one coming out at minimum
80
What order do you place the sutures on each vessel?
- 2 encircling first and leave space-in-between
| - THen place a transfixation in-between, closer to the side staying in
81
What is the correct spacing of suture
- Two closest together staying with the body
82
Where do you transect the vessel?
- In-between the transfixing and encircling
83
Make sure that you can correctly show the order of suturing with a vein and artery on the tissue to be removed
- See the image on page C53.
84
What is a way to reduce pain with amputation that utilizes a novel pain management technique?
- Nocita!
| - Could also do bupivacaine
