Ear surgery

Question 1

Indications for Sx

Answer 1

Inflamed/ hyperplastic
Resistant bacteria
Neoplasia (aural tumour)

Question 2

Instrument for skin reconstruction

Answer 2

Needle holders
Mayo- Metzenbaum scissors
Adson forceps
Extra- skin hooks

Question 3

Aims for skin reconstruction

Answer 3

Square skin edges
Accurate apposition
No overlapping
Slight eversion of wound edges
Follow Halsted principles

Question 4

Undermining and advancing skin

Answer 4

Indicated if wound too large for tension relieving sutures/ too small for flap
Frees skin from subcut attachment
Uses the skins elasticity for closure
Blunt/ sharp methods
Maintain blood supply
Undermine deep to panniculus layer where present

Question 5

Cutaneous pedicle grafts (skin flaps)

Answer 5

Portions of skin + s/c tissue moved between places
Best on head, neck and trunk
Larger than defect to be covered
Undermine below panniculus
Ensure healthy granulation bed at donor site
3:1 length:width

Question 6

Why flaps fail

Answer 6

Vascular occlusion - thrombi/ torsion
Tension - haematoma
Infection
Subjective methods for flap health assessment

Question 7

Free skin grafts

Answer 7

Full thickness meshed/ split thickness and pinch
Survive through revascularisation from graft bed

Question 8

Sx drains

Answer 8

Remove excess wound fluid, close dead space
Passive or active drains
Aseptic placement (ascending Dz common)
Cover drain exit to maintain asepsis
FB reaction will occur - extra fluid present
Remove if small volume of serosanguineous fluid produce

Question 9

Chronic otitis (beyond canal)

Answer 9

Tympanic mem rupture -> Otitics media -> Otitis interna
Bone sclerosis (CT/ MRI best)
CS- head tilt, circling
-nystagmus, ataxia
Para-aural abscess - palpable painful (when eating) swelling
-discharging sinus
Sx- lateral wall resection
Failure- dehiscence, stricture, persistent Dz

Question 10

Vertical canal ablation

Answer 10

Ind- neoplasia, trauma, vertical canal otitis
Canal dissected free and resect at horizontal junctions
High failure rate in otitis cases

Question 11

Total ear canal ablation
+ Lateral bulla osteotomy

Answer 11

Removes all Dz tissue
Wide clip
Lavage
Aseptic skin prep
Bupivicaine nerves
-Caudal auricular + Auriculotemporal
Complication
-Facial nerve paralysis
-Horners syndrome (cats)
-permanent vestibular signs
-abscess/ fistulas

Question 12

Ventral bulla osteotomy

Answer 12

Cats
-inflammatory polyp
Ventral dissection between muscles

Question 13

Reasons for chest drains

Answer 13

Air
Fluid
Persistent fluid -> active pleuro peritoneal shunt

Question 14

Placement of chest drains

Answer 14

IC space 7 or 8
Narrow bore more commonly used
Large bore
Purse string suture
Radiograph to check position
Bandage/ cover to protect drain

Question 15

Chest drain patient and drain care

Answer 15

O2
Multi modal analgesia
Drain (/ 1-6hr)

Question 16

Chest drain complications

Answer 16

Dyspnoea
Tube displacement

Question 17

Tracheal Sx Dz

Answer 17

Tracheostomy
Tracheal collapse
Tracheal perforation
Tracheal tumour

Question 18

Tracheostomy

Answer 18

Temporary
-Vtrl midline, transverse incision
Perm
-Same approach (sternohyoid msc apposed to trachea)
-create mucocutaneous border
Post op
-stoma care, cleaning, avoid obst.

Question 19

Tracheal tumours

Answer 19

Rare
Malignant - Osteosarc, SCC, lymphoma …
Benign - osteochondroma, polyps …
Mobilise trachea, stay sutures, resect

Question 20

Tracheal collapse

Answer 20

Mini dogs <1yr
Respiratory honk
Dx- CE, imaging
Meds- anti-tussive
Tx- tracheal stent, prosthetic tracheal rings

Question 21

Tracheal rupture

Answer 21

Dx- dyspnoea, cough, s/c emphysema
-imaging (pneumomediastinum, pneumo thorax

Question 22

Lung Sx

Answer 22

Lung laceration
Lung tumour
Lung abscess (pyothorax)
Lung lobe torsion

Question 23

Pneumothorax

Answer 23

Traumatic, spontaneous
Cons.- thoracocentesis, thoracostomy tube
Trauma- cons. Tx (3d)
Pulmonary bullae - Sx resection

Question 24

Pulmonary neoplasia

Answer 24

1° < metastatic
Adenocarcinoma
Older (boxer?)
CS- lethargy, haemoptysis
CT- solitary nodule
Sx- partial -> full lobectomy

Question 25

Pyothorax / pulmonary abscess

Answer 25

Sx indicated if no response to meds/ focal lesion
Remove affected abscesses and fibrinous tissue, flush
Place bilateral chest drain

Question 26

Lung lobe torsion

Answer 26

Rotation around axis
Large deep chested dogs
Hx- respiratory distress/ trauma
Ct- pleural effusion (can mask)
Tx- Sx/ PTS

Question 27

Pleural cavity and chest wall Cx

Answer 27

Chylothorax
Thymoma
Pectus excavatum
Thoracic wall tumour

Question 28

Chylothorax

Answer 28

Thoracic duct ligation

Question 29

Thymoma

Answer 29

Epithelial thymus tumour
CS- mid aged large breed dogs
50% have myaesthenia gravis
Med - chest tap and support
Sx - median sternotomy

Question 30

Pectus excavatum

Answer 30

Sternum and CC deformed
Brachycephalics often
Hyperpnoea , dyspnoea, poss. murmur
Physiotherapy
External splint

Question 31

Thoracic Rx pre op concerns

Answer 31

Acute Acute respiratory impairment
Fluid/ air may need removing

Question 32

Thoracotomy

Answer 32

Middle lobe R5
Intercostal approach (divide lateral latissimus dorsi)

Question 33

Median sternotomy

Answer 33

Dorsal recumbency
Midline incision, bone saw (leave 2 sternabrae intact)

Question 34

Thoracic post op concerns

Answer 34

O2
Multimodal analgesia
Drain v. chest tube
Remove drain 2ml/kg/day

Question 35

Thoracic wall trauma

Answer 35

S/c emphysema
Rib fractures
Paradoxical movement
CE- incl. cardiac assessment
-radiographs, CT
Meds - stabilise
Sx0 pin/ fire ribs
Flail - external splint