Surgical Skills - Study Tips 3

This bedsore is described by red skin and can go away shortly after the pressure is relieved.

Stage I

This bedsore is described as an ulcer/blister with partial dermal skin loss, and if it’s treated promptly, it can heal fairly quickly.

Stage II

This bedsore is described as having full skin loss with a deep, crater-like wound.

Stage III

This bedsore is described as the most serious due to the lethal infection that can occur. There is a large-scale loss of skin, with damage to muscle and bone may be exposed.

Stage IV

How long does it take for a decubital ulcer to show signs of healing?

2-4 weeks

What are the areas that are likely to develop decubital ulcers?

Boney prominences (hocks, knees, carpi)

What causes the lungs to collapse?

Pressure, weight

How long does a lung take to reinflate after atelectasis?

6-12 hours or longer

How long does it take for lung atelectasis to occur?

In a few hours

How should you prevent a dog from developing lung atelectasis?

Flip the dog from one side to another (on a schedule), have them in sternal recumbency, listen to breathing, copage (remove mucus), and “walking”

How do you prevent urine overflow?

Empty the bladder at least 3 times a day

What are characteristics of fecal incontinence?

• Diaper (keep clean to prevent UTI)

• High quality, low waste food (less feces)

• ‘Walk’ outside after eating

• Fiber

What are some of the complications of fecal incontinence?

• Constipation

• Not eating well

• 4 or more days without defecating is a problem

What are characteristics of urine scalding?

• Red. raw skin

• Inside thighs, perineum, back of feet/toes

• Foul odor

• Constant grooming of area

How is urine scalding prevented?

• Urinary Catheter: high maintenance & great infection risk

• Diaper: doggie or modified infant ones

• Bathe Frequently: use pet shampoo to avoid pH issues & dry

• ‘Spot’ Cleaning: personal cleanser & dry baths

• Powder: baby powder or medicated gold bond

What is electrical stimulation?

This is applied by an electrical stimulator that transmits a current from one electrode to another in a specific area of the body. By setting the waveform, frequency, duty cycle, and intensity parameters one can achieve a desired function and purpose.

What is a waveform?

The shape of the visual representation of pulsed current on current/time plot or voltage/time plot.

What is pulse rate or frequency?

The rate of oscillation in cycles per second, expressed as pulses/sec (pps) or hertz (Hz).

What is the duty cycle?

The amount of time the stimulator is delivering current compared with the rest period between contractions, usually measured in seconds.

What is ramp?

The time in seconds from when the current begins to the peak current.

What does ‘LASER’ stand for?

Light Amplification by Stimulated Emission of Radiation

Why is photobiomodulation (laser therapy) used?

• Pain management

• Control inflammation and tissue healing

• Stimulation of acupuncture points

• Treat acute and chronic edema

What are the types of thermotherapy?

Cryotherapy & Superficial Heat

What is cryotherapy?

The most effective of thermotherapy that is used immediately following trauma to provide analgesia, control bleeding, and reduce inflammation, edema, and muscle spasm.

What does superficial heat do?

Causes alteration of tissue viscoelastic properties, which result in increased soft tissue extensibility and decreased joint stiffness. Also causes vasodilatation that increases tissue oxygenation and transport of metabolites to exercising tissues and increases the rate of enzymatic and biochemical reactions that facilitate healing.

What is therapeutic ultrasound?

A deep heating modality that can elevate tissue temperature at depths of 2.5cm. It is an effective treatment modality for rehabilitating musculoskeletal conditions such as restricted ROM resulting from joint contracture, pain & muscle spasm, and wound healing.

What is shockwave therapy?

A high-energy sound wave technology that generates sound waves outside of the body, offering a noninvasive treatment option of dogs experiencing lameness and pain.

What are the guidelines for water therapy?

• Never leave a patient alone/unattended

• Always have a life vest

What are the indications of needing an OHE?

● Neoplasia of reproductive tract – early spay
● Treatment of neoplasia elsewhere influenced by repro hormones (mammary tumors)
● Injury to repro tract
● Dystocia
● Uterine torsion
● Abolition of heat cycle
● Congenital abnormalities
● Stabilization of other systemic dz: Diabetes melitus

How is an OHE patient draped?

4 quadrant

What is dystocia?

Difficulty giving birth

How is dystocia handled?

C-section

Which breeds are prone to dystocia?

Animals with a history & brachycephalic breeds (boxers, bulldogs, pekingese, pugs)

What drugs are administered during a c-section?

Naloxone, doxapram, epinephrine

What are the indications of an exploratory laparaotomy?

○ Surgical biopsies
○ Removal of abd. masses
○ Gastrointestinal obstruction
○ Traumatic injury: ruptured bladder, biliary tract rupture, gunshot/puncture, diaphragmatic hernia, pneumoperitoneum, acute abdomen (etc)

What is a gastrotomy?

Incision into stomach

What is an exploratory laparaotomy?

Abdominal exploratory surgery

What are the indications of a gastrotomy?

○ Foreign body removal
○ Biopsy of mass (neoplasia/fungal)
○ Mass removal
○ Pyloric outflow obstruction

What is an enterotomy?

Incision into the small intestine

What are the indications for an enterotomy?

○ Foreign body removal
○ Biopsy of small bowel

What is an intestinal resection and anastomosis?

Excision of a segment of bowel followed by reestablishment of the two remaining segments

What are the indications of a intestinal resection and anastomosis?

• Removal of section of dead or diseased bowel

  • Foreign body

  • Neoplasia

  • Intussusception

  • Necrosis

• Neoplasms of GI tract

  • Leiomyoma

  • Lymphosarcoma

  • Adenocarcinoma

  • Fibrosarcoma

What is the meaning of dilation?

When an organ is stretched beyond its normal dimensions

What is the meaning of volvulus?

Rotation of an organ on its axis

What is gastric dilatation volvulus?

Distended stomach that has rotated on it’s own axis

What is GDV classified as?

Surgical emergency

Who is predisposed to GDV?

Deep-chested, large breed dogs

What are the clinical signs of GDV?

○ Distended abdomen
○ Retching without production
○ Shocky
○ Abdominal pain
○ Hypersalivation
○ Restlessness

What is gastropexy?

Permanent fixation of stomach to the body wall

What is a cystotomy?

A surgical incision into the bladder

What are the indications of cystotomy?

○ Cystic calculi
○ Biopsy
○ Correct congenital abnormalities

What are the different methods of evaluating masses?

○ History

○ Physical exam

○ Clinical pathology

○ Diagnostic imaging

○ Tissue sampling

○ Surgery

When taking the history of a mass what are you looking for?

○ Location, number

○ Duration

○ Size (growing, shrinking)

○ Changes in appearance (color, size, ulceration)

What are the parameters of a physical exam when evaluating a mass?

○ Thorough general exam (with/without orthopedic and/or neurologic exam)

○ Evaluate local and regional lymph nodes

○ Map location and size of mass(es)

What is included during the clinical pathology of a mass evaluation?

• CBC/Chem

• Urinalysis

• Other tests depending on differential diagnosis

  • Cytology

  • Other blood tests

    • ACTH Stim. test or Dexamethasone suppression test

    • Ionized calcium

    • Parathyroid hormone panel

What is included during the diagnostic imaging of a mass evaluation?

○ Radiographs of affected areas/contrast studies

○ Ultrasound

○ Computed tomography

○ Magnetic resonance imaging

○ Nuclear scintigraphy

What are the stages of looking for metastasis (DI)?

○ 3-view thoracic radiographs

○ 2-view abdominal radiographs

What are the ways to diagnose the type of cancer?

○ Biopsy

○ Surgical removal w/ histologic exam

What are the techniques for biopsy of masses?

○ Tissue sampling

○ Minimally invasive biopsy

○ surgical biopsy

What are examples of tissue sampling?

○ Impression smears

○ Fine needle aspirate

What are examples of minimally invasive biopsies?

○ Needle core biopsy (Tru-Cut & bone biopsies)

○ Punch biopsy

○ Image-guided biopsy (uses ultrasound or CT)

What are examples of surgical biopsies?

○ Incisional biopsy

○ Excisional biopsy

○ Biopsy via minimally invasive surgery techniques (laparo-, thoraco-, arthro- scopic)

Where can bone marrow biopsies be done?

○ Proximal humerus

○ Ilial wing

○ Proximal femur

○ Proximal tibia (young dogs only)

What is an incisional biopsy?

Where a small sample of the mass is removed

What is an excisional biopsy?

Where the whole mass is removed

What are the characteristics of intracapsular margins?

○ Removal from within capsule or pseudocapsule

○ Debulking

What are the characteristics of marginal margins?

Removed at the margin of the tumor (capsule intact, no/little normal surrounding tissue)

What are the characteristics of wide excision margins?

Removal with margin of normal tissue surrounding the tumor (fascial planes deep to tumor)

What are the characteristics of radical excision margins?

Removal of the entire affected tissue compartment

What is dry-to-dry dressing?

When dry mesh gauze is directly applied to an open wound with embedded foreign material or necrotic tissue.

What is wet-to-dry dressing?

When a sterile, saline-soaked gauze sponge is applied directly to an open wound with embedded foreign material, devitalized tissue, and viscous exudate. Then a second layer of dry gauze sponges and rolled cotton is layered on the first layer and secured with rolled gauze and tape.

What is the primary layer of a bandage?

○ Sterile

○ Conform to body contours

○ Allow drainage to pass to secondary layer

○ Nontoxic, nonirritating

○ Minimize pain

What is the secondary layer of a bandage?

○ This is the bulk of the bandage

○ Functions: Holds drainage, provides support and/or immobilization, decreases dead space, reduces edema

○ Must cover the Primary layer completely

○ Must be thick enough to absorb all fluid

What is the tertiary layer of a bandage?

○ Holds first two layers in place

○ Apply with even pressure

○ Once wet/contaminated this layer is useless

What are the guidelines for bandage/splint application?

○ Ensure the bandage isn’t too tight

○ Keep secure, dry, and intact

What are the characteristics of a passive drain?

○ Fluid drains around, not through

○ Needs to be sterily covered

○ Depends on gravity

○ Ascending infection is greater than with active drains

What are the characteristics of active drains?

○ Depend on a vacuum

○ Drain deeper tissues, greater efficiency

○ Lower risk of infection

○ Obstruction is the primary complication

What is the dilution of Povidine-Iodine?

1:10 (100mls in 1L)

What is the dilution of Chlorhexidine?

1:40 (25ml in 1L)

What is primary wound closure?

¤Immediate closure of wound

¤Clean wounds

¤Clean-contaminated wounds

What is delayed primary wound closure?

¤Wound left open for 2-5 days

¤Closed prior to granulation tissue formation

¤Permits repeated lavage and debridement to convert wound to clean-contaminated status appropriate for closure

What is secondary wound closure?

¤Granulation tissue allowed to form in wound prior to closure

¤Deep narrow wounds-direct apposition over granulation tissue

¤Wide wounds-mobilize skin edges and advance over granulation tissue

What is second intention wound closure?

¤Dirty or infected wounds

¤Large wounds

¤Granulation, Epithelialization, Contracture

¤Potential complications: incomplete contracture, fragile epithelium, wound contracture

What are the characteristics of a thorax & abdomen bandage?

¤Similar layers and technique to a bandage on the extremity

¤May need to cross bandage in from of the fore limbs to prevent slippage

What are the characteristics of head bandages?

¤Placed similar to bandages of the extremities

¤Too tight if interfere with breathing or neck flexion

¤Should be able to insert fingers underneath bandage

¤Always mark where the ears are!!

How do you care for a chest tube?

1. Connect syringe

2. Remove safety clamp

3. Open stop-cock

4. Aspirate

5. Close stop-cock

6. Replace safety clamp

7. Remove syringe

How do you care for a urinary catheter?

¤Collection bag must be lower than the patient (Do not place on bare floor)

¤If any part dislodges, assume its contaminated and replace those parts

¤Check bag regularly to assure urine output: > 1-2ml/kg/hour average; Weigh bag hourly 1 gram = 1 ml urine; Empty only when full to avoid environmental contamination

¤Trouble shoot: pinched line in cage door, urinating around catheter, disconnected, emptied but not recorded, clogged with grit or blood clot

¤No urine + small bladder = BAD