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دانلود کتاب Veterinary surgery : small animal
دانلود کتاب جراحی دامپزشکی: حیوان کوچک
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Veterinary surgery : small animal
ویرایش: نویسندگان: Spencer A. Johnston, Karen M. Tobias سری: ISBN (شابک) : 9781437707465, 1437707467 ناشر: Elsevier/Saunders سال نشر: 2012 تعداد صفحات: 2777 زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 189 مگابایت
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e9781437707465v1 Front cover Endsheet 4 Endsheet 5 Veterinary Surgery: Small Animal Copyright page Editors Contributors Dedication Preface About the Book Website Table of Contents History of Veterinary Surgery The Hunted Animal Animal Domestication Companion Animals “Horse Doctor” Label Greco-Roman Period Early AD period Middle Ages European Influence The Influence of Anesthesia Asepsis The Hobday Era Small Animal Surgery in North America References I Surgical Biology 1 Inflammatory Response Acute Inflammation The Acute Vascular Response Vasodilation Permeability Stasis Leukocyte Extravasation Cellular Components Neutrophils Macrophages Lymphocytes Mast Cells Other Cell Types Inflammatory Stimuli Alarm Signals: Pathogen-Associated Molecular Patterns and Danger-Associated Molecular Patterns Pattern-Recognition Receptors Toll-like Receptors Neurogenic Inflammation Tachykinins Mediators of Inflammation Vasoactive Amines Cytokines Proinflammatory Cytokines Tumor Necrosis Factor. Interleukin-1. Interleukin-6. Chemokines. Antiinflammatory Cytokines Interleukin-10. Lipid/Cell Membrane–Derived Mediators Eicosanoids Prostaglandins. Leukotrienes. Proresolution Eicosanoids. Platelet-Activating Factor Reactive Oxygen Species Gaseous Mediators Nitric Oxide Carbon Monoxide Hydrogen Sulfide Acute Phase Proteins Negative Acute Phase Proteins Positive Acute Phase Proteins C-Reactive Protein. Serum Amyloid A. Serum Amyloid P. Complement Proteins. Coagulation Factors. Kininogen. 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 Detection of Mutations Molecular Cloning Transcriptomics RNA Silencing Proteomics Metabolomics Bioinformatics Systems Biology Applications of Molecular Biology to Small-Animal Surgery Pathogenesis Pharmacogenomics Stem Cell Development Gene Therapy Therapeutic Antibodies References References 3 Biomarkers in Clinical Medicine Biomarkers in Osteoarthritis Noncollagenous Biomarkers of Osteoarthritis Proteoglycan 7D4, 3B3, CS846. Keratan Sulfate, 5D4. BC-3, BC-14. OA-1. Biomarkers of Collagen Turnover Measurement of Type II Collagen Synthesis PIICP. PIIANP/ PIINP. Measurement of Breakdown of Type II Collagen CTX-II. C2C/UC2C. COL CEQ. HELIX-II. TIINE. COLL-2-1/COLL-2-1NO2. Noncollagenous, Nonproteoglycan Glycoproteins Cartilage Oligomeric Matrix Protein Summary of Biomarkers for Osteoarthritis Biomarkers and Inflammation Acute Phase Proteins and Inflammatory Biomarkers The Acute Phase Response Key Acute Phase Proteins in Dogs and Cats Albumin Alpha-1 Acid Glycoprotein C-Reactive Protein Ceruloplasmin Haptoglobin Serum Amyloid A Biologic Variation in Acute Phase Protein Concentrations Signalment Pregnancy Environmental Influences Drug Therapy Monitoring Disease Conditions Using Acute Protein Phases Tumor Necrosis Factor-Alpha and Interleukin-6 Biology of TNF-α Biology of IL-6 TNF-α and IL-6 in Companion Animal Disease States Adipokines and Interactions With Systemic Inflammation Adipokine Changes in Obesity Adipokines and Associated Diseases The Metabolic Syndrome and Insulin Resistance Adipokines and Inflammatory Diseases Adipokines and Orthopedic Disease Adipokines as Biomarkers References References 4 Stem Cells and Regenerative Therapy Stem Cells in Regenerative Surgical Strategy 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 Hyponatremia Hypernatremia Potassium Hypokalemia Hyperkalemia Calcium Hypocalcemia Hypercalcemia Magnesium Hypomagnesemia Hypermagnesemia Phosphorus Hypophosphatemia Hyperphosphatemia Chloride Hypochloremia Hyperchloremia Glucose Hypoglycemia Hyperglycemia Acid-Base Homeostasis The Hydrogen Ion and pH Law of Mass Action and the Henderson-Hasselbalch Equation Regulation of Acid-Base Balance Buffers Pulmonary and Renal 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 Gases 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 Cardiac Output Arterial Oxygen Content Defects in Oxygen Delivery Oxygen Uptake Oxygen Extraction Ratio DO2/VO2 Curve Cellular Response to Hypoxia and Lactate Pathophysiology of Shock Diagnosis and Monitoring Systems Clinical Assessment/Physical Examination Hemodynamic Assessment and Monitoring Arterial Blood Pressure. Central Venous Pressure. Cardiac Output. Metabolic Lactate. SvO2 versus ScvO2. Regional Perfusion Rectal Temperature. Gastric Tonometry/Sublingual Capnometry. Near Infrared Spectroscopy. Orthogonal Polarization Spectral Imaging Oxygenation Status Treatment Distributive Shock and Sepsis Pathophysiology Diagnosis of Sepsis Clinical Signs Biomarkers Treatment of Septic Shock Early Goal-Directed Therapy Source Control and Antibiotic Therapy Adrenal Insufficiency Other Uses of Steroids in Shock Glucose Control. Recombinant Human Activated Protein C (rhaPC). Septic Shock in Cats References References 7 Bleeding and Hemostasis Hemostasis and Fibrinolysis Primary Hemostasis Secondary Hemostasis The Cascade Model of Coagulation A Cell-Based Model of Coagulation Regulation of Hemostasis Fibrinolysis Hemostatic Testing Platelet Enumeration and Estimation Buccal Mucosal Bleeding Time Prothrombin Time and Activated Partial Thromboplastin Time Activated Clotting Time Fibrin Split Products d-Dimers Fibrinogen Thromboelastography Bleeding Causes of Surgical Bleeding Technical Causes Bleeding Disorders Coagulopathy of Trauma and Hemorrhage. Hemodilution. Hypothermia. Acidemia. Shock. Hypocoagulability in the Critically Ill Patient. Preoperative Hemostatic Assessment Hemostatic Screening Indications. Patient-associated factors. Procedure-associated factors. Screening Tests and Their Limitations. Diagnostic Workup Operative and Postoperative Bleeding Diagnosis Management Basic Principles. Plasma Component Transfusion. Platelet Transfusion. Prohemostatic Agents Desmopressin. Antifibrinolytics. Recombinant Factor VIIa. Prevention of Surgical Bleeding Specific Disorders Thrombocytopenia von Willebrand Disease Other Thrombopathies Inherited Coagulopathies Vitamin K Deficiency Hepatic Disease Thromboembolism Thrombotic Tendency Pathophysiology Causes Laboratory Assessment of Hypercoagulability Postoperative Thromboembolism Diagnosis of Venous Thromboembolism General Principles Diagnosis of Pulmonary Thromboembolism Initial Assessment. Secondary Assessment. Definitive Diagnosis. Management Overview of Antithrombotic Agents Anticoagulants Unfractionated Heparin. Low-molecular-weight heparin. Warfarin. Antiplatelet Drugs Aspirin. Clopidogrel. Treatment of Venous Thromboembolism Initial Therapy. Maintenance Therapy. Prevention of Thromboembolism in Surgical Patients Risk Assessment. Prophylactic Regimens. Disseminated Intravascular Coagulation Etiopathogenesis Diagnosis Clinical Presentation Laboratory Testing Management References References 8 Metabolism and Nutritional Needs of Surgical Patients Metabolic Changes Related to Illness and Disease Metabolic Changes Related to Surgical Injury Pathophysiology of Malnutrition Implications of Obesity for the Surgical Patient Nutritional Assessment and Planning Meeting Nutritional Requirements Calculation of Nutritional Requirements Monitoring and Reassessment Summary References References 9 Wound Healing Phases of Wound Healing Inflammation and Debridement Proliferation Remodeling and Maturation Healing of Specific Tissues Gastrointestinal Healing Fascial Healing Urinary Bladder Healing Bone Healing Species Differences in Healing Impediments to Wound Healing Local Factors Wound Perfusion Tissue Viability and Wound Fluid Accumulation Wound Infection Mechanical Factors Systemic Factors Primary Immunodeficiencies and Conditions That Impair Immune Function Cancer Age References References 10 Wound Infections and Antimicrobial Use Definition of Surgical Site Infection Risk Factors for Surgical Site Infection Degree of Bacterial Contamination Clipping of the Surgical Site Duration of Surgery Duration of Anesthesia Propofol Endocrinopathies Number of People in the Operating Room Sex Other Potential Risk Factors Prophylactic Perioperative Antibiotic Use Selection of the Antimicrobial Agent Timing of Antibiotic Administration Discontinuation of Antibiotic Administration Risk/Benefit Determination Surgical Site Infection Management Antibiotic Use Drainage References References 11 Evidence-Based Medicine and Outcomes Assessment Outcome Measures Outcome Assessment in Veterinary Medicine Stepwise Development of a Health Measurement Instrument* Step One: Devising the Items (Questions) Step Two: Selecting the Items (Questions) Step Three: Assessing Reliability and Validity Study Design and Subjective Versus Objective Measures Process Measures Conclusions References References II Surgical Methods and Perioperative Care 12 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 Sterilization by Radiation Indicators of Sterilization Storage of Sterilized Materials References References 13 Instrumentation Surgical Instruments Cutting Instruments Scalpel Scissors Rongeurs Periosteal Elevators Bone-Cutting Instruments Grasping Instruments Needle Holders Tissue Forceps Retractors Hand-Held Retractors Self-Retaining Retractors Suction Tips Miscellaneous Instruments Microsurgical Instruments Instrument Care Instrument Problem Solving References References 14 Preparation of the Patient, Operating Team, and Operating Room for Surgery Antiseptics Alcohols Iodophors Chlorhexidine Triclosan Other Agents Preparation of the Patient Draping Preparation of Surgical Personnel Scrub Suits Scrubbing Hands Gloves Gowns Footwear Headcovers Surgical Face Masks Facilities References References 15 Monitoring for Surgical Infection Surveillance as Part of the Infection Control Program Purpose of Surveillance Surveillance in Human Medicine Surveillance in Veterinary Medicine Surveillance Options Passive Surveillance Active Surveillance Syndromic Surveillance Environmental Surveillance Current Use of Surveillance in Veterinary Hospitals Personnel Use of Standard Definitions Costs of Surveillance Surveillance Programs for Veterinary Hospitals Monitoring Surgical Site Infection Rates Comparing Infection Rates Communications Surgical Site Infection Investigation Conclusion References References 16 Surgical Modalities: Laser, Radiofrequency, Ultrasonic, and Electrosurgery Radiofrequency Technology Tissue Effects of radiofrequency Energy Monopolar versus Bipolar Laparoscopic Considerations Argon Beam Coagulators Electrothermal Bipolar Vessel Sealing Devices Ultrasonic Energy—The Harmonic system Lasers Physics of Lasers Lasers and Tissue Interaction Types of Surgical Lasers Argon Lasers CO2 Lasers Nd:YAG Lasers Ho:YAG Lasers Excimer Lasers Lasers and Safety Considerations Ocular Hazards Toxic Smoke Production Fire Hazard Other Hazards References References 17 Suture Material, Tissue Staplers, Ligation Devices, and Closure Methods Suture Needles Suture General Suture Morphology Suture Coating Absorbable Suture Common Types of Absorbable Suture Catgut Rapidly Absorbed Synthetic Suture Polyglycolic Acid: Dexon Polyglactin 910: Vicryl Poliglecaprone 25: Monocryl Polyglytone 6211: Caprosyn Common Slowly Absorbed Synthetic Sutures Polydioxanone: PDS II Polyglyconate: Glycolic Acid Trimethylene Carbonate, Maxon Glycomer 631: Biosyn Common Nonabsorbable Sutures (Table 17-3) Silk Polypropylene Nylon Polymerized Caprolactam Polyester: Polyethylene, Polybutester, and Composites Stainless Steel Surgical Mesh Surgical Technique Staples Skin Staples Vascular Clips Linear Stapling Devices Circular Stapling Devices Adhesives Cyanoacrylate References References 18 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 Simple or Circumferential Ligations Transfixation Ligations References References 19 Surgical Hemostasis Hemostatic Agents Blood Flow Reduction Pressure/Tamponade Topical Vasoconstrictors: Epinephrine/ Adrenaline/Ephedrine Hypotension/Hypothermia/Reduced Perfusion Distant Control of Blood Flow Tourniquets. Topical Hemostatic Agents Mechanical Hemostatic Agents Gelatins. Bovine Collagen. Cellulose. Polysaccharide Spheres. Bone Wax and Ostene. Active Hemostatic Agents Thrombin. Alginates. Hemostatic Sealants Fibrin. Synthetic Sealants. Antifibrinolytics Serine Protease Inhibitor (Aprotinin) Lysine Analogues Miscellaneous Products Desmopressin (1-desamino-8-D- arginine vasopressin) Ethamsylate Hemostatic Polymers/Minerals Zeolite. Chitosan. References References 20 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 Open Passive Drains Closed Active Drains Drain Placement and Removal Potential Complications of Drains References References 21 Biopsy General Principles Biopsy Methods Needle-Core Biopsy Punch Biopsy Incisional Biopsy Specific Tissues Liver Gastrointestinal Tract Kidney Bone Endoscopic Biopsies Tissue Processing References References 22 Surgical Pain: Transduction (Peripheral Nociceptors) Heat Transduction Cold Transduction Mechanical Transduction Chemical Transduction Local Modulation of Transduction Transmission and Projection Dorsal Horn Neurons and Ascending Spinal Tracts Thalamocortical System Supraspinal Modulation of Sensory Input Local Modulation of Sensory Input at the Spinal Cord Plasticity of Nociception and Pain Peripheral Changes Central Nervous System (Spinal Cord) Changes Why Treat Pain? Assessment of Perioperative Pain Recognition of Pain Recommended Scale for Assessment of Perioperative Pain in the Clinic Strategies Preemptive Analgesia Multimodal (Balanced) Approach Surgical Technique References References 23 Anesthesia Principles and Monitoring Anesthesia Principles and Monitoring Anesthetic Drug Delivery Vaporizers Vaporizer Output. Methods of Vaporization. Circle Systems. Temperature Compensation. Vaporizer Agent Specificity. Anesthetic Circuits Rebreathing System Closed and Semi-Closed Circuit Rebreathing System Nonrebreathing Systems Endotracheal Tubes Intubation and Preoxygenation Difficult Intubation. Fresh Gas Carrier Gas Pressure Regulation. Gas Scavenging. Anesthesia Ventilators Anesthetic Monitoring Equipment Physiologic Considerations Anesthetic Depth Blood Pressure Monitoring Indirect Blood Pressure Measurement. Direct Blood Pressure Measurement. Electrocardiography Monitoring of Ventilation End-Tidal CO2 Monitors. Pulse Oximeter. Inhalant Anesthetic Monitoring Peripheral Nerve Stimulator Central Venous Pressure Noninvasive Cardiac Output Monitoring Thermodilution. Lithium Dilution Cardiac Output (LidCO). Pulse Contour Analysis (PulseCO). Noninvasive Cardiac Output (NiCO). Other Anesthetic Monitoring Anesthetic Drugs Opiates Morphine Hydromorphone Oxymorphone Meperidine Methadone Fentanyl Buprenorphine Butorphanol Tramadol Opioid Antagonism Tranquilizers Benzodiazepines Diazepam Midazolam Phenothiazines Acepromazine. α2-Agonists Xylazine. Medetomidine. Dexmedetomidine. Drugs Used for Anesthetic Induction Propofol Dissociative Agents (Ketamine and Tiletamine) Barbiturates Thiopental. Other Induction Agents Etomidate Alphaxalone Inhalant Anesthesia Minimum Alveolar Concentration Local Anesthetics Neuromuscular Blockade Anticholinergic Agents Nonsteroidal Antiinflammatory Drugs Pressors and Inotropes Anesthetic Practice Patient Assessment Designing an Anesthetic Protocol Anesthesia of Pets with Preexisting Conditions Anesthesia for Animals With Cardiac Disease Relevant Physiology and Pathophysiology Anesthetic Preparation Anesthetic Guide Premedication. Induction. Maintenance. Postoperative. Arrhythmias. Anesthesia for Animals With Endocrine Disease Thyroid Gland Relevant Physiology and Pathophysiology. Anesthetic Preparation. Anesthetic Guide Pancreas—Diabetes Mellitus Relevant Physiology and Pathophysiology. Anesthetic Preparation. Anesthetic Guide. Insulinoma Relevant Physiology and Pathophysiology. Anesthetic Guide. Adrenal Gland Relevant Physiology and Pathophysiology. Anesthetic Concerns. Anesthetic Guide. Respiratory Disease in Small-Animal Patients Pertinent Physiology Anesthetic Concerns. Anesthetic Guide Hepatic Disease Pertinent Physiology and Pathophysiology Anesthetic Concerns. Anesthetic Guide Renal Disease Pertinent Physiology and Pathophysiology Anesthetic Concerns Neurologic Disease Sepsis Pathophysiology Anesthetic Concerns Anesthesia for Specific Procedures Laparoscopy Cesarean Section (C-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 24 Equipment for Minimally Invasive Surgery Laparoscopy and Thoracoscopy Interventional Radiology/Interventional Endoscopy Equipment Operating Rooms/Angiography Suites Imaging: Rigid Telescopes Imaging: Flexible Endoscopes Imaging: Endoscope Sterilization Imaging: Cameras Imaging: Tower Components The Light Source The Insufflator The Monitor Data Recording Devices Imaging: Fluoroscopy Laparoscopy/Thoracoscopy Instrumentation and Techniques Principles of Abdominal Access: Veress Needle Technique Principles of Abdominal Access: Hasson Technique Principles of Thoracic Access Trocars and Cannulas Surgical Instruments Achieving Hemostasis/Vessel Sealing Devices Hemostatic Agents Laparoscopic Hemostatic Clips Laparoscopic Suturing Techniques Monopolar and Bipolar Electrocautery Vessel Sealing Devices Miscellaneous Instruments Suction Irrigation Devices Specimen Retrieval Bags Morcellators Endoscopic Staplers One-Lung Ventilation Tubes 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 25 Introduction to Oncologic Surgery for the General Surgeon The Origin and Progression of Cancer Cell Biology: Cell Division, Cell Cycle, 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, 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 Radiography Ultrasonography Nuclear Scintigraphy Computed Tomography and Magnetic Resonance Imaging Distant Metastasis Staging Patient Approach Perioperative Management Co-Morbid Conditions Pain and Analgesia Other Considerations Anesthetic Management Surgical Preparation Surgical Principles History Margins of Excision Wide and Radical Resections Marginal Resection Debulking Surgery Management of the Regional Lymph Node Lymph Node Staging Lymph Node Dissection: Diagnostic versus Therapeutic Intraoperative Considerations Surgical Planning Surgical Technique Intraoperative Tumor Disruption Wound Closure Tumor Margins—Concepts Published Margin Recommendations for Various Tumor Types Margin Assessment Communicating With the Pathologist Immunohistochemistry Interpretation of Margins on Pathology Report What to Do With Incomplete Margins? Multimodal Management Adjunctive Radiation Therapy Adjunctive Chemotherapy Basic Mechanisms of Cell Kill Timing Commonly Utilized Chemotherapeutic Agents for Surgical Diseases Alkylating Agents Vinca Alkaloids Antibiotics and Anthracyclines Platinum Agents Bisphosphonates Toxicity: Timing and Effects on Continuation of Therapy Immunotherapy Miscellaneous Agents Tyrosine Kinase Inhibitors Resistance Follow-Up Evaluation References References III Neurosurgery 26 Neurologic Examination and Neuroanatomic Diagnosis The Neurologic Examination Sensorium and Behavior Posture and Gait Posture Gait Paresis Ataxia Postural Reactions Postural Reaction Tests Hopping. Proprioceptive Placing (Paw Replacement) and Tactile Placing Responses Extensor Postural Thrust. Hemiwalking. Wheelbarrowing. Spinal Reflexes, Muscle Mass, and Muscle Tone Spinal Reflexes Patellar Reflex Biceps and Triceps Reflexes Withdrawal-Flexor Reflexes—Thoracic and Pelvic Limbs Crossed Extensor Reflex Perineal Reflex Cutaneous Trunci Reflex Muscle Mass and Muscle Tone Cranial Nerves Vision and Pupillary Light Responses (CN II, III, VII) Palpebral Fissure and Third Eyelid Symmetry (CN III, V, Sympathetic Nerves) Eyeball Position and Movement (CN III, IV, VI, VIII) Vestibular Function (VIII) Facial and Trigeminal Nerve Function (CN V, VII) Tongue and Laryngeal-Pharyngeal Function (CN IX, X, XI, XII) Sensory Evaluation Nociception Cutaneous Sensory Innervation Neuroanatomic Diagnosis Spinal Cord Peripheral Nervous System Lower Motor Neuron/Neuromuscular System. Peripheral Sensory Nerves. Multifocal Localizations and Diffuse Central Nervous System Disorders. 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 Creatine Kinase Serum Electrolytes Blood or Plasma Lactate and Pyruvate Urine Myoglobin Thyroid Screening Acetylcholine Receptor Antibody Additional Laboratory Testing Molecular Diagnosis of Inherited Neuromuscular Diseases Specific Diagnostic Procedures for Neuromuscular Diseases Electrodiagnostic Testing Electromyography “Normal” Spontaneous Activity. Insertional activity. Miniature end-plate potentials. End-plate spikes. Motor unit action potentials. Abnormal Spontaneous Activity. “Fibs” and “sharps”. Complex repetitive discharges. Myotonic potentials. Peripheral Nerve Conduction Studies Motor Nerve Conduction Velocity Testing. Sensory Nerve Conduction Velocity Testing. Cord Dorsum Potentials. Assessment of Nerve Root Function. F–Waves. H-Reflex. Electrophysiologic Assessment of the Neuromuscular Junction. Repetitive nerve stimulation. Single-fiber electromyography. Muscle and Nerve Biopsy Examination Muscle Biopsy Selection of a Muscle Muscle Biopsy Procedures Percutaneous Muscle Biopsy Procedure. Open Muscle Biopsy Procedure. Specimen Processing and Transport. Histochemical Analysis. Nerve Biopsy Selection of a Nerve Nerve Biopsy Technique (Common Peroneal Nerve) Nerve Specimen Processing References References 28 Imaging of the Neurologic System Advantages and Limitations of Neuroimaging Modalities Radiography Tomography: computed tomograpHy and magnetic resonance imaging Choosing the Most Appropriate Tomographic Imaging Modality Contrast Resolution Spatial Resolution Additional Advantages and Disadvantages of CT and MRI Ultrasonography and Scintigraphy Fundamentals of CT and MRI CT Tissue Contrast in CT MRI Pulse Sequences and Weighting Spin Echo and Multiecho Fast Spin Echo Inversion Recovery—T1 FLAIR, T2 FLAIR, STIR. Gradient Echo Spoiled Gradient Echo. Balanced Steady-state Free Precession. Multiecho Gradient Echo—Echoplanar Imaging. Diffusion-weighted imaging and diffusion tensor imaging. Perfusion imaging. Additional MRI Techniques Spectral Fat Saturation. Magnetic Resonance Angiography and Flow Velocity Quantification. Spectroscopy. Tissue Contrast in MRI Contrast Enhancement and Contrast Agents For CT and MRI Interpretation of CT And MR Images Brain Protocols Approach Imaging Variants and Incidental Findings Secondary Pathology Primary Pathology Spine Protocols Approach References References 29 Pathogenesis and Physiology of Central Nervous System Disease and Injury Background Anatomy Physiology Impulse Conduction Regulation of Central Nervous System Perfusion Pressure Autoregulation. Metabolic Autoregulation. Cerebral Ischemic Response and Cushing’s Reflex. Intracranial Pressure The Blood-Brain Barrier Physiology of the Immune System of the Central Nervous System Stem Cell Populations in the Adult Nervous System. Lesion Pathogenesis Contusion Primary Mechanical Damage Brain. Spinal Cord. Secondary Injury Mechanisms Compression Vascular Lesions Vascular Obstruction Hemorrhage Inflammatory Diseases Meningitis, Myelitis, and Encephalitis Contusion/Ischemic Injury 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 Behavioral Adaptations Food Restriction After Central Nervous System Injury References References 30 Medical Conditions of the Nervous System Classification of Disorders of the Vertebral Column and Spinal Cord Historical Information Neurologic Examination Degenerative Diseases Anomalies Metabolic Disorders Neoplasia Nutritional Diseases Infectious and Inflammatory Diseases Trauma Vascular Disorders Overview of Neurodiagnostics for Disorders of the Vertebral Column and Spinal Cord Cerebrospinal Fluid Analysis Cerebrospinal Fluid Collection Cerebellomedullary Cistern Collection Technique Lumbar Collection Technique Cerebrospinal Fluid Color Cerebrospinal Fluid Cell Counts and Cytology Cerebrospinal Fluid Total Protein Microbial Culture Serologic Testing and Polymerase Chain Reaction Serology Polymerase Chain Reaction Neuroimaging (Myelography, Computed Tomography, and Magnetic Resonance Imaging) Myelography Computed Tomography (CT) Magnetic Resonance Imaging (MRI) Differential Diagnosis for Disorders of the Vertebral Column and Spinal Cord Specific Disorders Degenerative Myelopathy Background. Clinical Signs. Etiopathogenesis. Neurodiagnostics. Treatment and Prognosis. Meningomyelitis Idiopathic Meningomyelitis Steroid-Responsive Meningitis-Arteritis Background. Clinical Signs. Neurodiagnostics. Etiopathogenesis. Treatment and Prognosis. Granulomatous Meningoencephalomyelitis Background. Clinical Signs. Etiopathogenesis. Neurodiagnostics. Treatment and Prognosis. Infectious Meningomyelitis Viral Meningomyelitis Canine Distemper Virus Meningoencephalomyelitis Background. Clinical Signs. Etiopathogenesis. Clinical progression of canine distemper virus meningoencephalomyelitis Neurodiagnostics. Treatment and prognosis. Feline Infectious Peritonitis Virus Background. Clinical Signs. Etiopathogenesis. Neurodiagnostics. Treatment and Prognosis. Protozoal Meningoencephalomyelitis (Toxoplasma gondii and Neospora caninum) Background. Clinical Signs. Etiopathogenesis. Neurodiagnostics. Treatment and Prognosis. Bacterial Meningomyelitis and Spinal Cord Epidural Empyema Background. Clinical Signs. Etiopathogenesis. Neurodiagnostics. Treatment and Prognosis. Discospondylitis Background. Clinical Signs. Etiopathogenesis. Neurodiagnostics. Treatment and Prognosis. Vascular Disorders Background Clinical Signs Etiopathogenesis Neurodiagnostics Treatment and Prognosis Summary References References 31 Cervical Spine 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’s Syndrome Incontinence Differential Diagnosis of Cervical Spinal Cord Disease Diagnostic Approach to Cervical Spinal Cord Disease Surgical Approaches to the Cervical Spine Ventral Approach to the Cervical Spine Ventral Approach to the Atlantoaxial Junction Lateral Approach to the Cervical Spine Dorsal Approach to the Cervical Spine Lateral Approach to the Brachial Plexus Atlantoaxial Instability Anatomy Epidemiology and Pathophysiology Clinical Signs Specific Diagnosis Conservative Treatment Indications for Surgery Specific Surgical Techniques Dorsal Techniques Atlantoaxial Wiring. Nuchal Ligament Technique. Dorsal Cross-Pinning. Kishigami Atlantoaxial Tension Band. Ventral Techniques Transarticular Lag Screws or Pins. (Figure 31-18) Pins and PMMA. Screws and PMMA. Surgical Complications Neurologic Deterioration Respiratory System Compromise Implant Failure Fracture of the Atlas or Axis Recurrent Pain Postoperative Care Prognosis/Outcome Brachial Plexus Trauma Anatomy Epidemiology and Pathophysiology Clinical Signs Specific Diagnosis Indications for Surgery Specific Surgical Techniques Neurotization Reimplantation Surgical Complications Neurologic Deterioration Cutaneous Trauma and Self-Mutilation Postoperative Care Prognosis/Outcome Disc Disease Anatomy Epidemiology and Pathophysiology Clinical Signs Specific Diagnosis Conservative Treatment Indications for Surgery Specific Surgical Techniques Ventral Slot A Slanted Ventral Slot Procedure Dorsal Laminectomy Limited Dorsolateral Hemilaminectomy With Removal of the Articular Process Fenestration Surgical Complications Respiratory Compromise Intraoperative Cardiac Dysrhythmias Blood Loss Neurologic Deterioration Vertebral Instability and Subluxation Seroma Formation Postoperative Care Prognosis/Outcome Site of Disc Herniation Degree of Central Nervous System Injury Duration of Disease Type of Treatment Cervical Spondylomyelopathy Anatomy Epidemiology and Pathophysiology Clinical Signs Specific Diagnosis Additional Diagnostics for Presurgical Evaluation Treatment Conservative Treatment Indications and General Considerations for Surgery Disc-Associated Cervical Spondylomyelopathy Osseous Compression Pure Ligamentous Compressions Surgical Techniques Direct Decompressive Techniques Ventral Slot. Inverted Cone Technique Dorsal Laminectomy Cervical Hemilaminectomy Indirect Decompression—Vertebral Distraction Techniques Distraction-Stabilization Using Metal Implants and Bone Cement Pins and Polymethylmethacrylate (PMMA) Screw Bar–PMMA Distraction Using the PMMA Plug Locking Plate Motion-Preserving Techniques Cervical Disc Arthroplasty Complications Postoperative Neurologic Deterioration Vertebral Canal and Transverse Foramina Penetration Adjacent Segment Syndrome or “Domino” Effect Laminectomy Membrane Implant Failure Collapse of Intervertebral Foramina Insufficient Decompression Postoperative Care Prognosis/Outcome Recurrence Rate Progression of Cervical Spondylomyelopathy and Long-Term Survival 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 Spine 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 Intervertebral Disc Fenestration Thoracolumbar Vertebral Column Imaging Traditional Imaging Modalities Radiography Myelography Multiplanar Imaging Modalities Computed Tomography (CT) Magnetic Resonance Imaging (MRI) Cerebrospinal Fluid Analysis Thoracolumbar Disc Herniation Medical Management Emerging Medical Therapy for Spinal Cord Injury in Dogs with Thoracolumbar Disc Herniation Surgical Management Outcomes After Surgical Treatment of Thoracolumbar Disc Disease Outcomes in Dogs Treated Surgically for Intact Deep Nociception Outcomes in Dogs Treated Surgically for Absent Deep Nociception Other Factors Associated With Outcome in Dogs With Surgically Treated Disc Herniation Cranial Lumbar/Thoracic Versus Caudal Lumbar Disc Herniation Dog Size and Type of Herniation Electrophysiology, Ultrasound, and Biomarkers Other Considerations Related to Surgical Technique Fenestration 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 Conditions Congenital/Developmental Malformations Hemivertebra, Block Vertebra, Butterfly Vertebra Spina Bifida Cartilaginous Exostoses (Osteochondromatosis) Pilonidal Sinus (Dermoid Sinus) Epidermoid Cyst Spinal Arachnoid Cyst Spinal Dysraphism Tumoral Calcinosis Leukodystrophy References Reference 33 Lumbosacral Spine Anatomy and Pathophysiology of Lumbosacral Disease Anatomy Pathophysiology Clinical Signs of Lumbosacral Disease Differential Diagnoses for Lumbosacral Disease/Cauda Equina Syndrome Diagnosis of Lumbosacral Disease Electrophysiologic Studies Radiographic Imaging Studies Survey Radiography Linear Tomography Venography Myelography Discography/Epidurography Cross-Sectional Imaging Techniques Computed Tomography Magnetic Resonance Imaging Medical Treatment Surgical Treatment of Lumbosacral Syndrome Dorsal Decompression Outcome and Prognosis References References 34 Spinal Fractures and Luxations Assessment and Diagnosis Trauma Assessment and Stabilization Neurologic Examination Imaging Radiographs Myelography Computed Tomography Magnetic Resonance Imaging Biomechanical Considerations Fracture Biomechanics Treatment Medical Nonsurgical Surgical Thoracolumbar Fractures and Luxations Pins and PMMA. External Fixation. Contourable Locking Plate. Other Techniques. Decompressive Procedures. Cervical Fractures and Luxations Lumbosacral Fractures and Luxations Postoperative Care Complications Prognosis References References 35 Medical and Surgical Management of the Brain-Injured Pet Brain Injury Physical Examination Fluid Therapy Oxygen Therapy Physical Examination Medical Therapy Seizures Due to Head Trauma Other Therapies Surgical Intervention Prognosis References References 36 Intracranial Neoplasia Primary Brain Tumors Diagnosis Treatment of Primary Brain Tumors Prognosis Secondary Brain Tumors References References 37 Congenital Brain Malformations Congenital Hydrocephalus and Intracranial Arachnoid Cysts Anatomy and Physiology Congenital Hydrocephalus Physical Examination Diagnosis Medical Treatment Surgical Treatment Intracranial Arachnoid Cyst Physical Examination Diagnosis Treatment Abnormalities of the Craniocervical Junction Chiari-Like Malformation Signalment Clinical Signs Diagnosis Treatment Medical Therapy Surgical Treatment Outcome and Prognosis Atlanto-Occipital Overlapping Dorsal Constriction at C1-C2 Atlantoaxial Instability References References 38 Anesthesia for Intracranial Surgery Physiology Monro-Kellie Doctrine Cerebral Perfusion Pressure Intracranial Pressure Cerebral Blood Flow Effects of Chemical Factors on Cerebral Blood Flow CO2. Oxygen. Cerebral Metabolic Rate for Oxygen Cushing’s Response Glycemia Pharmacology in Neuroanesthesia Intravenous Agents Dexmedetomidine Acepromazine. Ketamine. Opioids Fentanyl. Alfentanil. Remifentanil. Benzodiazepines Propofol Thiopental Etomidate Inhalant Agents Isoflurane Sevoflurane Nitrous Oxide Anesthesia Management for Neurosurgery General Preoperative Management Premedication Induction of General Anesthesia Maintenance of Anesthesia Noninvasive Procedures. Craniotomies. Monitoring Recovery. Treatment of Raised Intracranial Pressure/Strategies of Brain Protection. Hypothermia. Mannitol and hypertonic saline. Barbiturates. Lidocaine. “Tight brain.” References References 39 Spinal Neoplasia Signalment Age Breed/Gender Clinical Signs Diagnosis Tumor Location Diagnostic Testing Treatment Surgical Therapy Radiation Therapy Chemotherapy Symptomatic Care Specific Tumor Types Extradural Tumors Vertebral Neoplasia Osteochondroma/Osteochondromatosis/Multiple Cartilaginous Exostoses. Osteosarcoma. Lymphoma. Intradural/Extra-Axial Tumors Meningioma Nerve Sheath Tumors Signalment. Extrarenal Nephroblastoma Intra-Axial Tumors References References IV Musculoskeletal System 40 Tissues of the Musculoskeletal System General Organizational Features of Connective Tissues General Features of Cells 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 41 Fracture Biology and Biomechanics Bone Structure Biomechanical Concepts Cortical Bone Material Properties Cancellous Bone Material Properties Fracture Biomechanics Fracture Patterns Pathologic Fractures Fatigue Fractures Bone Healing Strain Theory and Bone Healing Secondary Bone Healing Primary Bone Healing Gap Primary Bone Healing Contact Primary Bone Healing Distraction Osteogenesis Biologic Healing Environment References References 42 Open Fractures Fracture Classification Wound Treatment Antimicrobial Therapy Initial Surgical Debridement Definitive Surgical Treatment Soft Tissue Treatment Fracture Treatment Complications References References 43 Internal Fracture Fixation Fracture Reduction Planning Open Anatomic Reconstruction Biological Osteosynthesis Open But Do Not Touch Minimally Invasive Osteosynthesis Implant Selection Orthopedic Wire Pins Kirschner Wires Steinmann Pins Interlocking Nails Designs Equipment Biomechanics Biology Guidelines for Appropriate Selection of Interlocking Nails and Preoperative Considerations General Technique and Instrumentation Interlocking Nail for Treatment of Long Bone Fractures in Small Animals Explantation 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 44 External Skeletal Fixation Introduction and History Components and Nomenclature of External Skeletal Fixators Linear External Skeletal Fixation Systems Pins/Kirschner Wires Used in Linear External Skeletal Fixation Systems Connecting Bars and Pin-Connecting Bar Clamps Used in Linear External Skeletal Fixation Systems Circular External Skeletal Fixation Systems Transfixation Kirschner Wires Used in Circular External Skeletal Fixation Systems Rings, Threaded Rods, and Nuts/Bolts Used in Circular External Skeletal Fixation Systems External Skeletal Fixator Frame Configurations and Biomechanics Guiding Principles of External Skeletal Fixator Application Bone Healing with External Skeletal Fixation Clinical Applications for External Skeletal Fixation Fixation of Distal Extremity Fractures: Radius and Tibia Proximal Long Bone Fractures: Humerus and Femur Fractures of the Mandible and Maxilla Spinal Fractures and Luxations Special Fracture Conditions Open Fracture Posttraumatic Osteomyelitis Nonunion Fractures Specific Orthopedic Conditions Angular Limb Deformities Limb Salvage Transarticular External Skeletal Fixation Aftercare Following Application of External Skeletal Fixation Complications of External Skeletal Fixation References References 45 Orthopedic Coaptation Devices and Small-Animal Prosthetics Principles of Orthopedic External Coaptation Devices Principles of External Coaptation for Fracture Management Patient Assessment Fracture Assessment Basic Guidelines for External Coaptation as Primary Fracture Management Fracture Reduction Fracture Alignment Standing Position Joints Proximal and Distal Temporary Splintage Guidelines for Selecting Appropriate External Coaptation Complications and Postapplication Care Bandages, Splints, and Casts Carpal Flexion Bandage The Robert Jones Bandage and Its Modifications Robert Jones Bandage Modified Robert Jones Bandage Reinforced Robert Jones Bandage Spica Splint Schroeder-Thomas Splint Casts Casting Material Application Cast Removal Complications and Postapplication Care The Full-Leg Cast Half-Cast Walking Bar Bivalved Cast Hobbles and Slings Hobbles Forelimb Hindlimb Ehmer Sling Pelvic Limb Sling Velpeau Sling Carpal and Tarsal Support Wraps Elbow Hygroma Orthotic and Prosthetic Devices for Small Animals History of Human Orthotic and Prosthetic Devices History of Veterinary Orthotic and Prosthetic Devices Steps in Creating a Custom Orthotic or Prosthetic Device Types of Orthoses Nonrigid Semi-Rigid Rigid Classifications of Orthoses Types of Injuries Sprains Stifle Contracture/Assist-Type Braces Orthosis Construction Measuring and Casting for Orthoses Prostheses Prosthetic Candidate Selection Surgical Considerations Postoperative Stump Management Prosthesis Construction Maintenance of Orthotic and Prosthetic Devices Introduction of the Device to the Patient Device Integration Through Rehabilitation Therapy Complications Osseointegration Prosthesis References References 46 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 47 Principles of Angular Limb Deformity Correction Introduction Normal Limb Alignment and Joint Orientation Defining Frontal, Sagittal, and Transverse Planes Bone Axes Joint Orientation Angles Humerus Radius Femur Tibia 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 Opening Wedges Closing Wedges Circular Cut Osteotomies Radial (Cylindrical) Osteotomies Dome Osteotomies Methods of Fixation References References 48 Osteomyelitis Classification Anatomy Pathophysiology Hematogenous Osteomyelitis Posttraumatic Osteomyelitis Biofilm Fracture Instability Diagnosis and Treatment Hematogenous Osteomyelitis Posttraumatic Osteomyelitis Acute Posttraumatic Osteomyelitis Chronic Posttraumatic Osteomyelitis Management of Infected Joint Prostheses References References 49 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 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 Acknowledgment References References 50 Scapula Scapular Body Fractures Fractures of the Acromion Scapular Neck Fractures Supraglenoid tubercle and Glenoid Fractures Scapular Luxation/Avulsion Ununited Accessory Ossification Center of the Caudal Glenoid References References 51 The Shoulder Anatomy Biomechanical Physiology Diagnosis of Shoulder Disorders Physical Examination Arthrocentesis Radiography Cross-Sectional Imaging Conditions Affecting the Bones of the Shoulder Osteochondritis Dissecans Diagnosis Treatment Glenoid Dysplasia Diagnosis Treatment Excision Arthroplasty. Arthrodesis. Multiple Epiphyseal Dysplasia Hypertrophic Osteodystrophy Incomplete Ossification of the Caudal Glenoid Chondrocalcinosis Conditions Affecting the Soft Tissues of the Shoulder Biceps Brachii Tendinopathy Diagnosis History. Physical Examination Techniques. Diagnostic Imaging. Treatment Medical Treatment. Surgical Treatment. Other Conditions Affecting the Tendon of Origin of the Biceps Brachii Muscle Medial Displacement of the Tendon of Origin of the Biceps Brachii Muscle Rupture of the Tendon of Origin of the Biceps Brachii Muscle Calcifying Tendinopathy of the Tendon of Origin of the Biceps Brachii Muscle Supraspinatus Tendinopathy Diagnosis Treatment Shoulder Joint Instability/Subluxation Medial Instability Diagnosis History and Physical Examination. Diagnostic Imaging. Arthroscopy. Treatment Postoperative Management and Outcomes Lateral Instability Traumatic Luxation Diagnosis Treatment Muscle Disorders Muscle Strain Teres Minor Myopathy Infraspinatus and Supraspinatus Muscle Contracture Other Conditions Villonodular Synovitis Synovial Chondrometaplasia Infraspinatus Bursal Ossification Miscellaneous Soft Tissue Mineralization Conditions References References 52 Fractures of the Humerus Anatomy Fractures of the Humerus in the Dog and Cat Proximal Humeral Fractures Proximal Physeal Fractures Proximal Metaphyseal Fractures Diaphyseal Fractures Surgical Approach Fixation Methods Conservative Treatment or External Coaptation for Humeral Fractures Intramedullary Pinning for Humeral Fractures Interlocking Nailing for Humeral Fractures External Skeletal Fixation for Humeral Fractures Bone Plates and Screws for Humeral Fractures Distal Humeral Fractures Supracondylar Fractures Humeral Condylar Fractures Fracture of the Lateral Part of the Humeral Condyle Fracture of the Medial Part of the Humeral Condyle Fracture of the Medial or Lateral Humeral Epicondyle. Intracondylar (T-Y) Fractures Incomplete Ossification of the Humeral Condyle and Incomplete Humeral Condylar Fracture. Prognosis and Aftercare after Humeral Fracture Repair References References 53 Surgical Diseases of the Elbow Anatomy Traumatic Luxation of the elbow joint Diagnosis Treatment Closed Reduction and Stabilization Open Reduction and Stabilization Joint Immobilization and Aftercare Prognosis and Complications Congenital Luxation of the elbow joint Caudolateral Luxation of the Radial Head Diagnosis Treatment Aftercare Lateral Rotation of the Ulna Diagnosis Treatment Closed Reduction and Immobilization Open Reduction and Immobilization Elbow Dysplasia Ununited Anconeal Process Epidemiology Pathogenesis and Pathophysiology Diagnosis Treatment and Outcome Ununited Medial Humeral Epicondyle Medial Compartment Disease Definitions Epidemiology Etiopathogenesis Pathophysiology Diagnosis Physical Examination. Radiographs. Computed Tomography. Other Imaging Modalities. Arthroscopy. Treatment Surgical Approach: Arthrotomy or Arthroscopy. Elbows With Mild to Moderate Degenerative Joint Disease Treatment of Lesions Affecting the Medial Portion of the Coronoid Process Treatment of Cartilage Lesions Affecting the Humeral Trochlea Treatment of Radioulnar Incongruence Elbows With Moderate to Severe Degenerative Joint Disease Sliding Humeral Osteotomy Postoperative Management Prognosis References References 54 Total Elbow Replacement in Dogs Current Systems—Design Rationale and Evolution Indications/Contraindications Preoperative Evaluation Surgical Techniques Iowa State System TATE Elbow System Postoperative Evaluation and Management Clinical Outcome—Complications Iowa State System TATE Elbow System Limitations of Total Elbow Replacement References References 55 Radius and Ulna Anatomy and Development Anatomy Growth and Development Bone Alignment and Breed Conformation Pathologic Conditions Juvenile Conditions Radial Shortening Ulnar Shortening Asymmetric Physeal Disturbance and Angulation During Development Antebrachial Angular Limb Deformity Surgical Planning. Uniapical Deformities. Biapical Deformities. Multiapical Deformities. Antebrachial Angular Limb Deformity Surgical Correction. Aftercare. Prognosis. Antebrachial Fracture in the Juvenile Patient. Adult Conditions Fractures of the Radius Fractures of the Proximal Radius Fractures of the Radial Diaphysis External Coaptation. Internal Fixation. External Skeletal Fixation. Fractures of the Distal Radius Fractures of the Radius and Ulna in Toy-Breed Dogs Fractures of the Ulna Fractures of the Proximal Ulna. Monteggia fractures. Fractures of the Distal Ulna. References References 56 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 Radial 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 References References 57 Fractures of the Pelvis Fractures of the Ilium Acetabular Fractures Combined Ilial and Acetabular Fractures Sacroiliac Luxation Sacral Fracture Fractures of the Ischium and Pubis Postoperative Care References References 58 Coxofemoral Luxation Anatomy Etiology and Pathophysiology Diagnosis Treatment Closed Reduction and Stabilization Augmentation of Closed Reduction Ehmer Sling. Hobbles. Ischioilial Pinning. External Fixators. Transarticular Pinning. Open Reduction and Stabilization Capsulorrhaphy. Prosthetic Capsule Technique. Transposition of the Greater Trochanter. Transarticular Pinning. Toggle Rod Stabilization. Fascia Lata Loop Stabilization. Transposition of the Sacrotuberous Ligament. Extra-articular Iliofemoral Suture. Surgical Stabilization of Ventral Luxations. Femoral Head and Neck Excision Arthroplasty. Triple Pelvic Osteotomy. Total Hip Arthroplasty. Postoperative Care Outcome References References 59 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 Hip-Extended Radiography Orthopedic Foundation for Animals Fédération Cynologique Internationale. British Veterinary Association/Kennel Club. Neutral-Position Radiography University of Pennsylvania Hip Improvement Program. Dorsolateral Subluxation. Flückiger Subluxation Index Palpation Ultrasound Computed Tomography and Magnetic Resonance Imaging Kinematic and Force Plate Studies Controlling Canine Hip Dysplasia Genetic Change: The Importance of Heritability and Selection Pressure Selection Pressure and Its Role in Genetic Change Reported Improvements in Hip Phenotype Are We Hitting the Bull’s-Eye? Nonsurgical Management of Canine Hip Dysplasia References References 60 Surgical Therapy of Canine Hip Dysplasia Anatomy Selection of Appropriate Surgical Options Juvenile Pubic Symphysiodesis Rationale, Patient Selection, and Timing Surgical Approach and Procedure Aftercare Pelvic Osteotomy Rationale and Patient Selection Evidence Surgical Approach and Procedure Technique Variations Aftercare Complications of Triple Pelvic Osteotomy Femoral Head and Neck Ostectomy Rationale, Patient Selection, and Timing Evidence Surgical Approach and Procedure Aftercare Complications of Femoral Head and Neck Ostectomy Total Hip Arthroplasty Overview and Patient Selection Cemented Total Hip Arthroplasty Surgical Approach Cement Preparation and Injection Acetabular Preparation and Implant Placement Femoral Preparation and Implant Placement Head Selection and Hip Joint Reduction Aftercare Cementless Total Hip Arthroplasty Differences in Commercial Systems Surgical Procedure Aftercare Complications of Total Hip Arthroplasty Aseptic Loosening Luxation Infection Femoral Fracture Subsidence and Pistoning Emerging or Discarded Therapies Coxofemoral Denervation Rationale and Patient Selection Surgical Approach and Procedure Outcomes Intertrochanteric Osteotomy Pectineus Myectomy Shelf Arthroplasty References References 61 Fractures of the Femur Introduction Surgical Anatomy Proximal Femur Anatomy of the Femoral Head and Neck Anatomy of the Trochanters and Trochanteric Fossa Growth of the Proximal Femur Vascular Supply of the Proximal Femur Femoral Diaphysis Anatomy of the Femoral Diaphysis Growth of the Femoral Diaphysis Vascular Supply of the Femoral Diaphysis Distal Femur Anatomy of the Distal Femur Growth of the Distal Femur Vascular Supply of the Distal Femur Fracture Classification Surgical Planning Imaging of the Femur Radiographic Assessment of the Femur Computed Tomography Surgical Approaches to the Femur Proximal Femur Femoral Diaphysis Distal Femur Specific Treatment Proximal Femoral Fractures Epiphyseal Fractures Capital Physeal Fractures Minimally Invasive Physeal Repair Capital Physeal Dysplasia Cervical Fractures Fractures of the Greater Trochanter Subtrochanteric Fractures Postoperative Care Complications Prognosis Salvage Procedures Diaphyseal Femoral Fractures Bone Plates Plate-Rod Constructs Intramedullary Rod (Pin) and Cerclage Wires Stack Pinning Interlocking Nails External Skeletal Fixation Postoperative Care Complications and Prognosis Distal Femoral Fractures Supracondylar Fractures Bone Plating. Interlocking Nails. Other Fixation Methods. Distal Physeal Fractures Distal Physeal Pinning. Other Fixation Methods. Condylar Fractures Unicondylar Fractures. Bicondylar Fractures. References References 62 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 Shape, Attachment, and Function Composition Blood Supply 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 Treatment Considerations 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 Surgical Evaluation Classification of Meniscal Tears Surgical Technique and Meniscal Evaluation Exposure Meniscal Evaluation (Observation) Meniscal Evaluation (Probing) Diagnosis of Degenerative Tears 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 Surgical Technique Method of Securing Suture and Suture Material Suture Anchorage Sites Outcomes and Complications Complications Fibular Head Transposition Outcomes and Complications 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 Complications Summary Osteotomy Procedures Cranial Tibial Closing Wedge Osteotomy Surgical Technique Tibial Plateau Leveling Osteotomy Preoperative Planning Tibial Plateau Leveling Osteotomy Position Surgical Technique Angular and Torsional Corrections Outcome and Complications Postoperative Tibial Plateau Leveling Osteotomy Neoplasia Tibial Plateau Leveling Osteotomy/Cranial Closing wedge ostectomy Surgical Technique Tibial Tuberosity Advancement Surgical Planning Surgical Technique Outcome and Complications Case Selection Low versus High Patellar Tendon Insertion Point Excessive Tibial Plateau Angle Angular and Torsional Limb Deformities Patellar Luxation Patient Size Triple Tibial Osteotomy Surgical Technique Caudal Cruciate Ligament Rupture Etiology, Pathogenesis, Pathophysiology, and Epidemiology Diagnosis Treatment Avulsion Fracture Midsubstance Tear Aftercare, Prognosis, and Outcome Patellar Luxation Functional Anatomy of the Normal Quadriceps/Patellar Mechanism Medial Patellar Luxation in Small-Breed Dogs Etiology and Pathogenesis Epidemiology and Pathophysiology Diagnosis Decision Making Surgical Technique Trochleoplasty Trochlear Sulcoplasty Trochlear Chondroplasty Trochlear Wedge Recession Trochlear Block Recession Tibial Tuberosity Transposition Soft Tissue Reconstructive Techniques Antirotational Techniques Medial Patellar Luxation in Large-Breed Dogs Etiology and Pathogenesis Epidemiology and Pathophysiology Diagnosis Diagnostic Imaging Treatment Surgical Technique (Distal Femoral Corrective Osteotomy) Postoperative Care, Prognosis, and Complications Lateral Patellar Luxation in Dogs Etiology and Pathogenesis Epidemiology and Pathophysiology Diagnosis Treatment Postoperative Care, Prognosis, and Complications Stifle JOINT Luxation and Collateral Ligament Injuries Etiology, Pathogenesis, Pathophysiology, and Epidemiology Diagnosis Treatment Surgical Techniques Extra-articular Stabilization Transarticular Stabilization Outcome, Prognosis, and Complications Patellar Fracture and Patellar Ligament Injuries Etiology, Pathogenesis, Pathophysiology, and Epidemiology Diagnosis Treatment of a Patellar Fracture Treatment of Patellar Ligament Rupture Outcome, Prognosis, and Complications Stifle Osteochondrosis Etiology and Pathogenesis Epidemiology Diagnosis Treatment Outcome and Prognosis Avulsion and Luxation of the Tendon of Origin of the Long Digital Extensor Muscle Etiology, Pathogenesis, Pathophysiology, and Epidemiology Treatment, Outcome, and Prognosis: Avulsion of the Tendon of Origin of the Long Digital Extensor Muscle Treatment, Outcome, and Prognosis: Luxation of Tendon of Origin of the Long Digital Extensor Muscle Avulsion of the Origin of the Gastrocnemius Muscle Etiology, Pathogenesis, Pathophysiology, and Epidemiology Treatment, Outcome, and Prognosis Total Knee Replacement Stifle Joint Arthrodesis References References 63 Fractures of the Tibia and Fibula Anatomy Developmental Anatomy Anatomy of Mature Dogs and Cats Fracture Epidemiology Proximal Fractures Diaphyseal Fractures Distal Fractures Preoperative Management Open Fractures Diagnostic Procedures Proximal Fractures Immature Animals Avulsion of the Tibial Tuberosity Physeal Fractures Mature Animals Metaphyseal Fractures Diaphyseal Fractures Repair Options External Skeletal Fixation Intramedullary Pin Fixation Intramedullary Pin and Auxiliary Fixation Interlocking Nail Plates Plate-Rod Combination Minimally Invasive Plate Osteosynthesis Aftercare Immature Animals Incomplete Fractures or Simple Fractures With Intact Fibula Simple (Transverse/Oblique/Spiral) Fractures Mature Animals Simple (Transverse and Short Oblique) Fractures Simple (Long Oblique and Spiral) Fractures Reducible Comminuted Fractures Nonreducible Comminuted Fractures Distal Fractures Immature Animals Physeal Fractures Mature Animals Malleolar Fractures Distal Metaphyseal Fractures Comminuted and Articular Fractures Complications External Skeletal Fixators 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 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 Fractured Malleolus Ligament Rupture Dealing With a Ruptured Ligament. Postsurgical Management. Rupture of the Short Collateral Ligament Shearing Injuries Clinical Findings Treatment Plantar Intertarsal Luxation or Subluxation Clinical Presentation Diagnosis Treatment Postsurgical Management Dorsal Intertarsal Subluxation Tarsometatarsal Subluxation and Luxation Treatment Postsurgical Management Tendon Problems Disruption of the Common Calcanean Tendon Complete Disruption of the Common Calcanean Tendon Management Postoperative Care Partial Disruption of the Common Calcanean Tendon (Avulsion of the Tendon of Insertion of the Gastrocnemius Muscle) Outcomes Luxation of the Tendon of the Superficial Digital Flexor Muscle Treatment Arthrodesis Techniques in the tarsus Arthrodesis of the Tarsocrural Joint/Pantarsal Arthrodesis Cranially Placed Plate Plus Lag Screw Medial Plate Technique Postoperative Management Outcome Partial Tarsal Arthrodesis Arthrodesis of the Calcaneoquartal Joint Postoperative Management Outcome Arthrodesis of the Tarsometatarsal Joints Postoperative Management Outcome References References 65 Amputations Surgical Techniques General Principles and Considerations Thoracic Limb Amputation by Disarticulation at the Scapulohumeral Joint Amputation by Removal of Scapula Pelvic Limb Amputation at the Mid-Diaphysis of the Femur Amputation by Disarticulating the Coxofemoral Joint Amputation by Acetabulectomy Outcome and Complications References References 66 Dentistry for the Surgeon Oral Examination History and Clinical Signs Extraoral Examination Intraoral Examination Tooth Formula in Dogs and Cats Dental Radiography Equipment Obtaining Radiographs Processing Radiographs 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 Maxillofacial repair, undertaken to restore the original anatomic configuration, can be accomplished with many techniques, including oral splints, interfragmentary wiring, standard plates, and miniplates. Two general methods are commonly used to obtain fracture fixation and restoration of function: (1) oral methods that utilize the teeth for the application of fixation devices, and (2) use of the bony skeleton itself. The former is addressed in Chapter 66; the latter is discussed here. This discussion is limited primarily to intraosseous wiring and plating techniques; the role of external skeletal fixation also is addressed. Miniplate fixation may provide the optimum environment for direct bone healing because of its ability to provide three-dimensional stability. In the mandibular and maxillofacial skeleton, implants must be placed at the most biomechanically favorable sites, so as to appropriately neutralize the tension forces and torsional moments that cause fracture distraction. Intraosseous Wire The basic premise of wire fixation is to use intraosseous wire as a rigid suture to reappose and compress fractured bone fragments together. Intraosseous wiring techniques thus rely on the static forces generated by the tension of the wire and by the frictional forces between corresponding bone fragments.3,36,48 No stability is imparted in rotation or bending. Adequate stability for healing can be attained only with accurate anatomic reduction and sufficient neutralization of two broad, opposing bone fragments.3,48 Consequently, intraosseous wiring techniques are most successful if all bone fragments can be anatomically repositioned, thereby enabling the bone and implants to share any applied loads.3,36,48Significant comminution or bone loss precludes the ability to obtain such precise anatomic reapposition of all bone fragments, as it is not possible to achieve continuous interfragmentary compression across each/all bone fragments.3,36,48 Intraosseous wires provide only two-dimensional stability because rotation continues to occur around the wires as they are passed through holes of slightly greater diameter than the wire.3,36,48 Comminuted fracture reconstruction often fails owing to the difficulty encountered in anatomically reconstructing and appropriately securing all bone fragments. Wiring of multiple small bone fragments, although technically feasible, often is not attainable. With many small bone fragments, it is unlikely that anatomic reduction of each and every fragment will be attained. Similarly, any gaps in reduction preclude this method of fixation; attempting to bridge small gaps by spanning wires across a gap to adjacent bone fragments will not be successful, as this form of fixation cannot function as a buttress device. Failure to anatomically reduce the fracture fragments exactly will result in an unstable fixation. In this situation, the bone fragments are not brought into apposition resulting in insufficient contact between the two opposing bone surfaces. Consequently, the wires are ineffective in compressing these fragments together, and stability is not obtained. The end result is that the fixation becomes loose, with further loss of the marginal reduction obtained. Moreover, failure to anatomically reduce the bone fragments results in malocclusion. The biomechanical limitations of this fixation method must be fully appreciated. Implants are small and require application in tension, so as to compress two opposing fragments together. For effective fixation, intraosseous wires must be placed along the lines of tension stress, so that any distractive forces do not overwhelm the implants.25 Application of the tension band principle takes advantage of the fact that these fixation devices are strongest in tension.7 Mandible In mandibular fracture, the lines of tensile stress are along the alveolar margin; therefore, it is along this surface that wire fixation is most effective.25,63 Torsional and shear forces also exist, each most prominent rostrally and at the ramus, respectively. Therefore, in addition to the tension band wire along the alveolar bone margin, a second area of fixation must be considered along the ventral bone margin to effectively neutralize shear and rotation.25,61,63 The second wire often is referred to as a stabilization wire (Figure 67-9).13,93 In the dog and cat, the small wire size enables its placement in the appropriate biomechanically advantageous position along the alveolar bone margin, while simultaneously avoiding impingement with the teeth.13 Sufficient space is available between the tooth roots of individual teeth and adjacent teeth to place intraosseous wire fixation into bone without causing damage to these structures (see Figure 67-9). Midfacial Skeleton The midfacial skeleton is supported by various buttresses that support the facial frame.20,32,42 Therefore, the primary forces to be neutralized are compressive. Thus, wire fixation is not indicated for these fractures. Relatively simple fractures that do not involve buttress support may be treated by this method of fixation, provided there is no potential for bony collapse of the wired fragments. The latter requires that the bone fragments can be locked into position when the wires are tightened, with no tendency for the reconstructed fragment to collapse on itself. This requirement usually dictates that the bone fragments are quite large. Wire Placement Appropriate positioning and tightening of intraosseous wires are paramount; this function is dictated by wire stiffness and strength. Most orthopedic wire is manufactured with similar quality; however, different manufacturers have wire of somewhat different strength and stiffness, and selection is based on personal preference. As a general rule, 1.0 to 1.25 mm wire (18 to 20 gauge) is used most often; wire <1.0 mm (<20 gauge) is of insufficient strength to maintain fracture reduction, even in small patients. Larger wire is more difficult to place and tighten appropriately; however, its use results in a more secure fixation. All drill holes for wires are placed such that the tension band wire will generally cross perpendicular to the fracture line; thus, as the wire is tightened, no shearing movement can occur. This may not always be possible, and to neutralize all shear and rotational forces across the fracture, a second (stabilization) wire is secured. This wire generally is placed parallel to the first and a few millimeters apart. With more unstable fracture configurations, such as oblique fractures, the second wire is placed at a divergent angle to the first, thus enhancing stability, so as to prevent overriding or rotation of opposing bone fragments. Drilling holes for the wire is recommended to be performed by hand with trocar-tipped Kirschner wires (K-wires) (0.062˝ or 0.045˝), which allows for more precise placement, so as to avoid the teeth. Hand drilling allows palpation of the tooth root; if encountered, drilling can easily be redirected. Drill holes need to be approximately 5 to 10 mm away from the fracture to prevent the wire from being pulled through the bone upon tightening. Conversely, if the drill holes are too far from the fracture line, insufficient tension will be generated upon tightening, and the wires will become loose when placed under stress. Orienting drill holes toward the fracture site results in a sloping hole that facilitates both positioning of the wire and subsequent tightening. In most mandibular and maxillofacial fractures, the bone fragments are not very mobile despite a wide surgical exposure; therefore all intraosseous wires are passed through drill holes, while the bone fragments remain in situ. By sloping the drill hole, the wire may be passed through one fragment, which directs it toward the fracture line, where it is then grasped; the end of the wire can then be redirected into the second bone fragment by looping it around on itself and passing it through the sloped drill hole in the opposite bone fragment. After the wire exits this fragment, it is pulled through while the loop in the wire between the two bone fragments is simultaneously untwisted. The area of the loop (and the small kink that develops in the wire) is eliminated from the area that is to be tightened by moving it completely through the drill hole in the second bone fragment (Figure 67-10). Wire Tightening Intraosseous wires may be tightened with a twist knot or a tension loop; it is essential that the wire be applied tightly to ensure a stable fixation. The twist method is more easily applied and allows better control of tightening. The tension loop wire is too easily overtightened in these flat bones with thin cortices, and this frequently results in the wire being pulled through the bone or creation of additional fractures. The hand-twist technique results in a better “feel” for fracture reduction and wire tightening. As the twist knot is tightened, tension must be applied by pulling up on the wire, thereby ensuring that the wire slides through the angled drill holes (the obtusely oriented holes on the far side of the bone fragments); furthermore, angled drill holes permit the bone fragments to slide into reduction with minimal resistance as the wire is tightened. As the wire twist is completed, tension is decreased to permit final tightening (Figure 67-11). It is important to recognize that the wire will not continue to slide (because of the now acutely oriented wire position on the near side of the fragments); to further ensure that sufficient tension is obtained to secure a tight wire, and the fracture has been firmly compressed, a second instrument is used to temporarily lever under the loop to additionally tighten the wire (see Figure 67-11), after which the final twisting is completed. During the final twisting, the wire is bent over against the bone perpendicular to both arms of the wire and away from the gingival margin. The wire is then cut to maintain at least three twists. Inappropriately tightened wires will lead to fixation failure, as the wires will not sufficiently compress together the opposing bone fragments. General orthopedic principles of wire tightening must be followed.54 Twisting with uneven tension on the two strands of wire, continued twisting after adequate tension is achieved, bending the twist over after twisting is completed, and bending the twist back parallel with the wire loop all result in loss of tension or metal fatigue, which may result in premature loosening or breakage of the wire.64 Wire Patterns The goal for intraosseous wire application of the mandible is a single wire, placed along the alveolar bone border, along the lines of tensile stress as a tension band wire. A second stabilization wire is placed parallel to this wire along the aboral (ventral) bone border. The combined support of these two wires is thus distributed over a greater area of the fracture. In the maxillofacial skeleton, thin monocortical bone fragments are difficult to appose without overriding (Figure 67-12). Similarly, in areas of bone curvature, the bone fragments will override. In both instances, supplemental support of the intraosseous wires is required to brace the bone so as to prevent overriding. With one technique, a “skewer-pin” can be utilized (Figure 67-13, A–B; see also Figure 67-12, C). In this technique, a Kirschner wire is drilled through both bone fragments and a figure of eight intraosseous wire pattern is placed over the exposed ends of the K-wire; the ends of the Kirschner wire are bent over to prevent Kirschner wire migration and loss of the figure of eight fixation. Both “arms” of the figure of eight wire are twisted to ensure uniform wire tension. With an alternative technique, a Kirschner wire may be secured on the outer surface of the bone as an internal “splint” (see Figures 67-12, D and 67-13, C–D). The Kirschner wire is secured by intraosseous wire inserted through drill holes in adjacent bone fragments and is tightened over the Kirschner wire applied to the outer surface of the bone spanning the fracture site; Kirschner wire migration can be prevented by bending one end of the Kirschner wire at a 90 degree angle and inserting it into a drill hole in the bone. These techniques provide limited three-dimensional support and therefore must be used prudently. During healing, most intraosseous wires will become incorporated into the developing callus. The ends of the wire twists, however, may erode the overlying oral mucosa; therefore, any wire that penetrates the mucosa becomes exposed and is removed after healing is complete. Any loose wires also are removed. Loose implants will interfere with revascularization and will act as a foreign body; both of which predispose to bone infection. Intraosseous Wire Mandible Midfacial Skeleton Wire Placement Wire Tightening Wire Patterns External Skeletal Fixator Plate Mandible Maxillofacial Skeleton Postoperative Care Complications Intraosseous Wire External Skeletal Fixator Plate Summary References References 68 Arthritis Introduction and Classification of Arthritis “Noninflammatory” Types of Arthritis Osteoarthritis Classification Etiology Genetics. Age. Bodyweight. Overweight and Obesity. Gender Status. Exercise, Diet, and Housing. Pathogenesis of Osteoarthritis Articular Cartilage. Synovium. Subchondral Bone. Pain in Osteoarthritis. Diagnosis and Staging of Osteoarthritis History Osteoarthritis in dogs. Osteoarthritis in cats. Clinical Signs of Osteoarthritis Osteoarthritis in dogs. Osteoarthritis in cats. Radiology of osteoarthritis. Other Imaging Modalities for Osteoarthritis. Synovial Fluid Analysis. Management of Osteoarthritis Weight Management. Exercise. Medical Management of Osteoarthritis. Symptom-modifying agents Nonsteroidal antiinflammatory drugs (NSAIDs). Nonsteroidal antiinflammatory drugs are one of the most commonly used classes of pharmaceutical in canine practice. Although a broad range of NSAIDs have been approved for use in dogs, a much narrower range is available for use in cats, and NSAIDs must always be used very carefully in cats. Generally, the term NSAID is restricted to those drugs that inhibit one or more steps in the metabolism of the arachidonic acid cascade. However, the mechanism of action of some of these drugs is not completely explained by inhibition of arachidonic acid metabolism. Structurally, NSAIDs can be broadly classified as salicylate or carboxylic acid derivatives, including indoles (e.g., indomethacin), propionic acids (e.g., carprofen), fenamates (e.g., mefenamic acid), oxicams (e.g., meloxicam), pyrazolones or enolic acids (e.g., phenylbutazone), and, more recently, coxibs (e.g., deracoxib, firocoxib). NSAIDs have been used to treat the chronic pain of osteoarthritis since aspirin was first marketed in 1899. Their popularity is due to their rapid efficacy for palliating the painful symptoms associated with this condition, although in a minority of patients, use of these agents may be associated with adverse events, which are occasionally serious. Nevertheless, a systematic review of management of canine osteoarthritis concluded that evidence was strongest for the efficacy of certain NSAIDs.278 As NSAIDs have been developed and our understanding of basic pharmacology has grown, pharmaceutical companies have tried to produce an NSAID that optimizes efficacy and diminishes the incidence of adverse events, particularly adverse events affecting the gastrointestinal system. In addition, the realization that osteoarthritis is often associated with the need for long-term treatment has brought innovations in the field of drug delivery and pharmacokinetics. This review will focus on these newer developments in NSAIDs for use in dogs with osteoarthritis. • Mode of action of NSAIDs Osteoarthritis is a complex disease process that affects all tissues of the synovial joint. Central to the condition is increased degradation of the extracellular matrix of articular cartilage with subsequent elaboration of inflammatory mediators and degradative enzymes leading to additional degenerative and inflammatory changes. Strong evidence indicates that the proinflammatory cytokines IL-1, TNF, and IL-6 may play a key role in this process. Synovitis appears to be a key element in the pathology of osteoarthritis, and the synovium appears to be a key tissue in nociception in affected joints.78 In late-stage disease, as cartilage is eroded, a greater rationale is seen for the role of subchondral bone in pain pathways. • Cyclooxygenase (COX) inhibition Phospholipids are released from the cell membrane when cell damage occurs. When oxygen reacts with the polyunsaturated fatty acid eiscosanoids, such as prostaglandins and leukotrienes, oxygen free radicals are synthesized. The most important of these polyunsaturated fatty acids, arachidonic acid is produced by the action of phospholipase A2 on cell membrane phospholipid. Metabolism of arachidonic acid via the COX pathway generates an unstable endoperoxide PGG2, which is converted to PGH2, the precursor of all prostaglandins and thromboxanes, with the release of toxic oxygen free radicals. Various enzymes act on PGH2 to produce thromboxane A2 and B2, PGE2, PGF2, and PGI2 (prostacyclin). PGE2 is considered to be the predominant eicosanoid associated with inflammatory conditions. PGE2 concentrations have been demonstrated to be elevated in synovial fluid from osteoarthritis joints, and PGE2 is associated with vasodilation, increased vascular permeability, and edema. In addition, PGE2 decreases the nociceptive threshold, thereby enhancing the pain response to other stimuli. These stimuli may include chemical substances such as bradykinin, histamine, and serotonin, which are also associated with the inflammatory response, or mechanical stimulation in the form of pressure or motion. PGE2 modifies both T-cell and B-cell function in part by inhibiting IL-2. The ability to decrease PGE2 formation is therefore viewed as a desirable event in decreasing pain associated with osteoarthritis. Advances in the early 1990s showed the presence of two isoforms of COX.185,350 Put simply, COX-1 is considered to be the constitutive form, as it produces prostaglandins that are important for normal physiologic function and are produced by many tissues, including gastrointestinal cells, platelets, endothelial cells, and renal cells. On the other hand, COX-2 is considered to be an inducible form of the enzyme, the expression of which is tightly controlled under basal conditions, but is dramatically upregulated in the presence of inflammation. Proinflammatory cytokines such as TNF and IL-1 stimulate the expression of COX-2 in many cells, such as synovial cells, endothelial cells, chondrocytes, osteoblasts, monocytes, and macrophages. Thus, most NSAIDs have their major action by blocking prostaglandin synthesis, by binding to and inhibiting COX; this action is both dosage and drug dependent, and the major therapeutic and toxic effects of NSAIDs have been correlated extensively with this effect. Recent data have confirmed that synovial and subchondral bone tissue from canine hips with osteoarthritis have increased COX-2 expression compared with healthy controls.192 This concept of COX-1 “good” and COX-2 “bad” greatly oversimplifies a very complex situation. It is important to note that COX-2 is constitutively expressed in the kidney and brain and mediates a cytoprotective effect in damaged or inflamed gastrointestinal mucosa. No clear delineation is noted between beneficial and inflammatory prostaglandins and their respective pathways. Nevertheless, much of the current literature is based on the hypothesis that an NSAID that selectively inhibits COX-2 without affecting COX-1 will allow analgesia without the common side effects of COX-1 inhibition. Methods of establishing COX-1 and COX-2 activity have relied on in vitro exposure of cell systems to increasing concentrations of the NSAID and subsequent measurement of the levels of enzyme activity. The amount of drug necessary to inhibit 50% of activity of each enzyme is recorded and expressed as a ratio of COX-2:COX-1 (Figure 68-10). A drug that inhibits COX-2 at a lower concentration than the concentration necessary to inhibit COX-1 is probably safer because COX-2 prostaglandins (inducible) are more likely than COX-1 prostaglandins (constitutive) to be inhibited at concentrations studied. Care is required to not overinterpret these ratios because the use of different cell systems precludes direct comparison of the data obtained in various studies. Also, species differences exist in the relative sensitivity of COX-1 versus COX-2 among NSAIDs, and the relative safety of an NSAID for one species should not be interpreted as safety for others; data in the target species are therefore preferred. In the late 1980s and the early 1990s, before the discovery of COX-2, several new NSAIDs had been developed with improved safety profiles; these were later discovered to be COX-2 selective (e.g., carprofen, meloxicam). • Lipoxygenase (LOX) inhibition The activity of lipoxygenases on arachidonic acid results in the formation of numerous products, in particular 5-hydroperoxyeicosatetraenoic acid (5-HPETE), an intermediary compound that is metabolized to form leukotriene (LT) A4, an unstable compound that is converted to leukotrienes B4, C4, D4, and E4. LTB4 is a potent chemotactic agent that attracts neutrophils and inflammatory cells, with subsequent degranulation and further enhancement of the inflammatory response. Hyperalgesia has been associated with the combination of LTB4 and polymorphonuclear leukocytes. LTB4 also activates endothelial cells, permitting adherence of leukocytes. LTC4, LTD4, and LTE4 are more direct proinflammatory compounds. Both LTB4 and LTC4 are produced by synovial tissue. A potential sequel of cyclooxygenase blockade by NSAIDs is increased production of leukotrienes from arachidonic acid that would have otherwise been metabolized to prostaglandin products. Leukotriene activity may partially explain the less than complete relief provided by NSAIDs. Thus developments are under way in producing dual COX/LOX inhibitors to combat this issue. • Other actions of NSAIDs NSAIDs also appear to alter cellular and humoral immune responses and may suppress inflammatory mediators other than prostaglandins and leukotrienes. Studies have shown that NSAIDs alter the inflammatory response by inhibiting activation of neutrophils8,113 and thus the release of inflammatory cellular enzymes such as collagenase, elastase, and hyaluronidase. These appear to be the result of interference with protein interactions within plasma membranes and of disruption of the response of inflammatory cells to extracellular signals by affecting signal transduction proteins. The extent of inhibition of neutrophil activation varies with the individual drug. The peripheral antiinflammatory activity of NSAIDs appears to correlate somewhat poorly with the analgesia that they provide, and this has led to the search for other modes of action. A central mechanism has been proposed and supported by the provision of analgesia by the intrathecal administration of extremely low doses of NSAIDs.230,306 Suggested mechanisms of central activity by NSAIDs include inhibition of prostaglandin synthesis, interaction with a central opioid mechanism, interaction with central serotonin activity, and interference with an excitatory amino acid such as glutamine in the central nervous system. Acetaminophen (paracetamol), a drug with potent analgesic and antipyretic activity but little peripheral antiinflammatory effect, is thought to act through the central nervous system. The analgesic effect of paracetamol is due to the indirect activation of cannabinoid (CBI) receptors. In brain and spinal cord, paracetamol, following deacetylation to its primary amine (p-aminophenol), is conjugated with arachidonic acid to form N-arachidonoylphenolamine, a compound already known as an endogenous cannabinoid.42 • Effects of NSAIDs on joint tissue Because NSAIDs may be used for prolonged periods, interest has arisen in the effects these drugs may have on the metabolism of joint tissues. Even if these effects are small, over a long treatment period, they may become cumulative. Studies in experimental dogs have shown inhibition of ex vivo proteoglycan synthesis following treatment with aspirin,249 whereas other NSAIDs have caused stimulation of proteoglycan synthesis when tested in vitro.34 In addition, certain NSAIDs have been demonstrated in vitro to decrease degradation of canine cartilage extracellular matrix molecules.212 It has further been suggested that effects on subchondral bone may be important in this process of disease modification in osteoarthritis, and certain NSAIDs have been studied in this regard.255 Conflicting results have been obtained in long-term studies involving human beings with regard to the effects on progression of osteoarthritis between groups treated with pure analgesics and those treated with NSAIDs. The clinical implications of many of these findings for veterinary patients remain unresolved. • Adverse effects of NSAIDs All NSAIDs can induce undesirable and potentially life-threatening adverse events. Without a placebo-control group in a study, it is impossible to know the true effect of an NSAID (experimental event rate) over and above the background rate (control event rate) of such adverse events in canine osteoarthritis populations. A recent systematic review of long-term (28 days or more) use of NSAIDs reported experimental event rates of 0 to 0.31, few control event rates are available with which to reference these figures.159 The most common clinical signs of toxicosis in published studies have been inappetence, vomiting, and diarrhea. However, the true incidence of gastrointestinal toxicity in dogs treated with NSAIDs is unknown. NSAIDs induce gastric damage through local and systemic effects. The systemic adverse effects of NSAIDs are associated with the inhibition of endogenous prostaglandin production. The natural mechanisms for gastric mucosal protection from gastric acid secretions are threefold: (1) secretion of a bicarbonate-rich mucus, (2) gastric epithelial cell apical membrane and cytosolic bicarbonate, and (3) increased blood flow, which readily releases bicarbonate and acts as a sink for gastric acid, quickly neutralizing and removing excess acid. A rich blood flow is also important for epithelial repair by restitution and replication. Endogenous PGE2 is important in maintaining the gastric mucosal layer, the quality of gastric mucus, mucosal blood flow, and the production of gastric acid. Risk factors for gastrointestinal toxicity in human beings include old age, concurrent administration of other medications, previous evidence of gastrointestinal bleeding or ulcer disease, and the presence of other disease. In elderly patients, changes that might contribute to decreased drug clearance and increased susceptibility to NSAID toxicity include decreased albumin levels, decreased hepatic and renal function, decreased metabolic rate, and changes in volume distribution. The effect of aging on an individual’s ability to metabolize NSAIDs is highly variable. However, it would appear prudent to err on the side of caution initially, dosing at the low end of the recommended range and making adjustments as necessary. Nearly all NSAIDs are able to impair platelet activity due to impaired prostaglandin (thromboxane) synthesis, again a COX-1–selective action. In addition to their antiplatelet effects, selected NSAIDs (e.g., phenylbutazone) have been associated with bone marrow dyscrasias. Gastric bleeding is the most common sign of bleeding problems, in part because of the ulcerogenic properties of these drugs. Prostacyclin (PGI2), which is mediated by COX-2, plays a role in the prevention of thrombosis within vascular channels; this is a possible effect of COX-2–selective drugs. In the kidney, vasodilatory and tubuloactive prostaglandins are protective, ensuring that medullary vasodilation and urine output continue during states of renal arterial vasoconstriction. PGE2 and PGI2 (COX-1 and COX-2) have important roles in maintaining renal blood flow and ion transport within the nephron. Any loss of this protective function becomes important in patients with compromised renal function. Predisposing factors associated with “analgesic nephropathy” include cardiac, renal, or liver disease in geriatric patients; hypovolemic states, including shock and dehydration; and the use of nephrotoxic (e.g., aminoglycosides) or nephroactive (e.g., diuretics) drugs. NSAIDs currently licensed for use in the United States and Europe for treatment of canine osteoarthritis Summary of NSAIDs for osteoarthritis. Other analgesics for osteoarthritis Candidate structure-modifying agents for osteoarthritis Nutritional Management of Osteoarthritis. Mesenchymal Stem Cell Therapies for Osteoarthritis. Surgical Management of Osteoarthritis. Joint debridement and micropick surgery. Joint replacement. Arthrodesis and salvage procedures. Euthanasia. Inflammatory Types of Arthritis Immune-Mediated Polyarthritis Etiopathogenesis Genetic Predispositions. Diagnosis of Immune-Mediated Polyarthritis History and Clinical Signs. Diagnostic Tests for Immune-Mediated Polyarthritis Synovial fluid analysis. Articular imaging. Hematology, serum biochemistry, and urinalysis. Other tests. Serology. Classifying a Case of Immune-Mediated Polyarthritis. Nonerosive Immune-Mediated Polyarthritis Idiopathic (Type I) Immune-Mediated Polyarthritis. Immune-Mediated Polyarthritis Associated With Infection Remote from the Joint (Type II Immune-Mediated Polyarthritis). Immune-Mediated Polyarthritis Associated With Gastrointestinal Disease (Type III Immune-Mediated Polyarthritis). Immune-Mediated Polyarthritis Associated With Neoplasia (Type IV Immune-Mediated Polyarthritis), Paraneoplastic Arthritis. Drug-Induced Immune-Mediated Polyarthritis Nonerosive Immune-Mediated Polyarthritis With Multisystem Disease Systemic Lupus Erythematosus and Systemic Lupus Erythematosus-Related Disorders. Breed-Associated Nonerosive Immune-Mediated Polyarthritis Syndromes. Erosive Immune-Mediated Polyarthritis Rheumatoid Arthritis. Other Erosive Immune-Mediated Polyarthritis Syndromes Polyarthritis of Greyhounds. Feline chronic progressive polyarthritis (periosteal proliferative polyarthritis of cats). Treatment of Immune-Mediated Polyarthritis and Prognosis Medical Management. Other Strategies for Immune-Mediated Polyarthritis Management. Surgical management. Prognosis for Canine and Feline Immune-Mediated Polyarthritis. Infective Arthritis Introduction Bacterial Infective Arthritis Diagnosis of Bacterial Infective Arthritis. Treatment of Bacterial Infective Arthritis. Patient Monitoring and Prognosis. Other Forms of Infective Arthritis Borrelial Arthritis. Bacterial L-Forms. Mycoplasmal Arthritis. Protozoal Arthritis. Fungal Arthritis. Rickettsial Arthritis. Mycobacterial Arthritis. References References 69 Miscellaneous Orthopedic Conditions Constitutional Bone and Cartilage Diseases Osteochondrodysplasias Dysostoses Amelia Hemimelia Dimelia Ectrodactyly Polydactyly Syndactyly Pediatric Bone Diseases Hypertrophic Osteodystrophy Panosteitis Craniomandibular Osteopathy Retained Ulnar Cartilaginous Core Legg-Calvé-Perthes Disease Slipped Capital Femoral Epiphysis Multiple Cartilaginous Exostoses Metabolic Bone Diseases Adult Bone Diseases Hypertrophic Osteopathy Disseminated Idiopathic Skeletal Hyperostosis Bone Cyst Miscellaneous Orthopedic Diseases Acute Caudal Myopathy Swimmer Syndrome Puppy Carpal Laxity Syndrome 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 Forelimb Rupture of the Long Head of the Triceps Brachii Muscle Rupture of the Serratus Ventralis Muscle Muscle Injuries In the Hindlimb 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 Severed Digital Flexor Tendons Injuries to the Common Calcanean Tendon Injuries to the Tendon of Origin of the Biceps Brachii Muscle Injuries to the Long Digital Extensor Tendon References References 71 Arthroscopy Equipment Arthroscope Cannula Camera Monitor Light Source Imaging Irrigation Egress Systems Hand Instruments Instrument Cannulas Joint Distractors Limb Positioners Power Hand Tools Electrocautery and Radiofrequency Devices Other Basic Equipment 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 Hock Joint Surgical Anatomy References References 72 Musculoskeletal Neoplasia and Limb-Sparing Surgery Diagnosis Biopsy Staging Local Staging Surgical Treatment Amputation Repair of Pathologic Fracture Fracture-Associated Osteosarcoma Scapulectomy Hemipelvectomy Limb-Sparing Surgery Surgical Technique—Distal Radial Resection Cortical Allograft Surgical Technique Endoprosthesis Surgical Technique Pasteurized Autograft Vascularized Ulnar Transposition Bone Transport Osteogenesis Irradiated Autograft Stereotactic Radiosurgery Postoperative Management Complications Other Limb-Sparing Surgery Methods and Sites Intercalary Limb-Sparing Surgery Ulnectomy Proximal Humeral Limb-Sparing Surgery Intraoperative Radiation Therapy Partial Amputation and Endoprosthesis Chemotherapy Radiation Palliative Therapy Appendicular Chondrosarcoma in Dogs Appendicular Osteosarcoma in Cats Tumors of the Joint Tumors of Muscle Tumors of the Adipose Tissue Tumors of the Digits Tumors 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 Diagnosis Articular Osteochondrosis Growth Plate Osteochondrosis Principles of Prevention Principles of Treatment Conservative Management Surgical Management Surgical Management of Articular Cartilage Defects Palliative and Reparative Techniques Restorative Techniques Summary References References 74 Gait Analysis Kinetic Gait Analysis Equipment Ground Reaction Forces Variation Kinematic Gait Analysis Equipment Kinematic Parameters Variation Spatiotemporal Parameters Inverse Dynamics Accelerometry Symmetry Indices 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 e9781437707465v2 Front cover Endsheet 4 Endsheet 5 VETERINARY Surgery Copyright page Editors Contributors Dedication Preface About the Book Website Table of Contents History of Veterinary Surgery The Hunted Animal Animal Domestication Companion Animals “Horse Doctor” Label Greco-Roman Period Early AD period Middle Ages European Influence The Influence of Anesthesia Asepsis The Hobday Era Small Animal Surgery in North America References 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 Selection Knot Security Suture Patterns Subcutaneous Tissue Apposition Continuous Subcutaneous Closure. Cutaneous Suture Patterns External Cutaneous Suture Patterns. Suture bite placement. Buried Intradermal Patterns. Burying the knot. Continuous horizontal intradermal pattern. Continuous vertical intradermal pattern. Continuous Subcutaneous-to-Intradermal Closure. Tissue Adhesives Fibrin Sealants Skin Stapling Primary Wound Closure Challenges Dog Ears Step Defects Postoperative Care Wounds Pain Management Nonsteroidal Antiinflammatory Agents Local Anesthetic Agents Cold Packing 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 Wound Classifications Types of Wound Management Primary Wound Closure (First Intention Healing) Delayed Primary Closure Healing by Contraction and Epithelialization (Second Intention Healing) Secondary Closure (Third Intention Healing) Decision Making Immediate Wound Care Irrigation Solutions Antimicrobial Treatment Wound Protection Definitive Wound Care Wound Preparation Wound Debridement Layered Debridement Nonsurgical Debridement Honey. Wet-to-Dry Bandages. Maggots. Moist Wound Healing Topical Antimicrobial Agents Topical Antibiotic Ointment Slow-Release Silver Dressings Bioscaffolds and Synthetic Matrix Dressings Chitosan Growth Factor–Containing Agents Negative-Pressure Wound Therapy References References 77 Tension-Relieving Techniques Surgical Principles Instrumentation Decision Making and Planning Tension, Shear, and Viscoelasticity Tension Shear Viscoelasticity Techniques for Relieving Tension Undermining Tension-Relieving Sutures Strong Subcutaneous Sutures Stent Sutures Far–Near–Near–Far and Far–Far–Near–Near Sutures Mattress Sutures Skin Stretching Techniques Pretensioning Sutures and Presuturing Acute (Intraoperative) Skin Stretching Walking Sutures Chronic Skin Expansion Relaxing Incisions Mesh Expansion (Multiple Punctate Relaxing Incisions) Simple Relaxing Incision V-Y Plasty Z-Plasty M-Plasty 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 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 Preputial Reconstruction Phalangeal Fillet Labial Flaps Lip-to-Lid Flap Guidelines for Distant Flap Development and Transfer 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 Surgical Technique Outcome Thoracodorsal Axial Pattern Flap Surgical Technique Outcome Dorsal Deep Circumflex Iliac Axial Pattern Flap Surgical Technique Ventral Deep Circumflex Iliac Axial Pattern Flap Surgical Technique Caudal Superficial Epigastric Axial Pattern Flap Surgical Technique Outcome Cranial Superficial Epigastric Axial Pattern Flap Surgical Technique Outcome Angularis Oris Axial Pattern Flap Surgical Technique Outcome Superficial Temporal Axial Pattern Flap Outcome Caudal Auricular Axial Pattern Flap Surgical Technique Outcome Superficial Brachial Axial Pattern Flap Surgical Technique Genicular Axial Pattern Flap Surgical Technique Outcome Reverse Saphenous Conduit Flap Surgical Technique Outcome Lateral Caudal Axial Pattern Flap Surgical Technique Outcome latissimus dorsi myocutaneous flap Surgical Technique Outcome 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 Common Causes of Graft Failure Postoperative Considerations Bandages Cosmesis Surgical Principles Instrumentation The Graft Recipient Site Where Grafts Will Take Where Grafts Will Not Take The Process of Engraftment (“Graft Take”) General Factors Adherence Plasmatic Imbibition Inosculation Vascular Ingrowth Types of Grafts Split-Thickness Grafts Definition and Indications Technique Graft Bed Preparation. Graft Harvest. Graft Placement. Donor Site Closure. Aftercare Bandages. Negative-Pressure Wound Therapy. Advantages and Disadvantages of Split-Thickness Grafts Full-Thickness Mesh Grafts Definition and Indications Technique Graft Bed Preparation. Graft Harvest. Graft Preparation. Graft Placement. Donor Site Closure. Aftercare Bandages. Managing Superficial Infections. Hyperbaric Oxygen Therapy. Advantages and Disadvantages Split-Thickness Mesh Grafts Full-Thickness Unmeshed Grafts Definition and Indications Grafting Technique Fluid Drainage Aftercare Advantages and Disadvantages Pinch and Punch Grafts Definition and Indications Technique Graft Bed Preparation. Graft Harvest. Graft Placement. Donor Site Closure. Aftercare Advantages and Disadvantages Strip Grafts Definition and Indications Technique Graft Bed Preparation. Graft Harvest. Graft Placement and Donor Site Closure. Stamp Grafts Definition and Indications Technique Advantages and Disadvantages Paw Pad Grafts Definition and Indications Graft Bed Preparation. Graft Harvest. Aftercare. Two-Stage Technique Graft Harvest. Graft Placement. Aftercare. Advantages and Disadvantages Mucosal Grafts Definition and indications Technique Graft Bed Preparation. Mucosal Graft Harvest. Application of Mucosal Grafts. Conjunctival Replacement Nasal Mucosa Replacement Aftercare Preputial Reconstruction. Conjunctival Reconstruction. Nasal Reconstruction. Advantages and Disadvantages References References 81 Burns Burn Injuries Etiologic Classification of Burns Thermal Burns Classification of Thermal Burns Depth of Tissue Destruction. Surface Area. Pathophysiology: the Inflammatory Response Local Response to Thermal Burn Injury Systemic Response to Thermal Burn Injury Pulmonary System: Smoke Inhalation Cardiovascular System: Hypovolemia, Vascular Dysfunction, and Generalized Edema Cardiovascular System: Myocardial Effects Gastrointestinal System Renal System Hematopoietic System Immune System Neurologic System Metabolic and Endocrine Changes Burn Treatment Initial First Aid for Burns Fluid Resuscitation of the Burn Patient Fluid Volume Fluid Type Treatment of Inhalation Injury Bronchial Hygiene Oxygen Therapy Pharmacologic Interventions Treatment of Burn Pain Procedural Pain Background Pain Breakthrough Pain Pain During Rehabilitation Nutritional and Metabolic Management of Burn Patients Treatment of Local Burn Wounds Small or Minor Burns Large Burns Sharp Surgical Debridement. Ultrasonic Surgical Debridement. Water-Jet Surgical Debridement. Autolytic Debridement. Cerium Nitrate. Chemical Burns Electrical Burns Frostbite Treatment References References 82 Specific Disorders Tumor Surgery of The Skin General Considerations Surgical Margins Biopsy Surgical Principles Factors Affecting Wound Healing Chemotherapy Radiation Tumor-Related Factors Tumor Staging and Patient Workup Tumor Staging Patient Evaluation Cytology and Histology Disease Extent Lymphatic System Function Lymphatics Lymph Nodes Lymphadenectomy in Surgical Oncology Lymphangitis Lymphedema Physiology Primary Lymphedema. Secondary Lymphedema. Diagnosis Treatment Neoplastic Skin Disorders Tumor Classification Papilloma Squamous Cell Carcinoma Etiology Clinical Findings Tumor Grade Treatment Cryosurgery. Plesiotherapy. Radiation Therapy. Photodynamic Therapy. Chemotherapy. Immunomodulatory Therapy. Surgery. Prognosis Basal Cell Tumors Sebaceous Gland Tumors Sweat Gland Tumors Perianal Hepatoid Gland Tumors Adenomas Adenocarcinomas Apocrine Gland Adenocarcinoma of the Anal Sac Canine Anal Sac Adenocarcinoma Prognosis in Dogs. Feline Anal Sac Carcinomas Hair Matrix Tumors Soft Tissue Sarcomas: Shared Characteristics Classification Presentation Diagnosis and Staging Complete Resection Incomplete Excision Marginal Resection Radiation Chemotherapy Prognosis Fibrosarcoma Hemangiopericytoma Peripheral Nerve Sheath Tumors Myxosarcoma (Myxofibrosarcoma) Feline Injection Site–Associated Sarcoma (Vaccine-Associated Sarcoma) Etiology Tumor Behavior Diagnosis Prognostic Factors Surgical Excision Radiation Chemotherapy Immunotherapy Prevention and Monitoring Lipoma Infiltrative Lipoma Liposarcoma Hemangiosarcoma of the Skin Canine Cutaneous Hemangiosarcoma Feline Cutaneous Hemangiosarcoma Feline Fibropapilloma (Feline Sarcoid) Mammary Tumors Anatomy and Function of the Mammary Glands Canine Mammary Tumors Incidence. Hormonal Influence on Mammary Tumor Development. Estrogen and progesterone receptors in mammary tumors. Other Factors Associated With Mammary Tumors. Histologic Subtypes. Inflammatory carcinoma. Presentation. Cytology and Biopsy. Staging. Surgery. Lumpectomy. Simple mastectomy. Regional mastectomy. Chain mastectomy. Prognosis. Adjunct Therapy. Feline Mammary Tumors Hormonal Influences. Other Factors Associated With Mammary Tumors. Presentation. Histologic Types. Fibroadenomatous hyperplasia. Diagnosis. Treatment. Prognosis. Adjunct Therapy. Male Cats. Mast Cell Tumors Canine Mast Cell Tumors Etiology. Presentation. Mast Cell Degranulation. Systemic Mast Cell Disease. Metastasis. Tumor Grade. Diagnosis. Staging. Selecting a Therapy. Surgery. Prognostic Factors. Clinical presentation. Tumor location. Clinical stage. Margins. Special stains. Radiation Therapy. Chemotherapy. Electrochemotherapy. Hypotonic Shock. Tyrosine Kinase Inhibitors. Recommendations to Owners. Feline Mast Cell Tumors Etiology. Presentation. Metastasis. Diagnosis and Staging. Treatment. Prognosis. Cutaneous Histiocytoma and Histiocytic Skin Disorders Cutaneous Histiocytoma Reactive Histiocytosis Histiocytic Sarcoma Extramedullary Plasmacytoma Cutaneous Lymphoma Transmissible Venereal Tumor Melanocytic Tumors Presentation Diagnosis Treatment Prognosis Tumor Location. Histology. Adjunct Therapy Immune Modulators. Nail Bed (Subungual) and Digital Tumors Dogs Specific Tumor Types in Dogs. Cats Miscellaneous Skin Conditions Skin Fold Dermatitis Interdigital Pyoderma Podoplasty Technique Pilonidal Sinuses Nasal Dermoid Sinus Cyst Acquired Sinus Tracts Etiology Diagnosis Treatment References References VI Abdomen 83 Spleen Anatomy Physiology Hematopoiesis Reservoir Function Immunologic Function Pathology Generalized Splenomegaly Splenitis or Inflammation Immune Reaction or Cellular Hyperplasia Congestion Infiltration Localized Splenomegaly Nodular Hyperplasia Pseudotumor Hemangioma Hamartoma Abscess Cysts Segmental Infarction Plaques Neoplasia 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 Pathophysiology and Clinical Findings Diagnosis Treatment and Prognosis Splenic Neoplasia Pathophysiology Clinical Signs Diagnostics Treatment Prognosis Benign Splenic Masses Postoperative Complications Hemorrhage Vascular Compromise Arrhythmias Disseminated Intravascular Coagulation Gastric Dilatation and Volvulus Infection Oxygen Transport References References 84 Abdominal Wall Reconstruction and Hernias Definitions 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 Anatomy, Etiology, and Pathogenesis Clinical Signs. Diagnosis. Treatment. Aftercare and Prognosis. Caudal Abdominal Hernias Hernia Categorization Inguinal Hernias Anatomy and Pathogenesis. Signalment and Clinical Signs. Diagnosis. Surgical Repair. Complications, Aftercare, and Prognosis. Scrotal Hernia Anatomy and Pathogenesis Clinical Signs Diagnosis Surgical Repair. Complications, Aftercare, and Prognosis Femoral Hernias Anatomy and Pathogenesis Clinical Signs Diagnosis Treatment Aftercare and Prognosis Traumatic and Incisional Hernias Traumatic Hernia Anatomy and Pathogenesis. Clinical Signs Diagnosis Treatment Aftercare and Prognosis. lncisional Hernias Pathogenesis Excessive Forces on the Incision Poor Holding Strength of the Wound Clinical Signs and Diagnosis Acute Incisional Hernias Chronic Incisional Hernias Incisional Evisceration Aftercare and Prognosis. Reconstruction of Large Abdominal Wall Defects Preoperative Patient Assessment Surgery Autologous versus Nonautologous Options Autologous Repair Methods Vacuum-Assisted Closure. Separation of Anatomic Components Abdominal Wall Partitioning Muscular Flaps Cranial Sartorius Muscle Flap (Figure 84-25). External Abdominal Oblique Myofascial Flap (Figure 84-26). Nonautologous Repair Methods Synthetic Mesh Repair. Biologic Tissue Grafts Mesh Reconstruction Technique Underlay Technique Description 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 Pathophysiology Diagnosis Clinical Signs. Physical Examination. Radiographs. Contrast Studies. Ultrasonography. Timing of Surgery Perioperative Care Surgical Technique Hernia Reduction. Hernia Closure. Suture Material and Patterns. Suture Placement. Alternative Methods of Closure. Pulmonary Reinflation. Postoperative Care Reexpansion Pulmonary Edema. Intraperitoneal Pressures. Prognosis Congenital Pleuroperitoneal Hernia Congenital Peritoneopericardial Hernia Pathophysiology Clinical Signs Diagnosis Radiography. Ultrasonography. Treatment Prognosis 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 Mechanical and Foreign Body Peritonitis Starch Granulomatous Peritonitis61,238 Chemical Peritonitis Sclerosing Encapsulating Peritonitis Parasitic Peritonitis Protozoal Peritonitis Septic Peritonitis Pathophysiology Clinical Signs Diagnosis Abdominal Paracentesis and Lavage Paracentesis Technique. Diagnostic Peritoneal Lavage Technique. Evaluation and Interpretation of Peritoneal Fluid. Treatment Fluid and Electrolyte Replenishment. Antimicrobials. Corticosteroids and Nonsteroidal Antiinflammatory Drugs. Surgery Goals of Surgery. Debridement. Lavage. Serosal Patching. Fibrin Sealant. Omentalization. Primary Celiotomy Closure. Laparoscopic Treatment. Open Peritoneal Drainage. Closed Peritoneal Drainage. Postoperative Management Nutritional Support. Transfusion Support. Miscellaneous Supportive Measures. Prognosis Other Peritoneal Disorders Penetrating Injuries Evisceration Urine Peritonitis Chylous Peritonitis Intraabdominal Abscesses Pathogenesis Clinical Signs Diagnostic Aids Treatment Pneumoperitoneum Hemoperitoneum Retroperitoneal Diseases Fistulous 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 Diagnosis Prognosis Glossectomy Aftercare. Postoperative Prognosis in Dogs. Glossectomy in Cats. Disorders of the Oropharynx Dysphagia Etiology and Diagnosis Structural Abnormalities and Masses. Functional Abnormalities. Penetrating Injuries to the Oropharynx Diagnostics Surgery Disorders of the Tonsils Tonsillar Inflammation Tonsillar Neoplasia Tonsillectomy References References 88 Salivary Glands Anatomy Parotid Gland Zygomatic Gland Mandibular and Sublingual Salivary Gland Mandibular Salivary Gland Sublingual Salivary Gland Minor Salivary Glands Physiology Nonsurgical Salivary Gland Disease Sialadenosis Sialadenitis and Necrotizing Sialometaplasia Surgical Salivary Gland Disease Sialocele Zygomatic Sialoceles Pharyngeal Sialoceles Sublingual Sialoceles Cervical Sialocele Sialoliths Salivary Gland Neoplasia Surgical Techniques Sublingual and Mandibular Sialadenectomy Zygomatic Sialadenectomy Parotid Sialadenectomy Treatment of Ranulas Treatment of Sialoliths References References 89 Mandibulectomy and Maxillectomy Anatomy Mandible Maxilla Canine Oral Tumors Tumor Types and Biologic Behavior Preoperative Staging Surgery Owner Preparation Preoperative Patient Preparation Technique for Mandibulectomy Rostral and Central Mandibulectomy (Figure 89-8). Caudal Mandibulectomy and Hemimandibulectomy. Technique for Maxillectomy Rostral and Central Maxillectomy. Caudal Maxillectomy (Figure 89-10). Postoperative Care Complications Cosmetic and Functional Results of Mandibulectomy and Maxillectomy Follow-up and Prognosis Adjuvant Therapy Radiation Therapy Chemotherapy and Other Systemic Therapy Feline Oral Tumors Tumor Types and Biologic Behavior Preoperative Staging Surgical Technique Prognosis and Adjuvant Therapy References References 90 Esophagus Anatomy Layers of the Esophageal Wall Esophageal Blood Supply and Innervation Physiology of Swallowing Esophageal Pathophysiology General Surgical Principals 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 Clinical Signs Diagnosis Treatment Prognosis Congenital Generalized Megaesophagus Esophageal Duplication Cyst Esophageal Foreign Bodies Clinical Signs Diagnosis Treatment Prognosis Esophageal Lacerations Clinical Signs Diagnosis Treatment Prognosis Esophageal Stricture Clinical Signs Diagnosis Treatment Prognosis Esophageal Diverticula Clinical Signs Diagnosis Treatment Prognosis Esophageal Fistulae Clinical Signs Diagnosis Treatment and Prognosis Cricopharyngeal Dysphagia Clinical Signs Diagnosis Treatment Prognosis Esophageal Neoplasia Clinical Signs Diagnosis Treatment Prognosis References References 91 Stomach Anatomy Gross Anatomy of the Stomach Omentum Vasculature, Lymphatics, and Innervation of the Stomach Gastric Morphology and Glandular Organization Gastric Layers Glands Physiology Motility Healing Characteristics Presurgical Preparation Fasting Antimicrobials General Surgical Principles Approach Minimizing Contamination Lavage Gastric Closure Suture Patterns Suture Material Staples General Surgical Techniques Gastric Biopsy Gastrotomy Partial Gastrectomy Determining Tissue Viability Gastric Wall Resection and Closure Gastric Wall Invagination Gastropexy Incisional Gastropexy Belt-Loop Gastropexy Circumcostal Gastropexy Gastrocolopexy Incorporating Gastropexy Minimally Invasive Prophylactic Gastropexy Techniques Grid Approach. Endoscopically Assisted Gastropexy. Laparoscopic Gastropexy. Pyloromyotomy and Pyloroplasty Fredet-Ramstedt Pyloromyotomy Heineke-Mikulicz Pyloroplasty Y-U Advancement Pyloroplasty Gastroduodenal Anastomosis General Postoperative Considerations Specific Diseases Hiatal Hernia Pathophysiology Clinical Findings Diagnostics Medical Management Preoperative Management Surgical Correction Postoperative Care, Complications, and Prognosis Gastroesophageal Intussusception Pathophysiology Clinical Findings Diagnostics Preoperative Management Surgical Correction Prognosis Hypertrophic Pylorogastropathy Pathophysiology Clinical Findings Diagnostics Preoperative Management Surgical Correction Postoperative Care, Complications, and Prognosis Gastric Foreign Body Pathophysiology Clinical Findings Diagnostics Preoperative Management Surgery Prognosis Gastric Neoplasia and Infiltrative Disease Classifications in Dogs Malignant Epithelial Tumors. Sarcomas and Stromal Tumors. Lymphoma. Benign Masses. Pythium. Lymphoma in Cats Clinical Findings Diagnostics Treatment Gastric Ulceration Pathophysiology Renal and Hepatic Disease. Nonsteroidal Antiinflammatory Drugs and Glucocorticoids. Clinical Findings Diagnosis Medical Management Histamine Receptor Antagonists. Proton Pump Inhibitors. Sucralfate. Misoprostol. Surgery Gastric Perforation Pathophysiology Clinical Signs Diagnostics Surgery Prognosis Gastric Dilatation and Volvulus Etiology Pathophysiology Blood Flow. Cardiac Dysfunction. Gastric Wall Necrosis. Bacterial Translocation. Reperfusion Injury. Clinical Findings Diagnostics Radiographs. Laboratory Findings. Plasma Lactate Preoperative Management Anesthesia Surgery Postoperative Management Recurrence Rates Prognostic Indicators Prophylactic Gastropexy References Reference 92 Small Intestine Anatomy Physiology Intestinal Motility Digestion and Absorption Intestinal Pathophysiology General Principles Fluid Therapy Antibiotic Prophylaxis Assessment of Intestinal Viability Choice of Suture Material for Enteric Closure Choice of Suture Pattern for Enteric Closure Knot-Tying Force Suture Line Reinforcement Surgical Procedures Intestinal Resection and Anastomosis Enterotomy and Intestinal Biopsy Enteroplication Postoperative Complications Septic Peritonitis Clinical Signs Diagnosis Treatment Prognosis Adhesions Short-Bowel Syndrome Treatment Prognosis Ileus Surgical Diseases Intestinal Luminal Obstruction: Foreign Bodies and Masses Clinical Signs Diagnosis Treatment Prognosis Intestinal Incarceration and Strangulation Clinical Signs Treatment Prognosis Intestinal Pseudo-obstruction and Ileus Infarction Linear Foreign Bodies Clinical Signs Diagnosis Treatment Prognosis Intussusception Clinical Signs Diagnosis Treatment Prognosis Mesenteric Volvulus Clinical Signs Diagnosis Treatment Trauma Clinical Signs and Diagnosis Treatment 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 Lag Phase Proliferative Phase Maturation Phase Healing of Individual Tissue Layers Factors That Negatively Affect Wound Healing Tissue Perfusion Methods for Improving Colonic Wound Healing Vascularized Tissue Wraps Colonic Reinforcement Cytokines Techniques for Colonic Wound Closure Suture Closure Suture Pattern Suture Material Staplers Biofragmentable Anastomosis Ring Sutureless Closure Laser Cyanoacrylates Fibrin Glue Perioperative Considerations Diagnostic Techniques for Large Intestinal Disease Radiography Ultrasonography Computed Tomography and Magnetic Resonance Imaging Scanning Endoscopy Preoperative Preparation of the Colon Antibiotic Prophylaxis Postoperative Management Analgesia Dietary Manipulation Surgical Procedures and Complications General Principles Cecal Resection (Typhlectomy) Colotomy Colectomy Sutured Anastomosis Stapled Anastomosis Biofragmentable Anastomosis Ring 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 Pathophysiology Mechanical Causes. Functional Causes. Feline Megacolon Clinical Findings and Diagnosis. Medical Management Laxatives. Cisapride. Surgical Management Outcome Colonic and Cecocolic Volvulus Colonic Entrapment Colonic Neoplasia Colonic Duplication References Reference 94 Rectum, Anus, and Perineum Anatomy Innervation Surgical Approaches to the Rectum Patient Preparation and Antibiotic Therapy Bowel Cleansing Antimicrobials Ventral Approach Dorsal Approach Rectal Pull-Through Lateral Approach Aftercare Complications Congenital Abnormalities of the Rectum and Anus Atresia Ani Clinical Signs and Diagnosis Treatment Complications and Prognosis Rectovaginal and Urethrorectal Fistula Clinical Signs and Diagnosis Treatment Complications Anogenital Clefts Anal and Rectal Prolapse Diagnosis Therapy Tumors of the Anus, Perineum, and Rectum Anal and Perianal Tumor Rectal Tumors Benign Rectal Tumors Malignant Rectal Tumors History and Physical Examination Diagnosis Surgical Options Benign Rectal Tumors. Malignant Rectal Tumors. Other Therapies for Anal and Rectal Tumors Prognosis Rectal Perforation Anorectal Strictures Surgical Options for Fecal Incontinence Anal Sacs Non-neoplastic Disease of the Anal Sacs Clinical Signs Treatment Anal Sac Neoplasia in Dogs Clinical Signs Diagnosis Treatment Complications and Prognosis Anal Sac Neoplasia in Cats Anal Sacculectomy Closed Technique Open Technique Complications Perianal Fistula Pathophysiology Diagnosis Medical Therapy Cyclosporine Ketoconazole and Cyclosporine Glucocorticoids Tacrolimus Azathioprine–Metronidazole Surgery and Immunosuppressive Therapy Surgical Treatment Resection Cryosurgery Deroofing and Fulguration Tail Amputation Laser Excision Perineal Hernia Surgical Anatomy Etiology Rectal Abnormalities Androgens Gender-Related Anatomic Differences Relaxin Prostatic Disease Neurogenic Atrophy Clinical Signs Bladder Retroflexion Diagnosis Medical and Dietary Management Preoperative Preparation of Surgical Patients Surgical Treatment Traditional Herniorrhaphy Internal Obturator Muscle Transposition Superficial Gluteal Muscle Transposition Semitendinosus Muscle Transposition Prosthetic Implants Biomaterials Porcine Small-Intestinal Submucosa. Porcine Dermal Collagen. Fascia Lata. Pexy Colopexy. Cystopexy. Vasopexy. Complications of Pexy Procedures. Staged Procedures Unusual Perineal Hernias Postoperative Care Complications Fecal Incontinence Sciatic Nerve Injury Urinary Dysfunction Tenesmus Recurrence Perineal Hernias in Cats References Reference 95 Liver and Biliary System Anatomy Lobes Attachments Blood Supply Biliary System Species Differences 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 Inflow Occlusion Pringle Maneuver. Total Hepatic Vascular Exclusion Hepatic Artery Ligation Hepatic Surgical Procedures Liver Biopsy Open Surgical Technique Laparoscopic Liver Biopsy Partial and Complete Hepatic Lobectomy Partial Hepatic Lobectomy Complete Hepatic Lobectomy Outcome 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 Surgical Procedures of the Extrahepatic Biliary Tract Decision Making in Extrahepatic Biliary Tract Surgery Choledochal Catheterization and Lavage Technique Cholecystotomy Technique Cholecystectomy Traditional “Open” Cholecystectomy Technique. Laparoscopic Cholecystectomy Technique. Cholecystoenterostomy Technique. Choledochal Stenting Technique Cholecystostomy Tube Traditional “Open” Cholecystostomy Technique Laparoscopic-Assisted Cholecystostomy Tube Placement Choledochotomy Technique Sphincter-Altering Procedures Specific Diseases Hepatic Abscesses and Cysts Dogs Clinical Signs. Diagnosis. Treatment and Outcome. Cats Liver Lobe Torsion Gallbladder Mucocele Etiology Diagnosis Treatment Medical Management. Incidental Mucoceles. Surgery. Prognosis. Cholelithiasis Pathophysiology Clinical Signs and Diagnosis Treatment and Prognosis Hepatobiliary Neoplasia Clinicopathologic Features Diagnosis Specific Neoplasms Hepatocellular Tumors Cholangiocellular (Bile Duct) Tumors Neuroendocrine Carcinomas Mesenchymal Tumors Other Primary Hepatic Neoplasms Metastatic Hepatic Neoplasia References Reference 96 Hepatic Vascular Anomalies Anatomy Portal Vein Hepatic Artery Hepatic Veins Embryology Portocaval and Portoazygos Shunts Patent Ductus Venosus Classification And Epidemiology Portosystemic Shunts Congenital Portosystemic Shunts Acquired Portosystemic Shunts Portal Vein Hypoplasia Hepatic Arteriovenous Malformations Pathophysiology Hepatic Encephalopathy Coagulation Disorders Diagnostic Evaluation Signalment History Clinical Signs and Examination Findings Portosystemic Shunts Portal Hypoplasia Hepatic Arteriovenous Malformations Clinical Diagnosis Clinicopathologic Findings Liver Function Testing Bile Acids Ammonia Coagulation Profiles Protein C Abdominal Effusion Evaluation Histopathology Diagnostic Imaging Abdominal Ultrasonography Scintigraphy Computed Tomographic Angiography Magnetic Resonance Angiography Portovenography Differential Diagnoses Treatment Medical Management Prognosis With Medical Management Alone Preoperative Medical Stabilization Surgical Treatment for Portosystemic Shunts Locating Portosystemic Shunts in Surgery Congenital Extrahepatic Portosystemic Shunts Extrahepatic Portocaval Shunts. Portoazygos Shunts. Congenital Intrahepatic Portosystemic Shunts Portal Catheter Placement. Multiple Acquired Portosystemic Shunts Measuring Portal Pressure Jejunal Vein Catheter Splenic Vein Catheter Portal Pressures Operative Mesenteric Portography Methods for Surgical Occlusion of Shunts Ameroid Constrictors Cellophane Bands Hydraulic Occluders Suture Ligation Determining the Degree of Shunt Attenuation. Surgical Approaches to Intrahepatic Portocaval Shunts Shunts of the Left Division: Extravascular Approach Dissection of the Left Hepatic Vein. Dissection of the Ductus Venosus. Dissection of the Left Portal Vein. Shunts of the Right Division: Extravascular Approach Dissection of the Shunt or Hepatic Vein Terminus. Dissection of the Portal Vein. Indirect Suture Passage. Shunts of the Central Division: Extravascular Approach Dissection of the Terminus of the Central Hepatic Vein or Shunt. Dissection of the Shunt. Dissection of the Portal Vein Branch. Intravascular Approaches Portal Venotomy. Transcaval Approach Intravascular or Extravascular Shunt Occlusion Combined With Extrahepatic Portocaval Anastomosis Portocaval Anastomosis With Ameroid Constrictor Placement 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 Dogs* Mortality Rates Long-term Outcome Predicting Outcome Based on Preoperative or Postoperative Findings Age, Body Weight, Breed, and Clinical Signs. Preoperative Blood Work. Liver Pathology. Shunt Location. Degree of shunt attenuation. Outcome in Cats* Surgical Treatment Of Hepatic Arteriovenous Malformations Interventional Radiology Techniques Percutaneous Transjugular Coil Embolization Postoperative Management Complications Hepatic Arteriovenous Malformation Cyanoacrylate Glue Embolization Complications Multiple Acquired Extrahepatic Portosystemic Shunts References References 97 Pancreas Anatomy Vascular Supply Innervation Pancreatic Ducts Physiology Glucose Metabolism Digestion Prevention of Autodigestion Regulation of Exocrine Pancreatic Secretion Healing of the Pancreas Anesthetic Considerations Specific Surgical Procedures Pancreatic Biopsy Blunt Dissection Technique Suture Fracture Technique Effects of Open Surgical Pancreatic Biopsy Laparoscopic Pancreatic Biopsy Partial Pancreatectomy Total Pancreatectomy Technique Outcome Pancreaticoduodenectomy Pancreatic Drainage Postoperative Care Nutrition Fluid Support Analgesia Antiemetics Reduction of Gastric Acid Production Surgical Diseases Pancreatitis Pathophysiology Clinical Signs Laboratory Findings Amylase and Lipase. Trypsinlike Immunoreactivity. Pancreatic Lipase Immunoreactivity. Imaging Preoperative Management Surgical Intervention Postoperative Care Prognosis Pancreatic Abscess Pathophysiology Clinical Findings Surgery Bacterial Cultures. Postoperative Care Prognosis Pancreatic Pseudocysts Pathophysiology Clinical Findings Therapeutic Intervention Postoperative Care and Complications Prognosis Pancreatic Exocrine Tumors Pathophysiology Clinical Findings Surgical Treatment Prognosis Insulinoma Pathophysiology Clinical Signs Laboratory Findings Imaging Preoperative Management Surgical Treatment Postoperative Care and Complications Treatment of Persistent or Recurrent Hypoglycemia Prognosis Gastrinoma Pathophysiology Clinical Findings Surgical Treatment Postoperative Management, Complications, and Prognosis References References 98 Feeding Tubes Methods Of Delivering Enteral Nutrition Coaxed Feeding Orogastric Intubation Nasoesophageal Tubes Indications and Contraindications Technique Complications Pharyngostomy Tubes Indications and Contraindications Technique Complications Esophagostomy Tubes Indications and Contraindications Technique Manual (Unassisted) Transesophageal Advancement. Needle-Assisted Percutaneous Placement. Tube-Assisted Percutaneous Placement. Eld Percutaneous Feeding Tube Applicator. Esophageal Feeding Tube Applicator. Aftercare Complications Gastrostomy Tubes Indications and Contraindications Techniques Surgical Placement. Percutaneous Endoscopic Gastrostomy Tube Placement. Nonendoscopic Percutaneous Tube Placement. Low-Profile Gastrostomy Tubes. Postoperative Management Tube Removal Complications Percutaneous Endoscopic Gastrostomy Tubes. Nonendoscopically Placed Percutaneous Tubes. Enterostomy Tubes Indications and Contraindications Techniques Standard Technique. Needle-Assisted Technique for Tubes Without Catheter Adaptors. Needle-Assisted Technique for Tubes With Catheter Adaptors. Gastroenterostomy Tube. Duodenostomy Through a Limited Approach. Low-Profile Enterostomy Tubes. Tube Care Complications Tube Feeding: Specifics Diet Initiation of Enteral Support Constant Rate Infusion Intermittent Bolus Feeding 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 Treatment of Fungal Rhinosinusitis Foreign Bodies Idiopathic Inflammatory Rhinitis Other Causes of Nasal Disease Diseases of the Nasopharynx Nasopharyngeal Polyps Treatment of 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 Indications and Preoperative Considerations Approaches to the Nasal Cavity Dorsal Approach to the Frontal Sinus and the Nasal Cavity. Ventral Approach to the Nasopharynx. Ventral Approach to the Nasal Cavity. Lateral Approach to the Nasal Cavity. Rostral or Alveolar Mucosal Approach. Postoperative Considerations and Complications. Sinusotomy Sinus Ablation References References 100 Palate Embryology Anatomy Physiology Palate Defects Pathophysiology Clinical Signs and Diagnosis Treatment Repair of Rostral Defects Overlapping Flap Technique for Hard Palate Repair Medially Positioned Flap Technique for Soft Palate Repair Medially Positioned Flap Technique for Hard Palate Repair Labial-Based Mucoperiosteal Flap for Repair of Oronasal Fistula Split Palatal U-Flap Technique Repair of Large Palatal Defects Prostheses 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 Partial Laryngectomy Total Laryngectomy Laryngeal Collapse Treatment Laryngeal Paralysis Etiology Congenital Laryngeal Paralysis Acquired Laryngeal Paralysis Clinical Findings Laboratory Findings Diagnostic Imaging Anesthetic Regimens for Laryngoscopy Emergency Medical Management Surgical Treatment Unilateral Arytenoid Cartilage Lateralization Unilateral Cricoarytenoid Lateralization. Thyroarytenoid versus Cricoarytenoid Sutures. Degree of Arytenoid Abduction. Outcome. Complications. Transoral Partial Laryngectomy Technique. Outcome. Complications. Video-Assisted Photoablative Laryngectomy. Ventral Laryngotomy for Partial Laryngectomy Technique. Outcome. Castellated Laryngofissure Technique. Outcome. Permanent Tracheostomy Prognosis Devocalization Techniques Transoral Vocal Cordectomy Ventral Laryngotomy With Vocal Cordectomy Laser Vocal Fold Resection 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 Indications Considerations Technique Management Tube Removal Complications Permanent Tracheostomy Indications Technique Complications Tracheotomy and Bronchotomy Resection and Anastomosis Indications Considerations Anesthesia. Tension. Effect of Age. Suture Materials and Pattern. Surgical Options. Surgical Approach Surgery Technique Management Complications Specific Conditions Tracheal Rupture Pathophysiology Clinical Findings and Diagnosis Treatment Tracheal Avulsion Pathophysiology Clinical Findings and Diagnosis Treatment and Outcome Tracheobronchial Foreign Bodies Pathophysiology Clinical Findings and Diagnosis Treatment Masses Neoplasia Benign Esophagotracheal and Esophagobronchial Fistulae Pathophysiology Clinical Findings and Diagnosis Treatment Tracheal Collapse Pathophysiology Signalment Clinical Findings and Diagnosis Radiographs. Fluoroscopy. Tracheoscopy. Grading System. Bronchial Collapse. Medical Management Acute Therapy. Chronic Therapy. Selection of Patients and Techniques for Surgery Extraluminal Prosthetic Tracheal Rings Technique. Outcome. Laryngeal Paralysis. Tracheal Necrosis. Pneumothorax. Extraluminal Spiral Prosthesis Intraluminal Stents Stent Size. Stent Placement. Postoperative Care. Outcome. Stent Fracture. Stent Migration. Exuberant Granulation Tissue. Tracheal Narrowing Miscellaneous Bronchial Conditions Congenital Lobar Emphysema Bronchiectasis Bronchogenic Cysts 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 Consequences of Thoracotomy on Pulmonary Physiology Hypoxemia Residual Pneumothorax or Pleural Effusion Pain 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 History Diagnosis Medical Management Surgical Treatment Outcome Bronchiectasis History and Diagnosis Treatment Lung Laceration Conservative Treatment Surgical Treatment Lung Lobe Torsion Clinical Findings Diagnosis Treatment and Outcome Pulmonary Neoplasia Diagnosis Surgical Treatment Prognosis Surgical Techniques Partial Lobectomy Stapled Partial Lobectomy Thoracoscopic Partial Lung Lobectomy Key-Hole Technique Total Lung Lobectomy Suture Ligation Stapling Technique Thoracoscopic Lung Lobectomy Pneumonectomy Pathophysiology Surgery 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 Transsternal Thoracotomy Transdiaphragmatic Thoracotomy Surgical Conditions of the Thoracic Wall Pectus Excavatum Infection Trauma Diagnostics and Supportive Therapy Surgery Neoplasia Resection of Thoracic Wall Tumors Thoracic Wall Reconstruction Muscle Flaps Commercial Products Available for Reconstruction Prosthetic Mesh. Biologic Grafts. Postoperative Care References References 105 Thoracic Cavity Anatomy Pleura Lymph Nodes Thoracic Duct Thymus Physiology Respiration Fluid Gradients Thymus Pathophysiology Types of Pleural Effusion Pure Transudate Serosanguineous Effusion Sanguineous Effusion Chylous Effusion Inflammatory Effusion Neoplastic Effusion Clinical Signs of Intrapleural Disease Diagnostic Imaging Radiography Ultrasonography Computed Tomography Thoracocentesis Technique Presurgical Considerations Thoracostomy Tube Placement Technique Tube Management Complications General Surgical Principles Intercostal Thoracotomy Technique Rib Resection Thoracotomy Median Sternotomy Transsternal Thoracotomy Thoracoscopy Technique Intercostal Approach. Paraxiphoid Transdiaphragmatic Approach. Complications Postoperative Management Monitoring Analgesia Complications Specific Conditions Trauma Etiology Treatment Outcome Pneumothorax Clinical Signs Diagnosis Treatment Chylothorax Etiologies Pathophysiology Clinical Signs Diagnosis Surgical Options Popliteal Lymphangiography. Intestinal Lymphangiography. Thoracic Duct Ligation. Thoracoscopy. Pericardiectomy. Cisterna Chyli Ablation. Omentalization. Pleurodesis. Decortication. Aftercare Management of Recurrent Effusion Percutaneous Drainage Systems. Pleuroperitoneal Shunts. Medical Management. Pyothorax Clinical Findings Laboratory Findings Pleural Exudate Diagnostic Imaging Treatment Nonsurgical Treatment. Surgery. Outcome Malignant Pleural Effusion Diagnosis Treatment Outcome Thymoma Clinical Findings Paraneoplastic Syndrome. Diagnosis Differentiation of Thymoma and Lymphoma. Myasthenia Gravis. Treatment Outcome Thymic Lymphoma Mediastinal Carcinoma 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 Pathophysiology Diagnosis Indications for Surgery Patent Ductus Arteriosus Ligation Outcome Pulmonic Stenosis Pathophysiology Diagnosis Indications for Surgery Surgical Techniques Transventricular Pulmonic Dilatation Valvuloplasty. Open Pulmonic Patch-Graft Valvuloplasty. Outcome Double-Chambered Right Ventricle Pathophysiology Diagnosis Indications for Surgery Correction of Double-Chambered Right Ventricle Outcome Ventricular Septal Defect Pathophysiology Diagnosis Indications for Surgery Pulmonary Artery Banding Open Repair for Ventricular Septal Defect Outcome Atrial and Atrioventricular Septal Defect Pathophysiology Diagnosis Indications for Surgery Open Repair of Atrial Septal Defects Outcome Tetralogy of Fallot Pathophysiology Diagnosis Indications for Surgery Surgical Techniques Modified Blalock-Taussig Shunt. Open Repair of Tetralogy of Fallot. Outcome Cor Triatriatum Pathophysiology Diagnosis Surgery Outcome Mitral Regurgitation Pathophysiology Diagnosis Indications for Surgery Surgical Techniques Mitral Valve Replacement. Mitral Valve Repair. Outcome Tricuspid Valve Dysplasia Diagnosis Indications for Surgery Tricuspid Valve Replacement Outcome Aortic Regurgitation Pathophysiology Diagnosis Treatment Heterotopic Aortic Valve Implantation Outcome Cardiac Neoplasia 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 Clinical Signs Treatment Acquired Pericardial Diseases Pericardial Rupture Pathophysiology Clinical Signs Radiographic Findings Echocardiography Surgical Treatment Pericardial Effusion Etiology Signalment and History Physical Examination Pericardial Fluid Cytology and Analysis Electrocardiography Radiography Echocardiography Treatment Pericardiocentesis. Pericardiectomy. Thoracoscopic Pericardial Window. Percutaneous Balloon Pericardiotomy. Outcome Constrictive Pericarditis Etiology Pathophysiology History and Physical Examination Electrocardiography Radiography Echocardiography Cardiac Pressures Cardiac Catheterization. Treatment References References 108 Vascular Surgery Anatomy General Vascular and Microvascular Surgery Instruments, Suture, and Graft Materials Vascular Exposure and Control Hemostasis and Anticoagulation Vascular Incisions and Closures Vascular Anastomoses End-to-End Anastomosis End-to-Side Anastomosis Side-to-Side Anastomosis Autologous Grafts Endovascular Surgery Instrumentation Vascular Access And Closure General Endovascular Techniques in Small Animal Practice Central Venous Catheter Placement Subcutaneous Venous Access Port Placement Embolotherapy and Embolectomy Specific Conditions Trauma and Hemorrhage Vascular Malformations and Arteriovenous Fistulas References References XI Urogenital System 109 Ovaries and Uterus Anatomy and Physiology Anatomy Ovaries and Ligaments Uterine Tube Uterus Reproductive Physiology Pregnancy and Parturition in Dogs Pregnancy and Parturition in Cats Surgery Indication and Benefits of Ovariectomy or Ovariohysterectomy Consequences of Ovariohysterectomy Prepubertal Ovariohysterectomy Pediatric Physiology Relevant to Surgery Surgery and Outcome Ovariohysterectomy Open Surgical Approach Technique (Figure 109-4). Complications. Laparoscopic Ovariohysterectomy Surgical Technique. Procedure-Related Complications. Ovariectomy Open Technique Laparoscopic Technique Disorders of the Ovary Diagnostic Techniques Imaging Clinical Pathologic Parameters in Ovarian Disease Surgical Exploration Ovarian Neoplasia Diagnosis and Staging Canine Ovarian Tumors Feline Ovarian Tumors Ovarian Cysts Nonfunctional Cysts Functional Cysts Ovarian Remnant Syndrome Congenital Abnormalities of the Ovary Disorders of the Uterus Diagnostic Techniques Abdominal Palpation Imaging Other Diagnostic Techniques Pyometra Pathophysiology Clinical Presentation and Diagnostic Testing Clinical Signs. Complete Blood Count. Biochemistry. Imaging. Surgical Treatment Preoperative Stabilization. Surgical Technique. Medical Management. Outcome and Complications Cystic Endometrial Hyperplasia, Mucometra, Hydrometra, and Hematometra Metritis Uterine Torsion Uterine Prolapse Uterine Rupture Dystocia Pathophysiology Clinical Signs and Diagnosis Treatment of Dystocia Cesarean Section Anesthesia Surgical Technique Neonatal Resuscitation Outcome and Complications Subinvolution of Placental Sites Uterine Neoplasia Canine Uterine Tumors Feline Uterine Tumors 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 Pathophysiology Clinical Signs Diagnosis Surgery Septa. Annular Lesions. Vaginectomy. Rectovaginal Fistulas Surgery and Outcome Anovulvar Cleft Surgery Acquired Conditions Recessed Vulva Pathophysiology Clinical Signs and Diagnosis Surgery and Outcome Vaginal Edema and Vaginal Prolapse Pathophysiology Vaginal Edema Treatment Vaginal Prolapse Treatment Clitoral Hypertrophy and Intersex Conditions Pathophysiology Treatment Neoplasia of the Vagina, Vestibule, and Vulva Pathophysiology Diagnosis Surgery and Outcome References References 111 Testes and Scrotum Anatomy Testes and Epididymides Scrotum Physiology and Histology Testes and Epididymides Scrotum Disorders Testes Anorchism and Monorchism Cryptorchidism Orchitis and Epididymitis Testicular Torsion Testicular Neoplasia Testicular Sampling Epididymides Epididymal Occlusion Scrotum Sterilization Nonsurgical Sterilization Techniques Surgical Techniques Canine Orchiectomy Closed Technique Open Technique Canine Scrotal Ablation Feline Orchiectomy Overhand Hemostat and Figure of Eight Hemostat Techniques Ligation Technique Square Knot Technique Vasectomy Cryptorchid Castration Abdominal Approach Peripreputial Approach 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 Treatment Penile Strangulation Local Treatment Partial Penile Amputation Preputial Shortening Persistent Penile Frenulum Penile Tumors Penile Amputation Paraphimosis Treatment Phimosis Treatment Balanoposthitis Treatment Preputial Foreign Bodies Preputial Trauma/Wounds Preputial Masses Preputial Hypoplasia Preputial Advancement References References 113 Prostate Anatomy Embryology Size Anatomic Relations Vessels Nerves Histology Physiology Secretions Hormonal Regulation of Prostatic Growth Diagnostic Approach to Prostatic Disease History and Physical Examination Digital Rectal Examination Laboratory Investigations Microbiologic and Cytologic Samples Biopsy Samples Diagnostic Imaging Radiography Ultrasonography Computed Tomography and Magnetic Resonance Imaging Nuclear Scintigraphy Diseases of the Prostate Benign Prostatic Hyperplasia Clinical Signs and Diagnosis Management Antiandrogens. Luteinizing Hormone Inhibitors. 5α-Reductase Inhibitor. Luteinizing Hormone–Releasing Hormone (Gonadotropin-Releasing Hormone) Agonists. Estrogens. Cystic Hyperplasia, Prostatitis, and Abscessation Clinical Signs and Diagnosis Management Ultrasound-Guided Drainage. Discrete Prostatic Cysts Clinical Signs and Diagnosis Management Prostatic Neoplasia Clinical Signs and Diagnosis Management Prostatic Metaplasia Clinical Signs and Diagnosis Management Prostatic Trauma Clinical Signs and Diagnosis Management Prostatic Surgery General Principles and Surgical Approach Postoperative Care Surgical Options for Prostatic Abscesses Marsupialization Ventral Drainage Omentalization Partial Prostatectomy Surgical Management of Prostatic Cysts Complete Resection Marsupialization Partial Resection and Omentalization Partial Prostatectomy Total Prostatectomy for Neoplasia 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 Survey Radiography Intravascular Contrast Studies Toxicity. Patient Preparation. Study Timing. Contrast Dose. Phases of Contrast Excretion. Pyelography Ultrasonography Resistance Index. Computed Tomography Magnetic Resonance Imaging Scintigraphy Variations in Glomerular Filtration Rate. Radiopharmaceuticals. Preoperative Considerations Postoperative Care Abnormalities of the Kidney Developmental Anomalies Renal Agenesis Renal Ectopia Fused Kidney Polycystic Kidney Disease Renal Calculi Pathophysiology Clinical Findings Treatment Renal Neoplasia Types of Neoplasia Clinical Findings Treatment Acquired Renal Cysts Perirenal Pseudocysts Renal Abscesses Renal Trauma Surgical Techniques Renal Biopsy Indications Instrumentation and Sample Size Approaches Percutaneous Biopsy. Ultrasound-Guided Biopsy. Keyhole Biopsy. Laparoscopic Biopsy. Wedge or Incisional Biopsy. Complications Nephrotomy Indications Surgical Technique Effect of Nephrotomy on Renal Function Partial Nephrectomy Indications Surgical Technique Complications Nephrectomy and Nephroureterectomy Indications Surgical Technique Nephrectomy versus Nephroureterectomy Complications Renal Autotransplantation References References 115 Ureters Anatomy Ureteral Diameter Topographic Anatomy Blood Supply and Innervation Microscopic Anatomy Ureteral Obstruction Pathophysiology Feline Ureterolithiasis Medical Treatment Lithotripsy Presurgical Considerations Localizing the Ureterolith Surgery Ureteral Catheter Placement. Postoperative Care Complications Canine Ureterolithiasis Treatment Lithotripsy. Ureteral Neoplasia Ureteral Trauma Ureteral Injury Associated With Ovariohysterectomy Ureterovaginal Fistula. Injury Secondary to Blunt Trauma Urinoma. Ureteral Ectopia Clinical Signs Diagnosis Contrast Radiography, Fluoroscopy, and Computed Tomography. Ultrasonography. Endoscopy. Surgical Correction of Ectopic Ureter Outcome of Surgery. Cystoscopic Laser Treatment Ureteral Ectopia in Male Dogs Ureteral Ectopia in Cats Ureteroceles Clinical Findings and Diagnosis Treatment Surgical Techniques General Principles Ureterotomy Use of Nephrostomy Tubes Ureteral Reimplantation (End-to-Side Neoureterocystostomy) Intravesicular Technique Outcome. Extravesicular Technique Tension Reduction Prognosis Neoureterocystostomy (Side-to-Side) Nephrotomy and Pyelotomy Indications for Nephrotomy Nephrotomy Outcome. 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 Partial Defects Complete Transection Catheter Placement After Repair Suture Material Urinary Diversion Surgical Procedures Urethrotomy Prescrotal Urethrotomy Urethrostomy Scrotal Urethrostomy in Male Dogs Perineal Urethrostomy in Male Cats Technique in Ventral Recumbency. Technique in Dorsal Recumbency. Outcome. Prepubic Urethrostomy Surgical Technique. Outcome. Urethral Anastomosis Surgical Technique Intrapelvic Exposure Outcome Congenital Disorders of the Urethra Hypospadias Epispadias Urethral Fistulas Acquired Disorders Urethral Obstruction Urethral Trauma Urethral Stricture Urethral Prolapse Urethritis References References 118 Sphincter Mechanism Incontinence Normal Control of Continence Pathophysiology Urethral Tone Urethral Length Bladder Neck Position Body Size and Breed Gonadectomy Hormonal Status Vestibulovaginal Stenosis Urethral Sphincter Mechanism Incompetence in Male Dogs Diagnosis Treatment Medical Treatment Surgical Options Colposuspension Urethropexy Artificial Urethral Sphincters 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 Graft Preparation Vascular Anastomosis Cold Storage Ureteroneocystostomy Additional Procedures 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 Renal Dysfunction Acute Rejection. Treatment. Chronic Rejection. Hemolytic Uremic Syndrome. Calcium Oxalate Urolithiasis. Retroperitoneal Fibrosis. Ureteral Obstruction. Complications Associated With Immunosuppressive Therapy Infection. Diabetes Mellitus. Neoplasia. 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 Low-Dose Dexamethasone Suppression Test Pheochromocytoma Perioperative Management Cortisol-Secreting Adrenal Tumor Pulmonary Thromboembolism Diagnosis and Treatment. Hypoadrenocorticism Glucocorticoids. Mineralocorticoids. Pheochromocytoma Surgery Approaches Ventral Midline Flank Approach Laparoscopy Surgical Technique Caval Invasion Prognosis Species Differences Cats Ferrets References References 121 Thyroid and Parathyroid Glands Anatomy Thyroid Glands Parathyroid Glands Ectopic Tissue Physiology Thyroid Hormones Parathyroid Hormone and Calcium Metabolism Feline Hyperthyroidism Pathophysiology Clinical Signs Clinical Findings Cardiac Disease Renal Disease Hypokalemia Diagnostics Scintigraphy Preoperative Management Anesthesia Surgery Approach Thyroidectomy Modified Extracapsular Technique. Modified Intracapsular Technique. Parathyroid Autotransplantation Staged Bilateral Thyroidectomy Postoperative Care Complications and Prognosis Hypoparathyroidism Treatment of Acute Hypocalcemia. Maintenance Therapy. Discontinuing Supplementation. Recurrence Hypothyroidism Carcinomas Alternative Therapies Medical Management Radioactive Iodine Canine Thyroid Tumors Pathophysiology Metastasis Functional Tumors Clinical Findings and Diagnostics Scintigraphy Cytology and Biopsy Preoperative Management Surgery Surgical Technique Postoperative Care Complications Prognosis Other Therapies Radioactive Iodine Radiation Chemotherapy Canine Hypothyroidism Diagnosis of Hypothyroidism Factors Affecting Diagnosis Systemic Effects of Hypothyroidism on Surgical Patients Cardiovascular Effects Coagulation Wound Healing and Infection Hyperparathyroidism Pathophysiology of Primary Hyperparathyroidism Skeletal Effects Renal Effects Clinical Signs and Diagnosis Ionized Calcium and Parathyroid Hormone Concentrations Ultrasonography Scintigraphy Preoperative Management Surgical Techniques Intraoperative Detection of Abnormal Glands Excision of External Parathyroid Glands Excision of Internal Parathyroid Glands Excision of Multiple Abnormal Glands Postoperative Care Complications and Prognosis Hypocalcemia Treatment of Acute Hypocalcemia. Maintenance Therapy. Disease Recurrence Cats Other Therapies References References XIII Ear 122 Pinna and External Ear Canal Anatomy The Pinna External Ear Canal Cartilages Nerves Vessels Conditions Affecting the Pinna Aural Hematoma Pinna Trauma and Lacerations Neoplasia Actinic Keratoses Squamous Cell Carcinoma Hemangioma and Hemangiosarcoma Basal Cell Tumors Mast Cell Tumors Histiocytomas Sebaceous Adenomas Other Tumors Infectious and Inflammatory Conditions Conditions Affecting the External Ear Canal Otitis Externa/Media Clinical Signs Pathophysiology Primary Causes Predisposing Factors Perpetuating Factors 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 Normal Findings Abnormal Appearance Otic Cytology and Biopsy Fine-Needle Aspirate, Grab Biopsy, and Impression Smear Diagnostic Imaging of the Ear Positioning Radiography Ultrasound Computed Tomography Magnetic Resonance Imaging Contrast Canalography and Fistulography Perioperative Considerations Patient Preparation Positioning Surgical Instruments Surgery of the Pinna Auricular Hematoma Nonsurgical Management of Auricular Hematoma Laceration Repair Subtotal and Total Pinnectomy Use of Pinna in Oronasal Fistula Reconstruction Other Techniques to Treat Pinna Disease Photodynamic Therapy for Squamous Cell Carcinoma Cryotherapy Surgery of the External Ear Lateral Wall Resection Vertical Ear Canal Ablation Vertical Ear Canal Incision for Polyp Removal Total Ear Canal Ablation and Bulla Osteotomy Maintenance of Ear Carriage in Dogs Pinna Cosmesis After Ear Canal Ablation in Cats Microbial Isolates Use of Drains Analgesia Studies Complications of Ear Canal Surgery Nerve Damage Hemorrhage Dehiscence Auditory Function 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 Middle Ear Polyps Cholesteatomas Congenital Anomalies Disorders of Middle Ear Drainage Secretory (Serous) Otitis Media Ciliary Dyskinesia Neoplastic Disease Presentation Septic Otitis Media Neurologic Signs Polyps Disorders of Tympanic Drainage: Secretory Otitis Media and Ciliary Dyskinesia Neoplastic Disease Diagnosis Physical Evaluation Otoscopy and Video-otoscopy Diagnostic Imaging Miscellaneous Techniques Cerebrospinal Fluid Analysis Brainstem Auditory Evoked Responses Impedance Audiometry Medical Treatment of Middle Ear Disease Conservative and Medical Management of Septic Otitis Media and Otitis Interna in Dogs Lavage and Removal of Debris Medical Therapy Conservative Management of Feline Inflammatory Polyps Management of Middle Ear Drainage Dysfunction Surgery Indications Lateral Access via Total Ear Canal Ablation (see Chapter 122) Dogs Cats Ventral Bulla Osteotomy Cats Dogs 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 Ankyloblepharon Eyelid Agenesis Dermoids Entropion Temporary Correction. Permanent Correction. Ectropion Wedge Resection. Margin-Sparing Techniques. Euryblepharon Pocket Technique for Permanent Medial Canthoplasty. Distichia Cryoepilation. Electroepilation. Ectopic Cilia Acquired Disorders Eyelid Neoplasia Chalazion Eyelid Reconstruction Wedge and Pentagonal Resection Simple Two-Layer Closure Sliding Pedicle Advancement Flap Myocutaneous Pedicle Graft Semicircular Flap Lip-to-Lid Flap Temporary Tarsorrhaphy Nasolacrimal System Anatomy and Physiology Diseases of the Nasolacrimal Drainage System Clinical Signs Diagnostic Tests Punctal Anomalies Nasolacrimal Cysts Blockage of the Nasolacrimal Duct Tear Film Deficiency Parotid Duct Transposition Conjunctiva Anatomy and Physiology Diseases of the Conjunctiva Non-Neoplastic Conjunctival Masses Conjunctival Neoplasia 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 Surgical Repositioning Orbital Rim Anchoring Technique. Morgan Pocket Technique. Protrusion of the Nictitating Membrane Neoplasia and Non-neoplastic Diseases of the Nictitating Membrane Excision of the Nictitating Membrane Foreign Body Removal Nictitating Membrane Flaps Cornea Anatomy and Physiology Indolent Ulcers Treatment Corneal Surgery Indications for a Keratectomy Procedure for Keratectomy Orbit Anatomy Clinical Signs of Orbital Disease Differential Diagnosis Exenteration Orbitotomy Modified Lateral Orbitotomy Orbitectomy Surgical Procedures for Globe Removal Evisceration Enucleation Approaches Subconjunctival Approach. Transpalpebral Approach. Removal of the Globe 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 Conjunctival Grafts Pedicle Graft. Corneoconjunctival Transposition Corneal Allografts Biosynthetic Grafts Corneal and Scleral Lacerations Mechanism of Injury Blunt Trauma Sharp Trauma 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
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