What are the characteristics of vaginal hyperplasia?
-exaggerated response to estrogen
-usually in intact, young bitches
-edematous protrusion of vaginal floor
-usually regresses with diestrus
-keep lubricated +/- retention sutures
What are the characteristics of vaginal prolapse?
-circumferential tissue protrusion
-can be an extension of hyperplasia or associated with dystocia, tenesmus, or forced separation of mating
-treat with digital reduction and OVH
-surgical excision if necrotic and nonreducible
What is the technique for a vaginal prolapse resection?
urethral catheterization and circumferential cut and sew excision
What are the steps to a Buhner suture for vaginopexy?
-place Gerlach needle into ventral incision and push it through subQ tissue, laterally to the vulva, exiting at the dorsal incision
-thread one end of tape into eyelet of the needle and pull it back, through the subcutaneous tissue
What are the characteristics of vaginal tumors?
-often benign leiomyomas or fibromas
-perform an episiotomy to improve visualization
-place a urethral catheter to avoid damage
-concurrent abdominal approach may be needed to free uterus/uterine stump and ligate vessels
What are the characteristics of vulvar tumors?
-can include any skin tumors
-perform local resection and reconstruction that permits urination
What is the purpose of an episiotomy?
expose the vestibule, caudal vagina, or urethral orifice
When is an episiotomy helpful?
-dystocia
-vulvar exploration
-excision of vaginal tumors
-excision of vaginal edema or prolapse
-urethral catheterization
What is the blade technique for an episiotomy?
-incise skin over midline dorsal to commissure
-cut remaining layers with scissors
-place stay sutures and urinary catheter
-close with two or three layer closure
What are the characteristics of perivulvar folds/recessed vulva?
-folds of tissue that overlap the vaginal opening can cause infection, inflammation, or urine retention
-clinical signs include vaginitis, cystitis, and skin fold dermatitis
-owners may complain of “incontinence” because trapped urine leaks out
-treatment is resection of excess folds
What are the characteristics of mammary tumors in female dogs?
-overall reported incidence of 1 to 4%
-higher incidence at 10 years and older; 13%
-40 to 50% are malignant
-spaying before 2.5 years of age decreases the risk
What are the characteristics of mammary tumors in cats?
-uncommon
-85 to 95% are malignant
-spaying before 2 years decreases the risk
How are mammary tumors diagnosed and prognosed in dogs?
-cytology has > 85% agreement with histology
-take thoracic rads to check for metastases
-type of surgery does not influence survival
-recurrence on ipsilateral side seen with simple mastectomy
-prognosis best with benign or nonaggressive tumors, tumors less than 2-3 cm in diameter, and no metastases
How are mammary tumors diagnosed and prognosed in cats?
-chain mastectomy improves survival
-may need to remove body wall if invasive
-prognosis best for tumors less than 2 cm
What are the characteristics of inflammatory mammary carcinoma in dogs?
-not a surgical condition
-mastectomy does not increase lifespan
-average survival after surgery is only 25 to 60 days with an 81% metastatic rate
-21% have prolonged clotting
What is the treatment for inflammatory mammary carcinoma?
-supportive care for pain, infection, and/or DIC
-piroxicam
What are the preparation steps for a mastectomy?
-clip widely
-position to include flank or axillary folds
-preplan any subQ drain placement
-prepare for OVH if intact; perform this procedure first
What are the steps of a simple lumpectomy?
-for encapsulated, benign masses < 1cm in diameter and not associated with skin or nipple
-incise skin over the mass
-dissect the subcutis to expose 1 cm around the lump
-ligate or cauterize vessels and transect the subcutis
-close subcutis and skin
What are the steps of a simple or regional mastectomy?
-incise skin along midline around glands and lateral to nipples
-cut subcutis along midline and lateral margins
-consider lymphatic connects when performing regional mastectomy
-transect deep subcutis laterally and medially down to rectus fascia
-continue subcutis transection and elevation until mammary tissues is reached cranially/caudally
-identify connecting mammary tissue at margins
-ligate and transect connecting mammary tissue
-dissect working from cranial to caudal
-ligate and transect any glandular confluence and vessels caudally
-close in 3 layers; take down fat or place a drain to prevent seromas
What are the steps to a chain mastectomy?
-incise medial and lateral to glands
-incise skin and subcutis at cranial boundary
-starting cranially, ligate supplying and connecting vessels while dissecting caudally
-elevate under subQ tissues at level of rectus sheath
-work cranial to caudal and medial to lateral
-resect body wall full thickness if tumors are adherent to rectus sheath
-identify and ligate caudal superficial a. and v. near inguinal ring
-close subQ tissues in one or two layers
-drains may be needed to close dead space
-walking sutures may be needed for excessive tension
What is done after surgery on the mammary glands?
-paint tissue sample margins and allow to dry before placing in formalin
-provide analgesia
-bandage to cover drain or limit dead space
-E-collar and exercise restriction for 10 to 14 days
What are the characteristics of inguinal hernias?
*can be congenital for acquired
*often a non-painful herniation of fat and omentum
-emergency if intestine, bladder, or uterus herniate and there is obstruction or ischemia
*diagnosed via palpation or ultrasound
*fetuses can survive gravid uterine hernia if repaired before week 7 of gestation
What are the steps to inguinal hernia surgery?
-expose hernial contents through inguinal, abdominal, or combined approach
-extend hernial ring if necessary
-reduce contents and close most of the ring; leave a gap caudally
What is a true hermaphrodite?
both testicular and ovarian tissue
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