Declaw and Amputation

Question 1

declaw - what is done, what age?

Answer 1

 Removal of the third digital phalanx (P3)
 Usually is performed between 3 and 12 months of age to prevent cats from scratching furniture or people
 Usually only the forelimb claws are removed
 Alternatives
- nailtrimming
- glue a vinyl cap to each claw every 6 to 8 weeks

Question 2

declawing impact on cats

Answer 2

increases unwanted behaviours, may increase risks of back pain

Question 3

declaw procedure - medications used for procedure, timing

Answer 3

 General anesthetic with multimodal analgesia
 Perioperative analgesia (buprenorphine, methadone, NSAID, or transdermal fentanyl) is recommended for a minimum of 24 to 48 hours after surgery
 Additional perioperative analgesia may (must?) be provided by blocking regional nerves with 0.5% bupivacaine

Question 4

declaw nerve blocks - what is blocked and how

Answer 4

• The dorsal and palmar branches of the radial, median, and ulnar nerves provide sensory innervation to the feline forepaw.
• These branches are blocked at four sites using 0.1 to 0.2 ml of 0.5% bupivacaine at each site (not to exceed a total dose of 2 to 3 mg/kg), which provides 4 to 6 hours of analgesia.

Question 5

how is the dissection done for declaw?

Answer 5

Dissection onychectomy disarticulates the third phalanx by transecting tendons, ligaments, and other soft tissue attachments.

Question 6

nail clipper onychectommy technique and issue

Answer 6

Nail clipper onychectomy should remove the entire ungual crest but often leaves a portion of the ventral flexor process of P3

Question 7

laser declaw vs blade

Answer 7

laser seems to cause less lameness during the first 7d, also less post-op complications
- long term outcome not significantly different, but may reduce complications…

Question 8

other indications for delcaw

Answer 8

 Onychectomy or more extensive digit amputation may be required to remove infected nail beds and neoplasms
 Most common nail bed tumors are squamous cell carcinomas, melanomas, soft tissue sarcomas, osteosarcomas, and mast cell tumors.
 Complete excision may require that adjacent phalanges be removed with the affected claw
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 Onychomycosis, usually caused by Trichophyton mentagrophytes, produces dry, cracked, brittle, and deformed nails with inflamed alopecic nail beds
 Follicular infections with Demodex spp. and staphylococci produce similar lesions

Question 9

declaw post op care, complications

Answer 9

• Mild bleeding after bandage removal (12-24h)
• Shredded paper for 2 weeks (no litter)
• Complications occur in 50% of patients
  > (i.e., pain, hemorrhage, pad damage, lameness, swelling, infection,
  claw regrowth, second phalanx protrusion, and palmigrade stance)
• Digital pad laceration prolongs healing
• Early postoperative pain - blade
• Late postoperative complications - clippers
• Nonabsorbable tissue adhesives
  > Postoperative lameness (frequently non-weight-bearing)
  > Infections
  > Foreign body
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• Improper tourniquet - neurapraxia, tissue necrosis, and lameness
• Radial nerve – signs resolve usually in 6-8 weeks
• Tight bandages - ischemic necrosis of the paw
• Incomplete removal of the germinal cells in the dorsal aspect of the ungual crest allows claw regrowth.
  > If only a small remnant of the flexor process remains, claw regrowth is not anticipated.
• Draining tracts – suspect claw regrowth (usually deformed)
• Flexor tendon contracture - retraction of the paw and digits to
  fixed flexion has been reported
  > resolved by deep digital flexor tenotomy
• Chronic pain evidenced by behavioral changes
  – (e.g., decreased activity, decreased appetite, or increased aggression)

Question 10

Deep Digital Flexor Tenectomy
- anatomy, results
- issues with this? is it recommended?

Answer 10

 Deep digital flexor tendon inserts on the flexor process of the third phalanx and is needed to flex the phalanx
 Claws remain retracted after the deep digital flexor tendons have been severed, which limits the cat’s ability to scratch
 Nails become thick and blunt and must be trimmed regularly
 Hemorrhage, infection, and lameness may occur postoperatively
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 Problems may include persistent lameness and ability to scratch, interphalangeal joint immobility, fibrosis, pain, and claw ingrowth into the digital pads
 Owners are frequently dissatisfied because of the cat’s continued ability to scratch, the unaesthetic appearance of the thickened claws, long-term lameness, and the necessity for nail clipping
 Cats may require an onychectomy to relieve clinical signs
 For these reasons, this technique is not routinely recommended

Question 11

Dewclaws
- what is the anatomy? differences between dogs?
- why might we want to remove?

Answer 11

 The dewclaw is the first digit of the canine rear paws
 First and second phalanges of the digit are inconsistent
 Dewclaws are absent in some dogs and double in others
 Great Pyrenees and Briards must have double rear dewclaws to meet breed standards
 Other breeds, loosely attached dewclaws are removed to prevent inadvertent or self-trauma during hunting or grooming

Question 12

Dewclaw Removal
- which ones do we remove?
- when? how?
- complications?

Answer 12

 Often only the rear dewclaws are removed
 Dewclaws can be removed at 3 to 5 days of age
with local analgesia
 Hemorrhage is more excessive after 5 days of age, and anesthetics are necessary
 Complications include hemorrhage, pain, infection, and dehiscence. Premature suture removal may cause scarring. Bandages applied too tightly may cause swelling or ischemic necrosis

Question 13

Digit Amputation
- indications
- level of amputation
- type of anesthesia?

Answer 13

 Indications - neoplasia, chronic bacterial or fungal infections, osteomyelitis, or severe trauma
 Affected digits are swollen and painful with thickened, dystrophic, or absent claws
 Squamous cell carcinoma is the most common tumor identified in canine and feline digits; however, numerous neoplastic processes can occur in this location
 Level of amputation is determined by the site of the lesion and the disease process
 General anesthesia is required

Question 14

Digit Amputation - Complications

Answer 14

 Complications include hemorrhage, infection, dehiscence, and recurrence
 Tight bandages may cause swelling or ischemic necrosis
 Primary weight-bearing digits are the third and fourth digits
 Dogs undergoing removal of one or both central weight-bearing digits, postoperative lameness is to be expected but may resolve over time in most dogs

Question 15

Digital Tumours
- who gets them?
- misdiagnosed as what?
- character? clinical signs?

Answer 15

 Digital tumors occur in older dogs (10 years)
 Rarely in cats (12.7 years)
 Often are initially misdiagnosed as
infections
 Male medium to large breed dogs
 Bone invasion is common
 Clinical signs:
- lameness, digit swelling and ulceration, and a fixed protruding, deviated, or lost nail
 Tumors must be differentiated from paronychia (nail infection)

Question 16

Digital Tumours
- most common types?
- how they behave / which are worse
- what dogs get subungual squamous cell carcinomas?
- prognosis?

Answer 16

 Squamous cell carcinomas, malignant melanomas, soft tissue sarcomas, osteosarcomas, and mast cell tumors are common digital tumors
 Squamous cell carcinomas, mast cell tumors, and melanomas arising in the subungual epithelium are aggressive and sometimes metastatic
 Black dogs are predisposed to subungual squamous cell carcinomas.
 The 1-year survival rate after digital amputation varies from 45% to 100%, depending on the tumor

Question 17

Caudectomy – Tail Amputation
- what is it? why do we do it?

Answer 17

 Amputation of a portion of the tail, which is performed to comply with breed standards or tradition, is ethically and morally controversial
 Many countries and veterinary professional organizations oppose the procedure when performed solely for cosmetic purposes.

Question 18

Caudectomy – Tail Amputation
- indications
- how it is done / where to cut?

Answer 18

 Therapeutic caudectomy is indicated for traumatic lesions, infection, neoplasia, and possibly perianal fistula
 The tail should be amputated with 2 to 3 cm of normal tissue margins when resecting tumors or traumatic lesions
 Amputation should be performed near the anus if the end of the tail chronically bleeds because of repeated abrasion or chewing
 Amputation near the base is recommended for avulsed tails and if necessary for tail fold pyoderma and perianal fistula.

Question 19

Amputation - Indications

Answer 19

 Irreparable fracture or soft tissue injuries
 Severe neurologic lesions – brachial plexus
avulsion
 Irreparable vascular occlusion – bandage complications
 Neoplasia
 Severe infection

Question 20

Amputation - Contraindications

Answer 20

 Giant breed dogs – forelimb > hindlimb (ie. front limb is worse to lose)
 Orthopedic issues affecting other limbs
 Metastatic disease affecting bones of other limbs

Question 21

do small animal pateints do well with limb amputation?

Answer 21

Small animal patients adapt well to amputation in most cases. If able to ambulate carrying the affected limb they should do well.

Question 22

Vessel Ligation for amputation - how to do it?

Answer 22

 Double ligate major arteries
 Ligate major veins after arterial ligation
 Ligate or cauterize smaller vessels

Question 23

Post-Operative Analgesia for amputation

Answer 23

 Diffusion Catheter:
> Bupivacaine Q4 h
 Mu Agonist morphinic
> Fentanyl CRI
 NSAID if no contra-indication
 Send home with buprenorphine SR
 Generally 1 to 3 days…