STOP THE PRESS! This blog edition is my first ever guest blogger post! Love it. Here Nicola Kulendra, European Specialist in Small Animal Surgery and a dear friend and colleague, shares some of her top surgery tips for you. Also be sure to look out for the free PDF giveaway at the end which contains some other points relating to Soft Tissue Surgery (that is my creation, not Nicola's).
My top 5 surgery tips!
- Don't Panic! If the abdomen is pooling with blood after a bitch spay, stay calm and compose yourself. The dog won't bleed out immediately, you have time to enlarge your incision, perform the duodenal/colonic manoeuvre to find your stump. If you can see the caudal pole of the kidney, your bleeding vessel won’t be far away so pack some swabs in and then use a small haemostat to grab your bleeder.
- Never close a wound with tension. If by the time you are placing skin sutures, there is a lot of tension across your wound then it's probably the wrong decision to close it. You can take the tension away in deeper tissues but if you are relying on the skin sutures to hold the tension then they will likely fail. It is better to leave the wound open or think about other techniques to close it, such as a local subdermal plexus flap or axial pattern flap. Remember, it is very rare to have to do an emergency skin flap so if in doubt, take some pictures and ask a colleague/specialist for tips.
- Intestinal foreign bodies - always do a full ex-lap. Any animal that eats a peach stone has a higher chance of eating another inappropriately-sized object so always do a full ex-lap with an incision from the sternum to the pubis. Always make sure you check the stomach proximally to the level of the oesophagus and the intestinal tract caudally to the colon. However, if an object has arrived at the colon then it is likely that it will make it to the anus. It is very rare to have to do a colotomy to remove a foreign object – if you find yourself about to do this, stop, take a moment to rethink, you sure?
- RTA with multiple pelvic fractures/abdominal trauma? Don't forget the urinary tract! Just because you can palpate a bladder doesn't mean it's not ruptured. In addition, it can take many hours for azotaemia to develop so you may not see anything on blood work immediately. A retrograde study is fairly easy to perform and should be performed if there is any doubt as to the integrity of the urinary tract.
- Open fractures. If you have a patient with an open fracture, give him/her analgesia and if stable perform a very wide hair clip with sterile lubricant such as KY Jelly in the wound. Next scrub the skin with dilute chlorhexidine/iodine again with your lubricant as a barrier in the wound. Next thoroughly lavage the wound with a green 21-gauge needle, 20 ml syringe and sterile saline/Hartmann’s solution. Cover the wound with a sterile dressing such as Allevyn® or Melolin®. If the wound is heavily contaminated consider a wet-to-dry dressing. Place a Robert Jones if the fracture is below the elbow or stifle.
Nicola Kulendra BVetMed (Hons) MVetMed CertVDI DipECVS MRCVS
European Specialist in Small Animal Surgery