Ear surgery Flashcards
Indications for Sx
Inflamed/ hyperplastic
Resistant bacteria
Neoplasia (aural tumour)
Instrument for skin reconstruction
Needle holders
Mayo- Metzenbaum scissors
Adson forceps
Extra- skin hooks
Aims for skin reconstruction
Square skin edges
Accurate apposition
No overlapping
Slight eversion of wound edges
Follow Halsted principles
Undermining and advancing skin
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
Cutaneous pedicle grafts (skin flaps)
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
Why flaps fail
Vascular occlusion - thrombi/ torsion
Tension - haematoma
Infection
Subjective methods for flap health assessment
Free skin grafts
Full thickness meshed/ split thickness and pinch
Survive through revascularisation from graft bed
Sx drains
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
Chronic otitis (beyond canal)
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
Vertical canal ablation
Ind- neoplasia, trauma, vertical canal otitis
Canal dissected free and resect at horizontal junctions
High failure rate in otitis cases
Total ear canal ablation
+ Lateral bulla osteotomy
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
Ventral bulla osteotomy
Cats
-inflammatory polyp
Ventral dissection between muscles
Reasons for chest drains
Air
Fluid
Persistent fluid -> active pleuro peritoneal shunt
Placement of chest drains
IC space 7 or 8
Narrow bore more commonly used
Large bore
Purse string suture
Radiograph to check position
Bandage/ cover to protect drain
Chest drain patient and drain care
O2
Multi modal analgesia
Drain (/ 1-6hr)
Chest drain complications
Dyspnoea
Tube displacement
Tracheal Sx Dz
Tracheostomy
Tracheal collapse
Tracheal perforation
Tracheal tumour
Tracheostomy
Temporary
-Vtrl midline, transverse incision
Perm
-Same approach (sternohyoid msc apposed to trachea)
-create mucocutaneous border
Post op
-stoma care, cleaning, avoid obst.
Tracheal tumours
Rare
Malignant - Osteosarc, SCC, lymphoma …
Benign - osteochondroma, polyps …
Mobilise trachea, stay sutures, resect
Tracheal collapse
Mini dogs <1yr
Respiratory honk
Dx- CE, imaging
Meds- anti-tussive
Tx- tracheal stent, prosthetic tracheal rings
Tracheal rupture
Dx- dyspnoea, cough, s/c emphysema
-imaging (pneumomediastinum, pneumo thorax
Lung Sx
Lung laceration
Lung tumour
Lung abscess (pyothorax)
Lung lobe torsion
Pneumothorax
Traumatic, spontaneous
Cons.- thoracocentesis, thoracostomy tube
Trauma- cons. Tx (3d)
Pulmonary bullae - Sx resection
Pulmonary neoplasia
1° < metastatic
Adenocarcinoma
Older (boxer?)
CS- lethargy, haemoptysis
CT- solitary nodule
Sx- partial -> full lobectomy
