Wednesday, February 22, 2012

883. Lateral saphenous artery - Golden Retriever tumour in front of knee

The case of the old Golden Retriever with a large knee tumour.

"Your vet quoted $300 for the operation," the mother said.
"Who was the vet?" I asked as the surgery to excise this large knee tumour will take a long time, at least one hour. I had quoted $500. The owner did not want blood test or histopathology of the tumour and that would save some money. Still, $500 for the whole procedure including drugs, e-collar and post-op care was very low.

ANAESTHESIA
50% of domitor + ketamine IV according to my guidelines written previously.
The dog was old and at 50% was really knocked out. A whiff of the isoflurane gas + O2 after 5 minutes of sedation enabled intubation.

SURGERY
I demonstrated the surgery to Dr Daniel by operating together as this would not be a simple surgery as removing a tumour from the side of the body where there is a lot of skin. Here, the tumour was massive at 7 cm x 8 cm x 5 cm and if the textbook advice is to be followed, a wide resection meant insufficient skin for stitching. A wide resection is important to remove all tumour cells but an big knee wound due to insufficient skin area to close is deadly for the dog post-op as bacterial infection comes in over time.

Use marker pen to know how to excise.

BLEEDING ARTERY
There is one spurting artery of around 2 mm in diameter from the skin surface lateral to the tumour. "It is the lateral saphenous artery," Dr Daniel said. I advised a "purse-string" suture with the 2/0 absorbable and he did it. The bleeding stopped. But profuse bleeding from all other tissues continued. Swab, swab, swab, swab.

"A bi-polar electrode will be most useful," he said.
"In old dogs, the faster the surgery is done, the safer it is for this 8-year-old. I excised the tumour fast and started stitching. The bleeding continue unabated as there were numerous veins and smaller arteries. In theory, the bi-polar electrode would be used to coagulate. I could also use the coagulation electrode by switching to it from excision electrode."

"Look, the tongue and gum colour of the Golden Retriever is getting purplish," I said. In theory, it is best to stop all bleeding. This prolonged anaesthesia and the dog dies.

In practice, I stitched up the wound and used bandaging. A live patient is what the owner wants, not a clean no-bleeding surgical wound. This is the good outcome that is what text books don't teach.

You can see pictures at www.toapayohvets.com now. Will update again.

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