Surgery Final Summaries

• Phases of wound healing

  1. Inflammation

  2. Proliferation

  3. Remodeling/maturation
• Inflammation


  • Stops bleeding
  • Causes vasodilation & redness/swelling
  • Initiates healing cascade
  • Removes debris
• Macrophages


  Involved in inflammation phase (days 0-4)
• Proliferation


  1. Restores blood flow

  2. Replaces lost tissue

  3. Achieves wound closure
• Proliferation


  • Characterized by angiogenesis and granulation tissue (days 4-12)
• Remodeling/maturation


  1. Replaces type 3 collagen with type 1

  2. Increases strength of tissue
• Contraction


  Yields full thickness skin with hair and glands, but can cause contracture and impair function
• Epithelialization


  Better for high tension areas, but skin is fragile and non-haired, slow (1mm/day)
• Factors that influence wound healing


  • Wound
  • Patient
  • Owner
• Steps of Wound Management

  1. Triage

  2. Clip

  3. Lavage/Cleanse

  4. Debridement

  5. Decide

  6. Dress

  7. Close
• Water soluble lubricant


  Used while clipping
• Lavage


  With 8psi isotonic crystalloids
• Cleanse


  With chlorhexidine gluconate 0.05% or Povidone Iodine 0.1% (PERIWOUND ONLY)
• Primary Closure


  First intention healing, immediately closed after management
• Delayed Primary


  Closure within 3-5 days before granulation tissue is present
• Second Intention Healing


  Contracture and epithelialization
• Secondary Closure


  Closure after establishment of granulation tissue (>5 days)
• Wound Classifications


  • Clean
  • Clean Contaminated
  • Contaminated
  • Dirty
• Dressing a Wound


  • Primary for contact
  • Secondary for absorption
  • Tertiary for protection and securing
• Passive Drains


  Rely on gravity and should be covered with bandage
• Active Drains


  Rely on suction and should be enclosed in the wound
• Drain removal


  When there is serosanguinous discharge with a decrease/plateau of output
• Factors for Skin Reconstruction


  • Wound
  • Patient
  • Owner
• Undermining


  Frees tissue so it can cover more area, dissect under the Panniculus Carnosus m.
• Techniques for closing large wounds with tension


  • Walking sutures
  • Pretensioning
  • Stents
  • FNNF/FFNN
  • Mesh expansion
• Simple Relaxing


  Only indicated in areas of high contamination like the anus
• Thoracodorsal Axial Pattern Flap


  Base at the point of shoulder used to cover thorax, axilla, shoulder and forelimb, supplied by the cutaneous branch of the Thoracodorsal artery
• Caudal Superficial Epigastric Axial Flap


  Base of the flap is caudal to the 5th mammae, used to cover the caudal abdomen, flank, prepuce and hindlimb
• Tumor behavior can influence case management, based on degree of local invasion/margin, metastatic potential and biological activity
• FNA

  Always FNA any masses, good screening test for Mast Cell Tumor, Melanoma, Lymphoma
• Biopsy


  Should consider risk of invasiveness of procedure, hemorrhage, or seeding of tumor cells
• Incisional biopsy


  Requires a second procedure to remove, expands margins for second surgery, do not take from the center as it may be necrotic
• Tru-Cut Biopsy


  Requires sedation and a local block
• Punch Biopsy


  Good for superficial lesions, not deep lesions
• Excisional Biopsy


  Removal of tumor and surrounding margins to submit for testing, risk of inadequate surgical margins
• The ideal biopsy should provide enough tissue for pathologist to make a diagnosis, not jeopardize the patient's well being, and not hinder future surgeries
• The First surgery provides the best chance for cure
• Wide and Radical margins are ideal, always change gloves and instruments prior to closure, primary closure is ideal
• Radical resection


  Removal of the entire affected tissue, i.e. amputation or removal of entire mammary chain
• Marginal Resection


  Dissection to the pseudocapsule, only successful with Lipomas