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Basic principles of soft tissue surgery

image of Basic principles of soft tissue surgery
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Abstract

The general principles of soft tissue surgery are as applicable to rabbits as they are to cats and dogs. These include Halsted’s basic principles of soft tissue surgery. The aim of this chapter is to highlight both the similarities and differences between rabbits and cats and dogs, so that veterinary practitioners can modify their existing surgical skills where necessary. : Removal of subcutaneous abscesses; Abdominal closure; Laparoscopic ovariectomy.

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Figures

Image of 11.3
11.3 Deterioration in tensile strength (as a percentage of original strength) in a variety of commonly used sutures. (Data from )
Image of Untitled
Image of Untitled
Image of 11.6
11.6 A rabbit in a normal rigid Elizabethan collar. Note that this restricts the rabbit’s ability to groom, to eat and to prehend caecotrophs. The edge of the collar can rub against the external side of the pinnae, causing skin erosion and pain. A soft collar that can be folded down over the shoulders is better accepted and less restrictive. This type of collar works well for wounds around the shoulder and chest, and does not restrict access to the perineal area, so caecotrophy can occur. It is, however, not useful for wounds that are located more caudally. (© Molly Varga)
Image of 11.8
11.8 A rabbit undergoing a laparoscopic procedure. Note the positioning in dorsal recumbency, with two ports in use, one for the endoscope and one for the forceps. (© Romain Pizzi, Zoological Medicine Ltd)
Image of 11.9
11.9 A rabbit undergoing laparoscopic surgery with three entry portals, illustrating the triangulation technique for port placement. (© Romain Pizzi, Zoological Medicine Ltd)
Image of 11.10
11.10 A two-portal technique, illustrating the sealed ports. Note the degree to which the abdomen has been distended by the gas insufflation. (© Romain Pizzi, Zoological Medicine Ltd)
Image of A large abscess located near to but not connected to the base of the ear. (© Molly Varga)
A large abscess located near to but not connected to the base of the ear. (© Molly Varga) A large abscess located near to but not connected to the base of the ear. (© Molly Varga)
Image of The abscess has been clipped, aseptically prepared and draped for surgery. (© Molly Varga)
The abscess has been clipped, aseptically prepared and draped for surgery. (© Molly Varga) The abscess has been clipped, aseptically prepared and draped for surgery. (© Molly Varga)
Image of The abscess capsule is dissected out in an attempt to remove as much of the abscess as possible intact. Bipolar radiosurgery forceps are being used to provide haemostasis. (© Molly Varga)
The abscess capsule is dissected out in an attempt to remove as much of the abscess as possible intact. Bipolar radiosurgery forceps are being used to provide haemostasis. (© Molly Varga) The abscess capsule is dissected out in an attempt to remove as much of the abscess as possible intact. Bipolar radiosurgery forceps are being used to provide haemostasis. (© Molly Varga)
Image of Most of the abscess has been removed, leaving only that portion that is so intimately attached to the underlying tissue that removal would cause unacceptable damage. All remaining pus is scooped out and the abscess capsule curetted using a Volkmann’s scoop. (© Molly Varga)
Most of the abscess has been removed, leaving only that portion that is so intimately attached to the underlying tissue that removal would cause unacceptable damage. All remaining pus is scooped out and the abscess capsule curetted using a Volkmann’s scoop. (© Molly Varga) Most of the abscess has been removed, leaving only that portion that is so intimately attached to the underlying tissue that removal would cause unacceptable damage. All remaining pus is scooped out and the abscess capsule curetted using a Volkmann’s scoop. (© Molly Varga)
Image of The abscess capsule is sutured to the surrounding skin or ‘marsupialized’. (© Molly Varga)
The abscess capsule is sutured to the surrounding skin or ‘marsupialized’. (© Molly Varga) The abscess capsule is sutured to the surrounding skin or ‘marsupialized’. (© Molly Varga)
Image of A small pad of foam dressing is sutured into the wound. This draws any discharge away from the wound surface and provides protection to allow a bed of granulation tissue to form. The foam dressing can be soaked in injectable antibiotics prior to placement in order to hold antibiotics in contact with the pyogenic membrane. The dressing may be left in situ for 3–5 days after surgery; it is then removed and direct cleaning of the abscess void can commence. (© Molly Varga)
A small pad of foam dressing is sutured into the wound. This draws any discharge away from the wound surface and provides protection to allow a bed of granulation tissue to form. The foam dressing can be soaked in injectable antibiotics prior to placement in order to hold antibiotics in contact with the pyogenic membrane. The dressing may be left in situ for 3–5 days after surgery; it is then removed and direct cleaning of the abscess void can commence. (© Molly Varga) A small pad of foam dressing is sutured into the wound. This draws any discharge away from the wound surface and provides protection to allow a bed of granulation tissue to form. The foam dressing can be soaked in injectable antibiotics prior to placement in order to hold antibiotics in contact with the pyogenic membrane. The dressing may be left for 3–5 days after surgery; it is then removed and direct cleaning of the abscess void can commence. (© Molly Varga)
Image of Sutures being placed in the abdominal wall (linea alba). Note the small size of the suture material. Care must be taken not to tie these sutures too tightly, or necrosis of the edge of the abdominal wall and discomfort and self-trauma may occur. (© Molly Varga)
Sutures being placed in the abdominal wall (linea alba). Note the small size of the suture material. Care must be taken not to tie these sutures too tightly, or necrosis of the edge of the abdominal wall and discomfort and self-trauma may occur. (© Molly Varga) Sutures being placed in the abdominal wall (linea alba). Note the small size of the suture material. Care must be taken not to tie these sutures too tightly, or necrosis of the edge of the abdominal wall and discomfort and self-trauma may occur. (© Molly Varga)
Image of Subcuticular sutures being placed. These sutures appose the skin edges, and cover the underlying suture line. Care must be taken to bury the ends of the final knot (Aberdeen knot) so they do not protrude through the skin, allowing entry of infection. (© Molly Varga)
Subcuticular sutures being placed. These sutures appose the skin edges, and cover the underlying suture line. Care must be taken to bury the ends of the final knot (Aberdeen knot) so they do not protrude through the skin, allowing entry of infection. (© Molly Varga) Subcuticular sutures being placed. These sutures appose the skin edges, and cover the underlying suture line. Care must be taken to bury the ends of the final knot (Aberdeen knot) so they do not protrude through the skin, allowing entry of infection. (© Molly Varga)
Image of The first suture being placed in the skin. Again, care must be taken not to tie these sutures too tightly; otherwise, discomfort and self-trauma may occur. (© Molly Varga)
The first suture being placed in the skin. Again, care must be taken not to tie these sutures too tightly; otherwise, discomfort and self-trauma may occur. (© Molly Varga) The first suture being placed in the skin. Again, care must be taken not to tie these sutures too tightly; otherwise, discomfort and self-trauma may occur. (© Molly Varga)
Image of The ovarian artery is grasped using bipolar forceps. (© Romain Pizzi, Zoological Medicine Ltd)
The ovarian artery is grasped using bipolar forceps. (© Romain Pizzi, Zoological Medicine Ltd) The ovarian artery is grasped using bipolar forceps. (© Romain Pizzi, Zoological Medicine Ltd)
Image of Grasping the ovary. (© Romain Pizzi, Zoological Medicine Ltd)
Grasping the ovary. (© Romain Pizzi, Zoological Medicine Ltd) Grasping the ovary. (© Romain Pizzi, Zoological Medicine Ltd)

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