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.