How a Misplaced Sponge Can Return to Bite YouMarch 15, 2016Forgetting a surgical sponge inside a veterinary patient is a taboo yet all-too-common situation. Because of blatant underreporting, reliable statistics do not exist in veterinary surgery, and few are available in human surgery. Sponge retention is a risk any time sponges are used in surgery, regardless of the procedure. Since retained sponges were first described in human surgery in 1884, they remain the most common accidentally retained surgical foreign bodies. This can lead to many complications after surgery, not to mention the potential of resulting medicolegal implications. Understanding the reasons for sponge retention can help you devise strategies to avoid this embarrassing pitfall. Small sponges, especially when soaked in blood, can be difficult to see in the surgical field. Not discarding used sponges immediately increases this risk. In deeper surgical areas, such as thoracic or abdominal body cavities, the use of small sponges creates an unnecessary risk of retention because they easily may become lost in the process. Also, using free small sponges without first attaching them to a hemostat or sponge forceps increases this risk. Phil Zeltzman, DVM, DACVS, CVJ A retained lap sponge attached to …
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The Veterinary Surgeon's Dilemma: To Biopsy or Not Biopsy?February 9, 2016Let’s discuss two common dilemmas that are commonly encountered in everyday veterinary surgery. What is your philosophy when it comes to biopsies? Dilemma No. 1 Let’s pretend you need to perform a cystotomy on a patient. While tying the patient to the surgery table, your technician notices a firm, not-so-mobile 1-inch-diameter mass on the hock. While you are in surgery, a receptionist calls the owner to see if he wants you to excise the mass. He approves the extra surgery fee but declines the fee for histopathology despite your impression that the mass is malignant. What would you do? Clearly, some colleagues will remove the mass with no second thought. Others firmly believe that “if it’s worth taking out, it’s worth sending out.” What is the right thing to do? Being lenient? Being dogmatic? We asked a few specialists to share their thoughts. Veterinary pathologist Jim Walberg, DVM, Dipl. ACVP, of VetPath Services in Stone Ridge, N.Y., reminds us that in human medicine, where lawsuits are so prevalent, all excised tissues are sent to pathology. “Similarly, we should insist that any mass excised be evaluated histologically,” Dr. Walberg said. “In reality, cost is often …
Why Gloves Can be Your No. 1 Weapon Against SSIsJanuary 20, 2016Originally published in the January 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today! Surgical site infections, or SSIs, are a constant concern for surgeons and surgery lovers. Infection can lead to dissatisfaction, distress and even death (spontaneous or via euthanasia). Given the rise of nosocomial infections from drug-resistant bacteria, keeping infection prevention front and center is of ever-increasing importance. The prevention of SSIs can be visualized as a patient/pathogen/procedure triangle: Patient factors relate to the incision or the wound, tissue depth, systemic defenses and risk factors such as diabetes (at least theoretically) and malnutrition. Pathogen factors include the bacteria, their quantity and virulence. Procedure factors are those we should strive to control: antibiotic prophylaxis, hypothermia avoidance, gentle tissue manipulation and aseptic technique. Using aseptic technique includes appropriate surgical attire. Caps, masks, gowns and surgical gloves are the first line of defense against SSIs. Surgical gloves, however, are not invincible and can perforate. Unfortunately, this happens much more often than we suspect. Defects often are not noticed until the gloves are removed after surgery and blood is observed on a finger. Noticing …
What Veterinary Dentistry Trends and Tools to Look for in 2016January 13, 2016Originally published in the January 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today! I’m writing this as I return from the 29th annual Veterinary Dental Forum in Monterey, Calif. This year, the forum was combined with the 13th World Veterinary Dental Congress, so leaders in the field from around the world converged upon Monterey. Here are some of the hot trends and tools for 2016 that I noted at the conference. Dental Radiography and Dental Teleradiology More and more general practices are getting digital dental radiography, and with good reason. Dental radiography provides the necessary information to allow veterinarians to diagnose and treat oral diseases. Radiography also provides assurance that treatment has been successful. The most important thing to do once you purchase a dental radiography system is to use it. Every patient can benefit from dental radiographs. Learning radiographic positioning and radiographic interpretation takes time. Positioning can be learned with a site visit or by attending continuing education events. Learning positioning will require some practice with a skull or cadaver to master the intricacies of tube head positioning. …
How to Repair Non-Invasive Jaw FractureOctober 16, 2015Originally published in the October 2015 issue of Veterinary Practice News. Enjoyed this article? Then subscribe today! I recently had the opportunity to teach at the AOVET craniomaxillofacial trauma and reconstruction course in Las Vegas. This is one of my favorite CE courses because it brings together veterinary dentists, veterinary surgeons, seasoned general practitioners and a human oral and maxillofacial surgeon to discuss approaches to various maxillofacial trauma cases. We all come away from the weekend realizing there is more than one way to repair a jaw fracture. The key is having multiple tools in your armamentarium. In this article, we’ll discuss one of various methods. Mandibular fractures in dogs and cats are most commonly due to fights with other dogs and cats, motor vehicle trauma and falls from a height. However, periodontal or endodontic disease can result in a pathologic mandibular fracture. Aggressive cancers also can cause pathologic mandibular fractures, but these are much less common than pathologic fractures due to perio/endo bone loss. Dogs usually fracture their mandibles through the …
A Veterinary Practitioner's Guide to Dental BursSeptember 22, 2015Originally published in the September 2015 issue of Veterinary Practice News. When it comes to extraction of firmly rooted teeth in dogs and cats, the high-speed hand piece is the most efficient tool for the job. It is used to remove bone lateral to the roots and to section multirooted teeth so that individual crown-root segments may be removed as if they were single-rooted teeth. The high-speed hand piece is driven by air and relies on revolutions per minute (RPM) to accomplish its job. It typically runs at 200,000 to 400,000 RPM. Because the hand piece relies on RPM and not torque, the tool is most efficient when used with a light touch and with the foot pedal pushed to the floor. Pressing too hard will result in binding of the bur and that unpleasant smell of burned hard tissue. Eye and face protection should be used at all times when using burs. The high-speed hand piece is held with a modified pen grasp (Figure 1), which provides the best control over the tiny burs placed in the head of the hand piece. The burs are secured with a push-button mechanism, a locking …
How to Treat the Congenital Cleft PalateAugust 21, 2015Originally published in the August 2015 issue of Veterinary Practice News. Cleft palate surgeries are one of my favorite procedures in dentistry and oral surgery. Maybe it is because the opportunity to see a puppy amidst a predominately geriatric patient population. Perhaps it’s because every cleft palate is just a little bit different than the previous one. The most likely reason is the exhilaration and challenge of repairing a defect that has already had three (or more!) attempts at repair prior to presenting to a specialist. © 2009, John Lewis, University of Pennsylvania. Figure 1A: Bilateral cleft lip in a 7-month-old pit bull. Figure1B: Bilateral clefts of the primary palate in the same dog. Terminology Defects of the primary palate occur from a lack of fusion of the developing incisive bone to the palatine process of the maxilla and/or defects of development of the soft-tissue structures of the upper lip. These defects are often extending from the midline incisive papilla, radiating rostrolaterally, unilaterally or bilaterally (Figure 1A and 1B). Unilateral cleft-lip defects in dogs occur more commonly on the left side, which is also …
How to Provide Better Pain Control Around SurgeryAugust 12, 2015Originally published in the August 2015 issue of Veterinary Practice News. Subscribe today! American Animal Hospital Association (AAHA) and the American Association of Feline Practitioners (AAFP) have recently published the "2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats." The entire article is easily found online (for free) to any interested reader. Full disclosure: What follows is not a summary of the AAHA and AAFP article, but a review of a few key points made by the authors as they relate to perioperative pain control. In addition, we interviewed the lead author, Dr. Mark Epstein. NSAIDs NSAIDs are a mainstay for chronic-pain management, as well as for perioperative use. However, "preexisting elevated liver enzymes are not a risk factor." The guidelines state that "the importance of maintaining a normotensive state during anesthesia is considered paramount when utilizing preoperative NSAIDs." Studies have shown that NSAIDs are more effective when given prior to surgery (concept of preemptive analgesia), but if IV …
10 Tips to Help You Save Time During SurgeryJuly 14, 2015Originally published in the July 2015 issue of Veterinary Practice News. Being a quick surgeon shouldn’t be a goal in itself. Being a good surgeon is a much wiser goal. However, being good and fast might be the ideal combination for the anesthetized patient’s sake. We polled four board-certified surgeons* who shared 10 pearls to become more efficient in the OR. This is a sequel to June’s column titled “How to save time before surgery.” Each suggestion may seemingly only shave off moments. But over the length of a procedure, these moments add up in such a time-sensitive environment. 1) Focus Thoroughly concentrate on the task at hand. Avoid talking about the weather, your upcoming vacation or the last episode of “Dancing with the Stars.” Avoid distractions and interruptions, such as unnecessary staff, loud music or phones in the OR. 2) Technicians During surgical procedures, appropriate staffing should never be underestimated. A well-trained, experienced technician can focus on anesthesia so that the surgeon can focus on the surgery. A good technician won’t be shy about notifying you of true concerns about the patient, as opposed to annoying beeping related to a faulty probe or electrode. The technician should be aware of the …
Vet School’s 3-D Printer Adds Personal TouchJune 17, 2015What they see is what they get at the Mississippi State University Veterinary Specialty Center, which is using a 3-D printer to construct plastic copies of patients’ damaged spines and skulls. The replicas spit out by the $2,200 LutzBot TAZ 4 3-D printer allow veterinarians and students to examine internal injuries up close and plan corrective measures. “We take CT scans of spinal injuries, convert them into three-dimensional images on a screen and convert those to files that can transmit that information to the printer,” said Andy Shores, DVM, MS, Ph.D., Dipl. ACVIM. “The result is a plastic model identical to what was on the screen.” The reproductions also assist in the education of Mississippi State veterinary students and neurosurgery residents, said Dr. Shores, chief neurosurgeon in the College of Veterinary Medicine. “The equipment prints out bony structures, so future students can see exactly how a particular injury looks and get a better appreciation for the condition we’re talking about while on rounds,” he said. “If you have a patient with a broken bone or vertebrae, to be able to put that structure in your hand goes a long way toward the students’ understanding what it is and how …
