Equine Surgery

Equip yourself for success with the only book on the market that covers all aspects of equine surgery! Equine Surgery, 5 th Edition prepares you to manage each surgical condition by understanding its pathophysiology and evaluating alternative surgical approaches. Explanations in the book describe how to avoid surgical infections, select and use instruments, and perfect fundamental surgical techniques including incisions, cautery, retractions, irrigation, surgical suction, wound closure, dressings, bandages, and casts. In addition to diagnostic imaging and orthopedic coverage, it includes in-depth information on anesthesia, the integumentary system (including wound management, reconstructive surgery, and skin grafting), the alimentary system, respiratory, and urogenital systems. Complete coverage of all the information needed to study for the American and European College of Veterinary Surgeons Board Examinations makes this edition an excellent study tool. Section on anesthesiology and pain management prepares you to manage these critical aspects of any surgery. Extensive, up-to-date orthopedic coverage includes joint disorders and joint trauma. Section on integumentary system contains information on wound management, reconstructive surgery, and skin grafting. Section on the alimentary system covers postoperative care, complications and reoperation guidelines. New techniques in vascular surgery keep you up-to-date with best practices. NEW! Expert Consult site offering 40+ videos of surgeons performing techniques so that you can quickly access drug and equipment information. NEW! Expansion of minimally invasive surgical techniques includes laser ablation procedures, implantation of plates against bones in orthopedic procedures, and laparoscopic procedures for soft tissue injuries. NEW! World-renowned contributors, featuring two new associate editors include over 70 of the most experienced and expert equine specialist surgeons, each providing current and accurate information. NEW! Current advances in imaging detect musculoskeletal conditions in the sports horse. Cover Equine Surgery Copyright Page Dedication Contributors Preface Organization Key Features of the Fifth Edition New Features Book Cover Acknowledgments Contents Video Contents I Surgical Biology 1 Shock Definition of Shock Classification of Shock Pathophysiology of Shock Clinical Signs of Shock Treatment Fluid Administration Types of Fluids Isotonic Crystalloids Hypertonic Crystalloids Colloids Whole Blood Current Recommendations Vasopressors Monitoring Capillary Refill Time Central Venous Pressure Urine Output Arterial Blood Pressure Lactate Oxygen Extraction Mixed Venous Partial Pressure of Oxygen Cardiac Output Regional Perfusion Hypotensive Resuscitation and Delayed Resuscitation Predicting Outcome On the Horizon Treatment Monitoring Physiologic Response to Trauma Mediators of the Stress Response: Ebb Phase Response to Trauma: Catabolic Period Response to Trauma: Anabolic Period References 2 Systemic Inflammatory Response Systemic Inflammatory Response Syndrome Pathophysiology of SIRS Cytokines Lipid-Derived Mediators Platelet-Activating Factor Acute Phase Proteins Reactive Oxygen Species Vasoactive Mediators Diagnosis of SIRS Treatment of SIRS and Prognosis Multiple Organ Dysfunction Syndrome (MODS) Pathophysiology of MODS Diagnostic Criteria for MODS Respiratory Criteria Hemostasis Criteria Gastrointestinal Criteria Renal Criteria Hepatic Criteria Cardiovascular Criteria Musculoskeletal Criteria Neurologic Criteria Treatment of MODS and Prognosis Common Causes of SIRS and MODS in Horses Sepsis Diagnosis of Sepsis Treatment of Sepsis Endotoxemia Pathophysiology of Endotoxemia Clinical Findings and Diagnostic Approach Clinical Management References 3 Fluids, Electrolytes, and Acid-Base Therapy Fluid and Electrolyte Balance Distribution of Fluids Acid-Base and Electrolyte Balance Acid-Base Terminology Assessing the Acid-Base and Electrolyte Status Henderson-Hasselbalch (Traditional Approach) Primary Acid-Base Abnormalities Metabolic Alkalosis and Acidosis Respiratory Acidosis and Alkalosis Mixed Acid-Base Disorders Quantitative Strong Ion Approach Strong Ions Total Mass of Nonvolatile Weak Acids (Atot) Measurement and Interpretation of Blood Gases Interpretation—Traditional Approach Interpretation—Quantitative Strong Ion Approach (Table 3-5) Unmeasured Anions Anion Gap Strong Ion Gap Lactate Designing a Fluid Therapy Regimen Volumes of Fluid to Administer Maintenance Dehydration Ongoing Losses Fluid Overload Type of Fluid Isotonic Crystalloids Sodium Bicarbonate Solutions (NaHCO3) Dextrose-Containing Solutions Hypertonic Crystalloids (7.2% NaCl) Colloids Rate and Route of Administration Intravenous Fluids Oral Fluids Materials for Fluid Therapy Intravenous Catheters Sites for Intravenous Catheterization in Horses Catheter Maintenance Coil Sets and Administration Sets Pump Delivery Oral Feeding Tubes References 4 Hemostasis, Surgical Bleeding, and Transfusion Physiology of Hemostasis Blood Vessels and the Role of the Vascular Endothelium Platelets and Primary Hemostasis Secondary Hemostasis and Models of Coagulation Coagulation Cascade Cell-Based Model Initiation Amplification Propagation Fibrinolysis Inhibitors of Coagulation and Fibrinolysis Inhibitors of Coagulation Inhibitors of Fibrinolysis Coagulation Testing Tests of Primary Hemostasis Prothrombin Time (Quick Test) Activated Partial Thromboplastin Time Activated Clotting Time Anticoagulant Testing Fibrin(ogen) Degradation Products Fibrinogen D-Dimer Viscoelastic Monitoring Hemostatic Dysfunction Inherited Conditions Acquired Conditions Inflammation and Coagulation Disseminated Intravascular Coagulation (DIC) Treatment of DIC Surgical Bleeding Indications for Whole Blood Transfusion Packed Red Blood Cells Plasma Blood Donation and Transfusion Donor Selection and Management Blood Typing and Crossmatching Blood Collection and Administration Collection Technique Alternatives to Allogeneic Blood Transfusion Systemic Adjunctive Treatments Topical Hemostatic Agents Mechanical Hemostatic Agents Purified Gelatin Sponge Oxidized Regenerated Cellulose Microfibrillar Collagen Hemostatic Agents Polysaccharide Hemostatic Agents Bone Wax Adhesives and Sealants Thrombin Products Fibrin-Based Sealants Tissue Adhesives References 5 Wound Healing Classification of Wounds Phases of Wound Healing Inflammatory Phase Tissue Formation Phase Angiogenesis and Vasculogenesis Fibroplasia and Granulation Tissue Formation Epithelialization Contraction Remodeling and Maturation Phase Wound-Healing Differences in the Horse Ponies Heal Faster Distal Limb Wounds Wound Expansion Effect of Motion Exposed Bone Infection Development of Exuberant Granulation Tissue Prolonged Inflammatory Phase Tissue Hypoxia Bandaging Management of Granulation Tissue General Factors That Influence Wound Healing Age Nutritional Status Type of Injury Tissue Perfusion Hemostasis and Hematoma Formation Débridement Wound Closure Technique Topical Therapy Stem Cells Pharmaceuticals Local Anesthetics Antiinflammatory Drugs Malignancy Summary References 6 Metabolism and Nutritional Support of the Surgical Patient Indications for Nutritional Support Pure Protein/Calorie Malnutrition Metabolic Response to Injury Metabolic Requirements Adults Increased Energy Demand Foals and Weanlings Protein Requirements Vitamin Requirements Assessment of Nutritional Support Enteral Nutrition Parenteral Nutrition References 7 Surgical Site Infection and the Use of Antimicrobials Introduction Surgical Site Infection Classification Risk Factors for Surgical Site Infection Infection and Sources of Microorganisms Endogenous Sources Exogenous Sources Microbe-Related Risk Factors Host-Related Risk Factors Systemic Risk Factors Age Concomitant Infection Gender Obesity Nutritional Status Immune Function Hypothermia Local Risk Factors Surgical Trauma Hypoxia Skin Conditions/Skin Penetration Foreign Material and Prosthetic Implants Surgical Risk Factors Surgical Procedure Patient and Surgeon Preparation Surgical Attire Surgical Technique and Duration of Surgery Suture Materials and Surgical Implants Topical Antimicrobial Therapy Bandages and Drains Nosocomial Infection Prevention and Management of Surgical Site Infection Diagnosis Clinical Signs Clinical Pathology Microbiology Imaging Techniques Pathogenic Bacteria Associated With Equine Surgical Site Infection Treatment of Surgical Site Infection Antimicrobial Prophylaxis Against Surgical Site Infection Antibiotic Classification Prophylactic Antibiotic Use Selection of Prophylactic Antimicrobials Timing and Duration of Antibiotic Administration Postantibiotic Effect Prophylactic Antibiotics Used in Horses β-Lactam antibiotics Aminoglycoside antibiotics Trimethoprim sulphonamides Special Routes of Administration and Dosages Antibiotic-Impregnated Polymethyl Methacrylate (AIPMMA) or Plaster of Paris (AIPOP) Other Regional Limb Perfusion Toxic Side Effects of Antibiotics Emergence of Bacterial Resistance to Antibiotics Summary of Antibiotic Prophylaxis References 8 Regenerative Medicine Introduction Platelet-Rich Plasma Biology of Platelet-Rich Plasma Generation of Platelet-Rich Plasma and the Platelet-Rich Plasma Classification System Composition of the Optimal Platelet-Rich Plasma Product Platelet-Rich Plasma in Horses for the Treatment of Tendon and Ligament Injuries Platelet-Rich Plasma in Horses for the Treatment of Osteoarthritis Autologous Conditioned Serum Autologous Protein Solution Stem Cells Stem Cell Biology Immunomodulation Versus Immunogenicity MSC Isolation From Horses MSCs in Horses for the Treatment of Tendon and Ligament Injuries MSCs in Horses for the Treatment of Cartilage Damage and Osteoarthritis Further Considerations and Future Directions References II Surgical Methods 9 Instrument Preparation, Antisepsis, and Disinfection Processing of Textiles Processing of Instruments and Devices Definitions of and Approaches to Disinfection and Sterilization The Cleaning and Sterilization Facility Cleaning Process Automated Processes Maintenance and Identification of Instruments Packaging Storage and Shelf Life Process Monitoring Cleaning Process Indicators Sterilization Indicator Systems Physical Sterilization Thermal Energy Filtration Radiation Chemical Sterilization Gas Sterilization Ethylene Oxide Hydrogen Peroxide Gas Plasma Liquid Chemical Sterilization Disinfectants Aldehydes Glutaraldehyde (GH) Ortho-phthalaldehyde Succindialdehyde Formaldehyde Peracetic Acid Hydrogen Peroxide (H2O2) Vaporized Hydrogen Peroxide (VHP) Electrolyzed Acid Water (EAW) Chlorine and Chlorine Compounds Miscellaneous Antiseptics Alcohols Chlorhexidine (CHX) Iodine Compounds Octenidine Phenols Quaternary Ammonium Compounds Polyhexamethylene Biguanide (PHMB) Choosing and Using Antiseptics Microbial Resistance to Disinfectants and Antiseptics References 10 Preparation for Surgery Decision Making/Operative Risk Primary Disease General Health Assessment Prediction Systems Reducing the Operative Risk Training Checklist Duration of the Procedure Personal Relationships Informed Consent Professional Relationship Preoperative Evaluation of the Patient History Physical Examination Supplemental Testing Physiologic Preparation Preparation for the Surgical Procedure Measures and Compliance Surgical Facility General Drains Induction and Recovery Rooms Patient Preparation Room Scrub Room Standing Surgery Instrument and Equipment Storage and Cleaning Temperature and Airflow Lighting Human Traffic Biosecurity Maintenance of the Facility Operating Team Scrub Attire Masks and Caps Head Cover Face Masks Gowns Gown-Donning Procedure Gown Removal Gloves Punctures Glove-Contamination Risk Gloving Techniques Foot Covers Jewelry and Nails Mobile Devices Surgeon’s Skin Current Recommendations and Procedures Staffing the Surgery Area Surgical Patient General Patient Preparation Positioning Standing Surgery Surgical Site Preparation Hair Removal Skin Preparation General Considerations Time and Method Choice of Antiseptic Attention Points Draping the Surgical Field Rationale for Draping Types of Draping Disposable Versus Nondisposable Drapes Plastic Drapes and Incise Films Drape Application Standing Surgery Finalizing the Surgical Procedure Debriefing Surgical Report Writing References 11 Surgical Instruments Materials Instruments for General Surgery Scalpels Steel Scalpels Disposable Scalpels Scissors Needle Holders Forceps and Clamps Thumb Forceps Hemostatic Forceps Tissue Forceps Clamps Towel Clamps Retractors Finger-Held Retractors Hand-Held Retractors Self-Retaining Retractors Suction Tubes Orthopedic Instruments Rongeurs Curettes Periosteal Elevators Bone-Cutting Instruments Bone Clamps Cerclage Wire Instruments Pin Insertion and Pin-Cutting Instruments Trephines Specific Equine Surgical Instruments Energy-Based Surgical Tools Identification References 12 Surgical Techniques Introduction Technique Training and Outcome Surgical Etiquette and Communication Improving Aseptic Technique Basic Manipulations of Surgical Instruments Scalpels Steel Scalpel Electro Scalpel Scissors Needle Holders Forceps Thumb Forceps Hemostat Forceps Tissue Forceps Tissue Incision and Excision Slide Cutting Stab or Press-Cutting Incision Scissor Incision Electro-Incision Tissue Excision Blunt Dissection Surgical Hemostasis Mechanical Hemostasis Pressure Ligatures Staples Surgical Repair Esmarch System Thermal Hemostasis Chemical Hemostasis Physical Hemostasis Tissue Retraction and Handling Tissue Handling Retraction Surgical Irrigation and Suction Surgical Irrigation Suction Curettage References 13 Minimally Invasive Surgical Techniques Introduction Procedures With Rigid Endoscopes Basic Equipment The Endoscopy Tower Light Source Video Camera Fluid Irrigation System Gas Insufflation System Basic Techniques The Principle of Triangulation Arthroscopy, Tenoscopy, and Bursoscopy Instrumentation Arthroscope and Arthroscopic Sleeve Hand Instruments Motorized Equipment Electrosurgery Basic Techniques for Arthroscopy, Tenoscopy, and Bursoscopy Arthroscopy Tenoscopy Laparoscopy and Thoracoscopy Instrumentation for Laparoscopic and Thoracoscopic Surgery Laparoscope Access Instruments Laparoscopic and Thoracoscopic Instruments Coagulation and Dissection Intracorporeal and Extracorporeal Knot Tying and Suturing Stapling Devices Tissue-Retrieval Devices Basic Technique for Laparoscopy and Thoracoscopy Standing Versus Recumbent Laparoscopic and Thoracoscopic Surgery Access Techniques in Laparoscopic and Thoracoscopic Surgery Procedures With Flexible Endoscopes Anatomical Structure of the Flexible Endoscope Basic Technique for Transvaginal NOTES in Mares Vertebral Canal Endoscopy Cardiovascular Minimally Invasive Procedures Embolization Surgical Technique Thrombectomy Surgical Technique Minimally Invasive Fracture Repair Imaging Control During Minimally Invasive Percutaneous Osteosynthesis Basic Principles of Screw and Plate Insertion Computer-Assisted Surgery Technical Equipment CT-Guided Osteosynthesis References 14 Cryosurgery Principles of Cryobiology Indications for Cryosurgery Cryogens and Cryosurgical Instrumentation Sprays Probes Cryosurgical Technique Normal Biological Reactions and Complications Future Directions References 15 Lasers in Veterinary Surgery Principles of Surgical Lasers Calculating and Controlling Laser Energy Laser–Tissue Interaction Delivery of Laser Energy Continuous and Pulsed Wave Mode Contact and Noncontact Mode Antimicrobial and Antiinflammatory Therapy in Laser Surgical Procedures Laser Safety Lasers Used in Veterinary Surgery Carbon Dioxide Laser Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) Laser and Gallium-Aluminum-Arsenide (GAL) Diode Laser Holmium:Yttrium-Aluminum-Garnet (Ho:YAG) Laser Pulsed Dye Laser Specific Laser Surgery Procedures Carbon Dioxide Laser Surgery Removal of Cutaneous Masses Removal of Ocular Masses Palmar Digital Neurectomy Ablation of the Cricoarytenoid Joint Endoscopic Surgery Palatoplasty Ventriculocordectomy Arytenoid Chondropathy Epiglottic Entrapment Subepiglottic Cysts Guttural Pouch Tympany Progressive Ethmoid Hematoma Endometrial Cysts Lithotripsy Distal Tarsal Joint Osteoarthritis Other Laser Procedures References 16 Suture Materials and Patterns Suture Classification Suture Characteristics Suture Size Flexibility Elasticity Surface Characteristics and Coating Capillarity Memory Tensile Strength Knot-Holding Capacity Relative Knot Security Loop Security Selection of Suture Materials Selection of the Biomechanically Appropriate Suture Size and Material Surgical Needles Suture Configurations Knots and Ligatures Knot-Tying Techniques Knot Efficiency Suture Tension Loop Sutures Knot-Tying Techniques for Minimally Invasive Surgery Knotless Suture Materials Suture Patterns Sutures for Specific Tissues Skin Subcutis Fascia Infected or Contaminated Wounds Muscle Gastrointestinal Tract Urinary Tract Tendon Blood Vessels Nerves Implant Prostheses Antimicrobial-Coated Suture Material Suture Anchors and Suture Buttons Surgical Staplers Stapling Devices Thoracoabdominal Stapler Gastrointestinal Staplers Ligating Dividing Stapler Ligating Clips Skin Staples Topical Tissue Adhesives 2-Octylcyanoacrylate Fibrin Glues Tapes: Steri-Strips References 17 Drains, Bandages, and External Coaptation Drains History Purposes Materials Types of Drains Principles of Drain Placement Passive Drains Gauze Drains Penrose Drains Sheet Drains Tube Drains Active Drains Closed Active Drains Open Active Drains Drain Management Drain Removal Drain Complications Drainage of Body Spaces Abdomen Thorax Synovial Cavities Bandages General Comments Foot Bandage Half-Limb Bandage Full-Limb Bandage Forelimb Hind Limb Carpal/Tarsal Bandages Robert Jones Bandage Splints and Special Bandages General Comments Boots Stent Bandage Abdominal Bandage External Coaptation (Casts) Materials Indications Technique Cast Application in the Standing Horse Cast Monitoring Cast Removal Cast Variations Cast Complications References III Recent Advances in Anesthesia 18 Balanced Inhalation Anesthesia Introduction Anesthetic Risk Modern Inhalation Anesthetic Drugs and Techniques Used for Balanced Anesthesia Modern Inhalation Anesthetics Lidocaine Alpha2-Adrenoreceptor Agonists Ketamine Opioids Centrally Acting Muscle Relaxants Guaifenesin Benzodiazepines Regional Anesthesia Techniques References 19 Modern Injectable Anesthesia for Adult Horses Short-Duration Injectable Anesthesia Ketamine and Ketamine Drug Combinations S(+)-Ketamine Tiletamine Propofol Alfaxalone Long-Duration Total Intravenous Anesthesia (TIVA) Ketamine–Guaifenesin–α2-Adrenoceptor Agonist (Triple-Drip) Ketamine–Midazolam–α2-Adrenoceptor Agonist Propofol Alfaxalone References 20 Anesthesia and Analgesia for Foals Introduction Physiological and Pharmacological Considerations as They Relate to Anesthesia in the Neonatal and Maturing Foal Cardiovascular System Transition From Fetal to Neonatal Circulation Hemodynamic Function Respiratory System Nervous System Development Early Postnatal Behaviors Body Metabolism, Biotransformation, and Excretion Body Water Content and Body Tissue Composition Thermoregulation Hepatic Function and Development Renal Function and Development Hematology and Biochemistry Anesthetic Management of the Systemically Healthy Neonate and Maturing Foal Preanesthetic Examination and Preparation Sedation of the Mare Anesthetic Management of the Neonate (≤1 Month Old) Sedation Induction and Maintenance of Anesthesia Anesthetic Management of the Pediatric/Juvenile Foal (1 to 4 Months Old) Sedation Induction and Maintenance of Anesthesia Monitoring During Anesthesia Anesthetic Depth and Drug Concentration Cardiovascular System Respiratory System Blood Glucose Body Temperature Fluid Management in the Perianesthetic Period Oxygen Supplementation and Mechanical Ventilation Recovery Perioperative Pain Management Perianesthetic Complications Requiring Intervention Impaired Cardiovascular Function Impaired Respiratory Function Hypothermia Return to Fetal Circulation Cardiac Arrest and Cardiopulmonary Resuscitation Anesthetic Considerations for the Critically Ill Neonate and Maturing Foal Foal With Uroperitoneum Foals Affected by Acute Intestinal Disease Foal With Thoracic Trauma References 21 Recovery From Anesthesia Management of Horses During Recovery Introduction General Considerations Maintenance of Breathing During Recovery Cardiovascular Considerations During Recovery Factors Influencing Recovery Inhalation Anesthetics Sedation, Analgesia Recovery Systems and Aids Recovery Stall Design and Construction Thick Mattresses Rope-Assisted Recovery Pool Recovery Sling Recovery Problems Encountered During Recovery Reluctance or Inability to Stand Myopathies Neuropathies Miscellaneous Problems References 22 Complications of Inhalation Anesthesia and Their Management Physiological Considerations Body Temperature Hypothermia Hyperthermia Cardiovascular System Heart Rate Blood Pressure Respiratory System Oxygenation Ventilation Electrolyte Imbalances Additional Considerations Behavioral Complications Upper Airway Management Myopathy and Neuropathy Gastrointestinal Considerations Alterations in Blood Glucose Urine Output Summary References 23 Chemical Restraint for Standing Procedures General Principles of Drug Administration Drug Selection Drugs Available for Chemical Restraint α2-Adrenoreceptor Agonists Mechanism of Action Leading to Sedation and Analgesia Uses Administration, Doses, Routes Other Effects and Side Effects Special Considerations and Contraindications Foals Combinations With Other Drugs Uses as a Constant-Rate Infusion Antagonists Phenothiazines Mechanism of Action Uses Administration, Dosages, Routes Other Effects and Side Effects Special Considerations and Contraindications Foals Combinations With Other Drugs Antagonists Butyrophenones Benzodiazepines Mechanism of Action Uses Administration and Routes Other Effects and Side Effects Foals Antagonists Opioids Mechanism of Action Uses Other Effects and Side Effects Anesthetic Adjuvants Long-Term Tranquilization Conclusion References 24 Equine Pain Management Physiologic Consequences of Pain Acute Pain Peripheral Sensitization Central Sensitization Chronic Pain Pain Assessment Analgesia Protocols Nonsteroidal Antiinflammatory Drugs Opioids α2-Adrenoceptor Agonists Local Anesthetics Lidocaine Infusions Drugs for the Treatment of Central Sensitization Intraarticular Analgesia Epidural Analgesia Drugs Used Complementary Therapy Extracorporeal Shock Wave Therapy Therapeutic Ultrasound Summary References IV Integumentary System 25 Principles of Plastic and Reconstructive Surgery Introduction Cutaneous Blood Supply Physical and Biomechanical Properties of Skin Lines of Skin Tension Skin Extensibility Creep and Stress Relaxation Principles of Wound Closure Incision Orientation Sutures and Patterns Basic Patterns Subcuticular and Intradermal Sutures Simple Interrupted Sutures Simple Continuous Sutures Corner Suture Tension-Relieving Patterns Mattress Sutures Far-Near-Near-Far Suture Walking Suture Support for Suture Lines Tension-Relieving and Skin-Mobilization Procedures Undermining Skin Tissue Debulking Tension-Release Incisions Mesh Expansion V-to-Y-Plasty and Y-to-V-Plasty Z-Plasty W-Plasty Skin-Stretching and Expansion Techniques Presuturing Intraoperative Tissue Expansion External Skin-Stretching Devices Tissue Expanders Cosmetic Closure of Skin Defects of Various Shapes Fusiform Defects Triangular, Square, and Rectangular Defects V-Shaped Defects Circular Defects Management of Skin Puckers (Dog-Ears) Skin Flaps Advancement Flaps Rotating Flaps Vascularized Free Tissue Transfers References 26 Skin Grafting Indications for Grafting Graft Classification Physiology of Graft Acceptance Recipient Bed Characteristics Adherence Serum Imbibition (Plasmatic Imbibition or Plasmatic Circulation) Revascularization Organization (Organic Union) Graft Contraction Graft Failure Fluid Accumulation Infection Inflammation Motion Grafting Techniques Preparation of the Recipient Site Preparation of the Donor Site Full-Thickness Sheet Grafting Split-Thickness Sheet Grafting Hand Instruments Drum Dermatomes Power-Driven Dermatomes Technique of Harvesting a Split-Thickness Sheet Graft Meshing Split-Thickness Sheet Grafts Applying Split-Thickness Sheet Grafts Acceptance and Cosmesis Island Grafts Punch Grafts Pinch Grafts Tunnel Grafts Modified Meek Grafting Technique Aftercare of the Donor Site Aftercare of the Recipient Site Allografts and Xenografts Storage of Grafts References 27 Management of Superficial Wounds, Deep and Chronic Wounds, Sinus Tracts, and Fistulas Anatomy First Aid Assessment Initial Management Restraint and Analgesia Initial Preparation Débridement Sharp Débridement Mechanical Débridement Chemical and Enzymatic Débridement Biological Débridement Autolytic Débridement Options for Wound Closure Stages of Wound Healing Wound Classification Bacteria in Wounds Bacteriologic Assessment Technical Considerations in Contaminated Wound Closure Wound-Closure Techniques Primary Closure Delayed Primary Closure Second-Intention Healing Dressings, Growth Factors, and Drugs Hypertonic Saline Dressing Honey Antimicrobial Dressings Hydrogels Calcium Alginate Dressings Topical Dressings Biological Dressings Stem Cells Growth Factors Semiocclusive Foam Dressings Silicone Dressings Negative-Pressure Wound Therapy Extracorporeal Shock Wave Therapy Corticosteroids Nonsteroidal Antiinflammatory Agents Tetanus Prophylaxis Specific Wound Considerations Deep Wounds Head and Neck Thorax Abdomen Extremities Axillary Lacerations Lacerations Involving Synovial Structures Heel Bulb Lacerations Chronic Wounds Management of Sinus Tracts and Fistulas Etiology Diagnosis Exploration Special Considerations Complications References 28 Skin Conditions Amenable to Surgery Sarcoids Epidemiology Treatment Surgical Excision Laser Ablation Ultrasonic Coagulation Cryotherapy Hyperthermia Radiotherapy Immunotherapy Intralesional Cisplatin Topical Application of Chemotherapeutics Imiquimod Aciclovir Other Agents Electrochemotherapy Squamous Cell Carcinoma Epidemiology Treatment Surgical Excision Irradiation Intralesional Chemotherapy Topical Chemotherapy Other Treatments Photodynamic Therapy Summary Melanoma Epidemiology Treatment Mast Cell Tumors Epidemiology Treatment Lipomas Epidemiology Treatment Cutaneous Habronemiasis Epidemiology Treatment Pythiosis Epidemiology Treatment Nodular Necrobiosis Epidemiology Treatment Papillomatosis Epidemiology Juvenile Papillomatosis Aural Plaques Treatment Dentigerous Cysts Etiology Treatment References V Alimentary System 29 Oral Cavity and Salivary Glands Dentistry Dental Anatomy Examination of the Oral Cavity and Teeth Disorders of the Incisors Overjet and Overbite (“Parrot Mouth”) Clinical Signs Treatment Underbite (“Sow Mouth”) Retained Deciduous Incisors Supernumerary Incisors Fractures of the Incisors Abnormalities of Incisor Wear Equine Odontoclastic Tooth Resorption and Hypercementosis Disorders of the Canine Teeth (Triadan 04s) Disorders of “Wolf Teeth” (Triadan 05s) Disorders of the Cheek Teeth Developmental Disorders of the Cheek Teeth Retained Deciduous Cheek Teeth Diastemata Clinical signs and diagnosis Treatment Rostral Positioning of the Maxillary Cheek Teeth Rows Displacements of the Cheek Teeth Supernumerary Cheek Teeth Acquired Disorders of the Cheek Teeth Acquired Overgrowths of Cheek Teeth Traumatic Disorders of the Cheek Teeth and Bars of the Mouth Idiopathic Fractures of the Cheek Teeth Restoration of Carious Infundibula Dental (Odontogenic) Tumors Cheek Teeth Periapical Infection Treatment of Disorders of the Cheek Teeth Extraction of Cheek Teeth Oral Extraction of Cheek Teeth Repulsion Removal of the Lateral Alveolar Plate (Lateral Buccotomy Technique) Minimally Invasive Transbuccal Technique Endodontic Therapy Retrograde Endodontic Therapy Orthograde endodontics Oral Cavity Soft Tissue Trauma Tongue Anatomy Trauma Lips Cheek and Gums Oral Cavity Foreign Bodies Persistent Lingual Frenulum Oral Cavity Soft Tissue Neoplasia Salivary Glands Anatomy Disorders Trauma Sialoliths Atresia of the Parotid Salivary Duct Salivary Mucocele and Ranula Heterotopic Salivary Tissue Idiopathic Parotiditis (“Grass Glands”) Neoplasia References 30 Esophagus Surgical Anatomy Clinical Manifestations and Evaluation of Esophageal Disease Clinical Signs Physical Examination Diagnostic Imaging Endoscopic Evaluation Manometric Evaluation Surgical Approaches Ventral Approach Ventrolateral Approach Approach to the Thoracic Esophagus Management of Esophageal Disorders Impaction Foreign Body Esophagotomy Ulceration and Esophagitis Rupture, Perforations, and Lacerations Esophagostomy Stricture Esophagomyotomy Partial Resection Resection and Anastomosis Patch Grafting Fistula Diverticulum Intramural Cyst Megaesophagus Reduplication Neoplasia Complications of Esophageal Surgery Dehiscence and Stricture Acid-Base and Electrolyte Alterations Laryngeal Hemiplegia Carotid Artery Rupture References 31 Stomach and Duodenum Anatomy Physiology Gastric Barrier Function Pathophysiology Mechanisms of Gastric Ulceration Gastroduodenal Reparative Mechanisms Diagnostic Techniques Endoscopy Ultrasonography Radiography Measurement of Gastric Emptying Disorders of the Stomach and Duodenum Gastroduodenal Ulcers Gastric Impaction Chronic Gastric Impaction and Dilation Gastric Rupture Gastric Neoplasia Gastric Outflow Obstruction Duodenitis-Proximal Jejunitis Duodenal Obstruction References 32 Spleen and Liver Spleen Anatomy Physiology Diagnostic Procedures Indications for Surgery Splenomegaly Neoplasia Splenic Infarction and Splenic Abscesses Splenic Rupture Preoperative Considerations Surgical Techniques Splenectomy Approaches 17th rib resection technique Surgical Procedure Laparoscopy-assisted open technique Laparoscopic hand-assisted splenectomy Splenorrhaphy and Partial Splenectomy Aftercare Complications Closure of the Nephrosplenic Space Liver Anatomy Physiology Diagnostic Procedures Indications for Surgery Biopsy Surgical Technique Aftercare Complications Bile Duct Obstruction Indications for Surgery Surgical Technique Aftercare Complications Closure of the Epiploic Foramen References 33 Colic Diagnosis History and Signalment Physical Examination Palpation of the Abdomen per rectum Nasogastric Intubation Clinical Pathology Abdominocentesis Ultrasonography Radiography Ancillary Diagnostic Aids Endoscopy Laparoscopy Decision for Surgery Preoperative Management Surgical Approaches to the Abdomen References 34 Principles of Intestinal Injury and Determination of Intestinal Viability Introduction Types of Obstruction Simple Obstruction Strangulating Obstruction Nonstrangulating Infarction Mechanisms of Injury Luminal Distention Mucosal Ischemic Injury Reperfusion Injury Determination of Intestinal Viability Clinical Assessment of Bowel Viability Ancillary Methods of Determining Intestinal Viability Fluorescein Dye Surface Oximetry Doppler Ultrasonography Intraluminal Pressure Histopathology Dark-Field Microscopy References 35 Jejunum and Ileum Anatomy Digestive Anatomy Physiology Intraluminal Digestion Absorption of Ions and Water Carbohydrate Absorption Protein Absorption Fat Absorption Absorption of Iron, Calcium, and Magnesium Intestinal Secretion Motility Control of Motility Motility of the Ileum Altered Motility Surgical Diseases of the Jejunum and Ileum Nonstrangulating Obstruction Ileal Impaction Muscular Hypertrophy of the Ileum Ascarid Impactions Duodenitis–Proximal Jejunitis Neoplasia Intestinal Inflammation and Fibrosis Eosinophilic Gastrointestinal Diseases Grass Sickness Miscellaneous Nonstrangulating Lesions Strangulating Obstruction Pedunculated Lipoma Entrapment in the Epiploic Foramen Volvulus Inguinal Hernia Surgery: Congenital Hernias Surgery: Acquired Hernias Intussusception Surgery: Ileocecal and Ileoileal Intussusceptions Surgery: Jejunojejunal Intussuscepti