Term
| From least to worst, which instruments cause the least amount of trauma? |
|
Definition
| -scalpel < scissors < CO2 < electroscalpel |
|
|
Term
| What instrument is better for repeated tissue manipulation? |
|
Definition
| -skin hooks or suture stays are better than tissue forceps |
|
|
Term
| What method do we use to decrease the risk of devascularization? |
|
Definition
| -dissect deep to the subdermal plexus |
|
|
Term
| What is primary skin closure? |
|
Definition
| -immediate direct closure |
|
|
Term
| What is delayed primary skin closure? |
|
Definition
| -delayed direct closure before onset of granulation tissue (<3-5 days) |
|
|
Term
| What is secondary skin closure? |
|
Definition
| -delayed direct closure after onset of granulation tissue (>3-5 days) |
|
|
Term
| What is second intention skin closure? |
|
Definition
| -indirect closure by onset of granulation tissue and epitheliazation |
|
|
Term
| What are our major concerns with closing wounds by second intention? |
|
Definition
-aesthetically or funcitonally unacceptable
-slow
-costly |
|
|
Term
| What are our skin closure options? |
|
Definition
-direct apposition
-plasty techniques
-pedicle flaps
-axial pattern flaps
-composite flaps
-grafts |
|
|
Term
| Technique to close skin depends on what? |
|
Definition
-elasticity of surrounding tissue
-location of the defect
-size of defect
-regional blood supply
-wound healing factors: systemic and locak |
|
|
Term
| What decides tension lines? |
|
Definition
-tension lines are formed by the predominant pull of fibrous tissue within the skin
-tension increases the risk of closure complications |
|
|
Term
| How do we change our surical plan to address the issues of tension? |
|
Definition
| -close wound parallel to skin tension lines |
|
|
Term
| What happens if we close wounds perpendicular to skin tension lines? |
|
Definition
-delays in healing
-wider scar
-more tension: dehiscence, pain
-dog ears |
|
|
Term
| What is undermining? Why do we do it? |
|
Definition
-seperation of the skin or panniculus muscle or both from underlying tissue by blunt and sharp dissection
-simplest technique the relieve tension and maximizes elastic potential of skin edges |
|
|
Term
| How do we undermine granulation tissue? |
|
Definition
-separate granulation tissue at the edges from epithelium
-caution!!!! don't be too agressive!!! |
|
|
Term
| What is the purpose of walking sutures? |
|
Definition
-moves skin across a defect
-obliterate dead space
-distribute tension over the wound surface
-stretches skin in small increments
-do not penetrate skin surface
-anchored in fascia and dermis |
|
|
Term
| What suture patterns do we use to help disperse pressure? |
|
Definition
-cruciate
-horizontal/vertical mattress
-far-ear-near-far |
|
|
Term
| What is the purpose of relaxing incisions? |
|
Definition
-made to allow apposition of skin edges
-heal by contraction/epitheliazation |
|
|
Term
| Where do we use relaxing incisions? |
|
Definition
| -legs, around eyes/enus, cover vital structures |
|
|
Term
| What are the differences between simple and multiple relaxing incisions? |
|
Definition
-Simple: less cosmotic, more relief
-Multiple: more cosmetic, less relaxaation, higher risk of circulatory compromise |
|
|
Term
| What is a V-to-Y plasty? When is it commonly used? |
|
Definition
-relaxing incision where you make a V next to the incision and sow it until it becomes a Y
-common iwth eyelid surgery |
|
|
Term
|
Definition
-lengthens or relaxes an incision
-cut Z next to the wond |
|
|
Term
|
Definition
| -puckers of skin at the end of the incision line |
|
|
Term
| How do ewe correct dog ears? |
|
Definition
-outline with an elliptical incision, remove redundant skin, appose skin edges
-cut off the dog ear |
|
|
Term
| Why are circular defects difficult surgically? |
|
Definition
|
|
Term
| What do we do to fix circular irregular skin defects? |
|
Definition
| -convert to linear: used for small defects, correct dog ears |
|
|
Term
| How do we convert circular defects to ellipse? |
|
Definition
-4:1 length to width ratio
-resects more skin than necessary! |
|
|
Term
|
Definition
| -cut V's 45 degrees from axis of tension |
|
|
Term
|
Definition
-cut triangles 30 degrees from axis of tension
-abundant skin must be available around defect |
|
|
Term
| How do we close triangular defects? |
|
Definition
| -start at points of triangle and suture inward |
|
|
Term
| How are rotational flaps closed? |
|
Definition
| -semicircular/three quarter circular flap of skin rotated at a pivot point into the defect |
|
|
Term
| Describe a single rotational flap. |
|
Definition
| -used when skin is available only on one side ofthe defect or rotation of skin results in a defect/distortion of adjacent structures |
|
|
Term
| Describe a bilateral rotational flap. |
|
Definition
| -little skin is available on both sides of defect/ |
|
|
Term
| How do we close a square or rectangle skin defect? |
|
Definition
| -start corners and work inward (skin must be available on all four sides of defect) |
|
|
Term
| What are advancement flaps? |
|
Definition
| -free a flap the same length as the wound and pull it over |
|
|
Term
| What is a rotational flap? |
|
Definition
-flap becomes increasingly shorter with increased rotation
-width of the flap = width of defect |
|
|
Term
| Describe how we close fusiform/elliptical skin defects? |
|
Definition
-place suture across widest part of defect
-divide each remaining segment in half with subsequent sutures |
|
|
Term
| How d we close crescentic skin defects? |
|
Definition
-close beginnin at the midpoint, each remaining segment closed by dividing segments in half
-place sutures on concave side closer, further on convex side |
|
|
Term
|
Definition
| -transfer of a segment of free dermis and epidermis to a distant recipient site |
|
|
Term
| What are full-thickness skin grafts? |
|
Definition
|
|
Term
| What is a partial-thickness skin grafts? |
|
Definition
-epidermis and variable dermis
-cannot do in cats (too thin) |
|
|
Term
| What are the types of skin grafts? |
|
Definition
-sheet or mesh (often preferred)
-punch, stamps, strip |
|
|
Term
| What are the advantages of mesh skin grafts? |
|
Definition
-increased surface area
-better conformity
-fluid drainage |
|
|
Term
| What four factors are critical to graft surviaval? |
|
Definition
-healthy vascular bed
-lack of motion
-contact between the bed and graft
-lack of infeciton |
|
|
Term
| What diagnostics are indicated by neoplastic masses? |
|
Definition
-fine needle aspiration
-biopsy, biopsy, biopsy |
|
|
Term
| What are our major concerns with resection of a neoplastic masses? |
|
Definition
-wide excision
-submit tissue for margins
-first attempt is the best attempt! |
|
|
Term
| What margins are needed for a lipoma, mast cell tumor, and a high grade sarcoma? |
|
Definition
-lipoma: 0cm
-mast cell tumor: 1-2 cm
-high grade sarcoma: 3cm |
|
|
Term
| In which cases are vulvar folds an issue? |
|
Definition
-fat dogs
-infantile, recessed vulva
-superficial dermatitis, urinary incontinence, recurrent urinary tract infections
-episioplasty |
|
|
Term
| In which breeds do we commonly see redundant skin folds at the tail? What complications does this cause? |
|
Definition
-Brachycephalics, Schipperke, Manx cat
-tail fold pyoderma is a common secondary complication |
|
|
Term
| Ho do we surgically correct redundant skin folds at the tail? |
|
Definition
| -tail fold resection that commonly leads to lack of a tail |
|
|
Term
| What are some common issues with ear pinna? |
|
Definition
-lacerations
-frost bite
-aural hematoma |
|
|
Term
| What are the three ways we fix pinna lacerations? |
|
Definition
-skin
-skin + cartilage
-skin + cartilage + skin |
|
|
Term
| What diagnostics do we use for aural hematomas? |
|
Definition
-collection of blood, serum, or both in the pinna
-exacerbated with shaking of the head |
|
|
Term
| What is the goal during repair of an aural hematoma? How do we do it? |
|
Definition
-Goal: obliterate dead space
-incision and suture, CO2, laser |
|
|
Term
| What commonly exacerbates aural hematomas? |
|
Definition
|
|
Term
| What must you absolutely do during recovery of an aural hematoma repair? |
|
Definition
| -bandage and immobilize the ear |
|
|
Term
| What are the indications for a lateral ear canal resection? |
|
Definition
-adjunct to medical management for otitis externa
-minimal hyperplasia of ear canal
-small neoplastic lesions of lateral aspcet of the vertical canal |
|
|
Term
| What are the purposes of a lateral ear canal resection? |
|
Definition
| -allows for increased drainage, aeration of canal, facilitates medication administration |
|
|
Term
| Do we still have to medicate the ear with a lateral ear canal resection? |
|
Definition
|
|
Term
| Do we use lateral ear canal resection for otitis media? |
|
Definition
| -NO, not for obstruction of the horizontal ear canal either |
|
|
Term
| What are the indicatiosn for a vertical ear canal resection? |
|
Definition
-Vertical canal disease: tumor, toitis externa confined to the vertical ear canal
-Horizontal canal must be normal
-better cosmetic appearance than with lateral resection when abundant hyperplstic tissue is present in and around vertical ear canal |
|
|
Term
| What are the indications for a total ear canal ablation? |
|
Definition
-chronic otitis externa with failure of medical management
-ossificaion, hyperplasia of entire canal
-neoplasia |
|
|
Term
| What must we also perform with a total ear canal ablation? |
|
Definition
| -MUST PERFORM A LATERAL BULLA OSTEOTOMY |
|
|
Term
| What are the indications for a ventral bulla osteotomy? |
|
Definition
-allows increased exposure to tympanic cavity
-technique for choice for cats: neoplasia, nasopharyngeal polyps
-better drainage of bulla
-CATS HAVE TWO COMPARTMENTS THAT MAKE UP THEIR BULLA |
|
|
Term
|
Definition
| -amputation of a portion/all of the tail |
|
|
Term
| What are the indications for a caudectomy? |
|
Definition
-Therapeutic: traumatic lesions, infection, neoplasia
-Cosmetic |
|
|
Term
| Describe an adult caudectomy. |
|
Definition
-general anesthesia
-V-shaped incision, vessel ligation, tension free closure |
|
|
Term
|
Definition
| -removal of the 3rd digital phalanx of cats |
|
|
Term
| What are some alternatives to onychectomy? |
|
Definition
-nail trims
-caps
-DDF tenectomy
-outdoor cat |
|
|
Term
| What are the three methods of onychectomy? |
|
Definition
-Scalpel
-Resco nail clipper: better chance of leaving ungual crest
-CO2 laser: less blood |
|
|
Term
| What kind of suture is used for onychectomy? Postop care? |
|
Definition
-absorbable, monofilament
-bandages for 24 horus and paper litter |
|
|
Term
| What are the complications of onychectomy? |
|
Definition
-hemorrhage, infection
-claw regrowth, lameness from remaining bone
-pad injury, tissue necrosis |
|
|
Term
| What are the indications for a canine onychectomy? |
|
Definition
-trauma
-tumor: SCC, melanoma, sarcoma
-infection |
|
|
Term
| Describe a puppy dewclaw removal. |
|
Definition
-at age 3-5 days
-do local anesthesia
-silver nitrate stick or pressure for hemostasis |
|
|
Term
| What are the two types of adult dewclaw removal? |
|
Definition
-defined bony articulation at metacarpophalangeal joint
-soft tissue attachment only |
|
|
Term
| What are some doubled dewclaw breeds? |
|
Definition
|
|
Term
| What are the indications for digit amputation? |
|
Definition
-neoplasia
-chronic infection: bacterial, fungal
-osteomyelitis
-severe trauma |
|
|
Term
| What are the primary weight-bearing digits? |
|
Definition
|
|
Term
| What is the purpose of the footpads? |
|
Definition
| -absorb shock, standing, and abrasive forces |
|
|
Term
| Describe the basic wound management we use for footpad lacerations. |
|
Definition
-irrigation
-two-layer wound closure, simple interrupted
-padded splint |
|
|
Term
| How do we treat interdigital pyoderma? |
|
Definition
-treat underlying cause first
-fusion podoplasty is performed if medical management fials |
|
|
Term
| What are some common issues with ear pinna? |
|
Definition
-lacerations
-frost bite
-aural hematoma |
|
|
Term
| What are the three ways we fix pinna lacerations? |
|
Definition
-skin
-skin + cartilage
-skin + cartilage + skin |
|
|
Term
| What diagnostics do we use for aural hematomas? |
|
Definition
-collection of blood, serum, or both in the pinna
-exacerbated with shaking of the head |
|
|
Term
| What is the goal during repair of an aural hematoma? How do we do it? |
|
Definition
-Goal: obliterate dead space
-incision and suture, CO2, laser |
|
|
Term
| What commonly exacerbates aural hematomas? |
|
Definition
|
|
Term
| What must you absolutely do during recovery of an aural hematoma repair? |
|
Definition
| -bandage and immobilize the ear |
|
|
Term
| What are the indications for a lateral ear canal resection? |
|
Definition
-adjunct to medical management for otitis externa
-minimal hyperplasia of ear canal
-small neoplastic lesions of lateral aspcet of the vertical canal |
|
|
Term
| What are the purposes of a lateral ear canal resection? |
|
Definition
| -allows for increased drainage, aeration of canal, facilitates medication administration |
|
|
Term
| Do we still have to medicate the ear with a lateral ear canal resection? |
|
Definition
|
|
Term
| Do we use lateral ear canal resection for otitis media? |
|
Definition
| -NO, not for obstruction of the horizontal ear canal either |
|
|
Term
| What are the indicatiosn for a vertical ear canal resection? |
|
Definition
-Vertical canal disease: tumor, toitis externa confined to the vertical ear canal
-Horizontal canal must be normal
-better cosmetic appearance than with lateral resection when abundant hyperplstic tissue is present in and around vertical ear canal |
|
|
Term
| What are the indications for a total ear canal ablation? |
|
Definition
-chronic otitis externa with failure of medical management
-ossificaion, hyperplasia of entire canal
-neoplasia |
|
|
Term
| What must we also perform with a total ear canal ablation? |
|
Definition
| -MUST PERFORM A LATERAL BULLA OSTEOTOMY |
|
|
Term
| What are the indications for a ventral bulla osteotomy? |
|
Definition
-allows increased exposure to tympanic cavity
-technique for choice for cats: neoplasia, nasopharyngeal polyps
-better drainage of bulla
-CATS HAVE TWO COMPARTMENTS THAT MAKE UP THEIR BULLA |
|
|
Term
|
Definition
| -amputation of a portion/all of the tail |
|
|
Term
| What are the indications for a caudectomy? |
|
Definition
-Therapeutic: traumatic lesions, infection, neoplasia
-Cosmetic |
|
|
Term
| Describe an adult caudectomy. |
|
Definition
-general anesthesia
-V-shaped incision, vessel ligation, tension free closure |
|
|
Term
|
Definition
| -removal of the 3rd digital phalanx of cats |
|
|
Term
| What are some alternatives to onychectomy? |
|
Definition
-nail trims
-caps
-DDF tenectomy
-outdoor cat |
|
|
Term
| What are the three methods of onychectomy? |
|
Definition
-Scalpel
-Resco nail clipper: better chance of leaving ungual crest
-CO2 laser: less blood |
|
|
Term
| What kind of suture is used for onychectomy? Postop care? |
|
Definition
-absorbable, monofilament
-bandages for 24 horus and paper litter |
|
|
Term
| What are the complications of onychectomy? |
|
Definition
-hemorrhage, infection
-claw regrowth, lameness from remaining bone
-pad injury, tissue necrosis |
|
|
Term
| What are the indications for a canine onychectomy? |
|
Definition
-trauma
-tumor: SCC, melanoma, sarcoma
-infection |
|
|
Term
| Describe a puppy dewclaw removal. |
|
Definition
-at age 3-5 days
-do local anesthesia
-silver nitrate stick or pressure for hemostasis |
|
|
Term
| What are the two types of adult dewclaw removal? |
|
Definition
-defined bony articulation at metacarpophalangeal joint
-soft tissue attachment only |
|
|
Term
| What are some doubled dewclaw breeds? |
|
Definition
|
|
Term
| What are the indications for digit amputation? |
|
Definition
-neoplasia
-chronic infection: bacterial, fungal
-osteomyelitis
-severe trauma |
|
|
Term
| What are the primary weight-bearing digits? |
|
Definition
|
|
Term
| What is the purpose of the footpads? |
|
Definition
| -absorb shock, standing, and abrasive forces |
|
|
Term
| Describe the basic wound management we use for footpad lacerations. |
|
Definition
-irrigation
-two-layer wound closure, simple interrupted
-padded splint |
|
|
Term
| How do we treat interdigital pyoderma? |
|
Definition
-treat underlying cause first
-fusion podoplasty is performed if medical management fials |
|
|
