Page 88 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 5 · Surgery of the ear
y of the ear
Chapter 5 · Surger

➜ OPERATIVE TECHNIQUE 5.2 CONTINUED
VetBooks.ir Closure

Before suturing the ear canal flaps to the skin, advance the skin edges towards one another to determine their final
position and to see whether further skin elevation will be needed. Place one or two simple interrupted skin sutures
between the advanced skin and the incision margin along the pinna to keep the skin in position.
Suture the ear canal epithelium from the drainage boards to the adjacent skin edges with non-absorbable
monofilament sutures in a figure-of-eight or simple interrupted pattern. If the drainage boards are under tension, secure
the cartilage of those flaps to the subcutaneous tissues before apposing the skin edges to the flap epithelium, making
sure that the new opening is not obstructed by folds or sags in the flaps. Appose the remaining skin in a T-shape.

PRACTICAL TIP

Before placing any sutures, pull the skin flaps over the site to determine how best to close the skin. Often the skin
incision must be extended ventrally or excess skin removed from around the proposed opening to prevent
obstruction of the new ostium whilst reducing tension on the closure

POSTOPERATIVE CARE
Protect the surgical site from trauma with an Elizabethan collar. In dogs that shake their ears vigorously, the pinna
should be taped to the head. Continue topical therapy and control of primary factors and clip the hair away from the
opening as needed to maintain ventilation and drainage.

OPERATIVE TECHNIQUE 5.3

Total ear canal ablation and lateral bulla osteotomy

PATIENT PREPARATION
• Clip the side of the face ventrally and dorsally to the midline, rostrally to the lateral commissure of the eyelid, and for
5–7 cm caudal to the palpable ear canal. Additionally, clip the convex and concave surfaces of the pinna.
• Flush the ear canal with sterile saline or dilute betadine solution. Prepare the surgical field with antiseptic solution
and scrub. During preparation and draping, the pinna can be suspended using a towel clamp and tape attached to
an intravenous fluid pole.
• Some veterinary surgeons administer antibiotics prophylactically (e.g. cefazolin 22 mg/kg i.v. at induction and again
within 2–6h) if the animal is not already on therapeutic perioperative antibiotics.

PATIENT POSITIONING
Lateral recumbency, with a folded towel under the side of the head. The pinna is usually draped into the sterile surgical
field.
ASSISTANT

Extremely useful.
ADDITIONAL INSTRUMENTS

Bipolar cautery and Gelpi or ring retractors are useful.
SURGICAL TECHNIQUE

Approach
Expose the affected ear canal through a lateral T-shaped incision that encircles the vertical canal opening and extends
to a point ventral to the level of the bulla. Make the initial skin incision around the opening of the vertical canal
just above the antihelix projection on the concave portion of the pinna. Use Mayo scissors to extend the skin
incision through the cartilage of the medial wall of the vertical ear canal.

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