Page 20 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 1 · Surgical principles and instrumentation

secure haemostasis and are particularly useful in areas useful in preventing excessive contamination of cut sur-
that may be difficult to access. Linear (also known as faces, particularly when they involve the lips and adjacent
VetBooks.ir thoracic surgery. They are available in a variety of lengths Surgical marker pen and plastic ruler
oral tissues.
thoracoabdominal) staplers are the most applicable to
between 30 and 90 mm. Cartridges corresponding to the
width of the stapler produce a double staggered row of
titanium staples in two standard sizes: A marker pen and ruler are used for planning and outlining
skin or mucosal incisions for the creation of flaps, repair of
• ‘Medium’ cartridges have 3.5 mm staples, which defects and removal of tissue (Reiter, 2013).
compress tissue to a width of 1.5 mm
• ‘Large’ cartridges have 4.8 mm staples, which Wedge props and mouth gags
compress tissue to a width of 2 mm. Props and gags aid in keeping the mouth open to allow
access to surgical sites in the oral cavity and oropharynx
A 30 mm width linear stapler is also available, which (Figure 1.13). Custom-made devices (such as needle caps
accepts ‘small/vascular’ cartridges that have the added
and syringe cases) are also useful. Note that keeping the
security of three staggered rows of 3 mm staples and mouth stretched open for prolonged periods of time
compress tissue to a width of 1 mm. This vascular stapler may cause strain to the masticatory muscles or injury to
is particularly useful for placing across the hilus of a lung the temporomandibular joints, and could detrimentally
for complete lung lobectomy or resection of an atrial affect maxillary arterial blood flow (particularly in cats)
appendage mass. Partial lung lobectomy may be per- (Reiter, 2014).
formed with linear or linear cutter staplers. Linear cutter
staplers fire four rows of staggered staples and cut
between the second and third rows, eliminating the need
to resect the redundant tissue with a blade. Further in-
depth information on the types and use of surgical staplers
is available in the BSAVA Manual of Canine and Feline
Surgical Principles.
Generally, complications associated with the use of
surgical staplers are few providing the instruments are
used correctly. The tissue to be stapled should be viable
and all layers of the tissue must be penetrated. It is very
important not to try to force an excessive amount of
tissue into the stapler. The stapled line must be inspected
carefully to detect any potential failure of the staples to
engage the tissue properly.

Orthopaedic equipment
Instruments and materials include orthopaedic wire (for
1.13 Spring-loaded mouth gags.
interdental, circumferential or intraosseous wiring), hypo-
dermic needles (to guide the wire), resin material (for build-
ing splints), Kirschner wire and Steinman pins (for external Swabs
skeletal fixation), and a plating system with supporting Laparotomy swabs: Laparotomy swabs can be very useful
tools (Reiter, 2013). for temporary packing of the oropharynx in dogs during
surgical procedures of the oral cavity and surrounding
Additional surgical equipment structures, as they provide additional protection against
aspiration of foreign material. A cord attaches the swabs
Drapes to the endo tracheal tube, ensuring that they are not left
In most surgical procedures four ‘quarter’ drapes are in place once the procedure is complete and the patient is
placed at the periphery of the sterile field. A single large recovered from anaesthesia. Moistened laparotomy swabs
drape with a central fenestration may also be placed over are useful in thoracic surgery for packing off areas of
the entire surgical field. Some surgeons additionally sew or lung and protecting the edges of thoracotomy incisions
clip drapes to the skin incision edges to provide extra pro- from retractors.
tection against wound contamination from bacteria, which
migrate to the skin surface from within the hair follicles Gauze swabs: The standard swabs used in general surgery
are 10 x 10 cm (4 x 4 inches). Gauze swabs of 7.5 x 7.5 cm
during surgery. Once the drapes are placed they must not
be repositioned. Disposable synthetic or reusable cloth (3 x 3 inches) are most commonly used for surgical proce-
dures in the oral cavity and oropharynx. Gauze swabs and
drapes may be used. There are advantages and disadvan-
small sponges can also be used for temporary packing of
tages to both and the choice is based on economics, the oropharynx in smaller dogs and cats.
laundering facilities and convenience. However, if a cloth
drape becomes wet it is no longer sterile owing to inevit- WARNING
able ‘strikethrough’. Compared with surgical procedures
that advance through the skin into deeper structures, the Swabs must be counted at the beginning and end of a
surface linings of the oral cavity and oropharynx are non- surgical procedure to ensure none are left inside a
sterile environments that cannot be prepared adequately wound or the thoracic cavity. All swabs must have a
with antiseptics to provide a sterile field. Nevertheless, radiopaque marker strip to enable their visualization
flushing the mucosal surfaces with dilute chlorhexidine on a radiograph
prior to surgery and draping the surrounding areas are

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