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VEM5432 Advanced Small Animal Surgery SEMESTER: FALL 2019 CREDIT HOURS: 3 CREDIT HOUR GRADING SYSTEM: A-E GRADING PHASE: 3 Course Coordinator Name: Daniel D. Lewis, DVM, DACVS Office: SAH-365 Phone: 352-294-4426 Email: [email protected] Office Hours: By appointment only.

Course Description Problem-oriented topics and lectures in small animal surgery. Soft tissue surgery topics including skin, oral cavity, nasal/mandible, esophagus, head/neck, intestine, thoracic cavity, urinary tract, liver/spleen; handling chest and abdominal trauma, reconstruction, and neoplasms. Orthopedic topics include basic and advanced principles and techniques of fracture management as well as reconstructive techniques of musculoskeletal abnormalities affecting small animals.

This course is designed to give the student a sound clinical understanding of a canine and feline soft tissue and . The course is targeted at students following the small animal tract, but many of the principles taught in this course can and do apply to other species. The course will emphasize a practical approach to commonly encountered clinical problems.

Student Learning Outcomes After successful completion of this course, students will be able to:

1. Introduction to Cutaneous & Reconstructive Surgery • Know the anatomy and functions of the skin. • Understand the blood supply to the skin in dogs and cats. • Know wound classification and significance. • Understand tension, tension lines, how to use them in the dog and cat. • Understand the principles of reconstructive cutaneous surgery; tissue handling, needle selection, suture material, and suture patterns. • Know different local” wound closure techniques.

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2. Cutaneous Surgery: Advanced Techniques • Understand classification of skin flaps. • Understand the principles of axial pattern flaps. • Understand the pathophysiology and principles of free skin grafting. • Know appropriate skin closure techniques for wounds with extensive tissue loss and/or limited local tissue for closure (i.e. distal extremities). • Know different local” wound closure techniques. 3. Fracture Mechanics, Classification & Healing • List the basic forces which cause fractures and what fracture patterns typically is associated with each force. • Draw a basic stress/strain or load/deformation curve and label the major components and points of the curve. • Rate bone’s resistance to failure in tension, compression, and shear forces. • Classify and describe a fracture based on its radiographic appearance. • Grade open fractures. • Classify growth plate fractures according to the Salter-Harris classification scheme, and discuss the significance of this classification scheme with regard to premature growth plate closure and prognosis. • Name the zone of the growth plate that Salter-Harris fractures typically traverse, and why this zone is biomechanically weak. • List the clinical and radiographic criteria that allow one to diagnosis a fracture. • Describe in detail the clinical, radiographic, and histologic events of 1o and 2 o fracture healing. 4. Lecture 5 Decision Making in Fracture Management • Understand the principles assessing fractures. 5. Management of Difficult Wounds • Have the ability to correctly classify a wound. • Be able to choose the appropriate wound management for the different wound classifications. • Have a thorough understanding of the wound healing process. • Understand the principles of basic wound management in each stage of healing. • Be able to recognize common causes of delayed or chronic wound healing. • Be familiar with the variety of wound care dressings and adjuncts and indications for using each, including: Wet-to-dry Hydrophilic dressings Sugar and honey Vacuum-assisted wound closure − Maggot therapy − Low-level laser therapy − Silver − − − • Know different local” wound closure techniques −

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6. Fractures of the Pelvis & Sacrum • Understand the pelvic anatomy and diagnose fractures/luxations from radiographs. • Understand and be able to apply the criteria which determine if a given pelvic fracture or fracture configuration can be managed non-surgically. • Be familiar with a lateral approach to the ilium and a greater trochanteric osteotomy approach to the acetabulum. • Understand surgical fracture fixation options for sacroiliac fracture/luxations, ilial shaft, acetabular and ischial fractures. • Be aware of soft tissue and neurovascular injuries and complications relevant to pelvic fractures. 7. Lecture 7/8 Ear Surgery • No objectives given. 9. Surgery of the Head & Neck • Know the indications for and procedure for esophagostomy. • Be familiar with surgical anatomy for esophagostomy, thyroidectomy, and mandibular/ sublingual sialoadenectomy. • Be familiar with the diseases that indicate thyroidectomy. • Understand the principles of pre and postoperative care of thyroidectomy patients. • Understand the role of parathyroid hormone in calcium regulation. • Know the clinical signs, treatment options, and prognosis for dogs with primary hyperparathyroidism. • Know the types of salivary mucoceles and how their treatments differ. • Be familiar with diagnosis, and perioperative care of dogs with salivary mucoceles. 10. Cleft Palate & Oronasal Fistulas • To understand the etiology, incidence, clinical signs, indications, techniques, postoperative care and complications associated with correction of cleft palate and oral nasal fistulas. 11. Fractures of the Femur • Diagnose and classify femur fractures from radiographs. • Be familiar with the craniolateral approach to the and lateral approach to the shaft of the femur. • Understand fracture fixation options for femoral physeal fractures, femoral neck fractures, and femoral diaphyseal fractures. • Formulate an appropriate surgical plan for a given femoral fracture and associated fracture assessment score. • Be aware of complications relevant to femoral fractures. • Describe how one would assess femoral and sciatic nerve function. • Understand why Schroeder-Thomas splints should not be used for femoral fractures.

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12. Distal Hindlimb Fractures: Tibia & Fibula • Diagnose and classify tibial and fibular fractures from radiographs. • Describe the medial approach to the diaphysis of the tibia. • Suggest appropriate fracture fixation options for physeal diaphyseal tibial fractures. • formulate an appropriate surgical plan for a given tibial fracture and associated fracture assessment score. • Describe potential complications relevant to tibial fractures and their repair. 13. Surgical Diseases of the Esophagus • Familiarize yourself with the anatomy and normal and abnormal swallowing mechanisms of the esophagus. • Be able to differentiate between the different neuromuscular and mechanical obstructions of the esophagus in terms of radiographic signs, clinical signs and surgical remedies. • Know which diagnostic tests are to diagnose the different disease conditions discussed in the lecture. • Know the different approaches to the esophagus. • Know principles of esophageal suturing and complications associated with esophagotomy and resection and anastomosis. • Know the radiographic diagnosis for PRAA and how it is treated surgically. 14. Surgery of the Stomach and Pylorus • Describe the normal anatomy of the stomach. • Interpret the basic techniques involved with gastric and pyloric surgery. • Discuss the diagnosis and management of gastric foreign bodies. • Describe the diagnosis and management of pyloric outflow obstruction. 15. Forelimb Fractures: Scapula & Humerus • Diagnose and classify scapular fractures from radiographs. • Be familiar with an approach to the craniolateral region of the joint and muscular attachments to the scapula. • Understand fracture fixation options for scapular body and neck fractures. • Formulate an appropriate surgical plan for a given scapular fracture and associated fracture assessment score. • Know indications for surgical repair of scapular fractures and why some can be managed conservatively. 16. Forelimb Fractures: Radius, Ulna & Carpus • Diagnose and classify radius and ulna fractures from radiographs. • Be familiar with the medial and lateral approach to the shaft of the radius. • Understand fracture fixation options for radius/ulnar fractures. • Formulate an appropriate surgical plan for a given radius/ulnar fracture and associated fracture assessment score. • Know considerations relevant to distal radial fractures in small breeds. • Know the definition of Monteggia fractures.

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17. Fractures of the Maxilla & Mandible • List the preoperative considerations that are important for an animal with a mandibular or maxillary fracture. • State which is the tension surface of the mandible and what forms of fixation utilize the mechanical properties inherent to this surface. • State what is the most important consideration in repairing fractures of the maxilla and mandible. • Discuss why it is advisable to intubate animals with complex intraoral fractures through a pharyngotomy or via a tracheotomy. • Describe how to perform a pharyngotomy for intubation. • Describe how tape muzzles are utilized for fractures of the maxilla and mandible. • Describe how to stabilize mandibular symphyseal fracture-separations. • Describe how an acrylic external fixator would be constructed to stabilize a complex mandibular fracture. 18. Management of Polytrauma • Introduce pathophysiology of polytrauma. • Describe the approach to polytrauma, triaging and prioritization of therapy. • Understand and describe the general principles of diagnosis and treatment to the most common injuries associated with polytrauma (diaphragmatic and abdominal hernia, pneumothorax, pulmonary contusions, open fractures). • Describe the general aims and scopes of fracture management in polytrauma. 19. Orthopedic Complications – I • Differentiate between a delayed and a nonunion fracture. • List the circumstances/factors that cause delayed and nonunion fractures. • Outline treatment options for a delayed union fracture. • List and describe (especially the radiographic characteristics) the different categories and subtypes of nonunion fractures and appropriate treatment of each of these fractures. • Define malunion and what implications malunion may have on limb function. • Discuss the therapeutic approach to malunion. • List the causes and discuss the pathophysiology of osteomyelitis. • Describe the radiographic characteristics of osteomyelitis. • Discuss the therapeutic approach to osteomyelitis. • Define fracture disease, its causes, and list ways it can be prevented. 20. Orthopedic Complications – II • Differentiate between a delayed and a nonunion fracture. • List the circumstances/factors that cause delayed and nonunion fractures. • Outline treatment options for a delayed union fracture. • List and describe (especially the radiographic characteristics) the different categories and subtypes of nonunion fractures and appropriate treatment of each of these fractures.

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• Define malunion and what implications malunion may have on limb function. • Discuss the therapeutic approach to malunion. • List the causes and discuss the pathophysiology of osteomyelitis. • Describe the radiographic characteristics of osteomyelitis. • Discuss the therapeutic approach to osteomyelitis. • Define fracture disease, its causes, and list ways it can be prevented. 21. Examination of the Orthopedic Patient • Be able to perform a basic complete orthopedic examination on a patient • Describe the anatomic landmarks for hand placement when evaluating cranial drawer in the stifle joint. • Describe the tibial compression (thrust) test with respect to performing the test and the mechanism by which it tests for cranial cruciate rupture. • Describe the anatomic landmarks used for evaluation of hip luxation and how they alter from normal in the luxated hip. • Explain where and how one should examine a dog for stifle effusion. • Describe how to examine a patient for . • Understand the importance of a neurologic examination in relation to the orthopedic patient. • Understand what is being tested when pain sensation is evaluated on the medial and lateral digits of the fore and hind limbs. • Explain how to test for muscular symmetry in the fore and hind limbs and explain why changes may be noted in the orthopedic patient. • Describe the gait abnormality that you would see in a patient with unilateral forelimb lameness. • Understand and be able to explain the Ortolani test, including performing the test and what its results may indicate. • Explain how to test for medial and lateral collateral damage in the carpal and tarsal joints. 22. Gastric Dilatation and Volvulus (GDV) • Explain the pathophysiologic changes associated with GDV. • Explain the principles of medical management for GDV. • Describe the surgery for treatment and prevention of GDV. 23. Surgery of the Small Intestine (Lectures 23 & 24) • Familiarize yourself with the gross and anatomy microscopic anatomy of the small intestine. • Know the basic pathophysiology of incomplete vs complete, high vs low and simple vs strangulated intestinal obstructions. • Know the surgical techniques and suture patterns and types of suture material useful or enterotomy and resection and anastomosis. • Be familiar with the diagnosis and treatment of common small intestinal obstructives such as foreign bodies, intussusception, intestinal volvulus and neoplasia.

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25. Treatment of Degenerative Joint Disease • Understand etiology and pathology associated with degenerative joint disease in small animals. • Be able to develop a plan for diagnosing DJD in small animals and determining a cause for it. • Be able to differentiate DJD from other forms of arthritis in small animals. • Understand all aspects of non-surgical and surgical treatment for DJD in small animals. • Be able to communicate all of the above and effectively educate clients with respect to management of DJD in their dog or cat. 26. Medical Management of Degenerative Joint Disease • Know the mechanisms of action of each of the pharmaceuticals and their side effects • Understand why tramadol is believed to be ineffective in pain management in canines • Understand the basics of the arachidonic acid pathway • Know which nutraceutical has the greatest evidence supporting its use • Know the basic proposed mechanism of action of each of the nutraceuticalsInflammatory 27. Polyarthropathy • Definitions of degenerative and inflammatory joint disease. • Classification of joint diseases. • Diagnostic tests used to diagnose and classify the types of joint disease. • Brief overview of the most common types of inflammatory joint disease. 28. Introduction to Rehabilitation • Goals of Rehabilitation. • Patients suitable for rehabilitation. • Basic physical modalities available. • Basic therapeutic modalities available. • Reasonable expectations for rehabilitation outcomes. 29. Anal & Perianal Surgery • To understand the regional anatomy of the rectum, anus, anal sacs and perineum. • To know the predisposing factors and treatment options for perianal fistula. • To know the predisposing factors and treatment options for perineal hernia. • To know the indications for anal sacculectomy and be able to describe the open and closed techniques. 30. Limb Deformities • List the potential causes of premature physeal closure in dogs and cats. • Classify physeal fractures by the slater-harris classification scheme, and discuss the importance of this classification scheme as it relates to potential premature physeal closure. • Name the zone of the growth plate through which physeal fractures traverse and why this region is predisposed to fracture.

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• Discuss how different methods of stabilization might influence the occurrence of premature physeal closure. • Describe the anatomic features of the distal ulnar physis which predispose it to premature closure. • Describe the changes that would be expected in the antebrachium if there was premature closure of the distal ulnar physis. • Regurgitate the percentage of growth the proximal and distal radial and ulnar growth plates contribute to the over length of the antebrachium. • List the factors that influence what ultimate deformity will develop if there is premature closure of a growth plate. • Discuss how to treat a 3-month old dog with an angular limb deformity of the antebrachium secondary to a premature closure of the distal ulnar physis, and how treatment would differ if this dog was a year old. • List what surgical measure can be taken to prevent a osteotomy from healing. • Describe the basic principles associated with performing a definitive corrective osteotomy. • Discuss what occurs during distraction osteogenesis. 31. Miscellaneous Developmental Orthopedic Conditions • The objective of this lecture is to familiarize the student with the more common development orthopedic conditions affecting smaller dogs, craniomandibular osteopathy and avascular necrosis of the femoral head, osteochondrosis of the stifle and hock will be discussed. • List breeds of dogs typically affected with cranial mandibular osteopathy. • Describe the typical presenting history, physical examination and radiographic abnormalities associated with cranial mandibular osteopathy. • Discuss appropriate treatment of a dog affected with cranial mandibular osteopathy and what factors might influence that dog’s long-term prognosis. • Give the typical signalment of a dog affected with avascular necrosis of the femoral head. • Give the approximate percentage of animals affected that are male/female and affected uni/bilaterally. • Describe the pathologic events associated with avascular necrosis of the femoral head and relate these to what is seen radiographically during the various stages of this condition. • Discuss appropriate treatment options for a dog with avascular necrosis of the femoral head. • List multiple terms used to describe hypertrophic osteodystrophy. • Discuss the purported etiologies of hypertrophic osteodystrophy. • Describe specific clinical signs typical of hypertrophic osteodystrophy. • Describe the radiographic signs characteristic of hypertrophic osteodystrophy and correlate the radiographic abnormalities with the histologic pathologic changes.

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• Discuss appropriate treatment and prognosis of a dog with hypertrophic osteodystrophy. • List the clinical signs typically of panosteitis. • Discuss the radiographic abnormalities associated with panosteitis and correlate the radiographic abnormalities with the histologic pathologic changes. • Discuss appropriate treatment and prognosis of a dog with panosteitis. 32. Diagnosis and Treatment of Patellar Luxations in Dogs and Cats • List the components of the extensor mechanism • Explain the function of the patella • Describe the possible etiologies and pathological changes associated with medial patellar luxation • Describe the grading classification scheme for medial patellar luxation • Diagnose medial patellar luxation on both physical examination and radiographically • Explain the rationale for the various methods used for surgical correction of both medial and lateral patellar luxations • Describe appropriate post-operative care following surgical correction of medial patellar luxation 33. Portosystemic Shunts: Diagnosis & Management • Be able to classify the different types of portosystemic shunts (PSS) • Be able to describe the metabolic ramifications of PSS • Know the clinical signs and laboratory test values in dogs and cats with PSS. • Know the types of diagnostic tests that can be performed to detect PSS • Know how to stabilize and medically manage animals with PSS • Know the surgical treatment options for the different types of PSS • Know the complications of management of portocaval shunts • Know the prognosis and anticipated outcomes in animals with PSS, with or without treatment 34. Surgery of the Spleen • Indications for partial splenectomy and complete splenectomy. • Differentials for splenic disease, how to diagnose splenic disease, and appropriate diagnostics • Different surgical techniques for splenectomy • Systemic effects and perioperative dangers of splenectomy. •

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35. Surgery of the Liver and Biliary System • Know what additional preoperative diagnostic tests should be done prior to hepatobiliary surgery. • Know 3 methods of hepatic biopsy. • Know the indications and general technique for partial lobectomy and lobectomy (partial hepatectomy). • Know the indications for cholecystectomy and cholecystoduodenostomy, the general surgical technique, and the complications applicable to each surgery. 36. Surgical Management of Abdominal Trauma • Know how to confirm hemoperitoneum, how to use conservative measures to treat it, and when exploratory laparotomy is required to resolve it. • Know how to confirm uroperitoneum is present and how to define the site of urine extravasation. • Know how to repair splenic or hepatic fractures. • Know how to manage temporarily or definitively traumatic injury to the urinary bladder and to the urethra. • Know how to confirm the presence of gastrointestinal perforation and septic peritonitis. 37. Abdominal Hernias • Know the definitions, terminology, and anatomy of abdominal hernias • Be able to discuss the parts of a hernia, pathophysiology, clinical signs and diagnosis. • Be familiar with the principles of surgical repair, complications, and aftercare. • Know the different types of abdominal hernias. 38. Canine Hip Dysplasia (CHD) • NO OBJECTIVES GIVEN 39. Cranial Cruciate Ligament Rupture & Meniscal Injury • Know the anatomy and functions of the cranial cruciate ligament (CCL) and the menisci. • Understand the reported mechanisms of CCL rupture and meniscal injury. • Understand the risk factors for CCL rupture and meniscal injury. • Know the typical CCL rupture syndromes. • Know why the medial meniscus is more commonly damaged than the lateral in CCL injury. • Understand the temporal relationship of osteoarthritis and CCL rupture. • Describe in detail how to perform a cranial drawer test and understand its significance. • Be able to identify radiographic changes consistent with CCL rupture. • Describe and understand the basis of the various treatment options for CCL rupture listed in the notes and the assigned reading. • Describe appropriate treatment of meniscal injuries.

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40. Urinary Tract Surgery: Urinary Tract Rupture; Uroperitoneum • How to diagnose urinary tract rupture. • Appropriate perioperative management. • Different surgical procedures and types of injury. • Postoperative management & complications. 41. Urinary Tract Surgery: Urethrostomy/Cystotomy • Overview – epidemiology. • Preoperative management. • Surgical approaches. • Postoperative management & complications. 42. Coxofemoral Luxation • Define the most common direction for coxofemoral luxations in dogs and cats. • Name the four mechanisms or anatomic structures that maintain coxofemoral joint stability as well as what structures must be disrupted for luxation to occur? • Describe the advantages of closed reduction of a coxofemoral joint and what are potential contraindications for a closed reduction. • Give the success rate following closed reduction of a coxofemoral luxation. • Describe the clinical signs associated with a coxofemoral luxation, especially those specific physical examination findings supportive of a craniodorsal coxofemoral luxation. • Give indications for using a devita pin or flexible external fixator and describe the potential complications associated with these techniques. • Know the pertinent anatomy associated with the craniolateral and dorsal surgical approaches to the coxofemoral joint. • Describe the indications and contraindications for the following techniques: capsulorrhaphy, prosthetic capsule reconstruction, transposition of the greater trochanter, iliofemoral sutures, toggle pin and triple pelvic osteotomy. • Discuss the prognosis following management of a coxofemoral luxation including what specific parameters worsen the prognosis for full return of function or increase the likelihood of recurrent luxation. 43. Hyperextension Injuries & Luxations of the , Shoulder, Stifle, Carpus & Tarsus • Elbow Luxations explain why traumatic elbow luxations relatively uncommon. name the most common direction of a traumatic elbow luxation and why. − describe the specific physical examination findings noted in association with a − traumatic lateral elbow luxation. − explain why radiographs are indicated in an animal suggested of having a traumatic elbow luxation and what view should be obtained. − discuss what are the indications for and the success rate for closed reduction of traumatic elbow luxations. − describe what type of external coaptation is required following closed reduction and why is this type of coaptation used. −

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define the indications for open reduction and stabilization of a traumatic elbow luxation. − give a prognosis following closed and open reduction and stabilization of a traumatic elbow luxation. − describe the most commonly reported type of congenital elbow luxation and what is its suspected cause. − describe the specific clinical and physical examination findings associated with congenital humeroulnar luxation. − discuss the indications for closed and open reduction and stabilization of a congenital elbow luxation. − give a prognosis following successful reduction and stabilization of a congenital elbow luxation. − • Scapulohumeral Luxations describe the major anatomic structures that stabilize the scapulohumeral joint. classify shoulder luxations into two major categories. − describe the most common direction or directions scapulohumeral luxation to occur − and list the breeds of dogs commonly affected with each type of luxation. − describe the anatomic abnormalities typically associated with congenital scapulohumeral joint luxation. − describe the specific clinical physical examination abnormalities associated with medial and lateral luxation of the shoulder joint. − discuss the success of closed reduction and conservative management in congenital and acquired scapulohumeral luxation. describe the type of splint that should be used − following closed reduction of a medial or lateral luxation. list the surgical options available to manage scapulohumeral luxation and discuss the indications for choosing a stabilizing technique vs. a salvage procedure. 44. Elbow Dysplasia− • Discuss the purported pathophysiology of each of the four developmental orthopedic conditions that commonly affect the of skeletally-immature, large and giant- breed dogs. • Describe the abnormalities that would be present on physical examination with each of these developmental orthopedic conditions. • Describe the specific radiographic abnormalities typical of each of these developmental orthopedic conditions and the radiographic projection(s) on which these abnormalities are best observed. • Discuss the most appropriate diagnostic modalities, treatment options and prognosis for each of these four developmental orthopedic conditions.

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45. Reproductive Tract Surgery: Prostate & Pyometra • How to diagnose prostatic and uterine disease. • Pathophysiology of prostatic cysts/abscess and pyometra. • Appropriate perioperative management of patients undergoing prostatic and uterine surgery. • Different surgical procedures and benefits/risks with each. • Postoperative management & complications associated with prostatic and uterine surgery. 46. Upper Airway Surgery in Dogs and Cats • To understand the diagnosis and pre/post-operative management of nasal & upper airway surgery. • To understand the various surgical recommendations for brachycephalic syndrome and laryngeal paralysis. • To understand common post-operative complications associated with nasal & upper airway surgery. 47. Interactive Case Discussion – Cranial Cruciate Ligament Rupture, Hip Dysplasia • NO OBJECTIVES GIVEN 48. Osteochondrosis in Dogs • Discuss the purposed pathophysiology of osteochondrosis. • Explain distinctions between osteochondrosis and osteochondritis dissecans on both the histologic and clinical levels. • List the common locations where osteochondrosis develops in the dog. • Discuss clinical signs associated with osteochondrosis at each common sites of occurrence in dogs. • Describe the physical examination findings that would be expected in association with osteochondrosis at each of the common locations in dogs. • Describe specific radiographic abnormalities associated with osteochondrosis in dogs for each of the common sites of occurrence and what radiographic views facilitate their identification. • Discuss specific treatment of osteochondrosis lesions at each of the specific sites of occurrence in dogs and the prognosis following treatment. 49. Surgery of the Trachea • To recognize and be able to diagnose common tracheal diseases, such as tracheal collapse. To be able to grade tracheal collapse using the 4 tiered scale. To understand the indications and best surgical techniques for managing tracheal collapse. Know the relevant tracheal anatomy. • What are the mechanisms of injury to the trachea. What are the clinical signs associated with these types of injury and what are the principals of diagnosis and therapy. • What are the basic techniques and limitations of tracheal resection and reconstruction. • What are the indications for tracheotomy. What are the anatomical changes in the trachea associated with this procedure. Be able to describe the different

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tracheotomy/tracheostomy techniques and the respective advantages and disadvantages of each. • Know the indications for permanent tracheostomy. Understand the long-term management considerations for these patients. 50. Thoracic Surgery & Diaphragmatic Hernia • Know the approaches for specific surgeries of the thoracic cavity. • Know the limitations of various approaches of the thoracic cavity. • Know how to approach a diaphragmatic hernia. • Know how a chronic diaphragmatic hernia differs metabolically from an acute diaphragmatic hernia. • Know indications for thoracic wall repair and the methods available to support the thoracic. • Know the indications and surgical treatment for pectus excavatum. 51. Management of Thoracic Trauma & Emergencies • Be familiar with clinical signs that suggest thoracic injury and blood gas values that would suggest poor ventilation. • Know how to manage a flail chest. • Be able to state some causes of pneumothorax and differentiate simple from tension pneumothorax, and pneumothorax from pneumomediastinum. • Know how to insert and how to manage a chest drain. • Know indications for thoracic wall repair and the methods available to support the thoracic wall. 52. Muscle & Tendon Injuries • Know the definitions and classification of muscle and tendon injuries • Be able to discuss the principles of tendon and muscle healing and the necessary injury management • Be familiar with the principles of surgical repair, complications, and aftercare • For the diseases/injuries discussed: diagnosis, anatomy, etiology and pathogenesis, treatment options, prognosis and post-operative care. 53. Cardiothoracic Surgery in Dogs & Cats • To understand the perioperative principles of cardiothoracic surgery. • To understand the pathophysiology of common cardiovascular diseases (e.g. Thoracic wall compromise, pericardial disease, patent ductus arteriosus, and pacemaker therapy). • To know the relevant cardiothoracic anatomy as it relates to surgical approach and treatment. • To know the surgical options, complications, and outcomes for common cardiothoracic diseases.

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54. Advanced Laparoscopy & Video-assisted Thoracic Surgery in Dogs & Cats • Understand uses and mechanisms of advanced endoscopic instruments. • Understand the relative indications and contraindications for advanced laparoscopic and VATS procedures. • Understand physiology of pneumothorax and one-lung ventilation. • Understand case work up and perioperative management.

Course Schedule* This weekly schedule contains topics, assignments, and exams. Please refer to Canvas for updates and announcements to any changes to this schedule.

Class meetings will be held in Equine Auditorium unless otherwise specified.

Contact Date Topic Hours 10/23/2019 Lecture 01: Intro to Cutaneous & Reconstructive Surgery 1.0 10/23/2019 Lecture 02: Cutaneous Surgery; Advanced Techniques 1.0 10/23/2019 Lecture 03: Fracture Classification & Biomechanics 1.0 10/23/2019 Lecture 04: Fracture Diagnosis & Healing 1.0 10/24/2019 Lecture 05: Management of Difficult Wounds 1.0 10/24/2019 Lecture 06: Pelvic & Sacrum Fractures 1.0 10/24/2019 Lecture 07: Ear Surgery 1.0 10/24/2019 Lecture 08: Ear Surgery 1.0 10/25/2019 Lecture 09: Surgery of the Head & Neck 1.0 10/25/2019 Lecture 10: Cleft Palate & Oronasal Fistulas 1.0 10/25/2019 Lecture 11: Femur Fractures 1.0 10/25/2019 Lecture 12: Distal Hindlimb Fractures 1.0 10/28/2019 Lecture 13: Esophageal Surgery & Vascular Ring Anomalies 1.0 10/28/2019 Lecture 14: Surgery of the Stomach & Pylorus 1.0 10/28/2019 Lecture 15: Forelimb Fractures (Scapula, Humerus) 1.0 10/28/2019 Lecture 16: Distal Forelimb Fractures (Radius, Ulna & Manus) 1.0 10/30/2019 Lecture 17: Mandible & Maxillary Fractures 1.0 10/30/2019 Lecture 18: Management of Polytrauma & Open Fractures 1.0 10/30/2019 Lecture 19: Fracture Complications – Discussion 1.0 10/30/2019 Lecture 20: Fracture Complications – Discussion 1.0 11/1/2019 Lecture 21: Examination of the Orthopedic Patient 1.0 11/1/2019 Lecture 22: Gastric Dilatation Volvulus 1.0 11/1/2019 Lecture 23: Intestinal Surgery 1.0 11/1/2019 Lecture 24: Intestinal Surgery 1.0 11/4/2019 Lecture 25: Treatment of Degenerative Joint Diseases 1.0 11/4/2019 Lecture 26: Medical Management of Degenerative Joint Disease 1.0 11/4/2019 Lecture 27: Inflammatory Polyarthropathy 1.0 11/4/2019 Mid-Term Exam Review 1.0 11/6/2019 Mid-Term Examination, (Lectures 1 - 27) 1.0

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Contact Date Topic Hours 11/11/2019 VETERAN'S DAY - NO CLASSES 11/12/2019 Lecture 28: Introduction to Rehabilitation 1.0 11/12/2019 Lecture 29: Anal & Perianal Surgery 1.0 11/12/2019 Lecture 30: Limb Deformities 1.0 11/12/2019 Lecture 31: Miscellaneous Developmental Orthopedic Conditions 1.0 11/14/2019 Lecture 32: Diagnosis and Treatment of Patellar Luxations in Dogs & Cats 1.0 11/14/2019 Lecture 33: Portosystemic Shunts: Diagnosis & Management 1.0 11/14/2019 Lecture 34: Surgery of the Spleen 1.0 11/14/2019 Lecture 35: Surgery of the Liver 1.0 11/18/2019 Lecture 36: Surgical Management of Abdominal Trauma 1.0 11/18/2019 Lecture 37: Abdominal (Including Diaphragmatic) Hernias 1.0 11/18/2019 Lecture 38: Canine Hip Dysplasia 1.0 11/18/2019 Lecture 39: Cranial Cruciate Ligament Rupture & Meniscal Injury 1.0 11/20/2019 Lecture 40: Urinary Tract Surgery: Urinary Tract Rupture: Uroperitoneum 1.0 11/20/2019 Lecture 41: Urinary Tract Surgery: Urethrostomy/Cystotomy 1.0 11/20/2019 Lecture 42: Luxations I (Coxofemoral Luxation ) 1.0 11/20/2019 Lecture 43: Luxations II (Hyperextension Injuries & Luxations of the Elbow, 1.0 Shoulder, Stifle, Carpus & Tarsus) 11/22/2019 Lecture 44: Elbow Dysplasia 1.0 11/22/2019 Lecture 45: Reproductive Tract Surgery: Prostate & Pyometra 1.0 11/22/2019 Lecture 46: Upper Airway Surgery in Dogs & Cats 1.0 11/22/2019 Lecture 47: Cranial Cruciate Ligament Rupture, Hip Dysplasia & Luxations 1.0 12/2/2019 Lecture 48: Osteochondrosis in Dogs 1.0 12/2/2019 Lecture 49: Surgery of the Trachea 1.0 12/2/2019 Lecture 50: Thoracic Surgery 1.0 12/2/2019 Lecture 51: Management of Thoracic Trauma & Emergencies 1.0 12/4/2019 Lecture 52: Muscle & Tendon 1.0 12/4/2019 Lecture 53: Cardiothoracic Surgery in Dogs & Cats 1.0 12/4/2019 Lecture 54: Advanced Laparoscopy & Video-assisted Thoracic Surgery 1.0 12/4/2019 Course Evaluations & Review for Final 12/7/2019 Final Examination, (Lectures 28 - 54) 54.0

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Required Textbooks • Small Animal Surgery, 4th ed. TW Fossum. Elsevier, 2013. (or 5th edn, 2019) • Course Notes, SCAVMA (also available online in pdf form for students enrolled in the course)

Recommended Textbooks/Materials • Brinker, Piermattei and Flo's Handbook of Small Animal Orthopedics and Fracture Repair, 5th ed. DeCamo CE. Elsevier, 2016. • Veterinary Surgery; Small Animal, Johnston &, Tobias, 2nd Ed, Elsevier 2018. (or 1st ed, 2011) • Other articles/videos will be available throughout the course notes. (See Learning Modules or SCAVMA Notes).

Methods of Evaluation Grades will be calculated based on the following:

Midterm Exam 81 Final Exam 81 Total 162 points

Grading Scheme Course grades will be assigned based on the following grading scheme. This grading scale is final.

A 100.00 – 94.00 A- 93.99 – 90.00 B+ 89.99 – 87.00 B 86.99 – 84.00 B- 83.99 – 80.00 C+ 79.99 – 77.00 C 76.99 – 74.00 C- 73.99 – 70.00 D+ 69.99 – 67.00 D 66.99 – 64.00 D- 63.99 – 61.00 E 60.99 – 0

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Course Policies • Attendance in all scheduled lectures is expected. • Students are responsible for all material and assignments from all scheduled activities. • Students should expect some examination questions which refer to material covered in lectures that may not appear in the notes. • Students will be expected to complete all supplemental reading assignments. • Please turn cell phones off during class. • Students late to class should enter through the back of the lecture hall.

Attendance in all scheduled lectures is expected. Students are responsible for all material and assignments from all scheduled activities. Instructors have the authority to administer unannounced quizzes, which may be given during the lecture periods. These quizzes will not account for more than 20% of the overall points in the course. Instructors may also, at any time, assess and record individual student attendance; course grades for those students who are absent without legitimate reason may be reduced by a half-letter grade for each instructional period for which an absence occurs. The class notes provided are intended to supplement the lecture presentations. Students should expect some examination questions which directly refer to material covered in lectures that may not appear in the notes. In addition, students will be expected to complete all supplemental reading assignments. Several of the lecture periods deviate from the traditional didactic lecture format. There may be radiographs, computer assignments including web pages or other materials posted to be reviewed prior to lecture.

There are two scheduled examinations for this course. The mid-term examination will cover lectures 1- 27. The final examination will cover lectures 28-54. Each lecture period will be assigned an equal number of points. These examinations may include projected images (radiographs, pictures of animals, intra-operative photos, microscopic images, etc.) as part of some questions.

Lectures and extra files may be placed on the UF E-Learning site at https://elearning.ufl.edu/. Students can access the course E-Learning site using their Gator Link login information. Only students who are registered for the course will have access to the site. Whenever possible, copies of the lecture slides and required reading or viewing can be found at this site. Course communications will be through the Online E-Learning site or by e-mail. The online material may be updated throughout the course, so o it should be checked frequently.

Curriculum Policies DVM curriculum policies are consistently held and reinforced across all DVM courses. Please visit the DVM webpage and review the curriculum policies listed within the student handbook (https://education.vetmed.ufl.edu/dvm-curriculum/student-handbook/).

Students with Accommodations Students who are seeking classroom or testing accommodations must contact the UF Disability Resource Center (http://www.dso.ufl.edu/drc/ 352-392-8565) for an assessment and to obtain a letter of accommodation. The DRC is located on the main UF campus. ASA (Office for Academic and Student

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Affairs) works closely with the DRC to ensure student accommodations are met in the classroom and during exams. Melissa Cox in ASA assists in coordinating exams and meeting recommended disability- related requirements for students with accommodations ([email protected]). This process can also be found on the DVM webpage within the student handbook (https://education.vetmed.ufl.edu/dvm- curriculum/student-handbook/).

Course and Instructor Evaluation Students are expected to provide feedback on the quality of instruction in this course by completing online evaluations at https://evaluations.ufl.edu. Evaluations are typically open during the last two or three weeks of the semester, but students will be given specific times when they are open. Summary results of these assessments are available to students at https://evaluations.ufl.edu/results/.

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Appendix A: Faculty Lecturers

Dr. Judit Bertran, DVM, MS, DACVS Email: [email protected]

Dr. Jose L. Carvajal, DVM Email: [email protected]

Dr. J. Brad Case, DVM, MS, DACVS Email: [email protected]

Dr. Jonathan Coffman, DVM Email: [email protected]

Dr. Christina De Armond, MVB Email: [email protected]

Dr. Cassio Ferrigno Email: [email protected]

Dr. Alex Fox-Alvarez, DVM, MS Email: [email protected]

Dr. Matthew D. Johnson, DVM, MVSc, CCRP, DACVS Email: [email protected]

Dr. Stanley Kim, BVSc, MS, DACVS Email: [email protected]

Dr. Dan Lewis, DVM, DACVS Email: [email protected]

Dr. Dr. Kaitlyn Mullen, DVM Email: [email protected]

Dr. Penny Regier, DVM, MS, DACVS Email: [email protected]

Dr. Valentine Verpaalen, DVM Email: [email protected]

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Appendix B: Other Information

Keywords Abdominal Trauma Intestinal Surgery Anal & Perianal Surgery Limb Deformities Cardiovascular Surgery Luxation Cleft Palette Muscle & Tendon Colorectal Surgery Musculoskeletal Abnormalities Cranial Cruciate Ligament Insufficiency Nasal & Upper Respiratory Surgery Cutaneous Surgery Oronasal Fistulas Degenerative Joint Disease Orthopedics Diaphragmatic Surgery Osteochondrosis DJD Patellar Luxation Elbow Dysplasia Pelvic Fractures Examination of Orthopedic Patient Portosystemic Shunts Femur Fractures Problematic Wounds Forelimb Fractures Reconstructive Surgery Fracture Biomechanics Rehabilitation Therapy Fracture Classification Small Animal Fracture Complications Soft Tissue Gastric & Pyloric Surgery Surgery Gastric Dilatation Volvulus Splenic Surgery GDV Thoracic Surgery Hepatic Surgery Thoracic Trauma Hernias Tracheal Surgery Hind Limb Fractures Veterinary Hip Dysplasia Urogenital Surgery Inflammatory Arthropathy

UF | COLLEGE OF VETERINARY MEDICINE