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58 Cards in this Set

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What should be included in the pre-operative workup for an ovariohysterectomy?
-Check history
-Physical examination (check for signs of estrus; if present expect increased vascularity)
-Blood work
What is the definition of a clean wound?
-Non-traumatic surgical wound
-No breaks in aseptic technique
e.g. castration or spay
What is the definition of a clean-contaminated wound?
-Surgery on respiratory, GI, U/G tracts without major spillage
-Minor break in aseptic technique
-spay where touch something non-sterile
What is the definition of a contaminated wound?
Gross spillage from viscous organ
Open wound < 6 hours old
Major break in aseptic technique
-Colon open up and spills
What is the definition of a dirty wound?
-Abscess, infected tissues encountered
-Open wound > 6 hours old
-already infected!
Do most surgeons give peri-operative antibiotics for ovariohysterectomies? What type of wound classification is this?
Technically clean-contaminated, but due to short anesthetic time and low level of tissue trauma by experienced DVMs, most people do not administer antibiotics
-can give a single dose of cefazolin 20-30 minutes prior to skin incision under certain circumstances: prolonged anesthetic time, excessive tissue trauma, pyometra, C-section
What area should you drape off for an ovariohysterectomy?
Drape for disaster: xyphoid to pubis (in case of dropped pedicle etc)
Where do you make the ventral midline incision when performing an ovariohysterectomy on a dog? cats?
Divide distance from umbilicus to pubis into thirds, dog= middle third, extend as needed; cats: cranial third, extend as needed
What is an alternative approach for the primary incision of an ovariohysterectomy?
Flank incision
-Wildlife, humane society etc.
Where are the uterine horns located in reference to the bladder, descending duodenum and descending colon?
-Dorsal to bladder
-Lateral to descending duodenum
-Lateral to descending colon
What do you do during an ovariohysterectomy after identifying the uterine horn?
Break down the suspensory ligament using digital pressure until ovary can be exposed adequately
-stabilize ovary by grabbing the proper ligament of the ovary either with a hemostat or your fingers
What do you do after breaking down the suspensory ligament and exposing the ovary during an ovariohysterectomy?
Fenestrate a hole in the mesovarium, essentially creating a linear tract from uterine horn to proper ligament to ovary to ovarian vascular pedicle
Why is it important to make sure that one tine from each hemostat enters the fenestration in the mesovarium during the 3 clamp technique of an ovariohysterectomy?
To ensure the linear tract is fully occluded by each hemostat
***Why is it really important to lot leave even the smallest fragment of ovarian tissue when performing an ovariohysterectomy?
Even the smallest fragment can re-implant in the body (SQ space, mesentery etc) and PRODUCE ANDROGENS----> ovarian remnant ---> stump pyometra
What should you do right after you remove the reproductive tract from the body during an ovariohysterectomy?
Visually inspect the ovaries to ensure complete removal
What type of ligatures do you want to use to tie off the vascular pedicle during an ovariohysterectomy?
-more proximal (closest to body) is the encircling ligature
-Transfixation ligature more distal to encircling ligature
What do you do after ligating both vascular pedicles when performing an ovariohysterectomy? What is the caution during this step?
Break down (or ligate if vascular) mesometrium to the level of the uterine body
-CAUTION: this is where accidental ureteral ligation can occur!!!
After fenesterating the mesometrium you should palpate the cervix and make sure to transect the uterine body cranial to the _______.
Cervix
How should the uterine body be ligated during an ovariohysterectomy in a smaller patient?
Encircling ligature distally and a transfixation ligature b/w the encircling and the planned site of transection
How should the uterine body be ligated during an ovariohysterectomy of a larger patient?
May require an encircling ligature distally and individual transfixations of each uterine artery and vein (on each side)
How should you pull the first uterine horn to find the second one?
Caudolateral
What are 3 possible intra-operative complications of an ovariohysterectomy?
1) Hemorrhage
2) Broken ovary
3) Torn uterus
How do we finding a bleeding right ovarian pedicle? Where do we look?
Look caudal to the kidney
-find the duodenum and pull it to midline to allow visualization
How do we finding a bleeding left ovarian pedicle? Where do we look?
Grab descending colon and pull it to midline
What are 6 post-operative potential complications of an ovariohysterectomy?
1) Hemorrhage
2) Dehiscence of body wall closure--> hernia and/or evisceration
3) Incisional bruising and/or seroma formation
4) Ovarian remnant syndrome--> pyometra
5) Incisional infection from self trauma (e-collar!)
6) Peritonitis (rare, but only bc most people pay close attention to sterile technique)
True or false. Ovariectomy provides a functional "spay" since it removes the ovarian tissue.
True
Where are the long term urogenital differences b/w an ovariectomy and ovariohysterectomy?
No significant differences
How does the procedure of an OVH vary from an OVE?
OVH is technically more complicated, time consuming and is probably associated w/ greater morbidity (longer incision, more intraop trauma, increased discomfort)
How does the technique of an OVE vary from an OVH?
Ligation and division occurs caudal to the ovary at the level of the proper ligament of the ovary instead of carrying the dissection caudally to the level of the uterine body
How can you perform a C-section and preserve the breeding status of an animal?
Via a hysterotomy (consult w/ owners pre-op)
What is different from a standard OVH when performing an en bloc ovariohysterectomy (OVH during C-section)?
-place hemostats and transect at each pedicle, but wait to come back and ligate the vessels once the reproductive track is out
-Hand off entire reproductive tract to an assistant +/- resuscitate puppies while the surgeon concentrates on quickly but carefully completing the procedure
What should you do before performing a hysterotomy and why?
Pack hysterotomy site w/ moistened lab sponges to minimize contamination from uterine contents
Where do you make your incision into the uterus for a hysterotomy?
Incise into the uterine bifurcation, extend towards a uterine horn if needed
Should you remove the placenta during a hysterotomy?
Gentle traction on fetus & placenta- only remove placenta if freely detaches
-clamp umbilicus and pass puppy
How do you close up a hysterotomy? Why is it important to be really accurate?
Two layer closure: care to be accurate bc decreases adhesion/stricture, potentially increased risk for dystocia in future pregnancies due to fibrosis at hysterotomy site
How do you correct a pyometra?
Similar to ovariohysterectomy, but tissues are more friable
What is different about the primary incision for correcting a pyometra? Why?
Consider longer incision to reduce amount of traction needed to expose the reproductive tract
What should you do before transecting the uterus when correcting a pyometra?
Pack off with moistened lap sponges prior to transection to minimize contamination
What should you do after removing the reproductive tract when correcting a pyometra?
Submit repro tract for histopathology and aerobic/anaerobic bacterial culture and sensitivity
What is the most common bacteria that is isolated from a repro tract with a pyometra?
E. coli
-usually susceptible to ampicillin or cephalexin
What is the primary indication for a mastectomy?
Mammary neoplasia
What is the risk of mammary neoplasia if the dog has an OVH before their first estrus? After first estrus, but prior to second (through 1 heat)? After second estrus?
Before 1st: 0.5%
After 1st: 8%
After 2nd: 26%!
If an OVH is performed after the second estrus the relative risk can still be reduced to ~40% if the female is spayed before _______ years.
2.5 years
What is the ratio of malignant : benign for canine mammary masses? Feline?
Dogs: 50/50
Cats: 80/20 (malignant/benign)
-behavior depends on histologic type
Are lumpectomies usually performed on dogs or cats? Why?
Lumpectomy aka an excisional biopsy is more often performed in dogs since about half of mammary masses are benign
What is the goal of the incision when performing a lumpectomy?
To have skin incision no larger than the original mass, in case a follow up surgery is needed and you have to take tissue around the surgical scar
- If surgical scar is larger than original mass and a more regressive resection is indicated based on histopath, now you have to plan
What do you need to do to maintain aseptic technique when removing multiple mammary masses?
Change gloves and instruments in b/w masses in case one comes back as malignant and other were benign then you have not accidently inoculated malignant neoplastic cells into another site
What is the goal with a regional mastectomy?
AKA wide excision: goal is to obtain a margin of grossly normal tissue around the mass of concern
How wide your margin is with a regional mastectomy depends on what?
the expected biologic behavior of the tumor
-Rule of thumb is take 3 cm
What is the general rule of thumb for which mammary glands drain to which lymph node?
-Glands 1 and 2 drain to the axillary lymph node
-Glands 4 and 5 drain to the inguinal lymph node
-Gland 3 may drain to either lymph node
When is a cranial regional mastectomy performed?
When a mass is affecting glands 1,2, or 3
When is a caudal regional mastectomy performed?
When a mass if affecting glands 3,4, or 5
What is the "deep" tissue margin of a mastectomy?
Usually at the level of the external fascial sheath of the external abdominal oblique, but in some cases invasion into the body wall by the tumor necessitates body wall resection (partial or full thickness)
What are the two types of radical chain mastectomy that can be performed?
Unilateral or bilateral
What are 2 ways to perform a bilateral radical chain mastectomy?
-Single session
-Staged
What are the advantages and disadvantages of performing a bilateral radical chain mastectomy in a single session?
-High tension, more concern for dehiscence
-Only one surgery and may be cheaper (unless dehiscence occurs)
How do you perform a staged radical chain mastectomy?
Perform a unilateral radical mastectomy then at ~2-4 weeks post-op perform the contralateral side after allowing the skin to have healed and stretched
What are 5 potential post-operative complications of a mastectomy?
1) Dehiscence
2) Incisional infection
3) tumor regrowth/ spread
4) Hemorrhage (inguinal canal and associated genitofemoral a. and v.)
5) Hematoma/ seroma