Veterinary Surgery: Small Animal Expert Consult, 2-Volume Set, 2nd Edition

Description

Focus on the "how" and "why" of medical/surgical conditions - the critical issues that lead to successful outcomes for your patients - with Veterinary Surgery: Small Animal Expert Consult, 2nd Edition. Expert Consult website offers access to the entire text online, plus references linked to original abstracts on PubMed.Comprehensive coverage?includes surgical biology, surgical methods and perioperative care, neurosurgery, and orthopedics in Volume One, and all soft tissue surgery organized by body system in Volume Two.Extensive references to published studies?available on Expert Consult show the factual basis for the material.Strong blend of clinical and basic science information?facilitates a clear understanding of clinical issues surrounding operative situations. Highly recognized contributing authors create chapters from their own experience and knowledge base, providing the most authoritative, current information available.Coverage of anatomy, physiology, and pathophysiology in chapters on specific organs?includes information critical to operative procedures and patient management.In-depth chapters on anesthesia, surgical oncology, tumors of the spine, and musculoskeletal neoplasia provide valuable resources for practicing surgeons, especially in the area of cancer treatment. Preoperative considerations and surgical implications for surgical procedures help surgeons make decisions about treatment approaches.NEW and UPDATED! Expert Consult website with print text plus complete online access to the book's contents, so you can use it anytime - anywhere.EXPANDED! Coverage of interventional radiology techniques in Volume Two (soft tissue volume) to provide cutting-edge information on contemporary imaging modalities that gain access to different structures of the patient's body for diagnostic and therapeutic reasons.NEW and UPDATED! Expanded coverage of coaptation devices and small animal prosthetics clearly explains how they are used in a variety of clinical situations. EXPANDED! Principles of minimally invasive plate treatment added to Volume One (orthopedic volume) to show how these advancements maximize healing and protect the patient while meeting the surgeon's goals in using fracture fixation. 9780323320498 v1 Front Cover IFC_expert consult ad Veterinary Surgery Copyright Page Contributors Dedication Preface Table Of Contents I Surgical Biology 1 Inflammatory Response Acute Inflammation The Acute Vascular Response Cellular Components Inflammatory Stimuli Alarm Signals: Pathogen-Associated Molecular Patterns and Danger-Associated Molecular Patterns Pattern Recognition Receptors Mediators of Inflammation Vasoactive Amines Cytokines Lipid/Cell Membrane–Derived Mediators Reactive Oxygen Species Gaseous Mediators Acute Phase Proteins Mediators and Outcomes of Inflammation Resolution Systemic Inflammation Multiple Organ Failure Immunosuppression Chronic Inflammation References References 2 Molecular and Cellular Biology Genetics Genes Gene Identification Gene Structure Control of Gene Expression Epigenetics Genomics Genetic Mutations Gene Linkage Studies of Association Genomic Estimated Breeding Values Molecular Cloning Transcriptomics RNA Silencing Proteomics Metabolomics Bioinformatics Systems Biology Applications of Molecular Biology to Small-Animal Surgery Pathogenesis Pharmacogenomics Gene Therapy Therapeutic Antibodies References References 3 Stem Cells and Regenerative Medicine Basic Developmental Hierarchy of Stem Cells Mesencymal Stem Cells Common Cell Sources and Delivery Methods Limitations and Concerns Regarding Mesenchymal Stem Cell Therapy in Small-Animal Practice Evidence to Support a Role for Mesenchymal Stem Cell or Stromal Vascular Fraction Cells in Small-Animal Surgical Practice Canine Studies Feline Studies Conclusions and Future Directions Acknowledgments References References 4 Platelet-Rich Plasma and Autologous Conditioned Sera Platelet-Rich Plasma Background and Definitions Theory and Potential Applications of Platelet-Rich Plasma in Small-Animal Practice Blood Sampling and Preparation of Platelet-Rich Plasma Current Limitations of Platelet-Rich Plasma in Small-Animal Practice Existing Canine Studies Autologous Conditioned Sera Theory and Potential Applications of Autologous Conditioned Sera in Small-Animal Practice Literature Supporting a Role for Autologous Conditioned Sera in the Management of Osteoarthritis Summary References References 5 Fluid Therapy Body Fluid Compartments and Rehydration Versus Resuscitation Perioperative Fluid Therapy Fluid Types and Uses Isotonic Crystalloids Hypotonic Solutions Hypertonic Solutions Synthetic Colloid Solutions Hypertonic Saline/Colloid Solutions Hemoglobin-Based Oxygen-Carrying Fluids Blood Products Blood Types Blood Storage and Administration Electrolytes Sodium Potassium Calcium Magnesium Chloride Glucose Acid-Base Homeostasis The Hydrogen Ion and pH Law of Mass Action and the Henderson-Hasselbalch Equation Regulation of Acid-Base Balance Total Carbon Dioxide Content Base Excess Anion Gap Primary Acid-Base Disturbances Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis Mixed Acid-Base Disturbances Interpretation of Blood Gas Values Venous Blood Gas Analysis Nontraditional Approach to Acid-Base Disturbances References References 6 Shock Pathophysiology of Impaired Oxygen Delivery and Oxygen Uptake Oxygen Delivery Determinants of Oxygen Delivery Oxygen Uptake Oxygen Extraction Ratio DO2/VO2 Curve Cellular Response to Hypoxia and Lactate Physiological Response to Shock Inflammatory and Hemostatic Response to Shock Diagnosis and Monitoring Systems Treatment Distributive Shock and Sepsis Pathophysiology Diagnosis of Sepsis Treatment of Septic Shock Septic Shock in Cats References References 7 Bleeding and Hemostasis Hemostasis and Fibrinolysis Primary Hemostasis Secondary Hemostasis Regulation of Hemostasis Fibrinolysis Hemostatic Testing Platelet Enumeration and Estimation Buccal Mucosal Bleeding Time Platelet Function Testing Prothrombin Time and Activated Partial Thromboplastin Time Activated Clotting Time Fibrin Split Products D-Dimers Fibrinogen Viscoelastic Testing: Thromboelastography and Rotational Thromboelastometry Bleeding Causes of Surgical Bleeding Preoperative Hemostatic Assessment Operative and Postoperative Bleeding Specific Disorders Thromboembolism Thrombotic Tendency Postoperative Thromboembolism Diagnosis of Venous Thromboembolism Management Disseminated Intravascular Coagulation Etiopathogenesis Diagnosis Management References References 8 Metabolism and Nutritional Needs of Surgical Patients Malnutrition Uncomplicated Starvation and Stressed Starvation Nutritional Status and Goals of Nutritional Support Nutrition and the Surgical Period Nontraumatized Surgical Patients Traumatized Surgical Patients Nutrition in the Postsurgical and Rehabilitative Phase Essential Nutritional Factors Water Energy Fat Carbohydrates Protein Determining Route of and Providing Nutritional Support References References 9 Wound Healing Components of Wound Healing Phases of Wound Healing Inflammatory Phase Proliferative Phase Maturation Phase Healing of Specific Tissues Gastrointestinal Healing Fascial Healing Urinary Bladder Healing Bone Healing Species and Gender Differences in Healing Impaired Wound Healing Local Factors Systemic Factors References References 10 Wound Infections and Antimicrobial Use Defining Surgical Site Infections Incidence and Impact Risk Factors Duration of Surgery Duration of Anesthesia Surgical Site Preparation Method of Wound Closure Antimicrobial Prophylaxis Comorbidities Pathogens Perioperative Antimicrobial Prophylaxis Postoperative Antimicrobials Management of Surgical Site Infections Specimen Collection and Testing Antimicrobial Therapy References References II Surgical Methods and Perioperative Care 11 Sterilization Cleaning of Surgical Instruments and Materials Manual Cleaning of Surgical Instruments Mechanical Cleaning of Surgical Instruments Wrapping Materials Types of Sterilization Liquid Chemical Germicides (Cold Sterilization) Steam Sterilization Ethylene Oxide Sterilization Ozone Sterilization Plasma Sterilization Vaporized Hydrogen Peroxide Sterilization by Radiation Other Sterilization Methods Cleaning and Sterilization of Endoscopes Indicators of Sterilization Storage of Sterilized Materials References References 12 Instrumentation Surgical Instruments Cutting Instruments Periosteal Elevators Bone-Cutting Instruments Grasping Instruments Retractors Suction Tips Miscellaneous Instruments Microsurgical Instruments Instrument Care Instrument Problem Solving References References 13 The Operating Room The Operating Room Team Roles of the Operating Room Team Surgical Skill Training Surgical Etiquette Operating Room Etiquette Operating Room Principles of Conduct Standard Operating Procedures Operating Room Briefing and Debriefing Operating Room Traffic Flow Communication in the Operating Room Operating Room Design, Infrastructure, and Table Setup Operating Room Functional Features Preparation of the Patient and Personnel General Principles of Surgical Asepsis Antiseptics and Disinfectants Preparation of the Surgical Patient Preparation of the Sterile Personnel Operating Room Apparel Other Apparel References References 14 Monitoring for Surgical Infection Surveillance as Part of the Infection Control Program Ongoing Systematic Analysis Interpretation Communication Goals of Surveillance Development of a Practical Surgical Site Infection Surveillance Program Passive Surveillance Active Surveillance Syndromic Surveillance Definitions Personnel Costs of Surveillance Surgical Site Infection Surveillance as Part of an Overall Infection Control Program Comparing Surgical Site Infection Rates Surgical Site Infection Cluster Investigation Conclusions References References 15 Principles and Use of Energy Sources in Small Animal Surgery Introduction Definitions and Principles of Electromagnetic Energy Tissue Effects of Electromagnetic Energy Types of Electrosurgical Devices Monopolar Electrosurgery Bipolar Electrosurgery Considerations for Use of Electrosurgical Devices During Minimally Invasive Surgery Advanced Electrosurgical Devices Bipolar Vessel Sealing Systems: LigaSure and EnSeal Ultrasonic Energy Systems: Harmonic System Comparison Lasers Physics of Lasers Laser–Tissue Interactions Laser Types and Applications General Safety Considerations Toxic Smoke Production Fire Hazard Ocular Hazards Other Hazards References References 16 Suture Material, Tissue Staplers, Ligation Devices, and Closure Methods Suture Needles Suture General Suture Morphology Suture Coating Absorbable Suture Common Types of Absorbable Suture Rapidly Absorbed Synthetic Suture Common Slowly Absorbed Synthetic Sutures Common Nonabsorbable Sutures (Table 16.3) Surgical Mesh Surgical Technique Staples Skin Staples Vascular Clips Linear Stapling Devices Circular Stapling Devices Adhesives Cyanoacrylate References References 17 Instrument and Tissue Handling Techniques Instrument Handling Use of Cutting Instruments Scalpel Scissors Other Cutting Instruments Use of Grasping Instruments Needle Holders Forceps Crushing-Type Tissue Forceps Noncrushing-Type Tissue Forceps Hemostatic Forceps Thumb Forceps Microsurgical Forceps Towel Clamps Use of Retractors Self-Retaining Retractors Hand-Held Retractors Suction Use Tissue Dissection and Manipulation Suturing Interrupted Patterns Continuous Patterns Knot Tying Ligation Techniques Conclusion References References 18 Surgical Hemostasis Hemostatic Agents Blood Flow Reduction Topical Hemostatic Agents Antifibrinolytics Miscellaneous Products References References 19 Bandages and Drains Bandages Contact (Primary) Layer Guidelines for Circumferential Layers Intermediate (Secondary) Layer Outer (Tertiary) Layer Pressure Relief Anchoring the Bandage Protecting the Bandage Changing the Bandage Costs Drains Mechanisms of Drainage Drain Placement and Removal Potential Complications of Drains References References 20 Biopsy General Principles Biopsy Methods Needle-Core Biopsy Punch Biopsy Incisional Biopsy Excisional Biopsy Endoscopic Biopsies Specific Tissues Skin/Subcutaneous Tissues Lymph Nodes Thyroid Abdominal Organs Thoracic Biopsies Bone Tissue Processing References References 21 Anesthesia Principles and Monitoring Anesthesia Principles and Monitoring Anesthetic Drug Delivery Anesthetic Circuits Rebreathing System Nonrebreathing Systems Endotracheal Tubes Fresh Gas Anesthesia Ventilators Anesthetic Monitoring Equipment Anesthetic Drugs Opioids Tranquilizers Drugs Used for Anesthetic Induction Other Induction Agents Inhalant Anesthesia Local Anesthetics Neuromuscular Blockade Anticholinergic Agents Nonsteroidal Antiinflammatory Drugs Pressors and Inotropes References References 22 Anesthesia Practice for Existing Conditions Anesthetic Practice Patient Assessment Designing an Anesthetic Protocol Anesthesia of Pets With Preexisting Conditions Anesthesia for Animals With Cardiac Disease Anesthesia for Animals With Endocrine Disease Respiratory Disease in Small-Animal Patients Hepatic Disease Renal Disease Pertinent Physiology and Pathophysiology Neurologic Disease Sepsis Pathophysiology Aggression Pathophysiology Anesthetic Concerns Anesthesia for Specific Procedures Laparoscopy Cesarean Section Neonatal Patients Orthopedic Procedures Dental Procedures Total Ear Canal Ablation Ophthalmologic Procedures Laser Surgery Anesthetic Complications Hypothermia Hypoxemia Hypotension Hypercarbia/Hypercapnia Malignant Hyperthermia Cardiac Arrest Tracheal Tears Gastroesophageal Reflux Postoperative Care References References 23 Fundamentals of Interventional Radiology and Interventional Endoscopy Interventional Radiology/Interventional Endoscopy Equipment Imaging: Fluoroscopy Imaging: Rigid Telescopes Imaging: Flexible Endoscopes Interventional Radiology/Interventional Endoscopy Instruments Access Guide Wires Introducer Sheaths Selective Catheters Balloons Drainage Catheters Stents Embolics Thrombolytics/Thrombectomy Devices Laser Lithotripters Contrast Agents Miscellaneous Devices References References 24 Fundamentals of Laparoscopy and Thoracoscopy Equipment Minimally Invasive Operating Rooms Imaging: Cameras Trocars and Cannulas Surgical Instruments Achieving Hemostasis/Vessel Sealing Devices Miscellaneous Instruments Suction Irrigation Devices Specimen Retrieval Bags Morcellators Endoscopic Staplers Principles of Access Principles of Abdominal Access Principles of Thoracic Access One-Lung Ventilation References References 25 Introduction to Oncologic Surgery for the General Surgeon The Origin and Progression of Cancer Cell Biology: Cell Division, Cell Cycle, and Cell Death Initiation, Promotion, Progression to Malignant Phenotype, and Carcinogenesis Heritable Carcinogenesis Biologic Carcinogenesis Physical Carcinogenesis Ultraviolet Light Ionizing Radiation Oncogenes Tumor Suppressor Genes Tumor Progression: Healthy, Dysplasia, Carcinoma In Situ, Localized Cancer, Regional Spread, and Disseminated Limitless Replicative Potential Apoptosis Patterns of Local Behavior and Metastasis The Cancer Stem Cell Hypothesis Client Education and Communication Surgical Limits Patient Assessment and Staging Fine Needle Aspiration and Cytology Approach to Biopsy Imaging Distant Metastasis Staging Patient Approach Perioperative Management Anesthetic Management Surgical Preparation Surgical Principles History Margins of Excision Management of the Regional Lymph Node Intraoperative Considerations Tumor Margins—Concepts Multimodal Management Adjunctive Radiation Therapy Adjunctive Chemotherapy Basic Mechanisms of Cell Kill Timing Commonly Used Chemotherapeutic Agents for Surgical Diseases Toxicity: Timing and Effects on Continuation of Therapy Immunotherapy Miscellaneous Agents Resistance Follow-Up Evaluation References References III Neurosurgery 26 Neurologic Examination and Neuroanatomic Diagnosis The Neurologic Examination Sensorium and Behavior Posture and Gait Postural Reactions Spinal Reflexes, Muscle Mass, and Muscle Tone Cranial Nerves Sensory Evaluation Neuroanatomic Diagnosis Spinal Cord References References 27 Neurodiagnostics Anatomy of the Motor Unit Classification of Neuromuscular Disorders Clinical Signs of Neuromuscular Disorders Diagnosis of Neuromuscular Disorders Minimum Database for Neuromuscular Disease Molecular Diagnosis of Inherited Neuromuscular Diseases Specific Diagnostic Procedures for Neuromuscular Diseases Muscle and Nerve Biopsy Examination References References 28 Imaging of the Neurologic System Advantages and Limitations of Neuroimaging Modalities Radiography Tomography: Computed Tomography and Magnetic Resonance Imaging Ultrasonography and Scintigraphy Fundamentals of Computed Tomography and Magnetic Resonance Imaging Computed Tomography Magnetic Resonance Imaging Contrast Enhancement and Contrast Agents for Computed Tomography and Magnetic Resonance Imaging Interpretation of Computed Tomography and Magnetic Resonance Images Brain Vertebral Column and Spinal Cord References References 29 Pathogenesis and Physiology of Central Nervous System Disease and Injury Background Anatomy44 Physiology Lesion Pathogenesis Contusion Compression Inflammatory Diseases Congenital Malformations/Degenerative Disorders Metabolic/Toxic Diseases Neoplasia The Problem of Edema in the Central Nervous System Intervertebral Disc Disease Consequences of Tissue Destruction for Central Nervous System Organization Neuron and Axon Loss Glial Damage Structural Alteration Recovery After Injury to the Central Nervous System Synaptic Plasticity Collateral Sprouting and Synaptogenesis References References 30 Medical Conditions of the Vertebral Column and Spinal Cord Classification of Disorders of the Vertebral Column and Spinal Cord Historical Information Neurologic Examination Overview of Diagnostics for Disorders of the Vertebral Column and Spinal Cord Cerebrospinal Fluid Analysis Microbial Culture Serologic Testing and Polymerase Chain Reaction Imaging (Myelography, Computed Tomography, and Magnetic Resonance Imaging) Differential Diagnosis for Disorders of the Vertebral Column and Spinal Cord Specific Disorders Meningomyelitis Idiopathic Meningomyelitis Infectious Meningomyelitis Viral Meningomyelitis Vascular Disorders Fibrocartilaginous Embolic Myelopathy Treatment and Prognosis Summary References References 31 Cervical Vertebral Column and Spinal Cord Clinical Signs and Neurologic Examination of Animals With Cervical Spinal Cord Disease Voluntary Movement Spinal Reflexes Muscle Tone Muscle Atrophy Sensory Dysfunction Neck Pain Horner Syndrome Incontinence Differential Diagnosis of Cervical Spinal Cord Disease Diagnostic Approach to Cervical Spinal Cord Disease Surgical Approaches to the Cervical Vertebral Column Ventral Approach to the Cervical Vertebral Column Ventral Approach to the Atlantoaxial Articulation Lateral Approach to the Cervical Vertebral Column Dorsal Approach to the Cervical Vertebral Column Lateral Approach to the Brachial Plexus Atlantoaxial Instability Anatomy Clinical Signs Specific Diagnosis Conservative Treatment Indications for Surgery Specific Surgical Techniques Surgical Complications Postoperative Care Prognosis/Outcome Brachial Plexus Trauma Anatomy Epidemiology and Pathophysiology Clinical Signs Specific Diagnosis Specific Surgical Techniques Surgical Complications Postoperative Care Prognosis/Outcome Intervertebral Disc Disease Anatomy Epidemiology and Pathophysiology Clinical Signs Specific Diagnosis Conservative Treatment Indications for Surgery Specific Surgical Techniques Complications Prognosis/Outcome Cervical Spondylomyelopathy Anatomy Epidemiology and Pathophysiology Clinical Signs Specific Diagnosis Additional Diagnostics for Presurgical Evaluation Treatment Indications and General Considerations for Surgery Disc-Associated Cervical Spondylomyelopathy Osseous Compression Pure Ligamentous Compressions Surgical Techniques Inverted Cone Technique Dorsal Laminectomy Cervical Hemilaminectomy Indirect Decompression—Vertebral Distraction Techniques Distraction-Stabilization Using Metal Implants and Polymethylmethacrylate Screw Bar–Polymethylmethacrylate Distraction Using the Polymethylmethacrylate Plug Locking Plate Alternative Distraction Techniques Motion-Preserving Techniques Complications Postoperative Care Prognosis/Outcome Extradural Synovial Cysts Anatomy Epidemiology and Pathophysiology Specific Diagnosis Indications for Surgery Specific Surgical Techniques Surgical Complications Postoperative Care Prognosis/Outcome References References 32 Thoracolumbar Vertebral Column Thoracolumbar Vertebral Column Anatomy Approaches to the Thoracolumbar Vertebral Column Dorsal Approach to the Cranial Thoracic Vertebral Column Dorsal Approach to the Thoracolumbar Vertebral Column Lateral Approach to the Thoracolumbar Vertebral Column Dorsolateral Approach to the Thoracolumbar Vertebral Column Approaches to the Thoracolumbar Spinal Cord Hemilaminectomy Dorsal Laminectomy Thoracolumbar Vertebral Column Imaging Traditional Imaging Modalities Radiography Myelography Cross-Sectional Imaging Modalities Computed Tomography Magnetic Resonance Imaging Cerebrospinal Fluid Analysis Thoracolumbar Intervertebral Disc Herniation Medical Management Emerging Medical Therapy for Spinal Cord Injury in Dogs With Thoracolumbar Intervertebral Disc Herniation Surgical Management Outcomes After Surgical Treatment of Thoracolumbar Intervertebral Disc Herniation Other Factors Associated With Outcome in Dogs With Surgically Treated Disc Herniation Electrophysiology, Ultrasonography, and Biomarkers Other Considerations Related to Surgical Technique Recurrence Alternatives to Fenestration for Prophylaxis Feline Thoracolumbar Intervertebral Disc Herniation Postoperative Management Urinary Bladder Voiding Disability Functional Neuroanatomy of the Urinary System Urinary Bladder Evacuation Urinary Tract Infection Additional Considerations for Postoperative Care Management of the Case of “Surgical Failure” Conclusions and Future Directions Thoracolumbar Intervertebral Disc Disease Miscellaneous Vertebral Column and Spinal Cord Conditions Congenital/Developmental Malformations Hemivertebra, Block Vertebra, and Butterfly Vertebra Spina Bifida Pilonidal Sinus (Dermoid Sinus) Epidermoid Cyst Subarachnoid Diverticula Myelodysplasia (Dysraphism) References References 33 Degenerative Lumbosacral Stenosis Anatomy of the Lumbosacral Articulation and Cauda Equina Pathophysiology of Degenerative Lumbosacral Stenosis Patient Signalment and Clinical Signs of Degenerative Lumbosacral Stenosis Differential Diagnosis of Degenerative Lumbosacral Stenosis Diagnosis of Degenerative Lumbosacral Stenosis Electrophysiologic Testing Radiographic Imaging Studies Cross-Sectional Imaging Techniques Medical Treatment of Degenerative Lumbosacral Stenosis Surgical Treatment of Degenerative Lumbosacral Stenosis Dorsal Laminectomy Foraminotomy Distraction and Fixation Outcome and Prognosis References References 34 Vertebral Fractures, Luxations, and Subluxations Assessment and Diagnosis Trauma Assessment and Stabilization Neurologic Examination Imaging Biomechanical Considerations Fracture Biomechanics Treatment Medical Nonsurgical Surgical Postoperative Care Complications Prognosis References References 35 Cranial Surgery Introduction Intracranial Physiology Primary and Secondary Brain Injury Preoperative Considerations Patient Evaluation Anesthetic Considerations Management of Intracranial Hypertension Patient Positioning Presurgical Imaging Operative Considerations Surgical Instrumentation Cranial Surgical Techniques Surgical Approaches and Relevant Surgical Anatomy Complications Postoperative Considerations Postoperative Imaging Monitoring Animals in the Postoperative Period Specific Surgical Indications Brain Biopsy Brain Neoplasms Brain Trauma Congenital Anomalies Ventriculoperitoneal Shunt Placement References References 36 Anesthesia for Intracranial Surgery Physiology Monro-Kellie Doctrine Cerebral Perfusion Pressure Intracranial Pressure Cerebral Blood Flow Cerebral Metabolic Rate for Oxygen Cushing Response Glycemia Pharmacology in Neuroanesthesia Intravenous Agents Inhalant Agents Anesthesia Management for Neurosurgery General Preoperative Management References References 37 Neoplasms of the Vertebrae and Spinal Cord Signalment Age Breed/Sex Clinical Signs Diagnosis Neoplasm Location Diagnostic Testing Treatment Surgical Therapy Radiation Therapy Chemotherapy Symptomatic Care Specific Neoplasm Types Extradural Neoplasms Intradural/Extramedullary Neoplasms Intramedullary Neoplasms References References IV Musculoskeletal System 38 Tissues of the Musculoskeletal System General Organizational Features of Connective Tissues General Features of the Musculoskeletal System Components of the Extracellular Matrix Collagen Proteoglycans Elastin and Elastic Fibers Other Components of the Extracellular Matrix Composition and Properties of Specific Connective Tissues Bone Cartilage Tendons, Ligaments, and Entheses Skeletal Muscle References References 39 Bone Biomechanics and Fracture Biology Biomechanical Concepts and Application Basic Concepts Force (Box 39.1) Moments Stress Strain Stress/Strain and Load/Deformation Analysis Bone Structure and Mechanical Properties of Bone Structural Hierarchy of Bone Bone Surfaces/Envelopes Bone Formation During Skeletal Development Intramembranous Ossification Endochondral Ossification Bone Modeling Fracture Biomechanics Fracture Biology Strain Theory and Bone Healing Primary Bone Healing (Direct Bone Healing) Secondary Bone Healing (Indirect Bone Healing) Special Environments in Bone Healing Acknowledgments Glossary References References 40 Open Fractures Fracture Classification Wound Treatment Antimicrobial Therapy Initial Surgical Debridement Definitive Surgical Treatment Soft Tissue Treatment Fracture Treatment Complications References References 41 Internal Fracture Fixation Fracture Reduction Planning Open Anatomic Reconstruction Biological Osteosynthesis Implant Selection Orthopedic Wire Pins Interlocking Nails Designs Equipment Biomechanics Biology Guidelines for Appropriate Selection of Interlocking Nails and Preoperative Considerations General Technique and Instrumentation Interlocking Nail for the Treatment of Long Bone Fractures in Small Animals Explanation of Interlocking Nails Results of Clinical Studies Complications Screws and Plates Screws Plates Principles of Locking Plates and Screws Biomechanics of Fixed-Angle Implants Description of Locking Implants Clinical Application Bone Plating Plate-Rod References References 42 External Skeletal Fixation Introduction Implants Linear External Skeletal Fixation Circular External Skeletal Fixation Hybrid External Skeletal Fixation Transarticular External Skeletal Fixation Guidelines and Techniques of Application Fracture Reduction Soft Tissue Safe Corridors Pin Position Pin Number and Configuration Preservation of the Pin-Bone Interface Postoperative Care, Healing, and Removal Specific Clinical Applications Long Bone Fractures Mandible/Maxilla Vertebral Column Bone Defects Complications Soft Tissue Injury Pin Tract Infection Construct Complications References References 43 Overview of Minimally Invasive Osteosynthesis Principles Historical Perspective Preoperative Planning in Minimally Invasive Osteosynthesis Surgical Techniques in Minimally Invasive Osteosynthesis Operative Room Setup Patient Positioning Surgical Approaches Reduction Maneuvers Dedicated Instrumentation in Minimally Invasive Osteosynthesis Intraoperative Fluoroscopy Reduction Tools Tunneler Biomechanical Concepts Applied to Minimally Invasive Osteosynthesis Outcome of Minimally Invasive Osteosynthesis Malalignment Joint Space Violation Neurovascular Injuries Delayed Union and Nonunion Implant Failure Conversion to Open Techniques Conclusion References References 44 Bandaging, External Coaptation, and External Devices for Companion Animals Introduction The Rationale for Bandaging Bandaging Options Decision Making Regarding Coaptation Orthoses Exoprostheses Patient Assessment and Measurements Casting or Scanning the Stump Exoprosthetic Fabrication Fitting and Training Initial Exoprosthetic Use Gait Training Daily Maintenance Repair Surgically Implanted Prostheses References References 45 Delayed Unions, Nonunions, and Malunions General Causes of Delayed Union, Nonunion, and Malunion Inadequate Mechanical Environment Inadequate Biologic Environment Delayed Unions Mechanical Causes of Delayed Union Biologic Causes of Delayed Union Treatment of Delayed Unions Nonunion Viable Nonunions—Identification and Treatment Nonviable Nonunions—Identification and Treatment Malunions Treatment of Malunions Other Methods for Treatment of Nonunion and Delayed Union Fractures Extracorporeal Shock Wave Therapy Pulsed Electromagnetic Field Low-Intensity Pulsed Ultrasonography References References 46 Principles of Angular Limb Deformity Correction Introduction Normal Limb Alignment and Joint Orientation Defining Frontal, Sagittal, and Transverse Planes Bone Axes Joint Orientation Angles The Center of Rotation of Angulation Method of Deformity Correction Planning Principles of Imaging Defining the Center of Rotation of Angulation The Transverse Bisecting Line Malalignment in the Frontal, Sagittal, and Transverse Planes Classification System of Angular Limb Deformities Deformity Types Based on Plane Concepts of Osteotomies The Angulation Correction Axis Paley’s Rules of Osteotomies Straight-Cut or Linear Osteotomies Circular Cut Osteotomies Methods of Fixation Bone Plates and Screws External Skeletal Fixation References References 47 Osteomyelitis and Implant-Associated Infections Introduction Etiology Pathogenesis Posttraumatic Osteomyelitis Hematogenous Osteomyelitis Clinical Signs and Diagnosis Posttraumatic Osteomyelitis Hematogenous Osteomyelitis Treatment Posttraumatic Osteomyelitis Hematogenous Osteomyelitis Infected Joint Prostheses Prevention References References 48 Bone Grafts and Substitutes Mesenchymal Stem Cells Growth Factors Transforming Growth Factor-Beta Bone Morphogenetic Protein Fibroblast Growth Factor Insulin-Like Growth Factors Platelet-Derived Growth Factor Gene Therapy Clinical Application of Bone Graft Techniques Osteogenesis Osteoinduction Osteoconduction Osteopromotion Autogenous Cancellous Bone Grafts Healing of Autogenous Cancellous Bone Grafts Allograft-Based Bone Graft Substitutes Healing of Cortical Allografts Demineralized Bone Matrix Cell-Based Strategies for Bone Regeneration Bone Morphogenetic Proteins for Augmentation of Bone Regeneration Synthetic Materials for Bone Graft Substitutes Ceramics Calcium Phosphate Ceramics Coralline Bone Graft Substitutes Tricalcium Phosphate Biphasic Calcium Phosphate Nanocrystalline Calcium Phosphate Calcium Sulfate Hydrogels Acknowledgment References References 49 Scapula Fractures Scapular Body Fractures Fractures of the Acromion Scapular Neck Fractures Supraglenoid Tuberosity and Glenoid Fractures Scapular Luxation/Avulsion Ununited Accessory Ossification Center of the Caudal Glenoid References References 50 The Shoulder Anatomy Biomechanical Physiology Diagnosis of Shoulder Disorders Physical Examination Arthrocentesis Radiography Cross-Sectional Imaging Salvage Procedures of the Shoulder Excision Arthroplasty Arthrodesis Conditions Affecting the Bones of the Shoulder Osteochondritis Dissecans Glenoid Dysplasia Multiple Epiphyseal Dysplasia Focal Humeral Head Dysplasia Hypertrophic Osteodystrophy Incomplete Ossification of the Caudal Glenoid Chondrocalcinosis Conditions Affecting the Soft Tissues of the Shoulder Biceps Brachii Tendinopathy Other Conditions Affecting the Tendon of Origin of the Biceps Brachii Muscle Supraspinatus Tendinopathy Shoulder Joint Instability/Subluxation Traumatic Luxation Muscle Disorders Other Conditions References References 51 Fractures of the Humerus Anatomy Fractures of the Humerus in the Dog and Cat Proximal Region of the Humerus Distal Region of the Humerus Fractures of the Humeral Condyle Prognosis and Aftercare Following Repair of a Fractured Humerus References References 52 Surgical Diseases of the Elbow Anatomy Skeletal Anatomy Neuromuscular Anatomy Joint Capsule and Ligamentous Support Functional Anatomy Surgical Anatomy Traumatic Luxation of the Elbow Joint Pertinent Anatomy Pathophysiology Diagnosis Treatment Prognosis and Complications Congenital Luxation of the Elbow Joint Type I: Humeroradial Luxation Type II: Humeroulnar Type III: Humeroulnar and Humeroradial Developmental Elbow Disease Ununited Anconeal Process Flexor Enthesopathy Medial Compartment Disease Acknowledgment References References 53 Total Elbow Replacement in Dogs Introduction: History of Total Elbow Replacement Current Systems: Design Rationale and Evolution Indications/Contraindications Preoperative Evaluation Surgical Techniques Iowa State System TATE Elbow System BANC Partial Elbow Replacement System Postoperative Evaluation and Management Clinical Outcome: Complications Iowa State System TATE Elbow System BANC Partial Elbow Replacement System Limitations of Total Elbow Replacement References References 54 Radius and Ulna Anatomy and Development Anatomy Growth and Development Bone Alignment and Breed Conformation Pathologic Conditions Juvenile Conditions Adult Conditions References References 55 Carpus, Metacarpus, and Digits Anatomy Carpal Bones Carpal Joints and Ligaments Metacarpal Bones and Joints and Sesamoid Bones Phalanges, Phalangeal Joints, and Associated Ligaments Specific Anatomic Differences in the Cat Function Kinematics of the Distal Thoracic Limb Mechanisms of Antebrachiocarpal and Metacarpophalangeal Injuries Carpal Fractures Intermedioradial Carpal Bone Fractures Accessory Carpal Bone Fractures Ulnar Carpal and Numbered Carpal Bone Fractures Fractures—Distal Limb Metacarpal and Metatarsal Fractures Digit Fractures and Luxations Sesamoid Diseases Ligamentous and Shearing Injuries Palmar Ligaments and Palmar Fibrocartilage Radial/Ulnar Collateral Ligaments Shearing Injuries Flexor Tendon Lacerations Arthrodesis of the Carpus Pancarpal Arthrodesis Partial Carpal Arthrodesis Carpal Luxation Nontraumatic Distal Thoracic Limb Conditions Metacarpophalangeal Osteoarthritis Carpal Laxity Syndrome Digit Masses Digit Amputation Paw Pad Corns Avascular Necrosis of the Carpal Bones References References 56 Fractures of the Pelvis Fractures of the Ilium Acetabular Fractures Combined Iliac and Acetabular Fractures Sacroiliac Luxation Sacral Fracture Fractures of the Ischium and Pubis Postoperative Care References References 57 Hip Luxation Anatomy Etiology and Pathophysiology Diagnosis Treatment Closed Reduction and Stabilization Open Reduction and Stabilization Postoperative Care Outcome References References 58 Pathogenesis, Diagnosis, and Control of Canine Hip Dysplasia Etiology and Pathogenesis Hip Development Biomechanics Genetics Joint Laxity Joint Fluid Pelvic Muscle Mass Hormonal Factors Weight and Growth Nutrition Environmental Factors Other Causes Proposed Pathogenesis of Hip Dysplasia Signalment and History Physical Examination Imaging Examination Radiography Palpation Ultrasonography Computed Tomography and Magnetic Resonance Imaging Kinematic and Force Plate Studies Controling Canine Hip Dysplasia Phenotypic Hip Screening Methods Genetic Change: The Importance of Heritability and Selection Pressure Nonsurgical Management of Canine Hip Dysplasia References References 59 Surgical Management of Hip Dysplasia Considering the Surgical Options Juvenile Pubic Symphysiodesis Anatomy Rationale for Juvenile Pubic Symphysiodesis Patient Selection and Efficacy Procedure Complications Pelvic Osteotomy Patient Selection Surgical Procedure Complications of Pelvic Osteotomy Total Hip Arthroplasty History Implant Materials Methods of Fixation Kinematics Indications and Contraindications Preoperative Planning Surgical Procedure Outcomes and Complications Radiographic Assessment Femoral Head and Neck Excision Indications Surgical Procedure Postoperative Care Complications Hip Denervation Indications Surgical Procedure Pectineus Myectomy References References 60 Fractures of the Femur Introduction Fracture Classification Surgical Planning Imaging of the Femur Surgical Approaches to the Femur Proximal Region of the Femur Surgical Anatomy Growth of the Proximal Region of the Femur Approaches to the Proximal Region of the Femur Stabilization of Fractures of the Proximal Region of the Femur Minimally Invasive Repair of Fractures of the Proximal Region Postoperative Considerations Femoral Diaphysis Surgical Anatomy Growth of the Femoral Diaphysis Approaches to the Femoral Diaphysis Fractures of the Femoral Diaphysis Implant Selection for Repair of Fractures of the Femoral Diaphysis Minimally Invasive Fracture Repair of the Femoral Diaphysis Postoperative Considerations Distal Region of the Femur Surgical Anatomy Growth of the Distal Region of the Femur Approaches to the Distal Region of the Femur Fractures of the Distal Region of the Femur Postoperative Considerations References References 61 Stifle Joint Anatomy, Structure, and Function Bones of the Stifle Joint Sesamoid Bones of the Stifle Joint Articulations of the Stifle Joint Ligaments of the Stifle Joint Meniscus Kinematics of the Normal Stifle Joint Meniscal Function Effect of Meniscal Release on Meniscal Function Kinetics and Kinematics of the Cranial Cruciate Ligament–Deficient Stifle Joint Theoretical Models of Stifle Joint Stability and Instability Cranial Cruciate Ligament Disease Avulsion of the Cranial Cruciate Ligament Acute Traumatic Rupture of the Cranial Cruciate Ligament Progressive Degeneration of the Cranial Cruciate Ligament Physical Examination Radiographic Evaluation Stifle Joint Arthroscopy Noninvasive Imaging Meniscal Injury, Examination, and Treatment Epidemiology, Etiology, and Pathogenesis Diagnosis Radiographic Evaluation Advanced Imaging Surgical Evaluation Classification of Meniscal Tears Surgical Technique and Meniscal Evaluation Principles of Meniscectomy Exposure and Portals Resection of Unstable Fragments Meniscal Rim After Partial Meniscectomy Probe Importance of the Peripheral Rim Instrumentation for Meniscectomy Techniques for Meniscal Resection Types of Meniscectomy Meniscal Release Technique Central (Midbody) Meniscal Release Caudal Meniscal Release Clinical Outcome and Decision Making for Meniscal Treatment Extracapsular Stabilization Lateral Fabellotibial Suture Fibular Head Transposition Intra-Articular Reconstruction Autograft Versus Allograft Xenograft Autograft Techniques (Bone–Patellar Tendon–Bone Versus Hamstring Tendon) Synthetic Grafts Graft Position/Fixation Surgical Technique in the Dog Summary Osteotomy Procedures Cranial Tibial Closing Wedge Osteotomy Tibial Plateau Leveling Osteotomy Tibial Plateau Leveling Osteotomy/Cranial Closing Wedge Ostectomy Tibial Tuberosity Advancement Triple Tibial Osteotomy Caudal Cruciate Ligament Rupture Patellar Luxation Medial Patellar Luxation in Small-Breed Dogs Medial Patellar Luxation in Large-Breed Dogs Lateral Patellar Luxation in Dogs Stifle Joint Luxation and Collateral Ligament Injuries Patellar Fracture and Patellar Ligament Injuries Stifle Osteochondrosis Avulsion and Luxation of the Tendon of Origin of the Long Digital Extensor Muscle Avulsion of the Origin of the Gastrocnemius Muscle References References 62 Total Knee Replacement in the Dog Introduction Design Considerations Case Selection for Total Knee Replacement Indications for Total Knee Replacement Contraindications for Total Knee Replacement Preoperative Evaluation Physical Examination Radiographic Evaluation Operative Procedure Postoperative Care Clinical Results After Total Knee Replacement Intraoperative Complications of Total Knee Replacement Postoperative Complications of Total Knee Replacement Conclusion References References 63 Fractures of the Tibia and Fibula Anatomy Developmental Anatomy Anatomy of Mature Dogs and Cats Fracture Epidemiology Fractures of the Proximal Region Fractures of the Diaphysis Fractures of the Distal Region Preoperative Management Open Fractures Diagnostic Procedures Fractures of the Proximal Region of the Tibia Immature Animals Mature Animals Fractures of the Diaphysis Repair Options Immature Animals Mature Animals Fractures of the Distal Region of the Tibia Immature Animals Mature Animals Complications External Skeletal Fixation Plate Fixation Tibial Deformity Pes Varus and Pes Valgus Acknowledgment References References 64 Tarsus and Metatarsus Anatomy General Individual Bones Articulations Ligamentous Support Innervation and Vascular Supply Clinical Evaluation of the Tarsus Diagnostic Imaging of the Tarsus Fractures of the Individual Tarsal Bones Fractures of the Talus Fractures of the Calcaneus Fracture of the Central Tarsal Bone Fracture Dislocation of the Central Tarsal Bone Second, Third, and Fourth Tarsal Bone Fractures Fractures of the Metatarsal Bones Tarsal Luxations and Subluxations Luxation or Subluxation of the Tarsocrural Joint Shearing Injuries Luxation or Subluxation of the Proximal Intertarsal Joint Due to Plantar Instability Subluxation of the Proximal Intertarsal Joint Due to Dorsal Instability Tarsometatarsal Subluxation and Luxation Deformity of the Tarsus External Metatarsal Rotation Tendon Problems Disruption of the Common Calcanean Tendon Arthrodesis Techniques in the Tarsus Arthrodesis of the Tarsocrural Joint/Pantarsal Arthrodesis Partial Tarsal Arthrodesis Arthrodesis of the Tarsometatarsal Joints References References 65 Amputations Introduction Surgical Techniques General Principles and Considerations Postoperative Care Outcome and Complications Partial Limb Amputation Partial Foot Amputation Tail Amputation Cranial Tail Amputation Caudal Tail Amputation References References 66 Dentistry for the Surgeon Oral Examination History and Clinical Signs Extraoral Examination Intraoral Examination Dental Formula in Dogs and Cats Dental Radiography Equipment Obtaining Radiographs Processing Dental Films Interpreting Radiographs Local and Regional Anesthesia Local Anesthetics Specific Nerve Blocks Periodontal Disease Periodontal Therapy Gingival Surgery Home Oral Hygiene Endodontic Disease Etiopathogenesis Clinical Signs and Diagnosis Endodontic, Restorative, and Prosthodontic Treatment Tooth Resorption Replacement and Inflammatory Resorption Clinical Signs and Diagnosis Treatment Stomatitis Clinical Signs and Diagnosis Treatment Tooth Extraction Extraction Instruments Mechanics Closed Extraction Open Extraction Jaw Fractures Maxillomandibular Fixation Circumferential Wiring Interdental Wiring and Intraoral Splinting References References 67 Mandibular and Maxillofacial Fractures Anatomic and Biologic Considerations Bone Healing Teeth in the Fracture Line Soft Tissue Considerations Periodontal Disease and Mandibular and Maxillofacial Fractures Biomechanics Mandible Maxillofacial Skeleton Teeth Occlusion General Anesthesia Endotracheal Intubation Surgical Positioning Surgical Approach Mandible Maxillofacial Skeleton Zygomatic Arch/Orbit Sequence of Repair Fixation Techniques Intraosseous Wire External Skeletal Fixator Plate Postoperative Care Complications Intraosseous Wire External Skeletal Fixator Plate Summary References References 68 Arthritis Introduction and Classification of Arthritis “Noninflammatory” Types of Arthritis Osteoarthritis Inflammatory Types of Arthritis Immune-Mediated Polyarthritis Infective Arthritis References References 69 Miscellaneous Orthopedic Conditions Constitutional Bone and Cartilage Diseases Osteochondrodysplasias Dysostoses Pediatric Bone Diseases Hypertrophic Osteodystrophy Panosteitis Craniomandibular Osteopathy Retained Ulnar Cartilaginous Core Legg-Calvé-Perthes Disease Slipped Capital Femoral Epiphysis Multiple Cartilaginous Exostoses Swimmer Syndrome Puppy Carpal Laxity Syndrome Metabolic Bone Diseases Adult Bone Diseases Hypertrophic Osteopathy Disseminated Idiopathic Skeletal Hyperostosis Bone Cyst Miscellaneous Orthopedic Diseases Acute Caudal Myopathy Iliopsoas Muscle Injury References References 70 Muscle and Tendon Disorders Disorders of Muscle Traumatic Disorders of Muscle Muscle Injury and Healing Diagnosis and Incidence General Principles of Treatment Surgical Management Specific Muscle Problems Muscle Injuries in the Thoracic Limb Rupture of the Long Head of the Triceps Brachii Muscle Avulsion of the Triceps Brachii Tendon of Insertion Rupture of the Serratus Ventralis Muscle Muscle Injuries in the Pelvic Limb Rupture of the Gracilis Muscle Iliopsoas and Pectineus Muscle Strain Muscle Contracture and Fibrotic Myopathy Infraspinatus Muscle Quadriceps Femoris Muscle Gracilis and Semitendinosus Muscle Flexor Carpi Ulnaris Muscle Myositis Ossificans Disorders of Tendons Tendon Healing General Principles of Tendon Repair Specific Tendon Problems References References 71 Arthroscopy Equipment Arthroscope Irrigation Egress Systems Hand Instruments Instrument Cannulas Joint Distractors Limb Positioners Power Hand Tools Electrosurgery and Radiofrequency Devices Other Basic Equipment Sterilization and Storage Basic Techniques of Small-Animal Arthroscopy Anesthesia and Analgesia Patient Preparation Draping Instrumentation of the Joint Fragment Removal Microfracture and Abrasion Arthroplasty Arthroscopic-Assisted Surgery Closure Recovery and Complications Arthroscopy of the Shoulder Joint Indications Equipment Patient Preparation and Positioning Instrumentation of the Shoulder Joint Surgical Anatomy Arthroscopy of the Elbow Joint Indications Equipment Patient Preparation and Positioning Instrumentation of the Elbow Joint Surgical Anatomy Arthroscopy of the Carpus Indications Equipment Patient Preparation and Positioning Instrumentation of the Antebrachiocarpal Joint Surgical Anatomy Arthroscopy of the Hip Joint Indications Equipment Patient Preparation and Positioning Instrumentation of the Hip Joint Surgical Anatomy Arthroscopy of the Stifle Joint Indications Equipment Patient Preparation and Positioning Instrumentation of the Stifle Joint Surgical Anatomy Arthroscopy of the Tarsus Indications Equipment Patient Preparation and Positioning Instrumentation of the Tarsocrural Joint Surgical Anatomy References References 72 Musculoskeletal Neoplasia and Limb-Sparing Surgery Osteosarcoma Diagnosis and Staging Surgical Treatment Chemotherapy Radiation Palliative Therapy Appendicular Chondrosarcoma in Dogs Appendicular Osteosarcoma in Cats Neoplasms of the Joint Neoplasms of Muscle Neoplasms of the Adipose Tissue Neoplasms of the Digits Neoplasms of the Digits in Cats References References 73 Osteochondrosis Definition and Classification Epidemiology Skeletal Development Overview Growth Plate Enlargement and Endochondral Ossification Epiphyseal Enlargement and Endochondral Ossification Etiology and Risk Factors Pathogenesis and Pathology Articular–Epiphyseal Cartilage Complex Growth Plate Cartilage Principles of Osteochondrosis Diagnosis Articular Osteochondrosis Growth Plate Osteochondrosis Principles of Osteochondrosis Prevention Principles of Osteochondrosis Treatment Nonsurgical Management Surgical Management Surgical Management of Articular Cartilage Defects Palliative and Reparative Techniques Restorative Techniques Summary References References 74 Gait Analysis Gait and the Gait Cycle Kinetic Gait Analysis Kinetic Gait Analysis Equipment Evaluation of Kinetic Gait Data and Methods Kinematic Gait Analysis Kinematic Gait Analysis Equipment Evaluation of Kinematic Gait Data and Methods Other Methods of Kinematic Gait Analysis Inverse Dynamics References References Index A B C D E F G H I J K L M N O P Q R S T U V W X Y Z 9780323320498 v2 Front Cover IFC_expert consult ad Veterinary Surgery Copyright Page Contributors Dedication Preface Table Of Contents V Skin and Reconstruction 75 Primary Wound Closure Skin Anatomy Skin Physiology Rate of Healing Wound Strength Species Differences Subcutaneous Tissues and Healing Skin Pathophysiology Tension Motion Self-Mutilation Patient Health Primary Wound Creation Scalpel Blade Electrocautery and Laser Hemostasis Patient Selection for Primary Wound Closure Patient Characteristics Wound Characteristics Primary Wound Closure Techniques Suture and Needle Selection Knot Security Suture Patterns Primary Wound Closure Challenges Dog Ears Step Defects Postoperative Care Wounds Pain Management References References 76 Open Wounds Pathophysiology Types of Wounds Abrasion Puncture Wound Laceration Degloving Injury Thermal Burn Decubital Ulcer Goals of Wound Management and Wound Classification Types of Wound Management Primary Wound Closure (First Intention Healing) Delayed Primary Wound Closure Secondary Wound Closure Healing by Contraction and Epithelialization (Second Intention Healing) Decision Making Immediate Wound Care Irrigation Solutions Antimicrobial Treatment Wound Protection Definitive Wound Care Wound Preparation Wound Debridement Moist Wound Healing Topical Antimicrobial Agents Bioscaffolds and Synthetic Matrix Dressings Chitosan Growth Factor–Containing Agents Negative-Pressure Wound Therapy References References 77 Tension-Relieving Techniques Tension, Shear, and Viscoelasticity Tension Shear Viscoelasticity Decision Making and Planning Preparation for Surgery Techniques for Relieving Tension Undermining Tension-Relieving Sutures Skin Stretching Techniques Incisional Negative-Pressure Wound Therapy Relaxing Incisions Closing Variously Shaped Wounds Crescent-Shaped Defects Triangular Defects Rectangular and Square Defects Circular Defects Dog Ears References References 78 Local or Subdermal Plexus Flaps Anatomy and Physiology Cutaneous Circulation Skin Elasticity Delay Phenomenon Growth Factors Important in Neovascularization Patient Preparation Guidelines for Flap Development Types of Subdermal Plexus Flaps Advancement Flap Rotation Flap Transposition Flap Interpolation Flap Plasty Distant Flaps Composite Flaps Examples of Subdermal Plexus Flaps Skin Fold Flaps Scrotal Flap Perivulvar Flap Preputial Reconstruction Phalangeal Fillet Labial Flaps Lip-to-Lid Flap Direct Distant Flaps Delayed Tube Flap Complications of Subdermal Plexus Flaps References References 79 Axial Pattern and Myocutaneous Flaps Anatomy Advantages and Disadvantages Species Differences General Considerations for Reconstructive Flaps Patient Preparation Flap Size Patient Positioning Recipient Bed Flap Development Surgical Closure Drains Postoperative Care Specific Axial Pattern Flaps Cervical Cutaneous Branch of the Omocervical Axial Pattern Flap Thoracodorsal Axial Pattern Flap Dorsal Deep Circumflex Iliac Axial Pattern Flap Ventral Deep Circumflex Iliac Axial Pattern Flap Caudal Superficial Epigastric Axial Pattern Flap Cranial Superficial Epigastric Axial Pattern Flap Angularis Oris Axial Pattern Flap Superficial Temporal Axial Pattern Flap Caudal Auricular Axial Pattern Flap Superficial Brachial Axial Pattern Flap Genicular Axial Pattern Flap Reverse Saphenous Conduit Flap Lateral Caudal Axial Pattern Flap Latissimus Dorsi Myocutaneous Flap Management of Necrotic Flaps Cause of Flap Necrosis Prevention of Flap Necrosis Monitoring Flaps Salvage of Failing Flaps References References 80 Skin Grafts General Considerations Classification Indications and Preoperative Considerations The Graft Donor Site Common Causes of Graft Failure Postoperative Considerations Surgical Principles Instrumentation The Graft Recipient Site The Process of Engraftment (Graft Take) Types of Grafts Split-Thickness Grafts Full-Thickness Mesh Grafts Split-Thickness Mesh Grafts Full-Thickness Unmeshed Grafts Pinch and Punch Island Grafts Strip Grafts Stamp Grafts Paw Pad Grafts Mucosal Grafts References References 81 Burns Burn Injuries Etiologic Classification of Burns Thermal Burns Pathophysiology: The Inflammatory Response Local Response to Thermal Burn Injury Systemic Response to Thermal Burn Injury Burn Treatment Initial First Aid for Burns Fluid Resuscitation of the Burn Patient Treatment of Inhalation Injury Treatment of Burn Pain Nutritional and Metabolic Management of Burn Patients Treatment of Local Burn Wounds Chemical Burns Electrical Burns Frostbite Treatment References References 82 Specific Disorders of the Skin and Subcutaneous Tissues Tumor Surgery of the Skin General Considerations Factors Affecting Wound Healing Tumor Staging and Patient Workup Lymphatic System Function Lymphatics Lymph Nodes Lymphadenectomy in Surgical Oncology Lymphangitis Lymphedema Neoplastic Skin Disorders Tumor Classification Papilloma Squamous Cell Carcinoma Basal Cell Tumors Sebaceous Gland Tumors Sweat Gland Tumors Perianal Hepatoid Gland Tumors Apocrine Gland Adenocarcinoma of the Anal Sac Hair Matrix Tumors Soft Tissue Sarcomas: Shared Characteristics Fibrosarcoma Perivascular Wall Tumors Peripheral Nerve Sheath Tumors Myxosarcoma (Myxofibrosarcoma) Feline Injection Site–Associated Sarcoma (Vaccine-Associated Sarcoma) Lipoma Infiltrative Lipoma Liposarcoma Hemangiosarcoma of the Skin Feline Fibropapilloma (Feline Sarcoid) Mammary Tumors Mast Cell Tumors Cutaneous Histiocytoma and Histiocytic Skin Disorders Extramedullary Plasmacytoma Cutaneous Lymphoma Transmissible Venereal Tumor Melanocytic Tumors Nail Bed (Subungual) and Digital Tumors Miscellaneous Skin Conditions Skin Fold Dermatitis Interdigital Pyoderma Pilonidal Sinuses Nasal Dermoid Sinus Cyst Acquired Sinus Tracts References References VI Abdomen 83 Spleen Anatomy Physiology Hematopoiesis Reservoir Function Immunologic Function Pathology Generalized Splenomegaly Localized Splenomegaly Diagnostic Imaging Techniques Radiography Ultrasonography Computed Tomography and Magnetic Resonance Imaging Diagnostic Sampling Perioperative Considerations Surgical Techniques Splenorrhaphy Partial Splenectomy Complete Splenectomy Surgical Conditions of the Spleen Splenic Trauma Splenic Torsion Splenic Neoplasia Benign Splenic Masses Postoperative Complications Hemorrhage Vascular Compromise Arrhythmias Systemic Inflammatory Derangement Gastric Dilatation Volvulus Infection Oxygen Transport References References 84 Abdominal Wall Reconstruction and Hernias Definitions, Classifications, and Hernia Components Anatomy of the Abdominal Wall Location of Abdominal Hernias Pathophysiology of Abdominal Hernias Space-Occupying Effects Incarceration Strangulation Principles of Abdominal Hernia Repair Surgical Conditions Ventral Abdominal Hernias Caudal Abdominal Hernias Traumatic and Incisional Hernias Reconstruction of Large Abdominal Wall Defects Preoperative Patient Assessment Surgery Autologous Versus Nonautologous Options Postoperative Management Complications General Hernia Repair Complications Prevention of Complications (Box 84.2) References References 85 Diaphragmatic Hernias Anatomy Embryology Physiology Surgical Approaches Hernias Traumatic Diaphragmatic Hernia Congenital Pleuroperitoneal Hernia Congenital Peritoneopericardial Hernia Diaphragmatic Eventration References References 86 Peritoneum and Retroperitoneum Embryology Anatomy Gross Anatomy Natural Openings Umbilicus and Linea Alba Transverse Fascia, Peritoneum, and Peritoneal Cavity Omentum Retroperitoneum Microscopic Anatomy Physiology Peritoneal Fluid Lymphatic Drainage Intraperitoneal Circulation Intraabdominal Pressure Healing of Peritoneal Injury Mesothelial Regeneration Adhesion Formation Adhesion Prevention Pathophysiology Peritoneal Defenses Inflammatory Response Omentum Ileus Reflex Rigidity Peritonitis Classifications Primary Peritonitis Secondary Peritonitis Aseptic Peritonitis Septic Peritonitis Other Peritoneal Disorders Penetrating Injuries Evisceration Urine Peritonitis Chylous Peritonitis Intraabdominal Abscesses Pneumoperitoneum Hemoperitoneum Retroperitoneal Diseases Sinus Tracts Mesothelioma Pathogenesis and Epidemiology Diagnosis, Treatment, and Prognosis References References VII Digestive System 87 Soft Tissues of the Oral Cavity Functional Anatomy and Physiology Lips and Cheeks Tongue Oropharynx Tonsils Physiology of Deglutition General Considerations Clinical Signs and Diagnostics Preoperative Preparation Disorders of the Lips and Cheeks Surgical Considerations Congenital Disorders Trauma Neoplastic Lesions Disorders of the Tongue Congenital Disorders Infectious Disorders Miscellaneous Conditions Trauma Neoplasia and Hyperplastic Lesions Disorders of the Oropharynx Dysphagia Penetrating Injuries to the Pharynx Disorders of the Tonsils Tonsillar Inflammation Tonsillar Neoplasia References References 88 Salivary Glands Anatomy Parotid Gland Zygomatic Gland Mandibular and Sublingual Salivary Gland Minor Salivary Glands Physiology Nonsurgical Salivary Gland Disease Sialadenosis Noninfectious Sialadenitis and Necrotizing Sialometaplasia Surgical Salivary Gland Disease Sialocele Sialoliths Salivary Gland Neoplasia Surgical Techniques Sublingual and Mandibular Sialadenectomy Zygomatic Sialadenectomy Parotid Sialadenectomy Ranula Marsupialization References References 89 Mandibulectomy and Maxillectomy Anatomy Mandible Maxilla Canine Oral Tumors Tumor Types and Biologic Behavior Preoperative Staging Surgery Postoperative Care Complications Cosmetic and Functional Results of Mandibulectomy and Maxillectomy Follow-Up and Prognosis Adjuvant Therapy Feline Oral Tumors Tumor Types and Biologic Behavior Preoperative Staging Surgical Technique Prognosis and Adjuvant Therapy Mandibular Regeneration and Immediate Reconstruction References References 90 Esophagus Anatomy Layers of the Esophageal Wall Esophageal Blood Supply and Innervation Physiology of Swallowing Esophageal Pathophysiology General Surgical Principles Surgical Approaches to the Esophagus Suture Materials and Techniques Surgical Techniques Esophagotomy Esophageal Resection and Anastomosis Esophageal Patching Esophageal Substitution Diseases of the Esophagus Vascular Ring Anomalies Congenital Generalized Megaesophagus Esophageal Duplication Cyst Esophageal Foreign Bodies Esophageal Lacerations Esophageal Thermal Injury Paraesophageal Abscess Esophageal Stricture Esophageal Diverticula Esophageal Fistulas Cricopharyngeal Dysphagia Esophageal Neoplasia References References 91 Stomach Anatomy Omentum Vasculature, Lymphatics, and Innervation of the Stomach Gastric Morphology and Glandular Organization Physiology Motility Healing Characteristics Presurgical Preparation Fasting Anesthetic Considerations Antimicrobials General Surgical Principles Approach Minimizing Contamination Lavage Gastric Closure General Surgical Techniques Gastric Biopsy Gastrotomy Partial Gastrectomy Gastropexy Pyloromyotomy and Pyloroplasty Gastroduodenal Anastomosis General Postoperative Considerations Specific Diseases Hiatal Hernia Gastroesophageal Intussusception Hypertrophic Pyloric Gastropathy Gastric Foreign Body Gastric Neoplasia and Infiltrative Disease Gastric Ulceration Gastric Perforation Gastric Dilatation Volvulus References References 92 Small Intestine Anatomy Physiology Intestinal Motility Digestion and Absorption General Principles Fluid Therapy Antibiotic Prophylaxis Choice of Surgical Approach Assessment of Intestinal Viability Choice of Suture Material for Enteric Closure Choice of Suture Pattern for Enteric Closure Suture Line Reinforcement Suture Line Leak Testing Surgical Procedures Intestinal Resection and Anastomosis Enterotomy and Intestinal Biopsy Enteroplication Postoperative Complications Septic Peritonitis Adhesions Short-Bowel Syndrome Ileus Surgical Diseases Intestinal Foreign Bodies Intestinal Incarceration and Strangulation Intestinal Pseudo-Obstruction and Ileus Infarction Intussusception Mesenteric Volvulus Trauma Intestinal Neoplasia Pythiosis Intestinal Ulcers Feline Gastrointestinal Eosinophilic Sclerosing Fibroplasia Congenital Malformations References References 93 Colon Anatomy Topographic Anatomy Vasculature, Lymphatics, and Nerves Microscopic Structure Physiology Electrolyte Transport Water Transport Secretion Short-Chain Fatty Acids Fecal Storage Immune System Healing of the Colon Stages of Wound Healing Factors That Negatively Affect Wound Healing Methods for Improving Colonic Wound Healing Techniques for Colonic Wound Closure Suture Closure Staplers Biofragmentable Anastomosis Ring Sutureless Closure Perioperative Considerations Diagnostic Techniques for Large Intestinal Disease Preoperative Preparation of the Colon Antibiotic Prophylaxis Postoperative Management Analgesia Dietary Manipulation Surgical Procedures and Complications General Principles Cecal Resection (Typhlectomy) Colotomy Colectomy Colostomy Combined Abdominal Transanal Pull-Through Colorectal Amputation Colopexy Laparoscopic Procedures Diseases of the Cecum Cecal Inversion Cecal Impaction Cecal Neoplasia Diseases of the Colon Megacolon Colonic and Cecocolic Volvulus Colonic Entrapment Colonic Neoplasia Colonic Duplication References References 94 Rectum, Anus, and Perineum Anatomy Rectum Anal Canal and Anus Anal Sacs Perineum Glands of the Anus and Perineum Specialized Muscles of the Rectum and the Anal Canal Innervation of the Rectum and Anus Patient Preparation and Antibiotic Therapy Emptying the Bowel Antimicrobial Agents Surgical Approaches to the Rectum Ventral Approach Dorsal Approach Lateral Approach Caudal Approach Aftercare Complications of Colorectal Resection Congenital Abnormalities of the Rectum and Anus Atresia Ani Rectovaginal and Urethrorectal Fistula Anogenital Clefts Anal and Rectal Prolapse Diagnosis Therapy Tumors of the Anus, Perineum, and Rectum Anal and Perianal Tumors Rectal Tumors Rectal Perforation Anorectal Strictures Surgical Options for Fecal Incontinence Anal Sac Abnormalities Nonneoplastic Disease of the Anal Sacs Anal Sac Neoplasia in Dogs Anal Sac Neoplasia in Cats Anal Sacculectomy Perianal Fistula Pathophysiology Diagnosis Medical Therapy Surgical Treatment Perineal Hernia Surgical Anatomy Etiology Clinical Signs Diagnosis Medical and Dietary Management Preoperative Preparation of Surgical Patients Surgical Treatment Uncommon Perineal Hernias Postoperative Care Complications Perineal Hernias in Cats References References 95 Liver and Biliary System Anatomy Lobes Attachments Blood Supply Biliary System Physiology Pathophysiology Regenerative Capacity After Hepatic Resection or Injury Traumatic Biliary Tract Rupture Extrahepatic Biliary Obstruction Bile Peritonitis Hepatobiliary Imaging Radiography Abdominal Ultrasonography Hepatobiliary Scintigraphy Computed Tomography and Magnetic Resonance Imaging Endoscopic Retrograde Cholangiopancreatography Preoperative Considerations for Hepatic Surgery Hemorrhage Hypoglycemia Anesthesia Bacteria Hemorrhage Control During Hepatic Surgery Capsular Hemorrhage Extensive Hemorrhage Hepatic Surgical Procedures Liver Biopsy Partial and Complete Hepatic Lobectomy Regional Tumor Management: Hepatic Embolization and Ablation Techniques Preoperative Considerations for Extrahepatic Biliary Tract Surgery Clinical Signs and Laboratory Testing Initial Patient Stabilization Antibiotic Administration EXTRAHEPATIC BILIARY TRACT SURGERY Decision Making in Extrahepatic Biliary Tract Surgery Choledochal Catheterization and Lavage Cholecystotomy Cholecystectomy Cholecystoenterostomy Choledochal Stenting Cholecystostomy Tube Choledochotomy Sphincter-Altering Procedures Specific Diseases Hepatic Abscesses and Cysts Liver Lobe Torsion Gallbladder Mucocele Cholelithiasis Hepatobiliary Neoplasia Clinicopathologic Features Diagnosis Specific Neoplasms References References 96 Hepatic Vascular Anomalies Anatomy Portal Vein Hepatic Artery Hepatic Veins Embryology Portocaval and Portoazygos Shunts Patent Ductus Venosus Classification and Epidemiology Portosystemic Shunts Portal Vein Hypoplasia Hepatic Arteriovenous Malformations Pathophysiology Hepatic Encephalopathy Coagulation Disorders Diagnostic Evaluation Signalment History Clinical Signs and Examination Findings Clinical Diagnosis Clinicopathologic Findings Liver Function Testing Coagulation Profiles Abdominal Effusion Evaluation Histopathology Diagnostic Imaging Abdominal Ultrasonography Scintigraphy Computed Tomographic Angiography Magnetic Resonance Angiography Portovenography Differential Diagnoses Treatment Medical Management Preoperative Medical Stabilization Surgical Treatment for Congenital Portosystemic Shunts Locating Portosystemic Shunts in Surgery Measuring Portal Pressure Operative Mesenteric Portography Methods for Surgical Occlusion of Shunts Surgical Approaches to Intrahepatic Portocaval Shunts Postoperative Management After Portosystemic Shunt Attenuation Complications Associated With Surgical Shunt Attenuation Hypoglycemia Hemorrhage and Anemia Portal Hypertension Seizures and Encephalopathy Recurrence of Clinical Signs Prognosis for Congenital Portosystemic Shunts Treated Surgically Outcome in DogsmReferences 18, 23, 24, 36, 64, 71, 95, 98, 100, 101, 105, 119, 122, 135, 136, 138, 157, 173, 197, 223, 248, 252, 263-265. Outcome in CatsqReferences 37, 87, 101, 127, 144, 172,189, 191, 250, 255. Surgical Treatment of Hepatic Arteriovenous Malformations Interventional Radiology Techniques Percutaneous Transjugular Coil Embolization Complications Hepatic Arteriovenous Malformation Cyanoacrylate Glue Embolization Multiple Acquired Extrahepatic Portosystemic Shunts References References 97 Pancreas Anatomy Vascular Supply Innervation Pancreatic Ducts Physiology Glucose Metabolism Digestion Healing of the Pancreas Anesthetic Considerations Specific Surgical Procedures Pancreatic Biopsy Partial Pancreatectomy Total Pancreatectomy Pancreaticoduodenectomy Pancreatic Drainage Pancreatic Transplantation Postoperative Care Nutrition Fluid Support Analgesia Antiemetics Reduction of Gastric Acid Production Diseases Pancreatitis Pancreatic Abscess Pancreatic Pseudocysts Pancreatic Torsion Pancreatic Exocrine Tumors Insulinoma Gastrinoma Glucagonoma References References 98 Feeding Tubes Methods of Delivering Enteral Nutrition Coaxed Feeding Orogastric Intubation Nasoesophageal Tubes Pharyngostomy Tubes Esophagostomy Tubes Gastrostomy Tubes Enterostomy Tubes Tube Feeding: Specifics Diet Initiation of Enteral Support Prevention and Management of Complications Discontinuation of Enteral Support References References VIII Respiratory System 99 Nasal Planum, Nasal Cavity, and Sinuses Anatomy Nose Nasopharynx Physiology Diagnostic Approach Historical and Physical Examination Findings Imaging Rhinoscopy and Nasopharyngoscopy Sample Submission Diseases of the Nasal Planum Neoplasia of the Nasal Planum and Nasal Planum Resection Diseases of the Nose and Sinuses Stenotic Nares Neoplasia Infection Foreign Bodies Idiopathic Inflammatory Rhinitis Other Causes of Nasal Disease Diseases of the Nasopharynx Nasopharyngeal Polyps Choanal Atresia Nasopharyngeal Stenosis Surgical Techniques Nasal Planum Excision Surgical Correction of Stenotic Nares Surgery of the Nasal Cavity, Frontal Sinus, and Nasopharynx References References 100 Palate Embryology Anatomy Physiology Palate Defects Pathophysiology Clinical Signs and Diagnosis Management of Traumatic Injuries Surgical Treatment Postoperative Care Overlong Soft Palate Pathophysiology Clinical Signs and Diagnosis Surgical Treatment Postoperative Care Complications Prognosis References References 101 Larynx Anatomy Canine Anatomy Feline Anatomy Physiology Laryngeal Neoplasia Treatment Laryngeal Collapse Treatment Laryngeal Paralysis Etiology Clinical Findings Laboratory Findings Diagnostic Imaging Anesthetic Regimens for Laryngoscopy Emergency Medical Management Surgical Treatment Prognosis Devocalization Techniques Postoperative Care Miscellaneous Laryngeal Conditions Laryngeal Cysts Inflammatory Laryngeal Disease Laryngeal Foreign Bodies Laryngeal Trauma Laryngeal Web Formation Epiglottic Conditions Epiglottic Retroversion Displacement of Glossoepiglottic Mucosa References References 102 Trachea and Bronchi Anatomy Structure Blood Supply, Lymphatics, and Innervation Size Physiology Diagnostics Radiography and Fluoroscopy Computed Tomography Tracheobronchoscopy Techniques: General Temporary Tracheostomy Permanent Tracheostomy Tracheotomy and Bronchotomy Resection and Anastomosis Specific Conditions Tracheal Rupture Tracheal Avulsion Tracheobronchial Foreign Bodies Masses Esophagotracheal and Esophagobronchial Fistulae Tracheal Collapse Bronchial Collapse Tracheal Narrowing Miscellaneous Bronchial Conditions Ciliary Dyskinesia References References 103 Lungs Anatomy Thoracic Cavity Lungs Pulmonary Physiology Ventilation Gas Diffusion Across the Blood-Gas Interface Gas Transport by Blood Gas Exchange Hypoxemia Consequences of Thoracotomy on Pulmonary Physiology Postoperative Monitoring Surgical Approaches Intercostal Thoracotomy Median Sternotomy Thoracoscopy Specific Conditions Congenital Diseases of the Lungs Cysts, Bullae, and Blebs Bronchoesophageal Fistulas Consolidated Lung Lobe and Abscess Bronchiectasis Lung Laceration Lung Lobe Torsion Pulmonary Neoplasia Surgical Techniques Partial Lobectomy Total Lung Lobectomy Pneumonectomy References References IX Thorax 104 Thoracic Wall Anatomy Boundaries of the Thoracic Cavity Skin Skeleton Muscular Anatomy Nerves and Blood Vessels Physiology and Pathophysiology Surgical Approaches to the Thorax Intercostal Thoracotomy Rib Resection Thoracotomy Median Sternotomy Xiphoid Resection Thoracotomy Transsternal Thoracotomy Transdiaphragmatic Thoracotomy Paracostal Approach Thoracoscopy Surgical Conditions of the Thoracic Wall Pectus Excavatum Sternal Cleft Infection Trauma Neoplasia Thoracic Wall Reconstruction Postoperative Care References References 105 Thoracic Cavity Anatomy Pleura Lymph Nodes Thoracic Duct Thymus Physiology Respiration Fluid Gradients Thymus Pathophysiology Types of Pleural Effusion Clinical Signs of Intrapleural Disease Diagnostic Imaging Radiography Ultrasonography Computed Tomography Thoracocentesis Technique Presurgical Considerations Anesthetic Considerations Thoracostomy Tube Standard Thoracostomy Tube Placement Wire-Guided Thoracostomy Tube Placement Tube Management Complications General Surgical Principles Thoracoscopy Postoperative Management Monitoring Analgesia Complications Specific Conditions Trauma Pneumothorax Chylothorax Pyothorax Caudal Mediastinal Abscesses Malignant Pleural Effusion Thymoma Thymic Lymphoma Other Mediastinal Neoplasia Benign Cysts References References X Cardiovascular System 106 Cardiac Surgery Anatomy Physiology Cardiac Cycle and Pressure-Volume Relationship Stroke Volume (Preload, Afterload, Contractility) Cardiac Output, Blood Pressure, and Vascular Resistance Electrophysiology Preoperative Considerations Anesthesia General Surgical Principles Strategies for Cardiac Surgery Beating Heart Surgery Inflow Occlusion Cardiopulmonary Bypass Surgical Conditions of the Heart Patent Ductus Arteriosus Pulmonic Stenosis Double-Chambered Right Ventricle Aortic Stenosis Aortic Regurgitation Ventricular Septal Defect Atrial and Atrioventricular Septal Defect Tetralogy of Fallot Cor Triatriatum Mitral Regurgitation Tricuspid Valve Dysplasia Cardiac Neoplasia Pacemaker Therapy Pacemaker Systems Preoperative Management Epicardial Pacemaker Placement Postoperative Care Complications References References 107 Pericardial Surgery Anatomy Function of the Pericardium Pathophysiology of Cardiac Tamponade Congenital Pericardial Disease Absence of Pericardium and Pericardial Defects Pericardial Cysts Acquired Pericardial Diseases Pericardial Rupture Pericardial Effusion Constrictive Pericarditis References References 108 Vascular Surgery Anatomy and Physiology General Vascular and Microvascular Surgery Instruments, Suture, and Graft Materials Vascular Exposure and Control Hemostasis and Anticoagulation Vascular Incisions and Closures Vascular Anastomoses Autologous Grafts Endovascular Surgery Instrumentation Vascular Access and Closure General Endovascular Techniques in Small Animal Practice Trauma and Hemorrhage Vascular Malformations and Arteriovenous Fistulas References References XI Urogenital System 109 Ovaries and Uterus Anatomy and Physiology Anatomy Reproductive Physiology Surgery Indication and Benefits of Ovariectomy or Ovariohysterectomy Consequences of Ovariohysterectomy Prepubertal Ovariohysterectomy Ovariohysterectomy Ovariectomy Laparoscopic Artificial Insemination Disorders of the Ovary Diagnostic Techniques Ovarian Neoplasia Ovarian Cysts Ovarian Remnant Syndrome Congenital Abnormalities of the Ovary Disorders of the Uterus Diagnostic Techniques Pyometra Cystic Endometrial Hyperplasia, Mucometra, Hydrometra, and Hematometra Endometrial Polyps Metritis Uterine Torsion Uterine Prolapse Uterine Rupture Dystocia Cesarean Section Subinvolution of Placental Sites Uterine Neoplasia Congenital Abnormalities of the Uterus References References 110 Vagina, Vestibule, and Vulva Embryology Anatomy and Physiology Diagnostic Evaluation Clinical Signs Cytology and Culture Endoscopy Surgical Approaches Episiotomy Ventral Approach to the Vagina Congenital Anomalies Vestibulovaginal Stenotic Lesions Rectovaginal Fistulas Anovulvar Cleft Acquired Conditions Recessed Vulva Vaginal Edema and Vaginal Prolapse Clitoral Hypertrophy and Intersex Conditions Neoplasia of the Vagina, Vestibule, and Vulva References References 111 Testes, Epididymides, and Scrotum Anatomy Testes and Epididymides Scrotum Physiology and Histology Testes and Epididymides Scrotum Disorders Testes Epididymides Scrotum Sterilization Nonsurgical Sterilization Techniques Surgical Techniques Perioperative Analgesia Canine Orchiectomy Canine Scrotal Castration Canine Scrotal Ablation Feline Orchiectomy Vasectomy Cryptorchid Castration Surgical Complications Postoperative Sterility References References 112 Penis and Prepuce Anatomy Penis Prepuce Physiology Penis Prepuce Specific Disorders Hypospadias Os Penis Deformity Os Penis Fracture Penile Wounds Penile Strangulation Persistent Penile Frenulum Penile Tumors Paraphimosis Phimosis Balanoposthitis Preputial Foreign Bodies Preputial Trauma/Wounds Preputial Masses Preputial Hypoplasia References References 113 Prostate Anatomy of the Canine Prostate Embryology Size Anatomic Relations Vessels Nerves Histology Physiology Secretions Hormonal Regulation of Prostatic Growth Diagnostic Approach to Prostatic Disease in the Dog History and Physical Examination Digital Rectal Examination Laboratory Investigations Microbiologic and Cytologic Samples Biopsy Samples Diagnostic Imaging Diseases of the Canine Prostate Benign Prostatic Hyperplasia Cystic Hyperplasia, Prostatitis, and Abscessation Discrete Prostatic Cysts Prostatic Neoplasia Prostatic Metaplasia Prostatic Trauma Prostatic Surgery in the Dog General Principles and Surgical Approach Postoperative Care Surgical Options for Prostatic Abscesses Surgical Management of Prostatic Cysts Total Prostatectomy for Neoplasia The Feline Prostate References References 114 Kidneys Gross Anatomy Vessels Innervation Physiology Functional Unit of the Kidney Urine Formation Renal Blood Flow Urine Concentration Healing of the Upper Urinary Tract Perioperative Management Diagnostic Tests Renal Imaging Preoperative Considerations Postoperative Care Abnormalities of the Kidney Developmental Anomalies Renal Calculi Renal Neoplasia Acquired Renal Cysts Perirenal Pseudocysts Renal Abscesses Renal Trauma Idiopathic Renal Hematuria Kidney Worms Surgical Techniques Renal Biopsy Nephrotomy Partial Nephrectomy Nephrectomy and Ureteronephrectomy Nephrostomy Tube Placement Renal Autotransplantation References References 115 Ureters Anatomy Ureteral Diameter Topographic Anatomy Blood Supply and Innervation Microscopic Anatomy Ureteral Obstruction Pathophysiology Feline Ureterolithiasis Canine Ureterolithiasis Ureteral Neoplasia Ureteral Strictures/Stenoses Ureteral Trauma Ureteral Ectopia Ureteroceles Surgical Techniques General Principles Ureterotomy Ureteral Reimplantation (End-to-Side Neoureterocystostomy) Neoureterocystostomy (Side-to-Side) Nephrotomy and Pyelotomy Ureteral Resection-Anastomosis Nephroureterectomy References References 116 Bladder Anatomy Innervation Blood Supply and Lymphatic Drainage Bladder Surgery Principles Wound Healing, Suture Material, and Suture Patterns Antibiosis Operating Technique Anesthesia for Bladder Surgery Diagnostic Techniques Cystocentesis Diagnostic Imaging Catheter Biopsy Cystoscopy Surgical Techniques Cystotomy Cystectomy Cystostomy Cystopexy Surgical Bladder Conditions Congenital Bladder Abnormalities Bladder Rupture Bladder Calculi Polypoid Cystitis Bladder Neoplasia References References 117 Urethra Anatomy Male Dogs Male Cats Female Dogs Female Cats Patient Evaluation Initial Assessment Diagnostic Imaging of the Urethra Surgical Principles Urethral Healing Suture Material Urinary Diversion After Repair Surgical Procedures Urethrotomy Urethrostomy Urethral Anastomosis Congenital Disorders of the Urethra Hypospadias Epispadias Urethral Fistulas Urethral Duplication Acquired Disorders Urethral Obstruction Urethral Trauma Urethral Stricture Urethral Prolapse Urethritis Fibroepithelial Polyps References References 118 Sphincter Mechanism Incontinence Physiologic Control of Continence Pathophysiology Urethral Tone and Length Bladder Neck Position Body Size and Breed Gonadectomy Hormonal Status Genital Conformation Urethral Sphincter Mechanism Incompetence in Male Dogs Diagnostic Assessment Treatment Medical Management Surgical Management Treatment in Male Dogs References References 119 Renal Transplant Indications Client Education Evaluation of a Potential Recipient Evaluation of the Urinary Tract Cardiovascular Disease and Hypertension Infectious Disease Evaluation of a Potential Donor Preoperative Treatment Feline Immunosuppression Canine Immunosuppression Anesthetic Protocols for Recipient and Donor Surgery Feline Canine Postoperative Care and Perioperative Complications Management of Anorexia Seizures and Hypertension Postoperative Renal Function Long-Term Management and Complications Patient Follow-Up Complications in Cats Complications in Dogs References References XII Endocrine System 120 Adrenal Glands Anatomy Physiology Glucocorticoids Mineralocorticoids Sex Hormones Catecholamines Identification of an Adrenal Mass Diagnosis of Functional Adrenal Tumors Cortisol-Secreting Adrenal Tumors Pheochromocytoma Perioperative Management Cortisol-Secreting Adrenal Tumor Pheochromocytoma Surgery Approaches Surgical Technique Prognosis Species Differences References References 121 Thyroid and Parathyroid Glands Anatomy45 Thyroid Glands Parathyroid Glands Ectopic Tissue Physiology Thyroid Hormones Parathyroid Hormone and Calcium Metabolism Feline Hyperthyroidism Pathophysiology Clinical Signs Clinical Findings Diagnostics Preoperative Management Anesthesia Surgery Postoperative Care Complications and Prognosis Alternative Therapies Canine Thyroid Tumors Pathophysiology Metastasis Functional Tumors Clinical Findings and Diagnostics Preoperative Management Surgery Postoperative Care Complications Prognosis Other Therapies Ectopic Thyroid Tumors Canine Hypothyroidism Diagnosis of Hypothyroidism Systemic Effects of Hypothyroidism on Surgical Patients Hyperparathyroidism Pathophysiology of Primary Hyperparathyroidism Clinical Signs and Diagnosis Preoperative Management Surgical Techniques Postoperative Care Complications and Prognosis Cats Other Therapies References References XIII Ear 122 Pinna and External Ear Canal Anatomy The Pinna External Ear Canal and Associated Cartilages Nerves Vessels Conditions Affecting the Pinna Aural Hematoma Pinna Trauma and Lacerations Neoplasia Infectious and Inflammatory Conditions Conditions Affecting the External Ear Canal Otitis Externa/Media Polyps Originating in the Middle Ear in Cats and Dogs Neoplasia Trauma and Avulsion Developmental and Congenital Para-aural Abscess Investigation of External Ear Conditions Clinical Signs Otoscopy Otic Cytology and Biopsy Fine Needle Aspirate, Grab Biopsy, and Impression Smear Diagnostic Imaging of the Ear Perioperative Considerations Patient Preparation Positioning Surgical Instruments Surgery of the Pinna Auricular Hematoma Laceration Repair Subtotal and Total Pinnectomy Use of Pinna in Oronasal Fistula Reconstruction Other Techniques to Treat Pinna Disease Surgery of the External Ear Lateral Wall Resection Vertical Canal Ablation Vertical Ear Canal Incision for Polyp Removal Total Ear Canal Ablation and Bulla Osteotomy Complications of Ear Canal Surgery Prognosis for Various Conditions After Ear Surgery Hematoma Otitis Externa Pinna Neoplasia External Ear Neoplasia References References 123 Middle and Inner Ear Anatomy of the Middle Ear Dogs Cats Physiology of the Middle Ear Anatomy of the Inner Ear Physiology of the Inner Ear Pathophysiology of Middle and Inner Ear Disease Septic Otitis Media Inflammatory Diseases of the Middle Ear Disorders of Middle Ear Drainage Deafness Presentation Septic Otitis Media Polyps Cholesteatoma Disorders of Tympanic Drainage: Secretory Otitis Media and Ciliary Dyskinesia Neoplastic Disease Diagnosis Physical Evaluation Otoscopy and Video-Otoscopy Diagnostic Imaging Miscellaneous Techniques Medical Treatment of Middle Ear Disease Conservative and Medical Management of Septic Otitis Media and Otitis Interna in Dogs Conservative Management of Feline Inflammatory Polyps Management of Middle Ear Drainage Dysfunction Surgery Indications Lateral Access via Total Ear Canal Ablation (see Chapter 122) Ventral Bulla Osteotomy Surgery for Cholesteatoma Tumor Management References References XIV Eye 124 Basic Ophthalmic Surgical Procedures Perioperative Considerations Anesthesia Oculocardiac Reflex Presurgical Preparation Positioning of the Patient and Surgeon Draping Illumination and Magnification Instrumentation and Hemostasis Prevention of Self-Trauma Globe Exposure Eyelids Anatomy and Physiology Special Surgical Considerations Developmental or Congenital Defects Acquired Disorders Eyelid Reconstruction Nasolacrimal System Anatomy and Physiology Diseases of the Nasolacrimal Drainage System Diagnostic Tests Punctal Anomalies Conjunctiva Anatomy and Physiology Diseases of the Conjunctiva Conjunctival Biopsy and Excision of Small Masses Surgical Repair of Conjunctival Defects and Lacerations Conjunctival Autografts to the Cornea Symblepharon Nictitating Membrane Anatomy and Physiology Everted Nictitating Membrane Prolapse of the Nictitating Membrane Gland Protrusion of the Nictitating Membrane Neoplasia and Nonneoplastic Diseases of the Nictitating Membrane Excision of the Nictitating Membrane Foreign Body Removal Nictitating Membrane Flaps Cornea Anatomy and Physiology Indolent Ulcers Corneal Surgery Orbit Anatomy Clinical Signs of Orbital Disease Differential Diagnosis Exenteration Orbitotomy Orbitectomy Surgical Procedures for Globe Removal Evisceration Enucleation References References 125 Emergency Ophthalmic Surgery Adenexa Eyelid Lacerations Nasolacrimal Lacerations Conjunctival and Third Eyelid Lacerations Retro-Third Eyelid Foreign Bodies Corneal Reconstruction Indications Autografts Corneal Allografts Extracellular Matrix Grafts Corneal and Scleral Lacerations Mechanism of Injury Prognosis Surgical Repair Corneal Foreign Bodies Lens Luxation Proptosis Glaucoma References References Index A B C D E F G H I J K L M N O P Q R S T U V W X Y Z