Suture Materials, Patterns and Disease of SA (male) Flashcards
1
Q
Functions of Suture Material
(4)
A
- mid-line abdominal incision - wound closure
- ligate structures (vessels)
- stay sutures
2
Q
Ideal Suture Material
- interaction with the tissue (8)
- Interaction with the surgeon (2)
A
- depends on how long that idividual tissue takes to heal
- complications: ex- abcesses
- want to reduce Post op infections
- want something that will not coil up easily
3
Q
Ideal Suture Material
-Material Properties (6)
Practical Considerations (3)
A
- non-capillary: doesnt wick up moisture including bacteria
4
Q
Classification of Suture Material
(origin/manufacture, persistence, structure)
A
5
Q
Classification - Origin & Manufacture
(2)
A
- cat gut on far left
- silk
- synthetic: much more predictable
6
Q
Classification - Persistence
(2)
A
- need to think about if absorbable or non- absorbable wound be more beneficial
- non-absorbable: causes encapsulation if there is an infection
- would be preferable for animals who are immunocompromised and/or on chemotherapy to use non-absorbable as they will have a longer wound healing time than a normal patient would
- also for tissues that will take a long time to heal: like tendon and need extra support or a PDA that would need long term closure (silk ligatures)
7
Q
Classification - Structure
(2)
A
- multi: can potential wick up bacteria
- mono: moves through tissue more easily, but need to be careful when handling as it is weaker
8
Q
Calssification - Coating, Color, Packaging
A
- can have coating on multi to help reduce drag and make it glide easily like a monofilament
- cassette: makes it so there is more readily available in a large amount
9
Q
A
- want to have a suture glide easily through if you are dealing with delicate tissue - (ex: cystotomy)
- abcess in lung: need to have a really strong suture to prevent any leaking
- Echo
10
Q
Choice of Suture Material
A
- They can be mixed in different ways
- how strong is that suture when it goes into the body? When is that strength lost?
11
Q
Synthetic Absorbable Multifilament
- materials (4)
- interaction with tissue (2)
A
- echo
- dexon sticks around for the longest
12
Q
Synthetic Absorbable Multifilament
- tensile strength & loss (2)
- handling & knotting (2)
- Use (2)
A
- polysorb is strongest
- coating over the multi-filaments
- very soft - if we are looking after brachiocephalic dogs, resection of palates - this would be a good option
13
Q
Synthetic Absorbable Monofilament - short duration
(materials, Interaction with tissue, Tensile Strength & loss)
A
- caprosyn absorvbeed faster than monocryl
14
Q
Synthetic Absorbable Monofilament - short duration
(handling & knotting, Use)
A
- monocryl is much nicer to handle
- Typically used for intradermal sutures and closure of viscera
15
Q
Synthetic Absorbable Monofilament - long duration
(materials, interaction with the tissue)
A
- much longer lasting material
- midline closures –> NEED it to be a strong closure
- has a lot of memory: need to stretch out while putting it in, need to put in more knots due to its high memory
16
Q
Synthetic Absorbable Monofilament -long duration
(Tensile strength & loss, Handling & knotting, use)
A
17
Q
Synthetic Non- absorbable Monofilament
(materials, Interaction with tissue, tensile strength)
A
- trade name –> material
- very strong
18
Q
Synthetic Non- absorbable Monofilament
(handling & knotting, use)
A
- use for extra- hepatic shunts (want to make sure these are permanently closed)
- hernia, tendon –> need to heal would need a lot of support
19
Q
Synthetic Non-Absorbable Multifilament
(materials, interaction with tissue, tensile strength)
A
- use when strength is the priority for that wound
20
Q
Synthetic Non-Absorbable Multifilament
(handling & Knotting, Use)
A
- some use them for skin closure
- (echo)
21
Q
Natural Absorbable Multifilament
(materials, Interaction with tissue)
A
- catgut is contraindicated for use in rabbits
- catgut is not used in the QMH
- absorption and handling is quite unpredictable
22
Q
Natural Absorbable Multifilament
(tensile strength & loss, Handling & knotting, use)
A
- It is a natural material so it is unpredictable in the body in terms of absorption
- poor security
- not really good to use clinically
23
Q
Natural Non- absorbable Multifilament
(materials, tissue interaction, tensile strength)
A
- become encapsulated in fibrous tissue once retained in the tissue
- will break as they are not very strong
- large vessel ligation - ductus arteriosis
- don’t use in viscera!
24
Q
Natural Non- absorbable Multifilament
(Handling & knotting, use)
A
25
Q
Rational Selection of Suture Material
A
- material should match strength of the tissue- depends on the collagen present
- echo
26
Q
General Rules to Avoid Complications
A
- avoid multi in contaminated wounds as they can increase risk of infection
27
Q
A
28
Q
A
- metric v USP system
- measure it using the same system (but need to be able to work between the two)
29
Q
Choice of Suture Size
A
*
30
Q
A
- example tissues and the sizes that you would use
31
Q
A
- retractors holding chest cavity open
- there is a stick overlying the heart
- need to suture ribs back together - echo
- needs to be air tight when closed
- stick also makes it contaminated - dont want multifilament and the suture also needs to be inert
- persistent suture material in the infected wound
32
Q
Advantages of Swaged- on needles
A
- take them out of the pack and they are ready to go
- hard to detach
- manufactured so that it is bound to the needle - less fraying
- sharper: going to cause much more damage to tissue with a blunt needle
33
Q
Surgical Needles- size & shape
A
- curved is measured to how much curve there is from the needle base?
34
Q
Surgical Needles - point
(non-cutting & cutting)
A
- non-cutting: good or delicate tissues
- cutting: good for passing through thicker or stronger tissues
35
Q
A
need to know for use in fine v. thick tissues
36
Q
Cutting vs. Reverse Cutting Needles
A
echo
*
37
Q
Surgical Needles- rational choice
A
- want something that will pass through tissue well enough to where it causes minimal damage
- a more firable tissue would require a finer needle
- If you are working a very small area, a curved needle wound be much easier than a straight
38
Q
Identifying the Suture Material Packet
A
- found on the cassettes as well
- A lot of people use the USP metric as that is what is said on the packer
*
39
Q
Suture Material Summary Points
(3)
A
*
40
Q
Why are suturing patterns important?
A
- when you are doing diff. types of surgery, needs suturing/closing to have different roles
- doing a cystotomy would require a different suture pattern most likely than a lung lobectomy, etc.
- Lung lobectomy - you would need the suture to be immedietaly air tight and water tight
41
Q
A
- suture loop that traverses the wound
- Knot does not lie on the incision as it would cause irritation and delayed healing of the wound
- tissue bite: distance between where you put your needle and the edge of the wound. would want this distance to be different depending on where and what you are suturing
- Other dimension woul be the distance between your individual sutures
42
Q
Rules for wound closure
(5)
A
- makes sense to include all layer cut to be sutured in closing
ex: bitch spay (skin, subcutaneous tissues, and muscle) - always use an appositional pattern unless not a good indication to (rare) - choose simple patterns!
- if your wound is under tension than your healing will be impaired
- When choosing suture size the smallest one you can get away with - avoid using too large of a diameter
- most common problem is that they are too tight - if it is too tight then you are imparing blood supply to your wound edges
- need to get your tissues well approximated while having a good blood supply to them as well - won’t help to have good contact if the tissue has become ischemic
43
Q
Classification of Patterns
(5)
A
44
Q
A
- Simple will pass from one side of the wound to the other and then be tied off
- mattress suture is one that crosses the wound more than once and is then tied off
- horizontal mattress: across the wound, parallel to the wound, and then accross the wound again
45
Q
Interrupted vs. Continuous
A
continuous:
- less suture material in the wound
- even out tension accross the whole suture line
- one knot at one end and then continue with the other through suture line
Interuppted:
- advantage is that you can fix one if it is messed up
- Dont continue with your suture line
- more tightly controlled accuracy in apposition and approximation- can also control tension of that site better
- takes more time as you need to tie more knots
46
Q
Appositional- Inverting- Everting
A
- appostitional: getting each layer to try appose each layer of tissue as you would find in the body
- there aren’t many situations where you would use an everting pattern
- There are some considerations where you would use inverting patterns
47
Q
Appositional (approximating)
A
48
Q
Inverting
A
- similar tensile strength to your approximating patterns with reduced risk of adhesions because you have serosa tucking into itself
- cuff at the bottom can become necrotic if the blood supply is impaired (could be due to your suture line)
- may also cause compromise to the lumen of your tissues this way which can be a problem (SI of a cat, you do not have room to do an inverting pattern)
49
Q
Everting
A
- easy to place, tensile strength is similar if not more than the other patterns
- endothelial contact on the mucosal lining means you have reduced risk of thrombosis
- stenosis: the abnormal narrowing of a body channel
- not something we would normally revert to
50
Q
Partial vs. Full Thickness Suture
A
- partial: you are more protected from the lumen (as in if you were doing intestinal surgery), suture material is more protected from the contents of the intestinal tract -reduced wicking from the lumen
- risk is that you miss the strength holding layer of the tissue that you are working with
-
full thickness: the only way you can be sure you will get the submucosa layer is to do a full thickness suture (white line in diagram is submucosa)
*
51
Q
One Layer v. Two Layer Closure
A
- two-layer closure might be more water tight
- stomach/uterus - clear that they fall into two layers–> is much better being closed in two layers
- SI might be better in one layer
52
Q
Tissue Layers & Suture Layers
A
- top 2: good for SI
- bottom left: appropriate for stomach closing
- bottom right: could close the uterus in this pattern
53
Q
A
- simple interrupted suture patterns in the SI
54
Q
Simple Interrupted
(appositional patterns: simple, quick & easy patterns –> good go to)
A
- single suture loop with your knot
- tightening sutures in one of the easiest things you can do wrong - may lead to inversion
- nice thing is that you can use this suture anywhere
55
Q
Intradermal/subcuticular
A
- for closing the layer underneath the dermis - start off deep and go to superficial layer
- knot is deep to the suture layer meaning it is not on top irritating the skin
- modified simple continuous suture - go deep, superficial, deep
56
Q
Approximating Sutures
(simple interrupted, poth & gold crushing, modified- Gambee)
A
- simple interrupted is recommended
- Poth & gold crushing - not used very often/recommended, basically make it very tight to where you are suturing through only the strength holding layer
- (modified) Gambee: don’t use too often, may just need for exams
57
Q
A
- good interrupted sutures
58
Q
Cruciate Matress
(figure of 8 suture)
A
- (appositional) mattress patterns: suture crosses over wound more than once - different to the simple sutures
- prevents the eversion that may happen with inerrupted sutures
- VERY easy to place these too tight! - need to keep nice and loose
- skin is where they are most commonly used
59
Q
Horizontal Mattress
A
- Can have ischemia in the middle of the tissue pattern as it may be blocking blood flow to the square surrounded by the suture pattern
- square of tissue that is there that isnt recieving any blood flow - can be prone to ischemia in the middle of that suture pattern
60
Q
Half-buried Horizontal Mattress
A
- modification of horizontal mattress suture
- good when you have tips of skin present- awkward flap, awkward wound to close
- Stay in the intradermal layer in the tip - then have the knot offeset on the surface
- avoid trauma to the very fragile skin tip in your wound
- Overall good for tricky wounds to close!
61
Q
Vertical Mattress
A
- different to horizontal mattress suture in that the tissue bites are perpendicular to the wound rather than parallel
- the way the sutures lie may cause some eversion of the wound
- good at resisting tension though!
- May have benefits over horizontal - avoids ischemia better
62
Q
A
- area of ischemia you may get from horizontal mattress is bigger than the vertical
- the main difference in doing vertical is that you will hopefully avoid the risk of ischemic areas
- far and far edges being just deep to the near and near suture
63
Q
Mayo Mattress
(“vest over pants”)
A
- used when you want to tighten tissue planes or have overlapping planes. Not a ton of places that you would want that
- patella luxation surgery - may want to imbricate the lateral side and make that tissue tighter
- suture line comes out and then goes directly deep to the other side -therefore tightening that suture will cause overlapping
- closing hernias or patella luxation surgery could be good for this
64
Q
Appositional continuous patterns
A
- simple continuous
- running suture (baseball stitch)
- subcutaneous or subcuticular
- Ford Interlicking (blanket stitch)
65
Q
Simple Continuous
A
- suture line advances on just one side of the wound (at the same level on that side)
- good for areas under low tension
- quick and simple
- not quite as strong as interrupted
- good even distribution of tension, but excessive tension on this suture can lead to puckering of the wound
- good apposition
66
Q
Running Suture
(Baseball stitch)
A
- similar to simple continuous but the suture is advancing on both sides of the wound
- lose accuracy and approximation and a bit of strength with this suturing most likely - may be best to stick with the simple continuous
67
Q
Subcutaneous or subcuticular
A
- We use continuous patterns to close the subcutaneous and subdermis -basically modifications of our various different continuous patterns
- subcutaneous: bites are perpendicular to the wound, changing the depth
- Subcuticular : going parallel, so not changing depth
68
Q
Ford Interlocking
(Blanket Stitch)
A
- another form of continuous, quite similar to simple continous
- pass new suture through the previous suture
- blanket stitch interlocking appearance
- quite strong, nice pattern to use - used most commonly in cows
- can be difficult to place and can be a bit ropey if your bites arent nice and square - but doesnt matter what it looks like as long as your appositions are square
- good to use for big long wounds in the skin
69
Q
A
- Ford Interlocking stitch used on a cow
70
Q
Non-Appositional Patterns
A
- Horizontal Mattress: under everting because it can tend to be everted depending on how you place it
71
Q
Lembert
(interrupted)
A
- variation on the vertical mattress and bites are perpendicular to wound edge
- causes a little inversion, but has high tensile strength
- continuous version of this pattern is probably what you would use in an equine intestinal surgery
72
Q
A
continuous version of the Lembert
-good for equine intestinal surgery
73
Q
Halsted
A
- Instead of tying off the suture when it comes out initially, they have gone ahead and done a mattress suture
- advantage to this would likely be strength and speed
74
Q
Cushing
A
- variation of continuous horizontal mattress
- bites penetrate the submucosa (important) and not the lumen
- this one does not penetrate the lumen
- hollow viscus - uterus would be main example
75
Q
Connell
A
- essentially the same as cushing but going for full thickness
- engaging all the layers that you want to but mainly your strength (suture) holding layer
76
Q
Czerny
(Czerny-Lembert)
A
- not common, but can use this to close the bladder
- 2 layer closure: essentially burying your initial closure
- may have inversion with your first pattern, but also causing compromise of the lumen possibly
77
Q
Parker-Kerr Oversew
A
- place a cushing suture over a clamp, remove the clamp, and then do a lembert over the top of that to invert the tissue
- can do this to close a stump (ex: a stump in a pyometria)
78
Q
Purse-String
A
- basically a continuous suture - might complicate it calling it a Lembert
- stump inversion or for feeding tubes (chest tubes, gastrostomy tubes)
- can also use this around the anus to prevent contamination if needed
79
Q
Continuous Horizontal Mattress
A
- appositional pattern as well
- ever so slight eversion that you get makes sure that endothelium is touching endothelium - good for cardiac surgery
- If you wanted to, you could oversew this with a simple continuous pattern as well
80
Q
Tension- relieving sutures
A
- we don’t want tensions on the edges of the wound - this would result in the impairment of healing
- Need to relieve the tension at the wound surface
- can remove the tension by either doing a flap or an advancement flap - various reconstructive techniques
- will depend on each individual case
- tension relieving sutures: basically sutures that distribute tension away from the wound edge
81
Q
A
- Named basically on where you put the needle
- Having sutures away from the wound edge they are reducing some of the tension
82
Q
Simple Interrupted Echelon Suture
A
- have normal simple interrupted pattern, but every 2 or 3 sutures you will place one away form the wound edge
- narrow bites are intended to get approximation
- wide bites are to relieve the tension
- can put quills on wide bites, reduce tension even further over a wider surface - less trauma underneath
83
Q
Quills + Horizontal Mattress
A
- quills can help distribute the tension over a wider surface allowing for less trauma to be caused to the tissue underneath
84
Q
A
- dauschund with a mastectomy - had to remove so much dirty tissue that they werent able to clean the wound at this go
- If there is not good way to close the tissue, may be good to wait until the tissue is able to be closed - left it for a couple of days so it can granulate
- wait for the wound to be healthy
- do not want to try and close something prematurely with tension where it was dirty
- could then do inguinal flap to close the wound after a few days with wet to dry dressing
85
Q
Quills + Vertical Mattress
A
- instead of end suture passing through the quill it is wrapped around it
- can use that in combination with a simple interrupted pattern
- could have simple interrupted pattern down the middle and then vertical mattress sutures far away from your would edge - take tension away from wound edge where you skin is healing
86
Q
A
- dog that had been impailed by a stick while on a walk
- actually didnt lose any skin, but because he was a greyhound
- hard to approximate after a day or two
- negative pressure wound therapy (V.A.C.) - foam dressing with a pump that helps aleviate tension on the area
- Also helpful in stimulating blood supply and other healing measures
87
Q
A
- do something you can do well and remember: keep it simple unless there is a good reason to not!
88
Q
Summary of Suture Patterns
A
89
Q
A
- even the best suturing will not heal properly if
90
Q
Vicryl
Polyglactin 910
A
91
Q
Monocryl
Polyglecaprone
A
92
Q
PDS II
Polydioxanone
A
93
Q
Nylon
A
95
Q
Perma-hand Silk
Silk
A
96
Q
A
- Inverting
97
Q
A
Appositional
98
Q
A
Eversion
102
Q
A
Polyglactin 910, ‘Vicryl’
- An absorbable suture material would be ideal for the mouth. A permanent suture material may hold bacteria and result in infection in the long term.
- Mucosa heals quickly so a rapidly absorbable suture material is best.
- Vicryl is soft. Monocryl being monofilament has spikey points when cut
103
Q
A
- The Lembert involves sutures placed perpendicular to the wound.
- The Connel involves sutures placed parallel to the wound.
- So the Connel results in a smaller reduction in the internal volume of a hollow organ.
105
Q
Missing Testicles
A
- very common in SA clinical practice
- common presenting sign, may be noticed incidently
- testis should be decended in cats and dogs at birth, but can give it 6 months
- If not, considered cryptorchid
106
Q
Cryptorchidism and other congenital anomalies
A
- not a single gene abnormality
- more common in pedigree dogs
- retained testicles are prone to becoming neoplastic and causing torsion by twisting on itself
107
Q
Treatment: Cryptochidism and other Congenital Anomalies
A
- advise castration to avoid future problems
- income stream for many practices, but every surgery has risks to it!
make sure that removal will really benefit the animal - Testicular hypoplasia tends to go with missing testis as they are not in correct location and can’t termoregulate, etc.
- actually having only 1 testicle is VERY VERY rare
108
Q
Testicles of Different Sizes
A
- owners typically notice this
- that one has become large or the other has become small, or both occurring at the same time
- need to do exam and take history
- most likely cause would be neoplasia
- US is going to be a good way to identify the cause, may occassionally want to do an excisional biposy or aspirate
109
Q
Neoplasia
A
- common in male dogs, and rare in cats
- echo
- quite common to find other masses on section in dogs, can often be other tumors as well
- descended testicels are more likely to have benign
- retained more likely to be malignant
110
Q
Neoplasia of Testicles and Malignancy
A
- sertoli cell tumors are often functional
- they are estrogen producing and will lead to feminisation
- drippy prepuce
- flank alopecia
- mammary gland development (echo for name- mammoglanastia)
111
Q
Neoplasia and Infertility
A
- production of estrogen mainly
- generally older dogs, but this can concern breeders
- diagnosis and treamtent usually involves castration
112
Q
Orchitis/Epididymitis
A
- usually occur together
- pretty painful when acute
- scrotal oedema (loss midline indentation you would see in a normal scrotum)
- resent investigation of rear end and will appear systemically ill
- echo
- tend not to see chronic infections in the UK, but third world maybe
- may get fibrosis and firm testicles - limit the abilit of the testis
113
Q
Orchitis/Epididymitis
(Infection and Treatment)
A
- Most likely from urinary tract
- treatment depends on use of the dog, but generally castration
- US image: dog with swollen scrotum, resulted in being a very abnormal testis
114
Q
Testicular Torsion
A
- rare
- this dog presented with vomiting, and then this was found after palpation and guessing that castration was the right method
- ischemic testis
- remember: vomiting is NOT always related to GIT disease
- by the time the testis is found, the testis is already ischemic and needs to be removed
115
Q
Protruding Penis
A
- social issue for owners generally
- dogs may be uncomfortable
- risk for trauma, bleeding and pain
- protruding penis is not the diagnosis
116
Q
Paraphimosis
A
narrowed preputial orifice: goes out, cant go back in, hairs and swelling
enlargement: may have gotten dry and swollen, not becuase they are already large
abnormally short prepuce: can be congenital or acquired
prepucial muscles: what you cut when you do a midline approach (echo)
117
Q
Paraphimosis
(treatment)
A
- If it got dry and won’t go back in: usually a quick easy fix–> lubricate it and put it back in
- phallopexy:( phallo –>penis, pexy- fix): procedure where incision is made on the inside of the prepuce and outside of the penis–> forms a scar to keep penis in the prepuce (echo)
- amputation: just shorten the penis to make sure that it is retained in the prepuce (example below)
118
Q
Priapism
A
- perisistent erection lasting longer than 4 hours after or without arousal
- especially in dogs
- associated with trauma to both species
- can become ischemic (picture)
119
Q
Priapism
(ischemic/non-ischemic)
A
- same categories in people can be used in dogs
- helps you decide what oyur treatment is going to be
- if something is ischemic then it is an emergency
120
Q
Priapism
(Diagnostics/Treatment Options)
A
- risk of thromboses!
- Most vets and specialist arent used to imaging the penis (hard to tell what “normal” looks like) - need info to drive us in how to manage that
- blood gas analysis of aspirated blood (compatible with normal venous blood or arterial?)
- If we are concerned that there may be some clotting of blood, therapeutic aspiration has been shown to help –> whole thing thing is expressed and flushed with saline and then… (?)
- If things are not diagnosed quickly and then you may end up with an ischemic penis that needs to be amputated
121
Q
Penile Masses
A
- urethral prolapse is not really a penile mass, but it tends to look like one - looks like a cherry mass at the very end of the penis (picture) –> use as a differential, has a very characteristic appearance
- other pic is a severe inflammatory response that almost looked like a mass
122
Q
Penile Tumours
A
- tumor types that relate to the tissues that you see
- think about transmissble venereal tumor when in third world countries!
- echo
123
Q
A
- chronic swelling (priapism)
- treated conservatively and US him –> didnt respond to treatment
- scrotal urethrostomy and penile amputation
- has thrombosis in his deep penile veins which is why it was so painful
- echo
124
Q
Penile Injury
A
- cats fight or dog bites
- horse jumping
- can be iatrogenic (second to surgery)
- variable presenting sign, often hemorrhage
- extravasation of urine if the actually injury has entered the urethra
- pic: dog caught it in a fencce, dog was in so much pain, could urinate –> needed partial penile amputation
- pic right: penis was prolapsed, had fracture os penis, the penile calculi –> this actually transpired that this was not an accidental injury (ex had kicked the dog)
*
125
Q
Other Penile Problems
(Hypospadias)
A
- pretty unusual
- failure of normal fusion of midline folds
- affects external genitalia
- can occur anywhere along that whole line
- can be bigger or smaller and involve the urethra as well
- how do we surgically correct that? only if it is affecting the dog negatively
126
Q
Persistent frenulum
A
- penis and prepuce are more joined at puberty and then are meant to separate after
- can vary in how extensive it is
- you can basically just snip it with local anaesthetic
- get a natural derivation of the penis as a result
127
Q
Phimosis
A
- pic: came from the derm service –> dog had an autoimmune disease affecting the mucocutaneous structures and ended up causing a stricture
- (echo)
128
Q
Preputial Discharge
A
- there is a range of normal remember! - varying amounts depending on dog
- may just have a bit more discharge ( leaving trails around the house)
- worry if it really becomes severe, blood tinge, or smelly
- is it from the prepuce or the urethral orifice?
- may need to sedate to look
- could find an underlying cause
- If not, just tell owners about expectations of normal and to use some wet wipes
129
Q
Difficulty Defeacating/Systemic Illness
A
- Dyschezia is an important sign in terms of males!
130
Q
Benign prostatic hypertrophy
(BPH)
A
- quite common
- can cause disease but is a normal aging change in an entire male dog
- in some dogs, the prostate will get so big that it will cuase problems and cause problems defecating
- If you have a big prostate or mass in caudal abdomen, it is going to press on other things (rectum) and cause difficulty to defecate
- need to diagnose by ruling out other causes
- can do biopsy if really unsure, but usually so common and by ruling out others shouldnt need to normally
131
Q
Surgical Treatment of BPH
A
- advantage/disadvantage: cant put the testis back after castration!
132
Q
Medical Treatment of BPH
A
- Tardak is an injection
- ANti-androgens and synthetic progestagen are first line treatments- can suggest to owners if appropriate, if not effective advise riding of testis
- GnRH analogue implany will reduce testosterone production
133
Q
Prostatitis/prostatic abscessation
A
- rare to see in castrated dogs
- these animals can be really ill
- this is the “male dog pyometra”
- but less likely to be diagnosed as it is more rare
- but can be serious (just like female) if not diagnosed properly!
134
Q
Prostatitis/Prostatic Abscessation
(Diagnosis and Treatment)
A
- rectal is very painful for these dogs! (take care, need restraint)
- vas deferens actually passes through the prostate and that way there can be involvement of the testicles
135
Q
A
- normal prostate on the left
- abnormal on right will get eccentric enlargement
- radiograph shows very large, eccentrically enlarged prostate
136
Q
A
- very echoic fluid in it
- debris
137
Q
A
- people are worried about draining prostate (as they expect pus) or doing aspiriate as it may cause septic peritonitis
- but need to drain the whole thing!
keep needle in the whole time using US and that keeps the escape routes minimal - echo
138
Q
Prostatic cysts and Paraprostatic Cysts
A
- paraprostatic: connect with the prostate (echo)
139
Q
Prostatic cysts and Paraprostatic Cysts
(diagnostics and treatment)
A
- Often incidental due to other investigations
- not as sick as those with prostatic abcesses
- treatment will depend on loaction and size - generally treat surgically (where castration would be part of the treatment plan, also want to biopsy the cyst wall as they can be involved with a neoplasia)
140
Q
A
- can be hard to tell what is prostate and bladder sometimes on US
- this is where radiography can be helpful
141
Q
A
- on left: bladder with mass, paraprostatic cyst –> had a retained testicle
- on right: cystic structures were arising from prostate, easier to manage than the other
- (echo)
142
Q
Prostatic Neoplasia
A
- the disease that is more liekly to occur in castrated animals
- can tend to arise form the urethral element of the prostate
- get interference with normal venous return
- prostate isnt always enlarged with tumors (can just feel hard and small, but can have a normal contour)
- very painful for animals
- can get this wispy new bone if there has been formation of new bone (in drawing - blue)
143
Q
A
- can note the wispy new bone forming
144
Q
Prostatic Neoplasia
(diagnosis and treatment)
A
- need to relieve disurea
145
Q
Prostatic Surgery
A
- Omentalisation is one of the most common surgeries (echo and read up on)
146
Q
A
- common surgery for prostatic abcesses
- drain the pus out
- pack in the omentum
149
Q
Closure of the Abdominal Wall
A
- Failure of abdominal wall closure can be catastrophic leading to herniation of abdominal organs into the subcutaneous space and in the worst case, complete escape of abdominal organs from the body.
- Leaving the peritoneum unsutured does not reduce the tensile or bursting strength of abdominal wounds in experimental animals.
- The external rectus sheath is a thick white fascia that is the primary strength-holding layer in ventral midline closures in animals.
- Suture holding strength is greater, if the suture is passed lateral to the junction between the linea alba and the recuts sheath, rather than if it just placed in the linea alba itself.
- The tensile strength of fascia is only 20% normal 20 days post op
- In experimental studies, a continuous suture in the external rectus sheath, has an equal resistance to the pressure of the abdominal organs, as an interrupted suture pattern.
- Closure of the subcutaneous fat is required simply to close dead space.
- Skin wounds are dependent on sutures for the first 5 to 7 days after closure of clean surgical wounds.
153
Q
After abdominal surgery the dog in the previous question starts high dose steroid treatment to treat an immune-mediated polyarthritis. Three weeks after surgery the dog develops a swelling along his ventral wound and examination shows that the wound in the external rectus sheath has opened up
How would you repair the external rectus sheath now?
A
- The dog has an incisional hernia
- This dog has now demonstrated delayed wound healing. This will continue as long as the steroid treatment continues, so a permanent solution, which is as secure as it can be, is now required.
- Prolene lasts indefinitely in the wound and is associated with minimal tissue reaction and therefore decreased chances of long term problems including infection.
- Simple interrupted patterns are more secure than simple continuous patterns.
154
Q
What is the name and purpose of the three sutures indicated by blue arrows?
A
- Horizontal mattress to prevent the wound from pulling apart i.e. to reduce tension.
