Schedule 3 Procedures

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Common occurrence

Concave side of pinna

Pressure is very painful

Common causes: self-inflicted trauma, head shaking, scratching, rubbing ear against objects

External causes: poor ear conformations, immune mediated, food allergies, hypersensitivities, ear mites

The underlying cause must be treated, otherwise haematoma will return after surgery!

Discuss costs with owner preoperatively - if underlying causes is dermatological some of treatments could be expensive

Draining technique:

Draining haematoma with a needle & syringe +/- instilling steroid

Rarely tolerated or curative

Usually fills with blood again

If left untreated - it will eventually resolve itself but it is painful due to fibrous contracture of tissues causing permanent damage and pinna deformity

Surgical technique:

1. Anaesthetise patient

2. Clip hair and surgically prepare skin

3. Make a longitudinal, s-shaped incision

4. Removed blood and fibrin clot

5. Curette cavity

6. Flush with sterile saline

7. Use 2.0/3.0/4.0 nylon/polypropylene suture material and swaged on straight cutting needle

8. Place horizontal mattress sutures, including all layers of pinna, in 2-5 rows parallel to incision

9. Tie sutures to convex side of pinna

Complications:

Delay in treatment or sutures placed too tight - irreversible cosmetic alterations to the pinna

Recurrence of haematoma is high (adjacent to original) - inadequate suture numbers or underlying cause of ear disease not treated

Consequences of poor technique - avoid 3 main branches of auricular artery & avoid placing sutures perpendicular to wound

WORST CASE SCENARIO: OCCLUSION RESULTS IN DIMINISED BLOOD SUPPLY --> PINNA NECROSIS

Suture less technique:

1. Clip and surgically prepare skin

2. Make elliptical incision in skin, curette and lavage with sterile saline

3. Tape either side of wound and reflect the pinna over some padding on top of head - similar to ear bandage

4. Put absorbent dressing (Alleyvn) over top of incision - change as necc depending on exudate. But keep in place for 3 weeks

5. Pinna completely immobilised, allowing drainage and healing by 2nd intention. By not using sutures, the pinna is kept flat which prevents thickening, wrinkling during healing. But only if animal does not interfere with it!

Fine Needle Aspirate Body:

1st step if fluid filled mass suspected

Valuable diagnosis for mast cell tumours

Performed without sedation/GA

1. Clip and scrub skin over mass - to make more visible and avoid introduction of bacteria

2. Immobilise mass with one hand whilst operating needle/syringe with other

3. Insert needle into mass

4. Create negative pressure by pulling syringe plunger back to 5-10mls

5. Whilst maintaining negative pressure, redirect needle about 2-5 times within mass

6. Release plunger and remove needle from mass

7. If blood is drawn, remove needle and change equipment

8. Detach syringe and fill with air

9. Reattach to needle and depress plunger to expel contents onto one or more slides

10. Deposit sample close to one end of slide

11. Place clean slide on top of sample and pull them away from each other

Core needle biopsy:

To obtain a cylinder of tissue from a solid mass

LA or sedation required

Trucut biopsy needle

Incisional biopsy:

To surgically remove a slice of tissue

It helps to include a margin of normal tissue to compare pathology results too

Risk of transferring potential tumour cells

Excision of a subcut mass (eg. lipoma):

1. Use a scapel and incise skin over mass

2. Use blunt and sharp dissection scissors to separate mass from surrounding tissues

3. Hold tissue to be excised with rat-tooth or tissue forceps

4. S/c tissue is abundant in most sites so excise some without too much concern

5. Deal with haemorrhage as appropriate. Attempt to identify these and clamp before cutting

6. Close dead space with an absorbable suture in a continuous pattern with rat-toothed forceps and needle holders

7. Close the skin - non-absorbable, simple, interrupted skin suture

Excision of masses involving the skin:

1. Make an elliptical insicion around mass

2. Include a border of at least 1.5cm of normal tissue

3. Use blunt and sharp dissection scissors to separate mass from surrounding tissue

4. Deal with haemorrhage

5. Close dead space and skin

Skin incision:

Greatly affects end result of procedure

Skin should only be cut with a scapel, crushing effect of scissors will impair wound healing

Striaghts incisions will close neatly

Elliptical incisions should have sides of equal length to facilitate neat closure

Subcutaneous dissection:

Handle abnormal tissue as little as poss and avoid cutting it - reduce risk of spreading disease into remaining tissue

Cutting causes less trauma to remaining tissues, but blunt dissection allows mass to be isolated more easily

Blunt dissection can be achieved by splitting tissues between fingers, wiping tissues with swab or opening scissors

Subcutaneous closure:

Important to eliminate dead space that is left following excision, to prevent seroma formation

Can be reduced with surgical drains, suturing is utilised more frequently

S/c tissue (muscle/fat) holds tension poorly so do not tie sutures too tightly

Tight enough to appose tissue though

Skin closure:

Should be achieved by neatly apposing edges of wound

Excessive tension should be avoided

Suture material, staples or adhesive can be used and choose appropriate suture pattern according to wound

Lancing:

1. Surgically prepare area over abscess

2. Lance over soft point with a stab incision using a scalpel blade

3. Pus is expressed

4. Cavity is flished with sterile saline or antiseptic solution

5. Continue flushing until fluid is clear. Digitally explore cavity to breakdown any pockets and flush again

6. Occassionally a drain is inserted

7. Aftercare includes daily flushing of cavity until contracted or filled with granulation tissue

8. Incision bathed and kept open initially to allow drainage

Aural Haematoma Surgery

Skin Mass Removal & Biopsies

Abscesses