Reconstruction of large skin defects following trauma or radical excision of neoplastic masses can be problematical, particularly when wounds occur on the extremities where there is not enough skin for primary closure. Options for management include: axial pattern flaps; local subdermal plexus flaps; skin grafts; and second intention healing. There may, however, be insufficient skin adjacent to the wound to allow second intention healing or the use of local subdermal plexus flaps. Second intention healing may also result in formation of fragile epithelium or wound contracture. Axial pattern flaps are used for the one-stage reconstruction of wounds. Flaps are usually raised from the trunk, neck or proximal limbs, where there is sufficient loose skin to allow closure of the donor site with minimal morbidity. They provide durable full-thickness skin with a predictable vascular supply, resulting in normal to near-normal hair growth and minimal visible scar tissue, although hair growth is in the opposite direction and may be of different length and texture to the hair in the local area. Functional results after successful axial pattern flap use are good, although some owners are dissatisfied with cosmetic results. The chapter considers Blood supply and axial pattern flaps; and Complications and flap failure. Case examples: Superficial cervical axial pattern flap for a face wound in a cat; Thoracodorsal axial pattern flap for an elbow wound in a dog. Operative techniques: Axial pattern flap; Thoracodorsal axial pattern flap; Superficial cervical (omocervical) axial pattern flap; Caudal superficial epigastric axial pattern flap; Lateral thoracic axial pattern flap; Deep circumflex iliac (ventral branch) axial pattern flap; Deep circumflex iliac (dorsal branch) axial pattern flap; Cranial superficial epigastric axial pattern flap; Superficial brachial axial pattern flap; Genicular axial pattern flap; Reverse saphenous conduit axial pattern flap; Superficial temporal axial pattern flap; Caudal auricular axial pattern flap; and Lateral caudal axial pattern flap

This chapter aims to outline the general organizational approach to the surgical fixation of fractures, along with describing some of the basic surgical techniques involved in fracture reduction and fixation. Fracture surgeries are often demanding in terms of technical skill needed, equipment requirements, time and also concentration by the surgeon. Preparation is vital for all aspects of the operation. Operative techniques: Fracture reduction; Insertion of intramedullary pins; Insertion of interlocking nail; Application of cerclage wire; application of tension-band wiring; Placement of external skeletal fixators; Insertion of positional screw; Application of lag screw; Application of dynamic compression plate; Application of neutralization plate; Application of bridging plate; Pin-plate stabilization.

Bone grafting is the transplantation or implantation of bone or a bone substitute into a site to replace missing bone or to enhance bone healing. This chapter looks at autografts; allografts; grow factors; mesenchymal stem cells and tissue engineering; alloplastic grafts; ideal bone graft properties. Operative technique: Harvesting of an autogenous cancellous bone graft.

Conditions affecting the structure and function of the carpus are common in small animal practice and can have debilitating consequences for thoracic limb function. This chapter covers the key aspects of anatomy, investigations, congenital abnormalities, developmental abnormalities, traumatic carpal injuries and arthrodesis. Includes Quick Reference Guide to Imaging Techniques by Thomas W. Maddox. Operative Techniques: Pancarpal arthrodesis; Partial carpal arthrodesis.

Extraction of teeth (exodontics) is one of the most frequently performed procedures in small animal practice. Utilizing good instrumentation and applying proper techniques can help to provide a stress-free and controlled procedure. Operative Techniques: Maxillary canine tooth extraction in the dog; Mandibular canine tooth extraction in the dog; Maxillary fourth premolar tooth extraction in the dog; Mandibular first molar tooth extraction in the dog; Extraction of the maxillary canine and cheek teeth in the cat; Extraction of the mandibular canine and cheek teeth in the cat; Crown amputation and intentional retention of resorbing root tissue in the cat.

Knowledge of the normal anatomy of the nasolacrimal duct, and the structures through which it travels, is required to investigate and treat rabbits with epiphora, dacryocystitis and chronic nasal discharge. This chapter observes anatomy of the nasolacrimal duct and related structures; aetiopathogenesis; diagnosis; medical treatment; dental treatment; surgical treatment; and prognosis. Quick Reference Guides/Techniques: Flushing the nasolacrimal duct; Marsupialization of the lacrimal sac.

This chapter covers anatomy, diagnosis and treatment of conditions of the distal limb, including surgical preparation, external coaptation, metacarpophalangeal and metatarsophalangeal joint injury, conditions of the palmar and volar sesamoid bones, the proximal and distal interphalangeal joint, tendon injuries, conditions of the digital pads and integument of the paw, infection of the paw. Includes Quick Reference Guide to Imaging Techniques by Thomas W. Maddox. Operative Techniques: The application of a digital external skeletal fixator; Amputation of the digit; Ungual crest ostectomy (permanent nail removal); Distal digit (phalanx 3) ostectomy; Incisional and excisional separation podoplasty; Corn excision; Sesamoidectomy.

Ear disease is a common presentation in rabbits; as in other species, it takes the form of otitis externa, media and/or interna. In cases of otitis externa or otitis media, where medical management is either impossible or unsuccessful or the situation is recurrent, surgery may be indicated. This chapter considers ear and sinus disease and surgery. Operative Techniques: Ear syringing; Lateral wall resection; Total ear canal ablation via lateral bulla osteotomy; Total ear canal ablation via a ventral bulla osteotomy; Flushing the dorsal conchal sinus via a dorsal approach; Flushing the dorsal recess of the maxillary sinus via a lateral approach; Flushing the ventral recess of the maxillary sinus via a lateral approach.

Respiratory distress is a life-threatening clinical syndrome that should be dealt with immediately. What is done in the initial approach to these animals can make the difference between life and death. This chapter covers initial assessment and stabilization, pathophysiology, diagnostic approach, diseases associated with respiratory distress and prolonged oxygen therapy. Operative Technique: Emergency tracheotomy.

The rabbit eye shows several anatomical differences compared to other mammals, some of which are important for surgery. This chapter details the relevant anatomy and looks at decision-making and treatment options. Operative Techniques: Corneal ulcer treatment; Correction of entropian or ectropian; Correction of eyelid dysplasia; Removal of prolapsed superficial gland of third eyelid; Pocket technique for re-placement of prolapsed gland of third eyelid; Surgical treatment of aberrant conjunctival overgrowth; Enucleation and exenteration.

Elective neutering of female dogs and cats is one of the commonest surgeries performed in veterinary practice. Over the last decade, sterilization techniques in the bitch have advanced with the introduction of laparoscopic techniques and the acceptance of both ovariectomy and ovariohysterectomy for routine neutering. This chapter addresses anatomy and surgical procedures, broken down into uterus; ovaries; vagina, vestibule and vulva; and external genitalia. Practical tips are highlighted throughout. Operative techniques: Canine ovariohysterectomy; Canine ovariectomy; Feline ovariohysterectomy; Caesarian section; Episioplasty; Episiotomy.

Rabbits are popular pets and many are presented to veterinary surgeons with a history of sudden lameness caused by a fracture. For many clinicians this is a daunting prospect. This chapter covers the various types of fracture in rabbits, how to formulate a treatment plan, treatment options, and assessment of the patient and fracture. It goes on to address orthopaedic surgery, the management of specific fractures and postoperative complications. Operative Techniques: External fixation of a tibial fracture.

Gastric dilation is a common clinical syndrome in rabbits and is often confused with ileus, gastrointestinal hypomotility or gut stasis. Some of the confusion originates in the terminology used, so the terms used in this chapter are defined in Figure 14.1 . This chapter covers anatomy and physiology of the gastrointestinal tract; intestinal obstruction; diagnosis of intestinal obstruction; site of obstruction; causes of intestinal obstruction; gastrointestinal hypomotility, together with a protocol for rabbits with gastric dilation. Quick Reference Guides/Techniques: Passing a stomach tube to decompress the stomach; Milking a foreign body through the small intestine.

The humerus lies within the brachium, articulating proximally with the scapular glenoid to form the shoulder joint and distally with the radius and ulna to form the elbow joint. This chapter looks at humeral diaphyseal fractures, fractures of the distal humerus. Operative techniques: Salter-Harris type I and II fractures of the proximal humerus; Salter-Harris type III fractures of the proximal humerus; Medial approach to the humeral diaphysis for bone plate application; Medial approach to the distal humerus for bone plate application; Lateral approach to the humeral diaphysis for bone plate application; Lateral approach to the distal humerus for bone plate application; Lateral condylar fractures; Medial condylar fractures; Intracondylar Y-T fractures; Intramedullary pinning; Pin-plate application; Linear external skeletal fixation of the humerus; Supracondylar humeral fractures; Placement of a medial to lateral transcondylar positional cortical bone screw for humeral intracondylar fissure.

Differentiation of large bowel disease from small intestinal disorders is based on history and clinical examination. The clinical signs are a result of disruption of the functions of the large bowel – namely, absorption of water and electrolytes from luminal contents, and storage and periodic expulsion of faecal material. This chapter addresses anatomy, diagnosis and treatment of many different conditions. Operative techniques: Colotomy; Colectomy; Typhlectomy (caecal resection); Incision colopexy; Anal ‘pull-out’ procedure for lesions requiring full-thickness resection; Rectal ‘pull-through’ procedure; Dorsal rectal approach; Ventral approach to the rectum; Perineal herniorrhaphy in a male dog; Anal sacculectomy; Anoplasty.

The testes are paired ovoid organs normally located in the scrotum and are responsible for producing both the male hormone (testosterone) and the male gametes (sperm). This chapter considers the anatomy and conditions of the testicle, the prostate gland and the penis and prepuce as well as urethrostomy procedures. Operative techniques: Canine castration; Prostatic abscess management (intracapsular prostatic omentalization); Partial resection and omentalization for discrete prostatic cysts; Canine penile amputation; Canine scrotal urethrostomy; Feline perineal urethrostomy (PU); Prepubic urethrostomy (PPU).

This chapter looks at the management of developmental abnormalities of the hard and soft tissues of the head, including occlusion and malocclusion, abnormalities of teeth, lip and palate defects. Operative Techniques: Obtaining a full-mouth impression, bite registration and creating stone models; Fabrication of a direct inclined plane; Active orthodontic appliance with brackets, buttons or ligature wires and elastic chain.

Periodontal disease is the most common pathological condition occurring in adult dogs and cats. This chapter covers the diagnosis and management of periodontal disease, providing detailed instruction on the use of a range of equipment, instruments and materials. Operative Techniques: Professional dental cleaning and closed periodontal therapy; Open periodontal therapy; Gingivectomy and gingivoplasty.

Although the use of operating loupes and surgical microscopes has been commonplace in human neurosurgery, ophthalmic surgery and reconstructive surgery for decades, experience with microvascular free tissue transfer is limited in veterinary surgery. Despite this fact, the utility of microvascular free tissue transfer for one-stage reconstruction of difficult problems, particularly of the distal limbs and the oral cavity, has been established. Early reconstruction of traumatic tissue loss using vascularized tissue is feasible, as is functional and cosmetic reconstruction after ablative cancer surgery. Tissues transferred in this manner are referred to as ‘microvascular free tissue transfers’, ‘free flaps’, ‘microvascular free flaps’, or ‘autogenous vascularized grafts’. Topics discussed are as follows: Microvascular technique; and Specific flaps in the dog and cat. Operative techniques: End-to-end anastomosis; End-to-side anastomosis; Raising a trapezius muscle flap; Raising a latissimus dorsi muscle flap; and Harvesting a vascularized ulnar graft.

Exploratory laparotomy involves a surgical approach to the abdominal cavity, to diagnose and potentially treat abdominal disease. In some cases, exploratory laparoscopy may be performed in place of laparotomy. This chapter details patient assessment and preparation; indications for laparotomy; site and length of incision; and organ handling. Operative Techniques: Exploratory laparotomy (coeliotomy) utilizing a ventral midline incision; Liver biopsy and lobectomy.

A sesamoid bone is a bone embedded within a tendon. Sesamoids are found in locations where a tendon passes over a bone or a joint. This chapter looks at the patella, the fabellae, the popliteal sesamoid. Operative techniques: Fracture of the patella; Avulsion of the fabella; Avulsion of the popliteus.

Fractures of the pelvis and sacroiliac (SI) joints are common, accounting for 20/30% of fractures in cats and dogs. This chapter covers assessment for surgical or non-surgical management, non-surgical management of pelvic fractures, surgical management of pelvic fractures. Operative techniques: Sacroiliac luxation – sacroiliac lag screw placement; Sacroiliac luxation – transilial pinning; Ilial body bone plating – lateral plate application; Ilial body bone plating – ventral plate application in canine patients; Ilial body bone plating – dorsal plate application in feline patients; Simple acetabular fractures – bone plate stabilization; Simple acetabular fractures - composite repair using screws, wire and polymethylmethacrylate.

Physiotherapy is involved with physical function, and physiotherapists regard movement and physical potential to be central to the health and well being of individuals. It is a ‘hands-on’ science-based healthcare profession concerned with the assessment, diagnosis and treatment of disease and disability through physical means. It is based upon the principles of medical science, and is generally held to be within the sphere of conventional (rather than alternative) medicine. Human physiotherapy is an internationally recognized discipline, and the positive benefits of physiotherapeutic intervention have been well documented. This chapter explains Veterinary physiotherapy; Legal restrictions; Role of the veterinary nurse; Indications for physiotherapy; Modalities and techniques; Physiotherapy in specific situations;

Portosystemic shunts (PSS) are abnormal vascular communications between the portal venous system and the systemic venous circulation. This chapter considers anatomy, pathophysiology, anaesthesia, current techniques for intra- and extrahepatic shunts and postoperative management. Practical tips and warnings are highlighted throughout. Operative technique: Attenuation of an extrahepatic portosystemic shunt.

Fractures of the radius and ulna account for 17/18% of all fractures in small animals, predominantly affecting the middle and distal third of the diaphysis. This chapter looks at anatomy; proximal fractures, diaphyseal fractures, distal radial and ulnar fractures. Operative techniques: Tension-band application to the proximal ulna; Plate application to the caudal ulna for simple fractures; Stabilization of comminuted proximal ulna fractures; Fractures of the ulna with concurrent luxation of the radial head (Monteggia fractures); Fractures of the proximal radius; Ulnar diaphyseal fractures – intramedullary pinning; Radial diaphyseal fractures – external fixation; Radial diaphyseal fractures – bone plating; Distal radial fractures – mature dog; Distal radial fractures – Salter-Harris type I; Styloid fractures.

The scapula is a flat bone that lies in the sagittal plane alongside the thoracic wall. This chapter reviews fractures of the scapular body, fractures of the scapular neck, fractures of the supraglenoid tuberosity. Operative techniques: Fractures of the scapular body; Fractures of the scapular neck; Fractures of the supraglenoid tuberosity.

Head trauma may result in fractures of the calvaria, the maxilla, the mandible and the detention, or any combination of these. This chapter covers principles of maxillofacial fracture treatment, techniques for managing maxillofacial fractures, management of specific fractures, fractures of the calvaria. Operative techniques: Intraoral techniques; Mandibular symphyseal wiring; Application of external skeletal fixation to the mandible or maxilla; Ventral approach and plate application to the mandibular body; Surgical approach to the temporomandibular joint and condylectomy.

This chapter considers a number of specific types of wound that may require surgical management, such as pharyngeal stick injuries, chronic draining sinuses, bullet, burn and bite wounds. It also discusses the surgical management of some specific skin conditions such as skin fold pyoderma and perianal fistulas. Causes of sinus tracts include bacterial infection, penetrating foreign bodies (e.g. plant awns, wood splinters, insect mouth parts), bone sequestra, surgical implants (e.g. sutures, meshes, orthopaedic implants) and neoplasia. Sinus tracts can occur at many locations on the body, depending on the cause, its point of entry/location and any migratory path. The interdigital spaces, ear canals, oral mucosa, conjunctiva and nares are common points of entry. All sinus tracts should be thoroughly investigated and explored surgically to determine and eliminate (if possible) the cause. It is important to develop a systematic approach to the investigation of sinus tracts. If the cause is not eliminated, the problem will recur. Chronic sinus tracts can be extremely frustrating to manage for the patient, client and veterinary surgeon, as small fragments of foreign material can be elusive and repeated surgical intervention may be required. The chapter looks at Chronic draining sinus tracts; Oropharyngeal stick injuries; Perianal fistulation (anal furunculosis); Bite wounds; Burns management; Projectile injuries; Redundant skin folds and skin fold pyoderma (intertrigo); Footpad surgery; Mammary gland surgery; and Wound bed vascular augmentation using omentum. Case examples: Management of a shotgun injury to the face. Operative techniques: Anal sacculectomy; Episioplasty; Caudectomy; Fusion podoplasty; Phalangeal fillet (Digital pad transfer); Footpad grafts; and Mastectomy.

Surgical conditions of the spleen are commonly encountered in small animal practice. In some instances splenic biopsy or partial splenectomy may be warranted, but in most cases splenectomy is the treatment of choice. This chapter looks at anatomy, surgical techniques, splenic conditions and postoperative considerations. Practical tips and potential complications are highlighted throughout. Operative techniques: Splenic biopsy and partial splenectomy; Splenectomy.

The stomach serves as a reservoir for food and initiates digestion. This chapter explores anatomy and different techniques. Practical tips are highlighted throughout. Operative techniques: Gastronomy; Gastric biopsy; Partial gastrectomy of the gastric fundus; Transverse pyloroplasty (Heineke-Mikulicz procedures); Y-U antral advancement flap; Pyloromyotomy (Fredet-Ramstedt procedure); Pylorectomy and gastroduodenostomy (Billroth I procedure); Oesophageal hiatal hernia repair.

This chapter covers anatomy, surgery of the pinna, otitis externa and media, otic and nasopharyngeal polyps, middle ear cholesteatomas in dogs and considerations for surgical success in patients with ear disease. Operative Techniques: Lateral ear canal resection; Vertical ear canal resection; Total ear canal ablation and lateral bulla osteotomy.

The lungs are divided into distinct lobes by fissures, allowing them to accommodate the movements of the thoracic wall and diaphragm. This chapter covers anatomy and physiology, diagnostic approach, postoperative considerations, lung trauma, pulmonary abscess, pneumonia and bronchiectasis, lung lobe torsion, spontaneous pneumothorax and lung neoplasia. Operative Technique: Partial or complete lung lobectomy.

Surgery of the oral cavity and oropharynx is required to treat neoplasia, traumatic and congenital lesions, and diseases affecting the lips and salivary glands. The clinical signs, diagnosis, surgical management, prognosis and postoperative care of these problems are addressed in this chapter. Operative Techniques: Partial rostral maxillectomy; Total mandibulectomy; Cleft palate repair; Split palatal U-flap technique; Oronasal fistula repair; Mandibular and sublingual salivary gland resection (lateral approach).

A drain is a conduit placed in the wound to remove fluid and air. This usually refers to surgical implants, typically Penrose drains or closed suction drains; however, an autogenous drain, the omentum, can be used in selective cases. An alternative method of providing wound drainage is to leave part of the wound open. This technique is effective in open peritoneal drainage and can also work well with severely contaminated or necrotic skin wounds. The chapter looks at Indications for drain usage; Types of drain; Drain placement; Postoperative and drain care; Drain removal; Complications; and Drains in specific surgeries. Case examples: Drainage of a flank abscess; Surgical management and drainage of a chronic mucocele. Operative techniques: Placement of a Penrose drain; Placement of an active suction drain

This chapter covers surgical anatomy, examination of the tarsus, diagnostic tools, surgical approaches, congenital conditions of the tarsus, developmental conditions of the tarsus and acquired conditions of the tarsus. Quick Reference Guide to Imaging Techniques by Thomas W. Maddox. Operative Techniques: Medial malleolar osteotomy and repair; Medial arthrotomy for osteochondritis dissecans of the medial ridge of the talus; Partial tarsal arthrodesis; Pantarsal arthrodesis; Repair of Achilles tendon rupture.

Most skin defects seen in small animal patients are created either by traumatic injury or by surgical resection of a diseased area of tissue. In cats and dogs the elasticity of skin, along with the frequent presence of adjacent loose skin in many areas of the body, allows the primary closure of many wounds. However, techniques to reduce tension or to harvest skin from adjacent areas can help, in some cases, to produce a tension-free closure that is less likely to result in wound-healing complications. A working knowledge of such techniques is essential, as their required use cannot always be predicted preoperatively. In situations where primary closure was anticipated but cannot be achieved due to unforeseen circumstances, these techniques can become invaluable. Many of the techniques described in this chapter are very simple and will often be used in combination during wound reconstruction. The chapter considers Blood supply to the skin; Skin tension; Techniques to overcome skin tension; and Complications of skin flaps. Case examples: Hemimaxillectomy and transposition flap for a maxillary mass; Axillary flaps after excision of a thoracic mass. Operative techniques: Walking sutures; Skin stretching; V-Y plasty; Z-plasty; Single pedicle advancement flap; Bipedicle advancement flap; Rotation flap; Transposition flap; Axillary fold flap; Inguinal fold flap

Fractures of the tibia and fibula are commonly seen in small animal practice. This chapter deals with fractures of the proximal tibia and fibula, fractures of the tibial and fibular diaphyses; fractures of the distal tibia and fibula. Operative techniques: Avulsion of the tibial tubercle; Separation of the proximal tibial physis; Tibia – medial bone plating; Tibia – intramedullary pinning; Tibia – external skeletal fixation; Separation of the distal tibial physis; Fractures of the medial and lateral malleoli.

Rabbit dentistry is a controversial topic and many types of treatment have been described. At the time of writing, there are no published comparative studies that evaluate the success or failure of any particular dental treatment for rabbits. This chapter looks at considerations for treatment; establishing a treatment plan; treatment of fractured teeth and jaws; treatment of incisor malocclusion; treatment of early signs of dental disease; treatment of spurs on the cheek teeth; and iatrogenic damage from dentistry. Operative Technique: Reshaping maloccluded incisors: an alternative method; Treatment of cheek tooth problems using handheld instruments; Treatment of cheek tooth problems using burrs; Pulpectomy.

The focus of this chapter is on animals in which urinary incontinence is the primary sign, although other urinary abnormalities may be present in some cases. Urinary incontinence is a common problem in dogs (around 5% of adult bitches; Forsee et al., 2013), with many affected animals managed medically in first-opinion practice, often after only minimal diagnostic investigations. This chapter looks at anatomy and physiology, investigation, differential diagnosis and different conditions. Practical tips are included. Operative techniques: Colposuspension; Cystourethropexy; Prostatopexy; Vas deferensopexy; Urethral submucosal collagen injection; Ureteroneocystotomy; Ureteral reimplantation.