SAOP3- MicroSurgery

  1. What are the basic important principals of microsurgery? (8)
    • use magnification (2-4x loupes, operating microscope)
    • sit down
    • elbow rest
    • pencil grip for instruments
    • proper instrumentation
    • small suture materials
    • gentle tissue handling, don't touch a tissue without doing something with it
  2. What instruments are unique to microsurgery?
    • castroviejo locking needle holders
    • #64 beaver blades
    • martinez corneal dissector
    • colibri forceps (for conj and cornea)
    • bishop harmon forceps (for conj and skin)
    • stevens tenotomy scissors
    • wescott tenotomy scissors
    • chalazion clamp
    • eyelid speculum
    • jaeger eyelid plate
    • muscle hooks, eyelid retractor
  3. What type of needles are used in microsurgery?
    • Cornea: spatula needle with swaged on 7-0 or 9-0 vicryl suture
    • Skin/ conj: cutting needles with swaged on 4-6, 6-0 vicryl or nylon suture
  4. Most canine eyelid masses are _______.
  5. Describe the basic principals of eyelid mass resection. (3)
    • use chalazion clamp to immobilize mass and provide hemostasis and a cutting surface
    • full-thickness, wedge-shaped excision through skin and tarsal plate with #15 blade
    • finish excision with tenotomy scissors
  6. How do you close the conj after a wedge resection of an eyelid mass?
    • close conj with 4-0 to 6-0 absorbable suture, starting distally and working towards eyelid margin
    • continuous horizontal mattress pattern
    • reverse direction at eyelid margin, so the loop across the top opposes the margins of the incision
  7. How do you close the skin after a wedge resection of an eyelid mass?
    • 4-0 to 6-0 non-absorbable suture
    • start with figure of 8 (modified cruciate) stitch at the eyelid margin; symmetry is imperative
    • leave long tags and incorporate them into simple interrupted
  8. Describe the temporary tacking sutures used to correct entropion in young animals.
    • 2-3 vertical mattress sutures using 4-0 to 6-0 non-absorbable suture
    • MUST START 1mm or less from eyelid margin!!!!
  9. What are considerations when planning for entropion repair? (3)
    • lower eyelid entropion is more common than upper
    • most also have macroblepharon
    • most also have lateral canthal laxity/ rolling (notching of eyelid near lateral canthus)
  10. What are indications for permanent lateral canthoplasty? (2)
    • macroblepharon
    • lateral canthal rolling/ laxity
  11. Describe permanent lateral canthoplasty procedure.
    • full-thickness excision of crescent, including upper and lower eyelid margin
    • two-layered closure (same as wedge resection closure)
    • AFTER--> modified hotz-celsus procedure should be performed
  12. What is the modified hotz-celsus procedure?
    • crescent-shaped wedge of skin removed from lower lateral lid
    • start AT MOST 1-2mm from lower eyelid margin
    • place middle two sutures first, then close with interrupteds
    • everts lower eyelid
  13. What are the characteristics of an indolent corneal ulcer? (4)
    • superficial
    • non-infected
    • slow to vascularize
    • loose epithelium around margins
  14. What is the treatment for an indolent corneal ulcer?
    • corneal cytology to rule out infection
    • topical anesthetic
    • debride epithelium with dry cotton-tipped swabs
    • multiple grid keratectomy with 25 gauge needle or diamond burr
  15. What is the follow up for an indolent corneal ulcer? (5)
    • terramycin TID, atropine q 48hr, e-collar
    • >90% are healed in 14 days
    • wait 2-3 weeks before repeated grid keratectomy
  16. What are indications for a superficial keratectomy? (5)
    • melting corneal ulcer
    • stromal abscess
    • corneal sequestrum
    • corneal dermoid
    • corneal neoplasia?
  17. What instruments are required for a superficial keratectomy?
    • #64 beaver blade or corneal dissector
    • colibri forcep
  18. How much of a dog's eyelid can you safely remove and still have primary closure? Cats? Horses?
    • Dogs: up to 33% of eyelid margin
    • Cats, Horses: up to 25%
  19. How much of the cornea can safely be removed by superficial keratectomy?
    up to 50% of stromal depth without need for a graft
  20. What are indications for a conj pedicle graft?
    • deep (>50% stromal depth), non-perforating corneal ulcer refractory to medical therapy
    • [descemetocele, mycotic keratitis, bullous keratopathy, stromal abscess, melting ulcer]
  21. How is a conjunctival autograft achieved?
    • debridement of affected cornea by superficial keratectomy
    • bulbar conj mobilized using stevens tenotomy scissors
    • dissect away tenon's fascia to create a thin flap without tension
    • appose conj and corneal epithelium
    • severe blood supply >8wks following sx to limit scar formation
  22. How big should the flap be for a pedicle graft?
    must be as wide as the defect and long enough to avoid tension or retraction when put in place
Card Set
SAOP3- MicroSurgery
vetmed SAOP3