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224 Cards in this Set
- Front
- Back
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What are the surgical options for repair of a proximal femur fx
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FHO
Diverging K-wires Lag Screw |
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Explain the approach to the femoral diaphysis
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Craniolateral incision
Incise through fascia lata at cranial border of biceps femoris Retract biceps femoris caudally Retract vastus lateralis cranially |
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What forces is an IM pin good for/bad for
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Good for: bending forces
Bad for: axial (compression) |
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What forces is an interlocking nail good for
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All forces
Will not collapse |
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Which diaphyseal fx repair methods can be dynamized
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Interlocking nails
ESF |
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What are the details for screw placement for an interlocking nail
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Place screws 2cm away from fx
Try to use 4 screws total |
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T/F: An IM pin is acceptable if there are multiple injuries
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False
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What surface is a 1a ESF placed on for radius/tibia
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Craniomedial
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What is the most common ESF used? the strongest?
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common- II
strongest- III |
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How often does the bandage have to be changed for ESF
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Every day at first
Can eventually do weekly |
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Who are supracondylar fx most common in
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4-11mths
Usually d/t trauma |
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How do you repair supracondylar fx
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Cross-pinning
Make sure cross is at least 1cm above the fx site |
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Where is the isthmus of the femur
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The proximal 1/3
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If there is a piece of metaphysis included in the supracondylar fx, what is its SH type
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II
if only physis = type I |
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What are axial pattern flaps based on
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Direct cutaneous arteries (and often the nerves)
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What does direct arterial supply allow axial patterns to do vs. local flaps
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increased length of flap
cover larger defects flap across greater distances |
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What areas is the Cd Superficial Epigastric Flap good for
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Flank
Inner thigh Stifle Perineum/Preputial |
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What is the survival rate for the Cd SupEpi Flap
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Consistent survival if only the caudal 3 mammary glands included
Drops to <50% survival if include mammary gland 2 |
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Where do you ligate the vessels for the reverse conduit flap
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b/t the femoral artery/vein and the medial saphenous artery/vein
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What vessels definitely have to be patent for the reverse conduit flap to work
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Cr and Cd branches of perforating metatarsal artery
Use Doppler |
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T/F: Place intradermal sutures in cases of reverse conduit flap
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False; will only increase tension
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What areas is the thoracodorsal flap good for
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Shoulder
Forelimb Elbow Axilla Thorax |
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What areas can you graft over? not graft over?
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Yes: Muscle, Fascia, Granulation tissue
No: Tendon or Bone (blood supply not good enough) |
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How long does it take new lymphatics to develop in the graft and establish drainage
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4-5 days post-op
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What is the first stage of graft healing and time frame
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Plasmatic Imbibition
First 48hrs Fluid comes out of granulation bed and goes directly into the graft (via capillary action) |
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What is the second stage of graft healing and time frame
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Inosculation
Capillary anastomosis w/ granulation bed and cut vessels of graft 48-72hrs |
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What is the third stage of graft healing and time frame
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Neovascularization
72hrs+ Capillaries grow up into new areas of the graft, or into pre-existing vessels w/in the graft |
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What are the reasons for graft failure
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Movement- shear forces worst
Edema Hematomas Infection |
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How often should the bandage be changed for grafts
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Every 72hrs at first so movement does not disrupt
Then q 48hrs for 2 wks |
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What are the advantages to meshing
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Graft gets bigger
Can contour better esp where there is undulation in wound Alloes fluid escape so there is intimate contact b/t graft and tissue |
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Why does the graft look bruised/hyperemic after 72hrs
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Hgb product absorption
We want this to happen |
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T/F: Head wounds can be grafted
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False
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What layers is the subdermal plexus deep to
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SQ
Panniculus Cutaneous trunci |
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T/F: When undermining, you should also get under the subdermal plexus
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True
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What are the pros/cons of relaxation incisions
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Pros: can stretch and decrease tourniquet effects
Cons: decreases blood supply |
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What is the difference b/t feline and canine granulation tissue
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Feline is less vascular and takes longer to heal
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What is the differencve b/t grafting in cats and dogs
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Grafts (and flaps) take better in cats than in dogs
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What are full thickness local flaps based on
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Subdermal plexus
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What are other names for full thickness local skin flaps
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Subdermal Plexus flaps
Random pattern flaps |
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Where are rotational flaps good for
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Head/Neck, Perineum
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What should you remember about measuring for a rotational flap
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Make flap (arc) 4x length of defect to decrease tension
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What is the rectangular 90degree flap called
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Transposition flap
Measure w/ suture before cut |
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What should you do about dog ears that develop when doing advancement flaps
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Leave them alone
They will regress over time |
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Who is the flank fold flap used mostly in
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Cats
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What is the most common cause of diaphragmatic hernia
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Indirect trauma (i.e. HBC)
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What criteria must be met for a diaphragmatic hernia to occur as the result of indirect trauma
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Increase in abdominal pressure w/ open glottis
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How many ribs have to be broken to have flail chest
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More than 4 consecutive ribs
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What percentage of DH cases are diagnosed >4wks after occurrence
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20%
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What are the signs of DH
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Can range from no overt signs to severe resp compromise
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What are the most common signs of DH
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Dyspnea
Arrhythmias (12%) |
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What are the most common rad changes seen w/ DH
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97% incomplete diaphragmatic silhouette
61% air-filled SI loops Incomplete cardiac silhouette |
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Which alternative techniques may have false negatives assoc'd (for dx of DH)
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+ Contrast Celiography
Pneumoceliography |
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What is the pre-op Mt rate for DH
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15%
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What is the Mt for DH cases taken to sx in first 24hrs
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33%
(this is higher than the pre-op Mt rate for DH) |
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When is DH a surgical emergency
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If cannot stabilize resp fxn despite aggressive management (O2 cage and thoracocentesis)
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Where should the incision for repair of DH extend to
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From xiphoid to umbilicus
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What are the most common organs herniated in DH (in order)
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Liver
Stomach SI (jejunum) Spleen |
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How should you work to repair a radial DH tear
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From dorsal to ventral
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What does free fluid in abd and liver congestion (on U/S) suggest in cases of DH
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That you closed it too snugly around the vena cava
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What is the first step in fixing a chronic hernia
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Enlarge the defect
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What is the #1 problem in cases of chronic hernias
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Pulmonary reperfusion injury
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What is the problem w/ adhesions in DH
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Increases sx and anesthesia time
Luckily, does not occur often in dogs |
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What is the most common complication after repair of DH
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Pneumothorax (esp. if chronic and if adhesions)
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What can you use if you are faced w/ a large DH defect (like those often seen w/ congenital hernias)
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Regional Muscle Flaps
(from peritoneum, transverse abd muscle) Omentum Synthetic material (i.e. polypropylene mesh) |
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What is the px for DH repair
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52-88%
Best if survives first 12-24hrs post-op |
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What are some reasons you could expect a worse px after DH repair
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Arrhythmias (VPCs)
Re-expansion pulmonary edema Multi-organ failure Shock Hypoventilation |
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Which is worse px: chronic or acute DH
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chronic (assuming that by acute we mean stable acute)
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What is PPDH a common result of
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Intrauterine trauma
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When should you perform hernia repair in a congenital case
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8-16wks
Fewer adhesions present yet More pliable skin/muscle/sternum/rib cage |
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T/F: All congenital hernias require repair
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False
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When should prophylactic Abx be used in cases of DH
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If hepatic herniation
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What is the px for congenital hernia after repair
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Guarded
B/c: re-expansion pulmonary edema anesthesia other congenital defects (i.e. cardiac) |
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What is one cause of primary peritonitis
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FIP
Primary is usually d/t IC |
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What is the px for primary peritonitis
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Poor
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What is secondary peritonitis usually d/t
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Bacteria (coliform or enteric, esp.)
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What is the most common etiology of peritonitis
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GI
Followed by U/G (often bladder rupture) |
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What is the most common cause of uroabd in cat and dog
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Cat- urethra
Dog- bladder |
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When is blood/bile in abdomen an emergency
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Only if also w/ bacteria causing increased inflamm response and Mb
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What is local peritonitis often d/t
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FB like sponge left in, trying to be walled off
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How does the px for generalized peritonitis differ from local
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Generalized has worse px (systemic signs)
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What is the most common cause of chemical peritonitis
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Uroabdomen
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How often is GI neoplasia the cause of peritonitis
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Rarely
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When do you do sx for peritonitis d/t GI neoplasia
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Only if obstructed
Histamine and Heparin present will impair wound healing and likely cause dehiscence |
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True/False: Abdominal trauma, if the cause of peritonitis, has to have occurred recently
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False
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What are some of the more common signs of peritonitis
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Fever >103
Generalized pain (can be local, but general more often) Shock |
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What do rads show in cases of peritonitis
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Loss of abd detail
Maybe free air, obstructed pattern, linear FB/plication |
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When should sx-induced abd free air be gone
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By 6wks post-op
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What is the #1 tool in referral setting for dx of peritonitis
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U/S
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What are the common lab findings in peritonitis
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Marked leukocytosis (>40,000)
Anemia/Hypoproteinemia E-lyte imbalance |
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What is the most useful diagnostic in most settings for peritonitis
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Abdominocentesis
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When should DPL be done
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Only after failure of response to aggressive medical management, or when there is non-diagnostic or negative abdominocentesis findings despite your great suspicion of peritonitis
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How Se is DPL for peritonitis
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95% Se
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What should always be done w/ the fluid obtained from abdominocentesis/DPL
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Cytology
Look for degenerate neutros and I/C bacteria |
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Besides cytology, what is also a helpful test to run on abd fluid in cases of suspected peritonitis
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Creatinine (to see if might be uroabdomen)
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What should you do for medical management of peritonitis
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Fluids 90 mL/kg/hr
Correct electrolytes Broad-spectrum Abx (single drug most common now; cephazolin, for example) |
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What are some controversial txs for peritonitis
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Low Dose Hep- for DIC
Steroids- for septicemia Banamine- for septicemia (but worry about renal fxn and GI ulcers) |
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What type of nutritional support is best in cases of peritonitis
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Combo of enteral and parenteral
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What are the most impt facets of surgical management of peritonitis
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Find/Stop Contamination
Vigorous lavage w/ saline (ONLY) |
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When is open peritoneal drainage recommended
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Cannot stop source of contam
Anaerobic infection Colonic rupture |
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What are the advantages of open peritoneal drainage
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Improved drainage
Access for inspection of abd Increased O2 tension (improves macrophage and neutro fxn) Decreased bacterial counts Decreased adhesions/abscesses |
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What are the disadvantages of open peritoneal drainage
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Hypoproteinemia
Evisceration Cost (lots of bandage changes) Nursing Care |
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What is the px for peritonitis
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Guarded (Mt 20-67%)
Worse for open peritoneal drainage, but these cases are worse anyway |
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What are the three fxns of the patella
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Modifies direction of pull of extensor muscles (quadriceps mechanism- vastuses and rectus femoris)
Acts as lever arm Provides cranial and rotational stability to the stifle |
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What holds the patella in the femoral trochlea
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Lateral Fascia Lata
Medial Femoral Fascia Med/Lat Retinaculum |
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What percentage of patellar luxations are medial
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75-80%
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What percentage of patellar luxations are bilateral? also have CCL rupture?
|
Bilateral- 25%
CCL concurrently- 15-20% |
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How are the distal femur, proximal tibia, and distal tibia affected by luxating patella
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Distal femur- lateral bowing
Proximal tibia- medial bowing Distal tibia- lateral torsion |
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T/F: Some grades of patellar luxation are non-wt bearing
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False
Even grade 4 usually bears wt |
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What Grade of luxation can be luxated, but manipulation of limb puts it back
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2
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What kind of lameness do you see w/ Grade 3 luxation
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Occasional skipping to weight bearing lameness
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What view is best for visualization of the femoral trochlea
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sky-line
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What are the DDx for patellar luxation
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Hip things- LCP, coxofemoral luxation, HD
CCL rupture Ligamentous/Muscle strain |
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Who is conservative management of luxation appropriate for
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Grade 1-2
Likely, older, asymptomatic patients |
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Where does the patellar ligament insert
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Tibial crest
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How can you affix the tibial crest after you have transposed it in a TTT
|
K wires
Tension Band |
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What is done more often: sulcoplasty or recessions
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Recessions
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Why is sulcoplasty less than ideal for luxation remedy
|
You are counting on scar tissue/fibrocartilage to fill in your created articular cartilage/subchondral bone defect (which is not as resilient as articular cartilage)
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Who is chondroplasty appropriate for
|
Those <5mths old
Elevate cartilage, remove subchondral bone, and then lay cartilage back down |
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What is the advantage of block recession, as compared to wedge
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Greater resistance to luxation when stifle in extension (takes out more surface area of trochlear notch)
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Which side is retinacular release done on
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The side of the luxation (i.e. medial for medial luxation)
Incise into fascia +/- jt capsule |
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Which side is retinacular imbrication done on
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The side opposite of the luxation (i.e. lateral side for medial luxation)
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What is the post-op care for patellar luxation sx
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MRJ bandage for 1-2 days
NSAIDs Hot/Cold compresses 5-7d Restricted exercise 1mth PT/Rehab for 1st 6wks Rads at 6-8wks |
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How do you deal w/ over/under correction for patellar luxation
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May need to redo sx, if still clinical
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How often does wound dehiscence occur in cases of patellar luxation
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Not often
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What is the px after sx for patellar luxation
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Good for grades 0-3
Guarded for grade 4 |
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Can animals affected w/ luxated patellas be bred
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Should not be
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What is the basic abnormality in patellar luxation
|
Biomechanical
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When can you deepen the trochlear groove w/o realigning the quads
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Never
It WILL fail ST techniques alone will NOT prevent reluxation |
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Why can CCL rupture be a sequela to patellar luxation
|
Loss of cranial stability of stifle makes it more likely
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What is the most common cause of abdominal trauma
|
HBC
Animal bite is second most common |
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Is free abdominal air an emergency
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Yes (unless had recent sx, and then it is harder to tell)
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Do you need sedation for DPL
|
Yes
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What might you see on abd fluid cytology if there is a ruptured hollow viscous organ
|
I/C bacteria
Vegetative material |
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Is uroabdomen a surgical emergency
|
No
Use aggressive fluids to diurese and lower K+ |
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When might a patient develop signs of biliary rupture
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May not be until 4-6 weeks after rupture
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When is biliary rupture an emergency
|
If there is bacteria
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What is the only reason you should take a hemoabdomen to surgery
|
Unable to stabilize despite aggressive management
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When is a ruptured hollow viscous an emergency
|
Always
Could cause sepsis |
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Where do most abd wall hernias occur
|
Caudal abdomen
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What is the most frequent penetrating wound
|
Gunshot
Mandatory exploration, unless in chest |
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Who is conservative therapy for (abd trauma)
|
Hemoabdomen
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Who should you stabilize, and then go to sx with (abd)
|
Uroabdomen
Hernias |
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Who is emergency sx indicated for (abd)
|
Ruptured hollow viscous
Non-responsive to medical mgmt |
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What are the 3 fxns of the CCL
|
Limits cranial translation of tibia w/ respect to femur
Prevents hyperextension of stifle jt Limits internal rotation of tibia (does not eliminate, but limits) |
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Why is it impt to test the CCL in extension and flexion
|
If caudolateral still intact, you might not get drawer in extension
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What are the 3 reasons for doing sx for CCL rupture
|
Remove damaged/abnormal tissues since ends can incite inflammation
Stabilize for periarticular fibrosis or provide fxnl stability Retard/Prevent SEVERE DJD |
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What movement of the stifle occurs in the X direction? Y direction?
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X- flexion/extension
Y- axial rotation |
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Why must you test for drawer as you tighten Lateral Retinacular Stabilization suture
|
If too tight, you will have leg stuck in flexion
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How does a TPLO work
|
Neutralizes tibiofemoral shear forces
Corrects slope so thrust does not occur |
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T/F: With TPLO, TWO, and TTA you may still have drawer after sx
|
True
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What side do you do the arthrotomy on for TPLO
|
Medial (will plate on the medial side of the tibia)
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What are 2 advantages of TWO over TPLO
|
Less equipment needed
Avoids working near joint |
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What is the goal of a TTA
|
Change angle of patellar ligament to be perpendicular to tibial plateau
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What angle should rads be taken at for TTA
|
135 degrees
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Which procedure for CCL do you need to use bone graft
|
TTA
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What are some problems assoc'd w/ Lateral Suture for CCL
|
Draining tract b/c non-absorbable suture
Wire-breakage (don't use any wire or anything braided) Instability |
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T/F: The Cd CL is fixed in the same ways
|
False
Usually just fix whatever else is wrong w/ the joint |
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What parts can be used for intracapsular reconstruction of CCL
|
Part of patellar ligament OR fascia lata
|
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T/F: Suture used for CCL Lateral Suture eventually disappears
|
True
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Which meniscus is more commonly damaged? Why?
|
Caudal pole of medial meniscus
Lateral meniscus is attached to the femur, so it moves w/ it |
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Where are most injuries w/in the medial meniscus
|
Within the inner 75% (where there is no blood supply)
|
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What percent of CCL dogs will rupture the other side w/in 2yrs
|
30-40%
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Are rads needed for intracapsular methods
|
No
Only for the osteotomies, and are done at 6-8wks post-op |
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What percentage of CCL dogs improve after sx
|
85-90%
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When would you elect to perform a complete or partial meniscectomy
|
When the meniscus is damaged
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What is the minumum O2 tension needed for wound healing
|
30mmHg
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What is the best adjunct we can do to help w/ wound healing
|
Debridement, in the form of hydrotherapy (10-15psi)
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How can you achieve 10-15psi
|
16G needle on 20mL syringe
|
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T/F: Hydrotherapy must be done under general anesthesia or at least heavy sedation
|
True
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What is the simplest mechanical adjunct we can use to get a wound to heal
|
Undermining to take advantage of viscoelastic properties of the skin
|
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What is stress-relaxation
|
Reduced force that is eventually needed to hold skin closed over time and maintain stretched collagen
|
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What is mechanical creep
|
Ability of skin to expand past its normal inherent elasticity
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What is the most impt skin layer to preserve in sx
|
Subdermal plexus (has tenuous blood supply)
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How does externally stretching the skin help
|
Displaces fluid around collagen to get collagen to rearrange longitudinally to tension
If done right, wound can close in 3 days! |
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What are 2 advantages to external skin stretching
|
Can keep observing the wound to make sure it is healthy
Decreases tension |
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When can external skin stretching be employed
|
Pre and Post Op
|
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When is Ioban Banding done
|
Post-op
Relieves tension and protects wound |
|
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What are some complications w/ the button method of stretching skin
|
If one suture pulls out, the whole line fails
Contamination Old/Thick, unhealthy, or infected skin does not hold sutures well |
|
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What sort of suture do you use for skin stretching w/ button
|
Non-absorbable
|
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What is the maximum tension of a sure closure device (SCD)
|
2.5kg
|
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How quickly can a 15cm wound be closed w/ DermaClose RC
|
24hrs
|
|
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What is DermaClose RC
|
Equipment that uses tension controller and tension wire to sense when then skin has relaxed enough for it to tighten further (via clutch) to bring edges closer together
|
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T/F: Vacuum Assisted Closure can be used on big wounds
|
True
|
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What is the purpose of the open-cell polyurethane ether foam in VAC
|
Allows maximal tissue ingrowth, and stimulates granulation tissue
|
|
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How far should the cover foam adhesive drape extend
|
5cm overlap into healthy tissue
|
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What are the C/I for VAC
|
Untreated osteomyelitis
Malignancy in the wound Over exposed BVs/organs Non-enteric and unexplored fistula Necrotic tissue w/ eschar F OMEN |
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How often should the VAC dressing be changed in a clean wound? contaminated?
|
Clean- q 48hrs w/ sedation
Contam- q24hrs and do 2nd debridement |
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What are the advantages of VAC
|
Controlled, closed wound now
Removes edema to increase vasc/lymph flow Increased proteolytic enzyme release Increased bacterial clearance Increased granulation tissue (mechanical stress/creep) Early wound prep Fewer dressing changes Bolster for skin grafts in difficult areas Increases survival of random flaps |
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T/F: Facial n. paraysis may resolve after sx
|
False
|
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Which compartment of the feline bulla do you enter
|
Ventromedial
|
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Where is the vestibular apparatus in regards to the bullae
|
Dorsomedial
|
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Where does the facial nerve exit
|
Stylomastoid foramen
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What artery supplies the pinna
|
Cd Auricular Artery
|
|
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What are the sensory and motor nerves to the ear
|
Sensory- Vagus
Motor- Facial |
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|
What ear procedure whould always be done w/ TECA? Why?
|
Lateral bulla osteotomy
Removes rest of epithelial lining |
|
|
Why are lateral ear canal resections done
|
To change the microenvironment of ear
Will still have to clean ears |
|
|
What part of the ear is used as the drain board for lateral ear canal resection
|
Part of vertical canal
|
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T/F: Lateral ear canal resection can be used a prophylactic sx in young
|
True
|
|
|
What are the indications for lateral ear canal resection
|
Chronic otitis externa (uncomplicated)
Polyp, etc. confined to vertical Minimal hyperplasia |
|
|
What are the C/I for lateral ear canal resection
|
End stage otitis externa
Stenosis of horizontal canal |
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What do you do if there is incisional dehiscence of a lateral ear canal resection sx
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Do not redo sx
Culture and give Abx Manage as open wound |
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What are some complications of lateral ear canal resection
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Continued otitis
Stenosis Incisional dehiscence-25% |
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What are the indications for TECA
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Chronic otitis
Calcified ear canal Neoplasia Trauma/Avulsion at annular cartilage |
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When should the ear be bx'd in TECA
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ALWAYS
send the entire ear Do C&S for Abx |
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What is the most impt technical aspect of the TECA
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Stay close to the cartilage
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How should the horizontal canal be transected in TECA
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Caudal to cranial to avoid cutting facial nerve
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What level is the annular cartilage at
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The level of the stylomastoid foramen
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What structures do you need to protect when doing a bulla osteotomy
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Use freer elevators to protect:
Facial nerve caudally Retroarticular v. cranially |
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What direction do you need to avoid while curetting in bulla osteotomy
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Don't go dorsomedial (semi-circular canals)
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When should you place a drain in TECA
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Only if abscess
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Why is it so impt to remember to lube the eyes after TECA
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All patients will have some facial n. palsy w/ palpebral n. fxn diminished
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What is the #1 complication of TECA
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Facial nerve palsy (lip droop, absent palpebral)
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What are #2 and #3 complications of TECA
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Incisional dehiscence
Inner ear damage |
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What do you do if there is a fistulous tract from a previous TECA
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Do VENTRAL bulla osteotomy
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How often is Horner's permanent in cats after TECA
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14%
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Who do ear polyps occur in, mostly
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Young cats (<2)
If mid-old age, more likely tumor |
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Where are most polyps
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In tympanic cavity
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What are the best views for evaluating bulla
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Open mouth rostro-caudal
Lateral |
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What is the recurrence rate for polyps if do traction avulsion
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50%
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What is the only definitive cure for polyps
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Ventral bulla osteotomy (recurrence <2%)
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What nerve should you be very careful to avoid when doing ventral bulla osteotomy
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Hypoglossal
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Why is CT/MRI impt in cases of suspected ear neoplasia
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To see if invaded through horizontal/vertical canal
Correlates w/ survival time |
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When should ear masses be bx'd
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Always
Unilateral dz suggests neoplasia possible |
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What is Bowen's dz
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Multicentric SCC
not related to UV Excision is curative Occurs on haired, pigmented areas |
