Page 21 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery

Mayo bowl and bulb syringe Cotton-tipped applicators
A sterile bowl for saline is always useful because exposed These are sterile, long wooden handles with a cotton bud
VetBooks.ir particularly important when large flaps are raised for repair ing blood from delicate tissue or applying haemostatic
tissues should be kept moistened during surgery. This is
tip on one end. They are useful for atraumatically absorb-
agents to incision sites. When moistened they can be used
of tissue defects in the oral cavity (e.g. palate surgery,
reconstruction of the nasal vestibule). Smaller bulb syringes
parathyroid from thyroid tissue).
or large catheters attached to a syringe can also be used to as a gentle dissecting tool in friable tissue (e.g. separating
flush the nasal passages of animals with small nostrils.
Moistened gauze swabs are less traumatic than dry swabs. Dental units
Lavage often improves visibility during dissection, and cold
lavage can provide excellent atraumatic haemostasis. Electrical and air-powered systems are available. Low-
Thorough lavage of contaminated or dirty surgical sites speed handpieces are used for polishing teeth, cutting
with a bulb syringe is mandatory. Warm saline is recom- bone and performing various other procedures. High-
mended when lavaging the thoracic cavity. This is less speed handpieces are primarily used for cutting holes in
likely to disturb normal cardiac rhythm and is a useful teeth for endodontic access, preparing dental defects for
method of treating mild hypothermia in anaesthetized restoration, sectioning multi-rooted teeth into single-
patients. A stainless steel Mayo bowl is practical because rooted crown–root segments in preparation for extraction,
it is autoclavable. Alternatively, plastic bowls may be used if removing and shaping alveolar bone, and making precise
gas sterilization is available. cuts in bony structures during mandibulectomy and maxil-
lectomy procedures. Various shapes, sizes and lengths of
burrs are available (Reiter, 2013).
Suction
Suction is mandatory for thoracic surgery to allow lavage Headlamp and surgical loupe
and removal of fluid and blood from the chest. A Poole Headlamps and surgical loupes are useful for surgery of
suction tip (Figure 1.14) is large and has a smooth rounded the oral cavity and in small patients, to provide good illumi-
tip and multiple openings, which makes it suitable for nation and adequate tissue magnification (Reiter, 2013).
suctioning the thoracic cavity. Frasier suction tips (Figure
1.14) or disposable plastic suction tips with a single end Medical lasers
hole are available for general surgery in a selection of sizes
(5–12 Fr). Most of these have a decompression hole, which The carbon dioxide (CO 2) and diode lasers are the lasers
can be covered or uncovered, to regulate suction pressure most commonly marketed to veterinary surgeons (veterin-
at the tip. Fine suction tips for gently aspirating blood arians). These lasers are used for incision, excision and
during dissection are very useful in head and neck surgery. ablation of soft tissues. The CO 2 and most solid-state diode
A fine suction tip is essential when performing a bulla lasers function through photothermal laser–tissue inter-
osteo tomy to enable lavage of the middle ear. action. Water, haemoglobin, melanin and some proteins
absorb varying wavelengths of laser light, resulting in tissue
heating, necrosis and vaporization. Smoke evacuators are
essential adjuncts to prevent inhalation of the laser plume.
CO 2 laser: CO 2 lasers (Figure 1.15) are used in nasal, oral
and oropharyngeal surgery for precisely cutting or vapor-
izing soft tissue with haemostasis. The CO 2 wavelength is

Nova Pulse
1.15 CO 2 laser.
(Courtesy of Lumenis Inc.)
1.14 Suction tips. 1 = Poole; 2 = Frasier.

Drains
Commonly used drains in general surgery include the
Penrose drain and various types of closed-system active
drains. The latter have the advantage of being a sterile
system, reducing the risk of iatrogenic infection, and are
particularly useful for wounds in awkward locations that do
not permit drainage via gravity. Oropharyngeal and sub-
lingual foreign body penetration, severe lower lip avulsion
and excessive iatrogenic dissection of tissue planes during
mandibulectomies and removal of lymph nodes/salivary
glands may sometimes warrant the use of surgical drains
to allow the withdrawal of fluids and discharge from the
wound. The use of a drain following routine total ear canal
ablation and bulla osteotomy is controversial but it is rec-
ommended if a large amount of drainage is expected (see
Chapter 5). A chest drain must be placed before the end of
all thoracotomy procedures to enable lung re-expansion
and allow removal of residual pleural fluid and air in the
postoperative period (see Chapter 11).

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