Skin Reconstruction COPY Flashcards
1
Q
What are the indications for OHE?
A
- Population control
- Prevention of mammary tumors
- Pyometra, dystocia, behavior
2
Q
When should OHE be performed?
A
- 6-9 mo
- Early spay of shelter cats at 6-16 weeks
3
Q
What are the different methods of “spay”?
A
- Ovariohysterectomy
- removal of both ovaries and uterus
- Ovariectomy - laparoscopically or open
- removal of both ovaries
- Pedicle tie for cats
- Common in HQHVSN programs
4
Q
What are the pre-op considerations for OHE?
A
- Hx: general health issues, reproductive and estrus cycle hx
- Physical exam:
- general assessment, inspect for mammary tumors, vulvar discharge and swelling (heat)
- Select pre-op bloodwork appropriate for individual
- PCV, TP
- CBC
5
Q
what is the incision site for a dog OHE?
A
- Divide ventral midline between the umbilicus and cranial brim of the pubis into thirds
- Cranial third - due to immobility of the ovaries
- Pre-pubertal dogs - middle third
6
Q
Where is the incision site for a cat OHE?
A
- Divide the ventral midline between the umbilicus and cranial brim of the pubis into thirds
- Middle third - due to immobility of the body of the uterus
7
Q
What Anatomy is important for OHE?
A
- Ovaries
- Uterus
- Ligaments:
- Suspensory
- Proper
- Broad
- Round
- Ovarian artery and vein
- Uterine arteries
8
Q
Where should the drapes be placed for an OHE?
A
- Cranial field towel must be placed at the level of the xiphiod
- Side towel edges over the mammary glands
- Caudal towel at the level of the cranial brim of the pubis
9
Q
Steps of an OHE?
A
- Ventral midline incision
- Use spay hook to locate uterine horns, trace horn to ovary to confirm
- hook faces up towards the body wall until it gets in the lateral gutter
- twist hook, scoop uterine horn
- straighten spay hook, pull gently upwards
- Place clamp on proper ligament of the ovary
- Break down the suspensory ligament
- Caudomedial traction on the proper ligament to tense the suspensory
- break lateral to medial, NOT ventrally
- Grasp suspensory ligament between thumb and index finger and twist
- Create window in the broad ligament caudal to the ovarian vessels
- open forceps parallel with vessels to avoid tearing them
- Perform modified triple clamp technique
- Place circumferential ligature proximal to the 1st carmalt
- remove as the suture is tightened down for better ligation
- Place transfixation ligature distal to the first, flashing the carmalt as the suture is tightened
- Transect distal to the transfixation ligature
- gently replace pedicle stump and examine for hemorrhage
- Examine the broad ligament
- ligate large vessels within
- ID and AVOID damaging the Uterine artery
- Tear do NOT cut the borad ligament to the level of the bifurcation of the body
- Repeat on the contralateral ovary
- Ligate the body of the uterus between the bifurcation and the cervix
- triple clamp technique
- Do NOT clamp uterus in cats, dogs in estrus, pregnant, or pyometra
- place circumferential ligature in the crush proximal to the cervix
- Transfixation ligature cranial to the 1st ligature
- +/1 individual ligation of uterin arteries
- Transect cranial to ligations
- Check ovarian bursae
- evaluate ovaries to ensure complete removal
- Check for hemorrhage in pedicles and stumps
- Closure
- linea alba
- subcutaneous tissue
- skin - subcuticular
- Tattoo
10
Q
What is the difference in OHE for pregnant, pyometra, or in heat animals?
A
- You may need to individually ligate the uterine arteries followed by a strangle knot around the entire uterine body
11
Q
What to do if there is bleeding?
A
- EXTEND INCISION - better exposure
- Find natural retractors
- Swab blood with sponges
- Identify bleeder and clamp
- Ligate
12
Q
What complications may arise from a OHE?
A
- Hemorrhage - most common
- Ovarian remnant syndrome / recurrent estrus
- incomplete removal of ovaries
- Treatment - surgical exploration during estrus
- Uterine stump pyometra
- associated with ovarian remnant - needs progesterone to occur
- Ligation of the Ureter
13
Q
what makes ligatio of the ureter more likely? how to reduce risk?
A
- Most commonly at the uterine body, rare at ovarian pedicle
- Moe likely with a distended bladder, moving the trigone cranially, creating slack ureters
- REDUCE RISK:
- ligate ovarian pedicle near ovary
- Express bladder before ligating uterine body
- Break down broad ligament
14
Q
What is the immediate Post-op Care for an OHE?
A
- Analgesia
- Monitor recovery
- Monitor for hemorrhage
- Provide warmth
- Monitor incision while in hospital
15
Q
What is the at home post op care for an OHE?
A
- Analgesia
- Strict exercise restriction
- Monitoring of incision site
- Drainage, swelling, bruising, dehiscence, licking
- E-collar to prevent licking
