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Patients undergoing soft tissue surgery

image of Patients undergoing soft tissue surgery
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Abstract

The goals of soft tissue surgery in small animals must ultimately be to improve quality of life or to prolong life. However, surgery itself represents a traumatic insult to the patient and, along with anaesthesia, results in disturbances to normal physiology. This chapter discusses The postoperative plan; Recovery from anaesthesia; Postoperative monitoring; Gastro-oesophageal reflux; and Wound management. Bladder rupture repair in a dog; Gastric dilatation-volvulus in a dog; Aspergillosis and laryngeal paralysis in a dog; Pharyngeal stick injury in a dog; Rectal adenocarcinoma in a dog; Bilateral thyroidectomy in a cat; Surgical wound breakdown in a working dog; Splenic rupture in a dog.

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Figures

Image of Positive contrast retrograde urethrocystogram demonstrating escape of contrast material into the peritoneal space, an irregular bladder outline, and the possibility of an irregular filling defect within the cranial pole of the bladder.
Positive contrast retrograde urethrocystogram demonstrating escape of contrast material into the peritoneal space, an irregular bladder outline, and the possibility of an irregular filling defect within the cranial pole of the bladder. Positive contrast retrograde urethrocystogram demonstrating escape of contrast material into the peritoneal space, an irregular bladder outline, and the possibility of an irregular filling defect within the cranial pole of the bladder.
Image of Intraoperative photograph of the bladder (bottom of the photo), demonstrating a tear in the ventral bladder wall, through which a pedunculated bladder mass (middle of the photo) had passed. The smooth deep red mass attached to the bladder mass is an organized haematoma.
Intraoperative photograph of the bladder (bottom of the photo), demonstrating a tear in the ventral bladder wall, through which a pedunculated bladder mass (middle of the photo) had passed. The smooth deep red mass attached to the bladder mass is an organized haematoma. Intraoperative photograph of the bladder (bottom of the photo), demonstrating a tear in the ventral bladder wall, through which a pedunculated bladder mass (middle of the photo) had passed. The smooth deep red mass attached to the bladder mass is an organized haematoma.
Image of This Dobermann developed postoperative facial oedema secondary to severe hypoalbuminaemia.
This Dobermann developed postoperative facial oedema secondary to severe hypoalbuminaemia. This Dobermann developed postoperative facial oedema secondary to severe hypoalbuminaemia.
Image of Getting down to the level of the dog may reassure him if he is anxious. (Courtesy of Rachel Lumbis)
Getting down to the level of the dog may reassure him if he is anxious. (Courtesy of Rachel Lumbis) Getting down to the level of the dog may reassure him if he is anxious. (Courtesy of Rachel Lumbis)
Image of Effleurage of the muzzle to reduce oedema. (Courtesy of Brian Sharp)
Effleurage of the muzzle to reduce oedema. (Courtesy of Brian Sharp) Effleurage of the muzzle to reduce oedema. (Courtesy of Brian Sharp)
Image of An underwater treadmill, with plenty of support, may be more suitable for a nervous patient. (© Linhay Veterinary Rehabilitation Centre)
An underwater treadmill, with plenty of support, may be more suitable for a nervous patient. (© Linhay Veterinary Rehabilitation Centre) An underwater treadmill, with plenty of support, may be more suitable for a nervous patient. (© Linhay Veterinary Rehabilitation Centre)
Image of A bitch following urinary tract surgery. An indwelling catheter is attached to a closed urine collection bag. The urine collection bag is contained within a transparent bag and placed on a clean incontinence sheet to decrease contamination. An Elizabethan collar has been fitted to prevent interference with the catheter. The surgical wound is covered with a light dressing. Intravenous fluid therapy is being given via a jugular catheter and direct arterial blood pressures are being monitored via a metatarsal artery catheter. The dog is on comfortable fleecy bedding (a large covering blanket for warmth was removed while the photograph was taken).
A bitch following urinary tract surgery. An indwelling catheter is attached to a closed urine collection bag. The urine collection bag is contained within a transparent bag and placed on a clean incontinence sheet to decrease contamination. An Elizabethan collar has been fitted to prevent interference with the catheter. The surgical wound is covered with a light dressing. Intravenous fluid therapy is being given via a jugular catheter and direct arterial blood pressures are being monitored via a metatarsal artery catheter. The dog is on comfortable fleecy bedding (a large covering blanket for warmth was removed while the photograph was taken). A bitch following urinary tract surgery. An indwelling catheter is attached to a closed urine collection bag. The urine collection bag is contained within a transparent bag and placed on a clean incontinence sheet to decrease contamination. An Elizabethan collar has been fitted to prevent interference with the catheter. The surgical wound is covered with a light dressing. Intravenous fluid therapy is being given via a jugular catheter and direct arterial blood pressures are being monitored via a metatarsal artery catheter. The dog is on comfortable fleecy bedding (a large covering blanket for warmth was removed while the photograph was taken).
Image of Right lateral abdominal radiograph demonstrating GDV.
Right lateral abdominal radiograph demonstrating GDV. Right lateral abdominal radiograph demonstrating GDV.
Image of Right lateral thoracic radiograph demonstrating an alveolar pattern in the ventral lung fields, typical of aspiration pneumonia.
Right lateral thoracic radiograph demonstrating an alveolar pattern in the ventral lung fields, typical of aspiration pneumonia. Right lateral thoracic radiograph demonstrating an alveolar pattern in the ventral lung fields, typical of aspiration pneumonia.
Image of Incisional gastropexy to secure the pyloric antrum of the stomach to the right abdominal wall.
Incisional gastropexy to secure the pyloric antrum of the stomach to the right abdominal wall. Incisional gastropexy to secure the pyloric antrum of the stomach to the right abdominal wall.
Image of Ventricular premature complexes interspersed with normal PQRS complexes in a dog with GDV. These were seen in the presence of a good pulse quality and normal blood pressures, negating the need for specific therapy. (Courtesy of Simon Dennis)
Ventricular premature complexes interspersed with normal PQRS complexes in a dog with GDV. These were seen in the presence of a good pulse quality and normal blood pressures, negating the need for specific therapy. (Courtesy of Simon Dennis) Ventricular premature complexes interspersed with normal PQRS complexes in a dog with GDV. These were seen in the presence of a good pulse quality and normal blood pressures, negating the need for specific therapy. (Courtesy of Simon Dennis)
Image of This ECG shows a ventricular couplet (two consecutive ventricular premature complexes, VPCs), with the second VPC occurring on the T-wave of the first VPC. This is referred to as the ‘R-on-T’ phenomenon. Such patients can be more likely to develop more severe ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation), so there may be a need for anti-arrhythmic therapy. Lead II; paper speed 25 mm/s; gain 1 cm/mV. (Courtesy of Simon Dennis)
This ECG shows a ventricular couplet (two consecutive ventricular premature complexes, VPCs), with the second VPC occurring on the T-wave of the first VPC. This is referred to as the ‘R-on-T’ phenomenon. Such patients can be more likely to develop more severe ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation), so there may be a need for anti-arrhythmic therapy. Lead II; paper speed 25 mm/s; gain 1 cm/mV. (Courtesy of Simon Dennis) This ECG shows a ventricular couplet (two consecutive ventricular premature complexes, VPCs), with the second VPC occurring on the T-wave of the first VPC. This is referred to as the ‘R-on-T’ phenomenon. Such patients can be more likely to develop more severe ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation), so there may be a need for anti-arrhythmic therapy. Lead II; paper speed 25 mm/s; gain 1 cm/mV. (Courtesy of Simon Dennis)
Image of Sensor of a pulse oximeter placed on a non-pigmented toe. (Reproduced from the BSAVA Manual of Canine and Feline Advanced Veterinary Nursing)
Sensor of a pulse oximeter placed on a non-pigmented toe. (Reproduced from the BSAVA Manual of Canine and Feline Advanced Veterinary Nursing) Sensor of a pulse oximeter placed on a non-pigmented toe. (Reproduced from the )
Image of Gastrostomy tube held in place by a light body bandage.(Courtesy of Hilary Orpet)
Gastrostomy tube held in place by a light body bandage.(Courtesy of Hilary Orpet) Gastrostomy tube held in place by a light body bandage.(Courtesy of Hilary Orpet)
Image of CT scan from a dog with aspergillosis, showing loss of the nasal turbinates in one nasal cavity. (Courtesy of CR Lamb. Reproduced from BSAVA Manual of Canine and Feline Musculoskeletal Imaging)
CT scan from a dog with aspergillosis, showing loss of the nasal turbinates in one nasal cavity. (Courtesy of CR Lamb. Reproduced from BSAVA Manual of Canine and Feline Musculoskeletal Imaging) CT scan from a dog with aspergillosis, showing loss of the nasal turbinates in one nasal cavity. (Courtesy of CR Lamb. Reproduced from )
Image of Golden Retriever with apergillosis undergoing daily local enilconazole treatment. Bilateral nasal discharge, worse on the left, is evident. The Elizabethan collar is cleaned regularly, but a small amount of discharge is still present.
Golden Retriever with apergillosis undergoing daily local enilconazole treatment. Bilateral nasal discharge, worse on the left, is evident. The Elizabethan collar is cleaned regularly, but a small amount of discharge is still present. Golden Retriever with apergillosis undergoing daily local enilconazole treatment. Bilateral nasal discharge, worse on the left, is evident. The Elizabethan collar is cleaned regularly, but a small amount of discharge is still present.
Image of Enilconazole treatment being performed outside. This dog’s Elizabethan collar has been removed for treatment and he has been made to feel relaxed. Enilconazole is being administered via four tubes placed via bilateral frontal sinusotomy into the frontal sinuses and nasal chambers. The dog is sitting with his nose pointing downwards to allow the enilconazole to drain through the nostrils.
Enilconazole treatment being performed outside. This dog’s Elizabethan collar has been removed for treatment and he has been made to feel relaxed. Enilconazole is being administered via four tubes placed via bilateral frontal sinusotomy into the frontal sinuses and nasal chambers. The dog is sitting with his nose pointing downwards to allow the enilconazole to drain through the nostrils. Enilconazole treatment being performed outside. This dog’s Elizabethan collar has been removed for treatment and he has been made to feel relaxed. Enilconazole is being administered via four tubes placed via bilateral frontal sinusotomy into the frontal sinuses and nasal chambers. The dog is sitting with his nose pointing downwards to allow the enilconazole to drain through the nostrils.
Image of Balls of food of a sausagemeat consistency. (Courtesy of Rachel Lumbis)
Balls of food of a sausagemeat consistency. (Courtesy of Rachel Lumbis) Balls of food of a sausagemeat consistency. (Courtesy of Rachel Lumbis)
Image of Expiratory vibrations: the hands are placed on the chest wall and, during expiration, a vibratory movement is applied in the direction of the normal movement of the ribs. (Courtesy of Brian Sharp)
Expiratory vibrations: the hands are placed on the chest wall and, during expiration, a vibratory movement is applied in the direction of the normal movement of the ribs. (Courtesy of Brian Sharp) Expiratory vibrations: the hands are placed on the chest wall and, during expiration, a vibratory movement is applied in the direction of the normal movement of the ribs. (Courtesy of Brian Sharp)
Image of Administration of oxygen via nasal prongs in a Great Dane with aspiration pneumonia. A pulse oximeter has been placed on the lip to monitor oxygen saturation.
Administration of oxygen via nasal prongs in a Great Dane with aspiration pneumonia. A pulse oximeter has been placed on the lip to monitor oxygen saturation. Administration of oxygen via nasal prongs in a Great Dane with aspiration pneumonia. A pulse oximeter has been placed on the lip to monitor oxygen saturation.
Image of Focal seroma formation 2 days following left arytenoid lateralization.
Focal seroma formation 2 days following left arytenoid lateralization. Focal seroma formation 2 days following left arytenoid lateralization.
Image of Temporal region of a dog one day after removal of four treatment tubes placed into the frontal sinuses for treatment of aspergillosis. The tube exit wounds were left to heal by second intention and have become sealed with eschars.
Temporal region of a dog one day after removal of four treatment tubes placed into the frontal sinuses for treatment of aspergillosis. The tube exit wounds were left to heal by second intention and have become sealed with eschars. Temporal region of a dog one day after removal of four treatment tubes placed into the frontal sinuses for treatment of aspergillosis. The tube exit wounds were left to heal by second intention and have become sealed with eschars.
Image of Oral examination, demonstrating a wound in the right side of the dorsal pharynx, containing a stick.
Oral examination, demonstrating a wound in the right side of the dorsal pharynx, containing a stick. Oral examination, demonstrating a wound in the right side of the dorsal pharynx, containing a stick.
Image of Intraoperative photo of a ventral midline exploration of the neck; a stick was found dorsal to the oesophagus.
Intraoperative photo of a ventral midline exploration of the neck; a stick was found dorsal to the oesophagus. Intraoperative photo of a ventral midline exploration of the neck; a stick was found dorsal to the oesophagus.
Image of Feeding the patient via a PEG tube. In the absence of direct supervision, the dog would be wearing an Elizabethan collar.
Feeding the patient via a PEG tube. In the absence of direct supervision, the dog would be wearing an Elizabethan collar. Feeding the patient via a PEG tube. In the absence of direct supervision, the dog would be wearing an Elizabethan collar.
Image of A harness should be used in place of a collar while the dog has a neck wound. (Courtesy of Samantha Lindley)
A harness should be used in place of a collar while the dog has a neck wound. (Courtesy of Samantha Lindley) A harness should be used in place of a collar while the dog has a neck wound. (Courtesy of Samantha Lindley)
Image of A ball is a much better ‘fetch’ toy than a stick. (Courtesy of Claire Corridan; reproduced from BSAVA Manual of Canine and Feline Behavioural Medicine, 2nd edition)
A ball is a much better ‘fetch’ toy than a stick. (Courtesy of Claire Corridan; reproduced from BSAVA Manual of Canine and Feline Behavioural Medicine, 2nd edition) A ball is a much better ‘fetch’ toy than a stick. (Courtesy of Claire Corridan; reproduced from )
Image of An ultrasound image of the descending colon, demonstrating an intraluminal soft tissue mass.
An ultrasound image of the descending colon, demonstrating an intraluminal soft tissue mass. An ultrasound image of the descending colon, demonstrating an intraluminal soft tissue mass.
Image of Exploration of the cranial abdomen revealed a nodular hepatic lesion with white discoloration.
Exploration of the cranial abdomen revealed a nodular hepatic lesion with white discoloration. Exploration of the cranial abdomen revealed a nodular hepatic lesion with white discoloration.
Image of Supportive bedding is required for elderly patients and will aid in the prevention of decubitus ulcers. (Courtesy of Liz Mullineaux)
Supportive bedding is required for elderly patients and will aid in the prevention of decubitus ulcers. (Courtesy of Liz Mullineaux) Supportive bedding is required for elderly patients and will aid in the prevention of decubitus ulcers. (Courtesy of Liz Mullineaux)
Image of Blocking visual access to other cats can help with in-clinic anxiety. (Courtesy of Liz Mullineaux)
Blocking visual access to other cats can help with in-clinic anxiety. (Courtesy of Liz Mullineaux) Blocking visual access to other cats can help with in-clinic anxiety. (Courtesy of Liz Mullineaux)
Image of Three hours after a bilateral thyroidectomy, this cat has already started to eat.
Three hours after a bilateral thyroidectomy, this cat has already started to eat. Three hours after a bilateral thyroidectomy, this cat has already started to eat.
Image of A female DSH cat 3 hours after a bilateral thyroidectomy. She is comfortable following buprenorphine, administered as a premedicant. The ventral cervical wound was left uncovered to prevent undue irritation. Normothermia was restored within 1 hour after anaesthesia. Toys have been placed in the cage to enrich the environment. Intravenous fluid therapy was continued postoperatively via a left saphenous catheter.
A female DSH cat 3 hours after a bilateral thyroidectomy. She is comfortable following buprenorphine, administered as a premedicant. The ventral cervical wound was left uncovered to prevent undue irritation. Normothermia was restored within 1 hour after anaesthesia. Toys have been placed in the cage to enrich the environment. Intravenous fluid therapy was continued postoperatively via a left saphenous catheter. A female DSH cat 3 hours after a bilateral thyroidectomy. She is comfortable following buprenorphine, administered as a premedicant. The ventral cervical wound was left uncovered to prevent undue irritation. Normothermia was restored within 1 hour after anaesthesia. Toys have been placed in the cage to enrich the environment. Intravenous fluid therapy was continued postoperatively via a left saphenous catheter.
Image of Horner’s syndrome has also been reported following thyroidectomy.
Horner’s syndrome has also been reported following thyroidectomy. Horner’s syndrome has also been reported following thyroidectomy.
Image of The wound contains some granulation tissue and some of the edges have begun to epithelialize and contract. Loose skin sutures have been placed around the wound to allow a wet-to-dry dressing to be tied into the wound.
The wound contains some granulation tissue and some of the edges have begun to epithelialize and contract. Loose skin sutures have been placed around the wound to allow a wet-to-dry dressing to be tied into the wound. The wound contains some granulation tissue and some of the edges have begun to epithelialize and contract. Loose skin sutures have been placed around the wound to allow a wet-to-dry dressing to be tied into the wound.
Image of Reconstruction of the open wound using a 90-degree subdermal plexus transposition flap.
Reconstruction of the open wound using a 90-degree subdermal plexus transposition flap. Reconstruction of the open wound using a 90-degree subdermal plexus transposition flap.
Image of There is some swelling and erythema of the skin flap.
There is some swelling and erythema of the skin flap. There is some swelling and erythema of the skin flap.
Image of Resolution of distal limb oedema is encouraged by effleurage massage: gentle stroking of the limb from distal to proximal. This dog had had an intramuscular lipoma removed from the medial thigh.
Resolution of distal limb oedema is encouraged by effleurage massage: gentle stroking of the limb from distal to proximal. This dog had had an intramuscular lipoma removed from the medial thigh. Resolution of distal limb oedema is encouraged by effleurage massage: gentle stroking of the limb from distal to proximal. This dog had had an intramuscular lipoma removed from the medial thigh.
Image of Aerobic and strength conditioning using a water treadmill may help return a working dog to full function. (© Linhay Veterinary Rehabilitation Centre)
Aerobic and strength conditioning using a water treadmill may help return a working dog to full function. (© Linhay Veterinary Rehabilitation Centre) Aerobic and strength conditioning using a water treadmill may help return a working dog to full function. (© Linhay Veterinary Rehabilitation Centre)
Image of An electric fan can be used to keep a caged dog cool. (Courtesy of Liz Mullineaux)
An electric fan can be used to keep a caged dog cool. (Courtesy of Liz Mullineaux) An electric fan can be used to keep a caged dog cool. (Courtesy of Liz Mullineaux)
Image of The Husky during a follow-up visit.
The Husky during a follow-up visit. The Husky during a follow-up visit.
Image of Ultrasound image of a spleen showing a rounded anechoic mass with hyperechoic strands, giving a septate appearance. (Courtesy of Frances Barr)
Ultrasound image of a spleen showing a rounded anechoic mass with hyperechoic strands, giving a septate appearance. (Courtesy of Frances Barr) Ultrasound image of a spleen showing a rounded anechoic mass with hyperechoic strands, giving a septate appearance. (Courtesy of Frances Barr)
Image of Intraoperative photo of the splenic mass. Bleeding has stimulated adhesion of the omentum to its surface.
Intraoperative photo of the splenic mass. Bleeding has stimulated adhesion of the omentum to its surface. Intraoperative photo of the splenic mass. Bleeding has stimulated adhesion of the omentum to its surface.
Image of ECG showing a non-sustained, monomorphic ventricular tachycardia, with rate up to 230 bpm. A ventricular arrhythmia of this rate, if frequent or sustained, is likely to result in signs of haemodynamic compromise, often necessitating therapy. Lead II; paper speed 25 mm/s; gain 1 cm/mV. (Courtesy of Simon Dennis)
ECG showing a non-sustained, monomorphic ventricular tachycardia, with rate up to 230 bpm. A ventricular arrhythmia of this rate, if frequent or sustained, is likely to result in signs of haemodynamic compromise, often necessitating therapy. Lead II; paper speed 25 mm/s; gain 1 cm/mV. (Courtesy of Simon Dennis) ECG showing a non-sustained, monomorphic ventricular tachycardia, with rate up to 230 bpm. A ventricular arrhythmia of this rate, if frequent or sustained, is likely to result in signs of haemodynamic compromise, often necessitating therapy. Lead II; paper speed 25 mm/s; gain 1 cm/mV. (Courtesy of Simon Dennis)
Image of Fluid therapy to maintain normovolaemia. The dog is resting on comfortable bedding in a quiet area. (Courtesy of Liz Mullineaux)
Fluid therapy to maintain normovolaemia. The dog is resting on comfortable bedding in a quiet area. (Courtesy of Liz Mullineaux) Fluid therapy to maintain normovolaemia. The dog is resting on comfortable bedding in a quiet area. (Courtesy of Liz Mullineaux)

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