Soft Tissue Surgery Flashcards
primary components of BOAS
stenotic nares
elongated soft palate
hypoplastic trachea
abberant nasal turbinates
macroglossia
redundant pharyngeal folds
what are the secondary components of BOAS and why they occur
negative pressure = edema, erythema, swelling
everted laryngeal saccules
everted tonsils
laryngeal collapse
why do dogs with BOAS have GI signs
primary or secondary inflam disease
regurg, sliding hiatal hernia, gastritis, esophagitis
what anatomic landmarks are used to assess the length of the soft palate?
the junction of the middle and caudal third of the palatine tonsils
stenotic nares treatment
vertical wedge resection
horizontal wedge resection
punch biopsy
nares amputation “traders”
alapexy
elongated soft palate treatment
staphylectomy
folded flap palatoplasty
compare and contrast laryngeal paralysis and laryngeal collapse, which one occurs as a result of BOAS and how is it addressed?
laryngeal paralysis - functional problem, laryngeal tieback
laryngeal collapse - secondary to BOAS, structural problem (cartilage integrity poor), prevention is best, +/- laryngeal tieback or permanent trach
causes of laryngeal paralysis in young animals
central neuro lesion
breed predisposition (husky)
causes of laryngeal paralysis in an old lab
peripheral neuro lesion
- most common being idiopathic polyneuropathy
- others: trauma, mass, iatrogenic, polyneuropathy from endocrine, infection, immune or hypothyroidism
what nerve is first to be affected in laryngeal paralysis? what does it innervate?
recurrent laryngeal n
innervates cricoarytenoideus dorsalis m (abducts arytenoid cartilage)
what are the two different clinical presentations for dogs with laryngeal paralysis?
acute on chronic - collapse, upper airway obstruction, pulmonary edema, heatstroke, aspiration pneumonia
chronic - exercise intolerance, bark change, cough, aspiration pneumonia
what is the most common surgical treatment for laryngeal paralysis and what is the goal?
Cricoarytenoid lateralization (“tie back”) - unilateral ONLY
goal is to increase diameter of rima glottis
what are the potential complications with a cricoarytenoid lateralization? what is the anticipated outcome?
aspiration pneumonia
suture failure
seromas
good-excellent, long term prognosis
what are the two types of congenital hernias?
PPDH
hiatal hernia
PPDH
connection between what?
organs displaced?
when do clinical signs arise?
what do animals often have with this?
peritoneal cavity and pericardium
liver > SI > stomach > GB > pancreas
usually incidental finding, asymptomatic for months/years
other concurrent congenital defects
hiatal hernia
what causes this?
organs displaced?
enlargement of esophageal hiatus allowing abdominal organs into the thorax
stomach most common
hiatal hernia treatment?
decrease size of esophageal hiatus (opened ventrally)
esophagopexy
left sided gastropexy (+/- G tube)
what should you avoid when doing surgery for hiatal hernia?
iatrogenic trauma to vagus n
complications with hiatal hernia surgery?
esophagitis, esophageal stricture, megaesophagus, failure to improve gastroesophageal reflux
diaphragmatic hernia
connection of what?
common cause?
peritoneal cavity and pleural space
trauma
Describe which clinical scenarios make a diaphragmatic hernia a surgical emergency
can’t stabilize or stomach is is herniated into the thorax
anatomy of the diaphragm
caval foramen
esophageal hiatus
aortic hiatus
complications associated with diaphragmatic hernias and their treatment
re-expansion pulmonary edema in CATS
recurrence
cardiac arrhythmias
cardiac arrest
pneumothorax
pleural effusion
Explain the prognosis and outcomes for diaphragmatic hernias
79-89% survival for diaphragmatic hernias
pelvic diaphragm anatomy
External anal sphincter muscle
Levator ani muscle
Coccygeus muscle
where is the most common location of a perineal hernia?
between levator ani and external anal sphincter muscles “caudal hernia”
predisposing factors for a perineal hernia?
breed - small dogs (e.g. mini poodles, boston terriers)
older intact male dogs - prostatic disease or relaxin hormone
causes of perineal hernia?
unknown etiology, but anything that causes increased abdominal pressure
what is the treatment of choice for a perineal hernia?
muscle replacement w/ internal obturator m
why is a herniorrhaphy a poor surgical option for perineal hernias?
the levator ani m will barely exist so closure of pelvic diaphragm is a poor choice
Describe a clinical scenario when a perineal hernia is an emergency
urinary obstruction
complications with a perineal hernia?
incisional complications
tenesmus
rectal prolapse
sciatic n entrapment
fecal incontinence (bilateral n damage)
urinary abnormalities
indication for cystotomy
stones in the lower urinary tract (bladder or if retropulsed into the bladder from urethra)
indication for urethrotomy
if stone cannot be retropulsed
1st time offender
NOT in cats – too small
indication for urethrostomy
if stone cannot be retropulsed
if has had multiple obstructions
preferred location for a urethrostomy in dog?
scrotal location
- urethra is the largest
- superficial (tension free, limited hemorrhage)
- minimizes urine scald
preferred location for a urethrostomy in cat?
perineal urethrostomy (PU)
(dissect to level of bulbourethral gland)
Explain how to perform retropulsion of urethroliths in a dog
general anesthesia
large rigid catheter
gauze to grip penis
lube and saline
extra finger for rectal PRN
post procedure rads
do you perform the cystotomy on the ventral or dorsal aspect? why?
ventral - less anatomy
in male does what approach is done for cystotomy?
caudal midline and parapreputial approach due to narrow urethra
holding layer of the bladder?
submucosa
for a cystotomy - full thickness defects gain 100% of normal strength in ___ days?
14-21 days
complications associated with a cystotomy beginning with the most common
self resolving hematuria and dysuria
incomplete removal
superficial incisional complications
uroabdomen
what is the difference between a skin graft and skin flap?
skin flap maintains bloody supply
skin graft has no vascular attachment and must reestablish blood supply
what is the difference between a subdermal plexus flap and axial pattern flap?
subdermal plexus flap - terminal branches of direct cutaneous aa, associated with cutaneous m (panniculus m layer)
axial pattern flap - known a and v that perfuse a tissue; mapped throughout the body
what are the 4 general principles of a skin flap surgery?
- limit flap length to size required to cover recipient bed w/o tension
- atraumatic tissue
- undermine deep to the cutaneous m
- healthy recipient bed
what are the 4 types of local subdermal skin flaps?
advancement
rotational
transposition
skin fold (inguinal or axillary)
what are the most common axial pattern flaps?
caudal superficial epigastric
thoracodorsal
what are the most common complications with a laparascopy?
insufflation of SQ tissue
splenic laceration
Describe different techniques for creating a capnoperitoneum (aka pneumoperitoneum)
veress needle
hasson technique
SILS port
Describe reasons for conversion from a laparoscopic procedure to an open procedure
hemorrhage
equipment malfunction
organ trauma
unanticipated findings
anesthetic complication
time
describe the surgical treatment for an aural hematoma
S shape or linear incision (parallel to blood supply)
multiple staggered rows of full thickness sutures
monofilament non-abs suture
knots on concave side
difference in dog and cat external ear canal neoplasia
dogs - epithelial, 60% malignant, unilateral
cats - 88% malignant, bilateral, SCC and anaplastic carcinomas
what are the indications of a lateral wall resection?
otitis externa reversible
small tumor of tragus or lateral wall not extending into horizontal canal
patent horizontal canal
contraindications of a lateral wall resection?
cocker spaniels
what are the indications of a vertical ear canal resection
vertical canal severely disease
horizontal canal normal
neoplasia or otitis externa of the vertical canal only (rare)
what are the indications of a TECA-LBO
chronic
end stage external ear dz
narrow horizontal canal
neoplasia
extensive middle ear disease
complications associated with aural hematoma
anesthesia
scar/deformity
complications associated with lateral wall resection +/- ventral bulla osteotomy
failure
dehiscence
stenosis of horizontal canal
self trauma (ecollar)
complications associated with vertical ear canal resection +/- ventral bulla osteotomy
stenosis
complications associated with TECA-LBO
hemorrhage
facial n paralysis (usually improves 2-4 weeks)
fistula
inner ear infection (vestibular signs)
horners syndrome (cat >dog)
loss of hearing
complications associated with a ventral bulla osteotomy
horners syndrome
vestibular signs
what the most common route of bacterial otitis media?
tympanic membrane (otitis externa)
what is the difference between a cat and dog bulla on CT?
cats have a septum dividing their bulla into two compartments
