NOTES ON COMMON SURGICAL PROCEDURES
I.
TAIL DOCKING in puppies
 Definition: partial amputation of the tail
 Indications: Usually for aesthetic purposes, but could be for traumatic injury
o Breed standards set by the AKC
 Patient Preparation/Procedure
o Performed on puppies 3-5 days old – NO ANESTHESIA
o Puppy should be supported in the palms with the hind limbs supported between
the middle and index fingers
o Rear of puppy is toward the surgeon
o Site is aseptically prepared
o Exact location is determined and tail is excised distal to desired location
o Hemorrhage is controlled
o Suture placed to oppose the ends of the tail
o Problems with amputating too much of the tail
 Post-operative Consideration
o Return to mother quickly
o Don’t allow dam to lick sutures out!
o Observe for hemorrhage/early removal of sutures/redness/drainage/open
surgery site
o Area can get infected
II. TAIL AMPUTATION in Adults
 Definition: partial removal of the tail
 Indications: Usually performed due to injury or chronic disease
 Patient preparation/Procedure
o Tail is clipped, aseptically prepared
o Some surgeons prefer patient to be in sternal recumbency and for tail to
positioned in air (vertically)
o Tourniquet at base of tail is useful for hemorrhage
o Skin is incised, tail is disarticulated at the joint that was specified (usually skin
incision is distal to disarticulation site to facilitate closure)
o Ligation of blood vessels
o Skin is sutured to cover caudal vertebrae that is now exposed
 Post-operative consideration
o Tail bandaging is difficult
o Monitor site for hemorrhage/swelling/drainage/redness/selftrauma/dehiscence
o Consider placing an Elizabethan Collar
o Skin sutures generally removed in 10-14 days
o Pain meds are important
III. DEWCLAW REMOVAL in puppies
 Definition: Amputation of the vestigial 1st digit & claw on the medial aspect of each limb
– if present
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Indications: Performed for aesthetic purposes, or to prevent potential injury
o Usually performed at time of tail docking
o Some breeds, such as Great Pyrenees, require the dewclaws to be present for
showing
Patient preparation/Procedure
o Aseptically clip and prepare surgery site
o Cradle puppy on its side and extend one leg at a time toward the surgeon
o Dewclaw is excised
o Hemorrhage is controlled (pressure, electrocautery)
o Can either heal by second intention or sutured closed (silver nitrate, surgical
glue)
Post-operative considerations
o Return to mother quickly
o Don’t allow dam to lick surgical area!
o Observe for hemorrhage/early removal of sutures/redness/drainage/open
surgery site
IV. DEWCLAW REMOVAL in adults
 Definition: Amputation of the vestigial 1st digit & claw on the medial aspect of each limb – if
present
 Indications: Performed for aesthetic purposes, or to prevent potential injury
 Patient preparation/Procedure
o GENERAL ANESTHESIA required
o Clip, aseptically prepare site
o Dewclaw is excised at the base (excision extends through joint, not the bone)
o Hemorrhage is controlled, skin edges are opposed with suture
o Paw is bandaged to prevent swelling, self-trauma post-operatively
o Sutures taken out in 10-14 days if present
o E-collar may be necessary
V. ONYCHECTOMY(Declawing)
 Definition: removal of the claw and the associated phalanx on each digit
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Indications: Elective procedure that usually involves only the front feet to prevent
scratching issues
Patient preparation/Procedure
o Surgical site is scrubbed, but not necessarily clipped for the procedure
o it is not recommended to trim the nails of the cat before the procedure
o A tourniquet placed DISTAL to the elbow will greatly reduce hemorrhage at the
surgical site. Placing the tourniquet proximal to the elbow may cause permanent
radial nerve damage. Tourniquet should not be in place for longer than 1.5 hours.
o 3 techniques for performing the surgery: scalpel, Rescoe nail trimmer, laser
o Care must be taken to avoid cutting the digital pads
o If the laser is used, alcohol is not to be used in the prep as it could cause a fire
o Sutures or surgical glue is used to close each incision. Care must be taken to not
place glue INTO the incision as it can cause lameness and a foreign body reaction.
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The feet are bandaged while the patient is still under anesthesia and should remain
in place for 24 hours.
Post-operative considerations
o Clay/sand litter should be avoided for 10 days post-operatively to avoid
accumulation within the wounds.
o Sensitivity of the limbs should improve within 2 weeks of surgery
VI. CANINE CASTRATION (orchidectomy, orchiectomy, neuter)
 Definition: removal of both testicles
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Indications: Usually performed to prevent unwanted impregnation, roaming, or aggressive
behaviors. Medical indications include prostate disorders, perinanal tumors, perineal
hernias, and testicular tumors.
Patient preparation/Procedure
o Surgery is often performed around 6 months of age prior to the development of
unwanted behaviors and sexual maturity.
o ALWAYS be sure that both testicles are present in the scrotum before the surgery
begins.
o Clip for a routine castration extends from the tip of the prepuce to the
abdominal/scrotal skin margin, and wide laterally to the inguinal region. Care is taken
not to involve the scrotum in the clip as the skin is very delicate and thin which makes it
prone to clipper burn and lacerations. Long scrotal hairs that will overlap into the
surgical field are trimmed.
o A preputial flush with a diluted antiseptic solution is performed before the site is
scrubbed.
o Prescrotal incision is made on the ventral midline which each testicle is removed from.
Each testicle is exteriorized from the abdomen by freeing all attachments and fat from
the spermatic cord. Each cord is clamped and ligated and each testicle is excised.
The single incision is closed in 2 layers: SQ and skin.
o The animal should be monitored post-operatively for excessive scrotal or incision licking.
Some swelling will normally be present. Excessive hemorrhage into the scrotal sac can
lead to a scrotal hematoma which can be severely painful and may necessitate a scrotal
ablation.
VII. FELINE CASTRATION
 Definition: removal of both testicles
 Indications: Performed to prevent fighting, roaming, spraying and to decrease urine odor. If
any improvement will be seen, it can take up to one month.
o Usually performed around 6 months of age, but more frequently this surgery is
being performed as early as 3 mths.
Check to be sure that the sex of the cat is correct.
 Patient preparation/Procedure
o Cat is usually placed in dorsal recumbency, with the legs tied cranially.
o Hair is removed from the testicle by either plucking or clipping.
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VIII.
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Alcohol is avoided, saline is used instead.
Incision is made on the scrotum over each testicle.
Testicle is removed by tying off the spermatic cord with suture or using the cord itself.
Scrotum is left to heal via second intention.
Scrotal swelling is common post-operatively.
Clay litter is avoided to prevent foreign objects in the surgical site.
CELIOTOMY- (laparotomy)
Definintion: a surgical incision into the abdominal cavity
o Location of incision is usually ventral midline, however other options include
paramedian, paracostal, parapreputial, and flank.
Indications: OHEs, intestinal biopsies, cystotomies, C-sections, GI surgeries, abdominal
cryptorchidectomies, splenectomies, diaphragmatic hernias, and exploratory surgeries.
Patient preparation/Procedure
o A wide area is always clipped and prepped for a laparotomy. Clip should extend
from xiphoid to the pubis. Laterally, the clip should extend to the edge of the ribs.
o Actual incision length will vary with each procedure.
o Ventral midline incision is the most common. A scalpel or electrocautery (set to cut)
is used to incise through the skin and subcutaneous layers. Once the linea alba is
reached, the surgeon uses forceps to elevate the linea and will perform a stab
incision into it which will be extended cranially and caudally.
o If retractors are necessary, moistened laparotomy pads should be used.
o Abdominal organs that are exteriorized should be kept moist with warm fluids and
handled with moistened gauze/lap pads.
o If a cavity is to be entered (bladder, intestines, stomach, uterus), care is taken to
isolate organ with laparotomy pads so that contents do not spill into the abdomen.
o A gauze/ lap pad count should be performed at the beginning and end of every
laparotomy.
o Always check the abdomen for instruments before closure.
o Closure is performed in 3 layers: linea alba, subcutaneous fat, skin.
IX. OVARIOHYSTERECTOMY (spay, neuter)
 Definition: refers to the surgical excision of the ovaries and uterus
 Indications: Procedure performed to prevent pregnancy, correct hormonal imbalances, prevent
and treat uterine infections, cysts, tumors, correct undesirable behaviors and congenital
deformities.
o OHE is recommended before the first heat cycle in dogs, as the incidence of mammary
tumors is much less.
-Usually performed between 4-6 months of age.
o If OHE is performed during estrus or pregnancy, increased vascularity to the area may
cause increased hemorrhage. This is seen more so in dogs than cats.
o Should wait 3-4 months post estrus or 6-8 weeks postpartum.
 Patient preparation/Procedure
o Patient is placed in dorsal recumbency
o Patient is clipped and aseptically scrubbed as described for general celiotomy
o Ventral midline incision made caudal to the umbilicus.
o Spay hook is used to retrieve the uterine horns.
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Ovarian pedicles are identified, clamped, and ligated before the ovaries are removed. Care
should be taken to visualize that the ureters are not involved in the ligatures. Failure to
remove the ovaries completely may result in the animal retaining signs of estrus, despite
removal of the uterine horns and uterus.
The broad ligament is transected to facilitate removal of the uterine horns and
exteriorization of the uterine body which is also clamped and ligated before being
transected.
The left ovary is easier to remove than the right ovary due to the more caudal location
within the abdomen.
Inspection for hemorrhage from the ovarian pedicles and uterine stump should be
performed before the closure of the surgical site.
Post-operative weight gain is often a concern for owners, which can be attributed to
alterations of hormonal levels in the body. Diet and exercise modification should remedy
the situation.
V. PYOMETRA
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Definition: infection/fluid accumulation within the lumen of the uterus due to endometrial
hyperplasia caused by progesterone production. Often occurs 1-2 months after a heat cycle.
Indications: Treatment of choice is ovariohysterectomy.
Patient preparation/Procedure
o Animals are generally compromised pre-operatively. Fluid and antibiotic therapy should
be instituted before the surgical procedure.
o DO NOT perform a cystocentesis in these animals!
o A spay is performed as described above, however the uterus is handled with extreme care
as it is enlarged, heavy, and friable. The ventral midline incision is typically longer than
with a routine spay.
o Any cultures of the uterine contents are performed after the uterus is removed from the
sterile field.
o Abdomen may be flushed with a sterile solution before closure.
VI. CESAREAN SECTION
 Definition: laparotomy performed to remove neonates from the uterus.
 Indications: Can be planned in advance, or performed in animals experiencing dystocia.
 Patient preparation/Procedure
o Clip patient before they are anesthetized to minimize length of anesthesia. Keep the animal
in lateral recumbency as long as possible to avoid dyspnea. Also, providing adequate
oxygen and tilting the table may greatly help the breathing of the animal.
o Ventral midline incision is performed.
o The fetuses are removed through an incison in the ventral aspect of the uterine body either
with the uterus still in place, or once it has been excised if an OHE is also being performed.
o Uterus is exteriorized and lap pads are placed if incision will be made with uterus still in
place.
o Care must be taken not to cut into a fetus when the uterus is incised.
o The fetuses are “milked” out of the incision one by one with their associated placenta and
the fetus is taken away from the surgical site.
o The birth canal is inspected for any remaining fetuses.
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The uterine incision is closed if the female is to remain intact and the abdomen is flushed
with a sterile solution. Skin sutures should be placed internally to prevent removal by the
puppies/kittens.
If the animal is to be spayed, the uterus is either removed as in an OHE before or after the
fetuses are removed. All ligations will be performed after the fetuses are removed. If the
uterus is removed before the fetuses are delivered, the technician will quickly deliver the
fetuses by making the uterine incision.
Milk production is not affected by performing an OHE at the same time as delivery.
When each fetus is removed from the uterus, it is placed on a clean, dry towel and the fetal
membranes are removed (first from the face) and the airway/nose are suctioned with a
bulb syringe. The umbilicus is clamped/tied and the baby is rubbed vigorously in order to
dry and stimulate breathing. If the animal’s respirations are weak, doxapram (a respiratory
stimulant) can be placed under the tongue. Respiration can also be stimulated by using a
22-25 gauge needle on the nasal philtrum until bone is felt to stimulate breathing. IF THE
ANIMAL CANNOT BE STIMULATED TO BREATH, “flinging” of the puppies can be attempted
to remove any additional fluid from the respiratory tract. IF A HEARTBEAT IS NOT
AUSCULTATED, CPR is begun.
Return the neonates to the mother as soon as she has recovered from anesthesia and all
should be discharged as soon as possible from the hospital.
Monitor the meeting of the mother/babies to be sure that she accepts them and is not
aggressive towards them. Nursing should begin as soon as possible.
VII. CYSTOTOMY
 Definition: incision into the urinary bladder
 Indications: Usually performed to remove stones, repair a rupture, remove tumors, or correct
congenital defects.
o Urinary catheters are often placed to facilitate urethral flushing/stone removal.
o Do not express bladder if the flow is obstructed or if the bladder wall may be friable.
 Patient preparation/Procedures
o Stay sutures are placed into the bladder wall prior to the incision.
o Incision is made in an avascular area on the ventral aspect of the bladder.
o Stones can be submitted for analysis and urine can be submitted for culture.
o The bladder wall closure should be tested for leaks and the abdomen is flushed.
o Hematuria may be present for 2-3 days post-operatively along with stranguria.
VIII. LUMPECTOMY
 Definition: surgical excision of a mass in the skin or SQ tissues
 Indications: suspected neoplasia, aesthetics
o All masses should be ideally submitted for histopathology.
o Metastasis check may be performed prior to surgery.
 Patient preparation/Procedure
o Masses should be manipulated as little as possible prior to surgery.
o A generous clip should be performed.
o 1-3 cm margins are obtained if possible to allow for the submission of clean margins.
o Margins are tagged to identify any areas of incomplete resection.
X. MASTECTOMY
 Definition: removal of a mammary gland (radical mastectomy is removal of a chain of mammary
glands)
 Indications: suspected neoplasia
 There is a significantly higher chance of a dog developing mammary cancer if it is spayed after
its first estrus.
 Most frequently occurring neoplasm in the female dog.
 Lung rads to check for metastasis should be performed along with lymph node evaluation.
Prognosis does not improve if the mass is removed, but metastasis is present.
 50% of mammary tumors are malignant in dogs, 80-90% are malignant in cats.
 If bilateral radical mastectomy is to be performed, the procedure must be staged to allow the
skin to close.
 A drain may be needed if a large amount of dead space is present.
SURGERIES THAT INVOLVE A LAPAROTOMY PREP/INCISION
XI. UMBILICAL HERNIA REPAIR
 Definition: A defect is present in the abdominal wall at the level of the umbilicus, allowing intraabdominal fat, omentum, or bowel to slip through.
o Usually congenital; discovered by a swelling at the umbilicus on physical exam.
o Uncomplicated hernias can usually be repaired at the time of sterilization.
o Complicated hernias involve bowel entrapment/strangulation and are emergency situations.
 Patient preparation/Procedure
o Ventral midline incision is made directly over the hernia without perforating hernia
contents. Depending on the contents of the hernia, they are either replaced back into the
abdomen or are excised.
o The edges of the defect are trimmed to freshen and the defect is closed. SQ and skin are
then closed as previously described.
XII. GI SURGERY (Gastrotomy, Enterotomy, Intestinal Resection and Anastomosis)
 Definition: Gastrotomy: incision into the stomach
 Definition: Enterotomy: incision into the intestine
 Definition: Intestinal Resection and Anastomosis: removal of a section of bowel and opposing
the fresh edges of the remaining bowel
o Normal bowel is pink, has good vasculature, and is active in motility. Devitalized bowel is
black, green, or gray in color, lacks motility, has a thin wall, and/or may lack bleeding
when incised.
 Indications: Often performed to obtain biopsies or remove foreign objects. An anastomosis is
performed when a portion of the GI tract needs to be removed due to disease or damage to the
area.
 Patient preparation/Procedure
o The patient should be clipped and aseptically scrubbed as for a celiotomy
o If these patients have been vomiting, the anesthetist should be aware that vomiting
could continue during the procedure. Insure proper tube placement and cuff inflation.
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Always pay attention to bowel that is exteriorized to be sure that the surgical team
doesn’t alter the blood flow to the intestines by handling the bowel inappropriately.
*GI CONTENTS ARE NOT STERILE. Prevent leakage into the abdomen. New
instruments/gloves/drape are to be used after the bowel has been entered.
Stay sutures are used for gastrotomies and enerotomies to prevent leakage.
A resection and anastomosis will require the technician to isolate the section of bowel
to be excised using Doyen forceps or their fingers to prevent leakage.
Leak tests are performed to ensure proper closure of incisions. Omentum is often placed
over the closure.
The abdomen is flushed and new instruments/gloves/drape are used to close the
laparotomy
Leakage will likely cause septic peritonitis. An abdominocentesis can be used to obtain
fluid for evaluation of peritonitis.
Most animals will be willing to eat within 24 hours of surgery. The intestinal tract thrives
on food for proper health and function. Begin with a small amount of water, then
introduce small amounts of food if vomiting does not occur. A highly digestible bland
diet (I/D, EN) should be fed until the animal shows they are recovering well from
surgery.
XIII.ORTHOPEDIC PROCEDURES
 Definition: any number of surgical procedures involving the musculoskeletal system
 Indications: Elective procedures include treatment for cranial cruciate ligament rupture, patellar
luxation, hip dysplasia, osteochondritis dissecans; Non-elective procedures include open
fractures, open dislocations, fractures involving the skull or spine.
 Fractures noted upon exam must be immobilized and bandaged. External coaptation is
important to reduce further disruption or damage to the fracture or fragments and the
surrounding soft tissue and prevents blood loss.
o bandages used for pre-operative & post-operative support are Robert Jones, Ehmer
sling(hip luxation), spica splint(humeral or femoral fractures), velpeau sling(scapular
fractures). All these bandages except for the Robert Jones can be used for long-term
external coaptation if surgery is not an option.
 Factors that may affect healing and recovery: 1) Age: younger patient are have faster healing
time, but are more difficult to confine for long periods. Complications related to growth plate
damage may be an issue. Older patients have a longer healing time and are more sedentary
which leads to muscle loss and weakness. 2) Weight: Obesity puts too much pressure on the
surgery site which could lead to premature loosening of the fixation. Large and overweight
animals need more assistance getting up and walking. 3) Owner Compliance: the animal’s
temperament influences how successful owners can be at following post-op procedures.
 Two types of fracture repair are internal fixation and external fixation.
o Internal fixation devices include bone plates and screws, IM pins, Kirschner wires,
cerclage wires, interlocking nails.
 Post-op care: strict confinement for 6-8 weeks, radiographs should be taken
every 4-6 weeks to monitor bone healing
o External fixation includes casts, rigid splints, kirschner-Ehmer fixation, and ring fixation.
 Post-op care: regular visits for cleaning of the pin tracts and tightening of
clamps. The external bars or rings need to be padded and wrapped to prevent
trauma to the patient and protect it from the environment. Strict confinement
for at least 4 weeks and radiographs every 4 weeks. Casts and splints should be
checked every week.
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Amputations
o Definition: removal of a forelimb or rear limb
o Indications: trauma, irreparable fractures, neurologic injuries, neoplasia, congenital
deformities
 Forelimb amputation – disarticulation of the shoulder joint or scapula removal
or mid-humeral
 hindlimb amputation- mid-femoral amputation or disarticulation of the
coxofemoral joint
Cranial Cruciate Repair
o rupture of this ligament causes instability of the stifle
o degenerative causes are the most common cause of the rupture
o Repair involves intracapsular or extracapsular repair or TPLO (performed by boardcertified surgeons)
XIV.
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AURAL PROCEDURES
Definition aural hematoma repair: repair of an aural hematoma secondary to otitis externa
or trauma
o Aural hematoma- refers to the formation of a hematoma within the auricular cartilage
on the concave surface of the ear.
o Indications: should be performed to relieve pain and prevent a permanently thickened,
cauliflower-like ear
 Patient preparation/Procedure:
o animals are placed in lateral recumbency with the affected ear up
o the hematoma should be drained through an incision
o vertical mattress sutures should be placed to close the dead space between the
auricular cartilages
o Lateral Ear Canal resection
o Definition: lateral ear canal resection: removal of the ear canal
o Indications: animals with chronic otitis or neoplasia
 allows drainage and ventilation
 patients should wear and e-collar until healed & sutures are removed
after 10-14 days
 tympanic membrane is more susceptible to damage
XV. OCULAR PROCEDURES
 Definition Entropion repair: correction of the rolling in of the eyelid causing ocular
irritation from eyelashes or facial hairs. The condition can either be developmental or
spastic
 Patient preparation/Procedure
o the patient is place in sternal or lateral recumbency
o shaving of the hair around the eye should be done carefully. Dilute baby
shampoo (1:3) with water can be used to clean the shaved area. It is then
followed by very dilute betadine solution (1:50). Sterile saline is then used to
flush the eye and any remaining dirt or particles.
o the Holtz-Celsus procedure is used to repair entropion
 Other eye procedures include enucleation, eyelid mass removal, cherry eye repair