Soft tissue surgery includes operations for cancer cases, ear surgery, lung surgery, hernias, liver or pancreatic surgery, and skin grafting.
Other problems such as surgery for trauma to the urinary system are not unusual. Our caseload for soft tissue cases expands every year and challenges the specialists at NOAH as much as the orthopaedic caseload.
We treat Neoplasia and tumours on all body areas (including the brain) at NOAH (North Dublin Orthopaedic Animal Hospital).
Chemotherapy is administered where appropriate. Tumour surgery depends on area, malignancy and blood supply. Surgical excision can also be part of treatment. If surgical treatment results in a severe laceration in the animal, a skin graft transferring a segment of free dermis or epidermis to the area need can be performed. Pedicle grafts are the most common form of skin grafting performed at NOAH.
The most common problems with dog ears are chronic infections that thicken and block the ear canal. Other issues that can cause blockage are tumours that fill the middle ear or external ear canal. These conditions usually require surgery.
A lot of ear infections can be isolated to cause and treated appropriately, with an expected resolution in two to four weeks, and usually restoring the dog back to a normal life. Sometimes an ear infection can be persistent and become chronic. These infections can reach the middle ear and result in painful symptoms such as dizziness, headaches, and a permeating foul odour.
Ear infections are sometimes a symptom of other disorders such as endocrine diseases or allergies. Investigation into these matters may be necessary to ensure that chronic infections get resolved as well as improving the overall health and welfare of the pet.
Chronic infections in one canal can be resolved through treatment, and possibly combined with surgery. But it is also common that these types of infections will occur due to underlying other causes in the opposite healthy ear canal. Medical therapies are necessary to control allergies along with proper hygiene and cleanliness of the ears to prevent further ear disease.
Read more about ear problems and treatments in dogs>>
Salivary gland excision can be performed to treat salivary gland neoplasia or mucocele. Neoplastic masses include adenocarcinomas or carcinomas and usually occur in the parotid and mandibular glands.
Oesophageal foreign bodies can cause obstruction to the oesophageal lumen. After a radiograph to make sure the foreign body has not moved, the foreign bodies can be removed endoscopically.
Oesophageal strictures occur when fibrous tissue in the muscle obstructs the lumen. The surgical treatment for strictures involves bougienage which is dilation of the stricture using blunt dilators.
Hyperthyroidism which occurs commonly in older cats can be surgically treated by thyroidectomy. The procedure must be performed cautiously to prevent hypoparathyroidism.
Thyroid neoplasms that occur in dogs, benign adenomas or malignant carcinomas, can sometimes be removed.
Laryngeal collapse is due to the loss of rigidity causing upper airway obstruction due to medial deviation of the laryngeal cartilage. Resection of the aryepiglottic fold can performed in patients with stage 2 laryngeal collapse. Permanent tracheostomy is recommended for patients with advanced laryngeal collapse.
Laryngeal paralysis is the failure of the arytenoid cartilages to abduct during inspiration. Surgical treatment is recommended for patients with moderate to severe respiratory distress. The techniques used include unilateral arytenoid lateralisation or partial laryngectomy.
Tracheal collapse is due to tracheal cartilage becoming flaccid and flattened. The goal of surgery is to support the tracheal cartilage and trachealis muscle. Surgical techniques used at NOAH involve tracheal stents made from a special polymer much the same as stents used in Human surgery. Dr. William McCartney of NOAH (North Dublin Orthopaedic Animal Hospital) was the first to use this technique in Ireland.
The most common thoracic surgery that we perform is removal of a lung lobe due to a tumour or other diseases that render the lobe useless. Other operations are Patent Ductus Arteriousus, foreign body retrieval, thoracic wall trauma or tumour removal. Diaphragmatic hernias would be common.
If a lung lobe is twisted (lung lobe torsion) along the long axis it can twist the bronchus and pulmonary vessels. Our recommended surgical treatment is a lung lobectomy due to rapid swelling and formation of adhesions causing the lung tissue to be unviable. Lung lobectomies are also performed at NOAH (North Dublin Orthopaedic Animal Hospital) for lung tumours.
Diaphragmatic hernias occur when the abdominal organs penetrate into the cranial mediastinum via the diaphragm. Surgical techniques to correct this include diaphragmatic hiatal reduction and placation, oesophagopexy and left sided fundic gastropexy. NOAH has achieved a very high rate of success with these cases over the years.
Other surgeries include nephrectomy, ectopic ureters corrective surgery (neouretrostomy or uretroneocystostomy), urethral stents, subtotal colectomy (for megacolon), liver tumour resection, and partial pancreatectomy.
Gastric Foreign Body
Dogs are indiscriminate eaters, ingesting rocks, sticks, plastic toys and other objects. Cats tend to ingest linear foreign objects. Symptoms include intermittent vomiting, with the vomiting being induced when the object is being forced into the pyloric antrum. Foreign bodies can be removed via a gastrotomy incision.
GDV refers to a stomach that is enlarged with air or forth (dilation) and malpositioned (volvulus) due to an airflow obstruction. It is an acute condition with a mortality rate of 20% – 45% in treated animals. Once the animal is stable with medical management, surgical intervention to untwist the stomach in the opposite direction to the volvulus is needed. The main aims of the surgery are to inspect the stomach and spleen to remove any necrotic material; to decompress the stomach and correct the malposition if present; and to adhere the stomach to the body wall to prevent further malposition.
Portosystemic shunts are vascular anomalies that allow blood which would normally be metabolised and excreted from the stomach, intestines, spleen and pancreas to enter the systemic circulation. The liver is not stimulated to grow, hepatic atrophy ensues with hepatic encephalopathy. The goal of surgery is to occlude the abnormal vessel. At NOAH Dr. William McCartney has successfully implanted ameroid constrictors for the treatment of portosystemic shunts.
Bile Diversion Therapy
Bile flow diversion is carried out when the common bile duct is obstructed or traumatised and the gallbladder is not involved. Cholecystoenterostomy, is the procedure and is where the gallbladder is opposed to the intestine to allow bile flow directly into the intestine.
Most choleliths are asymptomatic, and removal of calculi are indicated when symptoms occur. The surgical treatment of choice is cholecystectomy. The prognosis is excellent when the calculi can be removed and a cholecystectomy can be performed.
Intestinal tumours most commonly occur in the colon and rectum in dogs and small intestine in cats. Adenomatous polyps and adenocarcinomas are the most common colorectal cancers. Others include lymphosarcomas, leiomyomas, plasmacytomas, mast cell tumours, and carcinoids. Surgical resection is treatment of choice for intestine neoplasms.
In cases where there is a potential trauma to the abdomen, an exploratory laparotomy can be performed to visualise the internal organs.
Urethral blockage due to stones necessitates urethrostomy either temporary or permanent to relieve the blockage in cats and dogs. It is a common surgery and in many cases life saving.
Urethral prolapse occurs when the protrusion of the urethral mucosa. Surgical resection of the mucosa is the treatment of choice.
Focal neoplastic lesions that occur on the urethra can be resected via a transpubic surgical approach and urethral resection and anastomosis.
Muscle surgery commonly involves treating contractures, for example, quadriceps, infraspinatous or avulsions. It occurs when the normal muscle tendon unit is replaced by fibrous tissue causing functional shorting of the muscle or tendon. Surgery involves releasing the fibrous tissue and adhesions allowing full range of motion.
A muscle contusion is where there are varying degrees of haemorrhage and fiber disruption of the muscle tissue. Rarely, if the haemorrhage or interstitial fluid compromises blood flow to the muscle it can lead to compartment syndrome. Surgical treatment involves incising the fascia to decompress the muscle compartment.
Lacerations are tears in the muscle-tendon unit. Muscular lacerations require appositional sutures. Delicate manipulation and apposition is needed if the laceration goes through a tendon.
Nerve (Peripheral Nerve Repair)
Clean and sharp lacerations of nerves are easier to heal than crush or avulsion injuries. The earlier the nerve is repaired, the better the healing, re-innervation and normal function of the end organ. Dr. William McCartney of NOAH veterinary hospital has successfully repaired a number of sciatic nerve lacerations through early appositional suturing.