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Sunday, November 16, 2014 SUNDAY, NOVEMBER 16, 2014 Wet Lab and Hands-on Learning Event! Continuing education in a small group clinical setting on the campus of the specialty practices in Tustin ® ADVANCED CARE FOR PETS Advancing th gy e Art of Veterinary Dermatolo SUNDAY, NOVEMBER 16, 2014 Wet Lab and Hands-on Learning Event! PRESENTATION NOTES Groups Speakers Topics ECFA Julius Brinkis, DVM, DACVO Eyelid Mass Wedge Resection VSS Tony Cambridge, BVMS, DACVS Wound Closure Techniques and Surgical Reconstruction Options AVMI Mike Broome, DVM Advanced Imaging Case Studies - Answering the Clinical Question. AVIM Cindy Duesberg, DVM, ACVIM Catheterizing the Female Dog Can be a Bitch Michelle Cieplucha, DVM AVCC Sarah Zimmerman,DVM, DACVIM (Cardiology) The Echocardiogram: When and Why (Notes available on-site) ADC Melissa Hall, DVM, DACVD My Five Favorite Products in Dermatology Patients and Why! VCG Mona Rosenberg, DVM, DACVIM (Oncology) Cytology and Slide Preparation for Everyday Lumps and Bumps Sara Fiocchi, DVM, DACVIM (Oncology) Julie Bulman-Fleming, DVM, DACVIM (Oncology) David Bommarito, DVM, MS, ACVR, DACVIM (Oncology) VNC Stephen Hanson, DVM, DACVIM (Neurology) Strange “Neuro” Cases Stacy Dillard, DVM, DACVIM (Neurology) AVSG Sarah Beaman, DVM Taps and Tubes After Hours Diane Craig, DVM, DACVS OCVS Andrea McDooling, BVSc, MS, DACVIM (SAIM) Immune Mediated Polyarthritis (Notes available on-site) Ashley Cruse, DVM, DACVIM (SAIM) Leyla Fatourechi, DVM, DACVECC CE CERTIFICATES WILL BE AVAILABLE FOR PICK-UP FOLLOWING YOUR LAST SESSION AND COMPLETION OF YOUR EVALUATIONS OF TODAY’S PROGRAM www.AVSG.net ® ADVANCED CARE FOR PETS Advancing th gy e Art of Veterinary Dermatolo EYELID MASS WEDGE RESECTION Julius Brinkis, DVM, DACVO and Douglas Esson, BVSc, MRCVS, DVM, DACVO Eyelid lacerations as well as tumors affecting the lid margins are relatively commonly encountered. As a consequence eyelid re-apposition is a frequently performed procedure. Referral to an ophthalmologist is sometimes not possible; however the anatomy of this region dictates a high risk for post-surgical complication and failure. As a consequence we will aim to provide a brief anatomical and surgical review of simple eyelid repair following wedge resection. This review will take the form of a short video presentation followed by an instructional wet lab (using pig eyes), guided by Drs. Esson DACVO & Brinkis DACVO, who will also be available (time-permitting) to discuss interesting or challenging cases. Eye Care for Animals acknowledges Cara Animal Care Products for providing wet lab instrumentation & suture material. NOTES ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Wound Closure and Surgical Reconstruction Techniques Tony Cambridge BVMS MRCVS Dip ACVS www.vssoc.com Email: [email protected] (949) 936-0055 The majority of wounds in our patients, be it from trauma or tumour resection, are simply closed. Having a variety of available practical techniques can allow the surgeon to avoid significant complications associated with large wound dehiscence or the compromise of distal tissue associated with a closure that is too tight, on a limb for example. KISS- "Keep It Simple, Stupid" Apply the least complex method that has a high probability of success. Use of towel clamps/skin hooks and/or temporary sutures to map or test a closure. If you don't think it will stay closed, it probably won't. Augment the closure with Button Stents! Be aware of distal extremity closures that are too tight. If any doubt, re-exam day 1 and day 2 post-op. Be prepared to open the wound if a compromise occurs. Don't be scared to admit this is a wound you can't close and convert to partially closing with a plan for secondary intension healing augmented by stents, tie over dressing, skin stretching or a second "planned" surgery. Always have a plan B available whenever you think it could be less than a simple closure. Shave much more hair than you expect to remove. Consider the use of simple flaps or if you are feeling brave, complex flaps. Axial pedicle flaps are based on precise anatomic vascular pedicles giving advantage of much longer flaps without a wide base. When using Flaps the K.I.S.S. principle is out, GO BIG OR GO HOME, small flaps add little to a closure defect. Big flaps close wounds but require LARGE areas to be shaved ahead of time. Dead space and seroma are your enemy, plan accordingly. Use wound drains prior to closure if you think you might need them. They can always be removed. Penrose drain is a 2 way street- exposed drains ideally should be covered. Buy Suction drains and have them in your clinic. If you don't have them, you won't use them. Wound stents can be made from tubing buttons. They are simple and easiest to use; Buy 3 sizes of Buttons have them ready in your clinic steam or cold sterilize. Use them to; 1. Assist in abolishing/compressing dead space. 2. As stents to support a wound closure. 3. As anchor points for skin stretching/traction with umbilical or suture to partially close wounds. K.I.S.S. meets GO BIG OR GO HOME !! Flank Fold and Elbow fold Flaps- Simple practical flaps. Greta in cats and majority of dogs Caution in Pit Bull/Bull terrier type breeds which have little surplus skin in these locations. base is ideally 2:1 base to length of free flap, cat’s skin is elastic and more tolerant of narrow base, can often make flaps 1:1 and then stretch to carpus/tarsus from Axilla/Flank Flank fold flap used to cover lateral and medial Or cover entire lateral thigh, note cranial stifle defect and 360 degree proximal tibia wound closure from donor site Elbow Flap used to cover an axillary medial elbow defect Elbow flap used to cover antebrachium down to the carpus Flank folds can also be used to close large central abdomen or groin defects. References Hunt, G. B. (1995). Skin fold advancement flaps for closing large sternal and inguinal wounds in cats and dogs. Veterinary Surgery : vs, 24(2), 172–175. Hunt, G. B., Tisdall, P. L. C., Liptak, J. M., Beck, J. A., Swinney, G. R., & Malik, R. (2001). Skin-fold advancement flaps for closing large proximal limb and trunk defects in dogs and cats. Veterinary Surgery : vs, 30(5), 440–448. Drains available form Victor Medical. Trochar Drain- 10Fr Jackson Pratt Flat Drain SU130-1309 10mm Jackson Pratt Flat Drain SU130- 0321 100ml Jackson Pratt Reservoir (grenade) SU130-1305 NOTES ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
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