Surgery

The term elbow dysplasia refers to a degenerative disease of the elbow joint. There are several different potential causes for the problem, that may occur singly or at the same time in the same animal. Elbow dysplasia occurs primarily in medium to large breed dogs. Dogs with elbow dysplasia typically show signs of lameness before reaching one year of age, although in some cases lameness may not become apparent until middle age.

The treatment for this disease can involve surgical and/or medical options. If you think your dog is experiencing problems in his or her elbow joint, be sure to discuss your concerns with your veterinarian.
 

The Surgery Department is open from 7:30 a.m. to 6:00 p.m. Typically, we admit cases in the morning hours, so that diagnostic work, x-rays, or other tests can be performed during the day. Although we routinely schedule surgeries Monday through Friday, the surgeons are able to perform emergency surgery 7 days a week, 24 hours a day. Your pet should not receive any food after midnight the night before evaluation, so that the stomach will be empty in case sedation or anesthesia is required for any diagnostic work or surgery.

Many diagnostic procedures (such as CT scans and orthopedic x-rays) require sedation of the patient; these patients are usually able to go home the same afternoon.

Some diagnostic procedures (such as a myelogram) and all surgeries require general anesthesia. These patients will stay overnight so their recovery can be monitored by our overnight I.C.U. doctors. Discharge hours for these patients are between 12:00 p.m. and 5:00 p.m. the following day.
 

This is a hereditary, developmental disease that affects the hip joints of dogs. Certain breeds are more likely to be affected than others. Although its occurrence in large and giant breeds is well documented, there is evidence that it may also be present in smaller breed dogs and cats as well.

Poor conformation of the hip and thigh bone structures result in a 'looseness' of this ball and socket joint. This looseness allows the ball part of the joint to move in the socket, instead of remaining stable as it should in a healthy, normal, tight fit. This abnormal movement can create wear and tear in the joint, leading to arthritis. Although signs of the disease do not typically appear until after the dog matures, puppies as young as five to six months can be affected. Hip pain, stiffness, abnormal gait patterns, an
audible 'clicking' sound while walking, and a reluctance to exercise are all possible signs of hip dysplasia.

The disease is usually diagnosed using radiographs, or x-rays. The treatment for this condition is primarily surgical. In one type of procedure, the Triple Pelvic Osteotomy, or TPO, the bones of the pelvis are cut apart and rotated to more correct positions. In Total Hip Replacement (THR) procedures, a dog's diseased hip joints are replaced with prosthetic ones. The goal of both surgeries is to provide your pet with some measure of normal activity and function and to reduce the pain associated with the condition. A very high level of success is reported with these surgeries. However, as with all major procedures, it is very important to follow your veterinary surgeon's recommendations regarding recovery and rehabilitation.
 

Many owners are increasingly seeking specialized care for their pets, just as they do with other family members, in order to secure the very best outcome. If your pet is facing surgery, here are some questions you may wish to ask your general practitioner veterinarian:

• How often have you performed this type of surgery?
• Does the surgery require any special equipment?
• Is it available?
• Does my pet's surgery require a specialist?
• What should I expect the outcome of the surgery to be?
• What follow up care is necessary?

Source: The American College of Veterinary Surgeons

Veterinarians who want to become board certified in small animal surgery must seek additional, intensive training to become a specialist and earn this prestigious credentialing. Specialty status is granted by the American College of Veterinary Surgeons (ACVS). A veterinarian who has received this specialty status will list the initials, 'DACVS,' after his or her DVM degree. Or, the veterinarian may indicate that he or she is a 'Diplomate' of the ACVS. The word 'Diplomate' typically means the specialist has achieved the following:
 

Obtained a degree in veterinary medicine from a university certified by the American Veterinary Medical Association following completion of undergraduate requirements.

Completed a one year general internship, plus an additional three to four years of advanced training in a residency at a veterinary teaching hospital where the veterinarian will have trained with some of the best surgeons in the field and obtained hands on experience. Surgery residents also have to complete a case log in soft tissue, orthopedic, and neurologic surgery.

Completed the credentialing application process established by the ACVS, including publication of research results.

Passed a rigorous examination.

After completing and passing all of these rigorous requirements, the veterinarian is then recognized by his or her peers as a board certified specialist in veterinary surgery. When your pet needs the care of a veterinary surgeon, years of additional training and education will be focused on helping him or her to recover from injury or illness and enjoy the highest quality of life possible.

• Tumor removal
• Limb amputation
• Cruciate ligament repair (TPLO's and other traditional methods)
• Hip replacement
• Surgical repair of elbow dysplasia
• Spinal problems/herniated discs
• Gastric dilatation/volvulus
• Wound management and skin reconstruction
• Congenital defects
• Urinary obstructions
• Cancer Surgeries

Cancer does appear to be becoming more common in both dogs and cats, most likely because they are simply living longer. However, early detection and specialized care are leading to increased survival and cure rates in almost all the types of cancers that afflict pets. From surgery to chemotherapy to radiation therapy, veterinary cancer specialists (link to cancer specialty page) can offer your pet the very latest diagnostic and treatment options and the best chance of survival. With optimal treatment, cancer in many cases simply becomes another manageable chronic disease.

Surgery is one of the most common treatment options for pets with cancer, and can lead to enhanced survival times and better quality of life for many affected pets. Your veterinary surgeon will work closely with your general practitioner or veterinary oncologist to ensure your pet is getting the very best care.

Three orthopedic surgeries that are commonly performed in pets are triple pelvic osteotomy (TPO), total hip replacement (THR), and cruciate ligament repair (TPLO).

In the TPO procedure, the bones of the pelvis are cut apart and rotated to more correct positions. In THR procedures, a dog's diseased hip joints are replaced with prosthetic ones. TPO's and THR's are two commonly used surgical techniques for the treatment of canine hip dysplasia (CHD), an inherited and potentially painful disease that affects the hip joints of millions of dogs. Cruciate ligament disease can
occur in both dogs and cats, who usually tear or rupture this ligament while exercising, playing, or simply landing incorrectly after a jump. The ligament will not heal without surgery. Surgery helps to stabilize the pet's knee joint and prevent further wear on the joint and associated structures. An increasingly common surgical technique to correct this situation is called the Tibial Plateau Leveling Osteotomy'"or TPLO.
 

Surgery is a major medical procedure and is often associated with pain in both animals and humans. You can be assured that your veterinary team (your pet's general practitioner veterinarian, veterinary surgeon, and any other veterinary specialists involved in your pet's care) will prescribe pain management options to help keep your pet as comfortable as possible before, during, and after surgery. If you are concerned about pain management for your pet, simply ask your veterinarian.
 

Acetabular fracture: A fracture (break) of the acetabulum (hip socket) is usually stabilized with internal fixation: surgically exposing the bone, realigning the fractured area, and attaching a bone plate with screws to maintain alignment as the bone heals.

Achilles tendon repair: Through a surgical incision, the damaged portion of the Achilles tendon is trimmed, to the level of healthy tissue. Multiple heavy-gauge nonabsorbable sutures are then placed through the tendon, and also through holes drilled in the fibular tarsal bone, to securely reattach the ends of the tendon. A cast is then placed to maintain the tarsal joint in extension during healing.

Alar fold resection: a wedge-shaped region of the alar fold (the tissue at the nostril) is delicately excised, on each side, to maximize the diameter of the nostrils and improve airflow.

Ablation of the ear canal: Surgical removal of the entire ear canal, to eliminate severe chronic ear infection. This procedure is always performed in combination with a bulla osteotomy, surgically exposing the interior of the tympanic bulla (the bony chamber of the middle ear) to remove the infected lining tissue within. This procedure does not involve removal of the pinna (ear flap).

Adrenalectomy: Surgical removal of the adrenal gland, typically performed to remove a tumor. Animals (and humans) have two adrenal glands, located just ahead of the right and left kidneys.

Amputation – front leg: Removal of most or all of the leg, typically to eliminate a cancerous tumor, or in cases where the leg has been very severely injured.

Amputation – hind leg: Removal of most or all of the leg, typically to eliminate a cancerous tumor, or in cases where the leg has been very severely injured.

Amputation – toe: Removal of a toe, typically to eliminate a cancerous tumor, or in cases where the toe has been very severely injured.

Amputation – tail: Removal of most or all of the tail, typically in cases where the tail has been very severely injured, or paralyzed.

Amputation of tail, for tail fold pyoderma: The severely malformed tail and all of the overlying skin folds are surgically removed (leaving several coccygeal vertebrae undisturbed ahead of the point of transection, to ensure that none of the sacral nerves are damaged). The subcutaneous tissues and skin are then sutured, to create a smooth, comfortable surface.

Anal sacculectomy (anal sac removal, also referred to as “anal gland removal”): Removal of the anal sacs (two small pouches just under the skin adjacent to the anus), to eliminate recurrent infection/abscess formation, or to alleviate persistent discharge and odor.

Arthrodesis of carpus (fusion of the wrist joint): Surgically fusing the bones at the carpus, to eliminate trauma-induced instability.

Arytenoid lateralization (laryngeal tie-back): A surgical procedure to treat laryngeal paralysis, which causes the airway wall to collapse. Through an incision on the side of the neck, sutures are placed to pull one of the arytenoid cartilages of the larynx into a partially open position. This will permanently restore a comfortable ability to breathe easily.

Atlanto-axial subluxation stabilization: Through an incision on the underside of the neck, the atlas and axis (the first 2 vertebrae in the neck) are surgically exposed. The joint surface cartilage between these 2 vertebrae is delicately removed using a high speed drill, and small stainless steel bone pins are placed to stabilize the vertebrae in their proper alignment. Methylmethacrylate bone cement is then applied to permanently maintain the pins in position, to create permanent stability of these vertebrae.

Atresia ani correction: An incision is made in the perineum, to expose the rectum internally. The rectal lining tissue is then sutured to the circumference of the anal region, to create an opening wide enough for the stools to pass.

Bladder stones (cystic calculi): In many patients, laser lithotripsy (elimination of the stones using minimally invasive laser treatment) can be performed. In other patients, minimally invasive laparoscopic stone removal is recommended. In some patients, a cystotomy (surgical approach into the bladder) is necessary.

Bloat (aka gastric torsion, GDV, or gastric dilatation & volvulus): In this condition, the stomach rotates 180 degrees or more, filling with air and cutting off its own blood supply. Untreated, this condition is rapidly fatal. Immediate surgical treatment is necessary; the abdomen is surgically opened, and the stomach is rotated back to its normal position. Then, a gastropexy is performed, surgically attaching the stomach to the internal surface of the body wall, so that the stomach can never rotate again.

Brachycephalic syndrome: This is a condition seen with short-faced breeds such as Bulldogs, Pugs, and Persian cats. Due to the complex facial features, the airway is often obstructed with stenotic nares, elongated soft palate, and everted laryngeal saccules. Surgical treatment can be performed to alleviate these conditions by an alar fold resection (see above), soft palate resection (see below), and laryngeal sacculectomy (surgical removal of the protruding portion of the saccules)

Bulla osteotomy: Through an incision on the underside of the neck just behind the jaw, the tympanic bulla (the bony chamber of the middle ear) is surgically exposed. The lower surface of the bulla is then removed, allowing curettage to remove the infected lining tissue within.

Cesarean section: Surgical removal of puppies or kittens, through an incision in the uterus.

Carpal arthrodesis (fusion of the wrist joint): Surgically fusing the bones at the carpus, to eliminate trauma-induced instability.

Carpal fusion (arthrodesis, aka fusion, of the wrist joint): Surgically fusing the bones at the carpus, to eliminate trauma-induced instability.

Carpal shearing injury stabilization: Patients who have been struck by a car will occasionally have severe abrasion (shearing injury) of the skin, soft tissues, ligaments, and underlying bone at the carpus (wrist joint). This creates a large open wound, and severe instability. Surgical treatment depends on the precise location and severity of the injury. Stability is restored by repairing or replacing damaged ligaments, using orthopedic implants; in severe cases arthrodesis (carpal fusion) may be necessary. Severe loss of skin may necessitate skin grafts.

Carpometacarpal arthrodesis: Performed to alleviate trauma-induced instability at this joint. Through an incision on the front of the paw, the carpometacarpal joints (in humans, this is where the bones of the wrist meet the bones of the palm) is surgically exposed. The joint surface cartilage is removed using a high-speed drill. Bone graft is then placed to promote healing, and stainless steel bone pins are placed to maintain rigid internal stability and precise, straight alignment. A splint is then placed to protect the area during the initial healing period.

Castration (neutering): Surgical removal of the testicles.

Cervical ventral slot (cervical disc rupture): When an intervertebral disc has ruptured in the cervical (neck) region, an incision is made on the underside of the neck, to expose the vertebra. Then, a “ventral slot” (a very small surgically-created window through the disc and vertebrae) is created, into the spinal canal, to remove the ruptured disc material.

“Cherry eye” (third eyelid gland prolapse): A small incision is made in the mucosa (surface lining tissue), at the base of the protruding third eyelid gland. Using dissolving suture material, sutures are delicately placed to pull the third eyelid gland back into its normal position.

Cholecystectomy: Surgical removal of the gallbladder, to eliminate chronic pain and nausea due to infection (cholecystitis) or a mucocele (overdistention of the gallbladder due to accumulation of thick, mucoid secretions).

Cholecystoduodenostomy: Surgically creating an opening from the gallbladder into the duodenum (the uppermost section of the small intestine), in order to bypass an obstruction of the bile duct. Bile duct obstruction can result from scar tissue due to inflammation of the bile duct or pancreas, choleliths (gallstones), or tumors.

Chylothorax: In this condition, chyle (fat-containing fluid absorbed through the digestive tract) leaks into the thorax (chest cavity) from the thoracic duct (a small chyle-containing vessel leading from the abdomen, through the thorax, into the veins near the heart. As the thorax fills with chyle, the lungs are unable to expand properly, resulting in breathing difficulties. In addition, the chyle causes chronic inflammation and scarring of the lung surfaces. Surgical treatment involves creating an incision through the chest wall, and placing sutures to ligate the thoracic duct and surrounding tissues in an effort to prevent chyle leakage.

Cleft palate repair: Incisions are made in the oral mucosa (lining tissue), lip, and skin, creating flaps which are then sutured into position to reconstruct the area.

Colopexy: Through an abdominal incision, the colon is retracted forward, to eliminate looseness and thereby prevent rectal prolapse (protrusion of the rectal wall through the anus) from recurring. In this slightly stretched position, a surgical attachment is then created from the colon to the inner surface of the body wall to permanently maintain this positioning.

Cruciate ligament stabilization (lateral suture): In small dogs, when the cruciate ligament (the main stabilizing ligament within the knee joint) ruptures, the joint can be stabilized using heavy gauge nonabsorbable suture material.

Cryptorchid neuter: In some male dogs, one or both testicles fail to descend from the abdomen into the scrotal sac; this condition is called cryptorchidism. The retained testicle can be surgically removed, in some cases laparoscopically, and in other cases through a small incision into the abdomen.

Cystic calculi (bladder stones): In many patients, laser lithotripsy (elimination of the stones using minimally invasive laser treatment) can be performed. In other patients, minimally invasive laparoscopic stone removal is recommended. In some patients, a cystotomy (surgical approach into the bladder) is necessary.

Cystotomy: Surgical exposure of the interior of the bladder, to remove calculi (stones), or tumors. In many cases this can be accomplished using minimally invasive techniques using a laparoscopic, or a laser.

Diaphragmatic hernia: Dogs and cats sustaining a blunt force injury to the chest, such as being struck by a car or falling from a height, may develop a hernia (tear) in the diaphragm (the thin muscular membrane separating the chest and abdominal cavities). The abdominal organs may then move forward into the chest, preventing the lungs from properly expanding, and creating severe breathing difficulties. Surgical repair of the diaphragmatic hernia allows a return to a normal, active quality of life, with no impairment of breathing.

Dislocation (luxation) of the elbow: In some case, “closed reduction” (manipulating the elbow back into alignment, while the patient is anesthetized) can be accomplished. In these patients, a cast is placed for several weeks.

If proper alignment and stability cannot be achieved by closed reduction, or if the elbow luxates (becomes dislocated) again, then “open reduction” (surgical repair) is needed. The bones of the elbow are surgically exposed, and placed into proper alignment. Then, bone screws are placed, and heavy gauge suture material was attached to them, to restore the collateral ligamentous support for the joint. The overlying tissues are sutured, and a splint is placed to maintain stability as the joint heals.

Dislocation (luxation) of the hip: Blunt force injury, such as being struck by a car, may cause the hip joint to luxate (dislocate). In some cases, closed reduction (manipulating the hip back into position, with the patient anesthetized) can be successful. In other patients, if closed reduction cannot be performed or does not give adequate stability, then open reduction is performed: surgically exposing the hip joint, and placing heavy gauge suture using specialized orthopedic implants to stabilize the joint.

Dislocation (luxation) of the knee: The severely displaced stifle (knee) joint is surgically exposed. The medial and lateral menisci (2 small cushions of cartilage within the joint) are inspected, and if they are damaged, partial or complete removal is performed. In addition, the torn remnants of cruciate ligament are removed. The medial collateral ligament on the inner edge of the joint, and the lateral collateral ligament on the outer edge of the joint, are also evaluated. Heavy gauge suture material is then placed on the sides of the joint, to achieve realignment and stability.

In many cases, an external fixator is then applied, placing bone pins through the femur and the tibia, above and below the joint. These pins are then attached to an external connecting bar, to maintain rigid stability of the joint as it heals.

Ectopic ureters: In this congenital defect, one or both ureters (which carry urine from the kidney to the bladder) do not enter the bladder in a normal location. Instead, they are ectopic (malpositioned), entering the urethra (below the bladder) or the sphincter region of the bladder. In many cases, minimally invasive laser treatment is effective. In some cases, surgical repositioning of the ureter may be needed.

Elbow luxation stabilization: In some case, “closed reduction” (manipulating the elbow back into alignment, while the patient is anesthetized) can be accomplished. In these patients, a cast is placed for several weeks.

If proper alignment and stability cannot be achieved by closed reduction, or if the elbow luxates (becomes dislocated) again, then “open reduction” (surgical repair) is needed. The bones of the elbow are surgically exposed, and placed into proper alignment. Then, bone screws are placed, and heavy gauge suture material was attached to them, to restore the collateral ligamentous support for the joint. The overlying tissues are sutured, and a splint is placed to maintain stability as the joint heals.

Enterotomy: A surgical incision into the intestine, usually performed to remove a foreign object which has been swallowed.

Entropion: Excessive skin folds of the eyelids can result in hair and skin contacting the surface of the cornea, producing pain and damaging the corneal surface. Surgical removal of the excessive skin alleviates the problem.

Enucleation: Surgical removal of the entire globe of the eye; typically performed due to severe injury, or to eliminate chronic pain caused by various conditions which produce pain and blindness.

Exploratory laparotomy: Surgical evaluation of all of the internal organs; typically, small tissue specimens are obtained from multiple organs and submitted to the laboratory for biopsy, to identify any chronic inflammatory conditions, cancer, etc.

External fixator: In certain fractures, stabilization is achieved by placing bone pins directly through the skin into the underlying bone, and linking the pins by an external connecting bar. This technique preserves blood supply to the damaged area of bone, and reduces the risk of infection which might develop around internal orthopedic implants.

Fragmented coronoid process removal (elbow dysplasia): A loose fragment of bone and cartilage at the coronoid process region of the elbow can be removed arthroscopically, to alleviate pain.

Femoral head and neck excision (also referred to as FHNE, femoral head ostectomy, or FHO): Surgical removal of the femoral head (the “ball” of the ball-and-socket hip joint), to eliminate chronic pain due to arthritis, malformation, degenerative changes in the femoral head, or injury.

Fracture (broken bone) stabilization: Numerous techniques are used to stabilize a fractured bone: bone plates, bone screws, bone pins, external fixators, and various other orthopedic implants.

Front leg amputation: Removal of most or all of the leg, typically to eliminate a cancerous tumor, or in cases where the leg has been very severely injured.

Partial gastrectomy: The abdomen is surgically opened and the stomach ulcer or tumor, along with a margin of surrounding stomach tissue, is removed. The stomach incision was closed with two layers of dissolving suture material.

Gastric torsion (aka “bloat”, GDV, or gastric dilatation & volvulus): In this condition, the stomach rotates 180 degrees or more, filling with air and cutting off its own blood supply. Untreated, this condition is rapidly fatal. Immediate surgical treatment is necessary; the abdomen is surgically opened, and the stomach is rotated back to its normal position. Then, a gastropexy is performed, surgically attaching the stomach to the internal surface of the body wall, so that the stomach can never rotate again.

Gastropexy (elective): In certain large breed dogs, an elective gastropexy can be performed: Through a minimally invasive laparoscopic technique, a gastropexy (surgical attachment of the stomach to the interior surface of the body wall) is performed, to prevent any chance of the patient developing a gastric torsion (bloat) later in life.

Hemilaminectomy: When the patient develops an intervertebral disc rupture in the thoracolumbar region (the midportion of the back), a hemilaminectomy is performed: Surgically creating a very small window in the vertebrae (the bones of the spine) to remove the ruptured disc material. This alleviates pressure on the spinal cord, allowing the nerves the best possible chance to heal.

Hemimandibulectomy, partial mandibulectomy, or rostral mandibulectomy: When a tumor involves the mandible (lower jaw), then the region of the mandible containing the mass, and a surrounding margin of the soft tissues, bone, and adjacent teeth, is surgically removed. The underlying tissues and the mucosa (gum tissue) are then sutured closed.

Hemimaxillectomy, partial maxillectomy, or rostral maxillectomy: When a tumor involves the maxilla (upper jaw), then the region of maxilla containing the mass, and a surrounding margin of the soft tissues, bone, and adjacent teeth, is surgically removed. The underlying tissues and the mucosa (gum tissue) are then sutured closed.

Hemipelvectomy: When cancer involves a large region of the pelvis, a hemipelvectomy may be recommended: removing half of the pelvis, along with the hind leg, in order to give the maximum possible chance of eliminating the malignancy within the bones of the pelvis. Polypropylene mesh is often used to reconstruct the lower edge of the body wall, to prevent any abdominal hernia from developing. The overlying fat and subcutaneous tissues and skin are then sutured to create a smooth contour.

Hiatal hernia repair: through an abdominal incision, the stomach is gently pulled back from the diaphragm. Two gastropexies (permanent sutured attachments of the stomach surface to the interior of the body wall) are then created, one on the left side and another on the right side, to prevent the stomach from herniating forward into the thoracic cavity.

Hind leg amputation: Removal of most or all of the leg, typically to eliminate a cancerous tumor, or in cases where the leg has been very severely injured.

Hip luxation (dislocation): Blunt force injury, such as being struck by a car, may cause the hip joint to luxate (dislocate). In some cases, closed reduction (manipulating the hip back into position, with the patient anesthetized) can be successful. In other patients, if closed reduction cannot be performed or does not give adequate stability, then open reduction is performed: surgically exposing the hip joint, and placing heavy gauge suture using specialized orthopedic implants to stabilize the joint.

Humeral condylar fracture stabilization: Through an incision at the elbow, the humeral condyle (the upper bone of the elbow joint) is manipulated back into its proper position. An orthopedic screw and a stainless steel bone pin are placed, to firmly stabilize the alignment.

Hygroma: A hygroma is a large fluid filled swelling which can develop over a “pressure point”, usually at the point of the elbow. Drainage of the fluid will not resolve the problem, since the fluid quickly re-accumulates. So, surgical removal of the fluid filled sac is performed, placing multiple layers of sutures in the underlying tissues to prevent any recurrence.

Iliac fracture: A fracture (break) of the ilium (the largest, weight-bearing bone of the pelvis, ahead of the hip joint) is usually stabilized with internal fixation: surgically exposing the bone, realigning the fracture, and attaching a bone plate with screws to maintain alignment as the bone heals.

Inguinal hernia repair: Through an incision in the overlying skin, the abdominal fat protruding through the hernia (abnormal opening in the body wall) is replaced into the abdomen. The edges of the hernia are then sutured closed, to permanently eliminate this abnormal opening.

Intestinal foreign body removal: The abdomen is surgically opened, and through an incision in the intestine, the foreign object is removed.

Intestinal resection & anastomosis: In some cases, obstruction by a foreign object can cause severe inflammation and devitalization of a section of the small intestine. So, a resection and anastomosis is performed, removing the damaged region of the intestine, and suturing the ends of the healthy portions of intestine together to reestablish continuity.

Intestinal tumor removal: An intestinal resection and anastomosis is performed, removing the region of the intestine containing the mass, and suturing the ends of the adjacent portions of intestine together to reestablish continuity.

Ischial tuberosity resection: this procedure is designed to eliminate a chronic decubital (pressure) sore at the ischial tuberosity (the bony point at the back edge of the pelvis, just below and to the side of the tail base). An incision is made to expose the ischial tuberosity. The muscles are delicately separated from the bone, and the point of bone is then surgically removed. The muscles and skin are sutured to create a smooth, comfortable contour.

Jejunostomy tube: A feeding tube which is placed into the jejunum (the middle portion of the small intestine).

Juvenile pubic symphysiodesis: Through an incision on the underside of the pelvis, the symphysis (region of bone growth) on the midline of the pubis (the bone comprising the floor of the pelvis) is surgically excised, and the edges are cauterized. An orthopedic wire is then placed to eliminate the space between the right and left sides of the pubis. This procedure prevents any further growth of the pubis; and since the remainder of the pelvis continues to grow at a normal speed, the result is a more stable angle of the hip socket (acetabulum) on the right and left sides.
With this procedure, a concurrent ovariohysterectomy (spay) or neuter can be performed.

Laparoscopic gastropexy (elective): In certain large breed dogs, an elective gastropexy can be performed: Through a minimally invasive laparoscopic technique, a gastropexy (surgical attachment of the stomach to the interior surface of the body wall) is performed, to prevent any chance of the patient developing a gastric torsion (bloat) later in life.

Laparoscopic ovariectomy: Using a minimally invasive laparoscopic technique, the ovaries are surgically removed, ligating the blood vessels using stainless steel clips and/or suture.

Laryngeal tie-back (arytenoid lateralization): A surgical procedure to treat laryngeal paralysis, which causes the airway wall to collapse. Through an incision on the side of the neck, sutures are placed to pull one of the arytenoid cartilages of the larynx into a partially open position. This will permanently restore a comfortable ability to breathe easily.

Lateral ear canal resection: Although rarely performed, this technique can be useful in helping to alleviate recurrent otitis externa (infection of the external ear canal). The lateral (outermost) wall of the vertical ear canal is surgically removed, down to the level of the horizontal ear canal. The skin edges are then sutured to the cut edges of the ear canal. This procedure allows the horizontal canal to open directly to the skin surface, maximizing ventilation and drainage. This will give the best possible chance of eliminating the persistent infection within the ear canal.

Since the ear canal itself is usually very thickened with chronic inflammation, it is more common to perform a total ear canal ablation & bulla osteotomy (T.E.C.A.B.O.).

Lip avulsion repair: Multiple heavy-gauge sutures are placed around the teeth (and through several tiny holes drilled through the bone) to securely reattach the lower lip which had been torn away from the lower jaw. The mucosa (gum tissue) is then sutured closed.

Liver lobectomy: A surgical treatment of liver tumors isolated to one of the liver lobes. The abdomen is surgically opened, and the section of the liver containing the tumor is removed, using surgical stapling devices to prevent bleeding. The remainder of the abdomen is inspected as well.

Lumbosacral laminectomy: To alleviate severe pain due to pinching/compression of the nerve roots at the lumbosacral junction (where the spine joins to the pelvis), a laminectomy can be performed: removing the thin layer of bone and fibrous tissue above the nerve roots, and excising the accessible portions of the protruding disc below the nerve roots, to alleviate nerve root compression and thereby alleviate pain. In some cases, orthopedic implants are also used to stabilize the lumbosacral junction.

Lung lobectomy: In some cases, this can be accomplished using minimally invasive thoracoscopic techniques. In many cases, however, it is necessary to make an incision between two ribs. Then, the lung lobe containing the tumor is surgically removed, using surgical stapling tools to ligate the vessels and the bronchus.

Mass removal: The tumor, along with a margin of tissue surrounding it and beneath it, are surgically removed. The subcutaneous tissues and skin are then sutured.

Mastectomy: The entire mammary chain containing the tumor, along with the maximum possible margin of tissue surrounding it and beneath it, is surgically removed. (In dogs, occasionally only a portion of the mammary chain is removed, depending on the specific type of tumor. In cats, the entire mammary chain is typically removed). The subcutaneous tissues and skin are then sutured. In patients who have tumors in both the right and left mammary chains, simultaneously removing both sides is rarely possible since it usually would create excessive tension on the incision. So, one mammary chain is removed initially, and 2 weeks later, the opposite mammary chain can be removed.

Metacarpal fracture pinning: through an incision on the upper surface of the paw, each of the fractured metacarpal bones (in humans, these are the bones of the palm) is surgically exposed and realigned. Very small diameter bone pins are placed to maintain alignment. A splint is then placed to protect the area during the healing period.

Metatarsal fracture pinning: through an incision on the upper surface of the paw, each of the fractured metatarsal bones (in humans, these are the bones of the instep of the foot) is surgically exposed and realigned. Very small diameter bone pins are placed to maintain alignment. A splint is then placed to protect the area during the healing period.

Nephrectomy: Typically performed if a tumor is present in the kidney, or if severe chronic infection, obstruction, or congenital abnormalities have rendered the kidney nonfunctional. The blood vessels leading to the kidney are surgically ligated, and the entire kidney is removed, along with the majority of the ureter (which leads from the kidney into the bladder).

Nonunion femoral fracture plating: in some untreated fractures (broken bones), the bone ends may not heal solidly, resulting in an unstable region of fibrous tissue between the bone ends. This is known as a nonunion. Surgery is the only effective means of treatment. The nonunion region is cut away, using a bone saw, down to the level of healthy bone above and below. These healthy bone ends are then aligned and compressed together, using a stainless steel bone plate and screws.

Nosectomy: Typically performed for invasive tumors. The entire nose, including the internal nasal cartilage, is removed to the level of the underlying nasal bones. The area is then sutured to maintain alignment and positioning of the upper lip, and to adjust the diameter of the new nasal opening.

OCD (osteochondritis dissecans) of the elbow: A loose fragment of bone and cartilage at the coronoid process region of the elbow can be removed arthroscopically, to alleviate pain.

OCD (osteochondritis dissecans) of the shoulder: Using an arthroscope, the interior of the shoulder joint is visually inspected. The osteochondritis dissecans lesion (consisting of either a loose cartilage flap, or a deep pocket of degenerative cartilage) is removed, using a grasping forceps or a curette.

OCD (osteochondritis dissecans) of the stifle (knee): Using an arthroscope, the interior of the stifle (knee) joint is visually inspected. In some cases, the osteochondritis dissecans (OCD) cartilage flap can be removed, using a grasping forceps. In other cases, the OCD lesion consists of a large area of malacic (degenerative) cartilage; and curettage may require an incision into the joint, to gain optimal access.

Oronasal fistula: the edges of the fistula (the abnormal opening between the oral and nasal cavities) are excised. Then, a rotating flap of mucosa (the surface lining tissue of the mouth) is created using the adjacent region of the gum and lip tissue. This flap is sutured to the edges of the fistula to achieve complete closure. Alternatively, some cases require a hard palate bipedicle flap closure, mobilizing 2 strips of the adjacent mucosa while leaving each strip attached at each end. These 2 strips of tissue are then slid together and sutured over the fistula to achieve complete closure.

Ovariohysterectomy (“spay”): the ovaries and uterus are surgically removed, ligating all of the blood vessels using stainless steel clips and/or suture.

Pancreatic abscess debridement: the severely inflamed pancreas is surgically evaluated, and any abscess pockets are identified. These abscesses are drained and then a portion of the omentum (intra-abdominal fatty tissue) is sutured into each abscess cavity to promote healing. A closed suction drain is placed, to help evacuate infected fluid from the abdomen during the initial healing period.

Pancreatic mass removal: The mass, along with a small surrounding margin of pancreatic tissue, is surgically removed, while delicately preserving the intestinal blood vessels directly adjacent to the area.

Most pancreatic masses are malignancies. So, even if the adjacent liver is visually normal, a small specimen of liver tissue is submitted for biopsy to check for any microscopic evidence of metastasis.

Parathyroid mass removal: Through an incision on the underside of the neck, the parathyroid mass (adjacent to the thyroid gland), along with a small surrounding margin of the thyroid tissue, is surgically removed.

Patellar luxation stabilization: this is a very common congenital/developmental condition, particularly in small dogs, in which the patella (kneecap) is unstable/dislocated/malpositioned/”slipped”. To restore proper anatomic alignment of the patella and knee joint, a modified wedge recession trochleoplasty is performed, deepening the groove beneath the patella. A tibial tuberosity transposition is then performed, shifting the bony point of attachment of the patellar tendon to pull the patella into a straight alignment. Stainless steel bone pins are placed, to stabilize this area as the bone heals. The adjacent ligamentous tissues are then sutured, to achieve maximum stability.

Patellar fracture repair: Through an incision on the front of the knee, the fractured patella (kneecap) is surgically exposed. A bone pin and a figure-of-8 orthopedic wire are placed, to precisely realign the bone fragments. In addition, a heavy gauge suture is often passed along the uppermost edge of the patella, parallel to the patellar tendon, and through a hole drilled in the tibial tuberosity (just below the knee joint). This suture is then tightened, to eliminate tension on the patella during weight-bearing, in order to give the best possible chance of healing.

Patellar tendon laceration repair: The ends of the patellar tendon are sutured together, using heavy gauge nonabsorbable suture material. In addition, a heavy gauge suture is often passed along the uppermost edge of the patella, parallel to the patellar tendon, and through a hole drilled in the tibial tuberosity (just below the knee joint). This suture is then tightened, to eliminate tension on the patellar tendon during weight-bearing, in order to give the best possible chance of healing.

Patent ductus arteriosus: A condition that results in the failed closure of a fetal vessel near the heart. Occlusion of this vessel can usually be performed by a minimally invasive catheterization procedure, using fluoroscopy (motion picture x-ray). In extremely small patients, open chest surgery may be required to ligate the vessel.

Pectus excavatum splinting: In this congenital condition, the sternum (“breastbone”) is malformed, curving upwards towards the spine, greatly reducing the size of the chest cavity. This interferes with the function of the lungs. To improve the alignment of the sternum, under general anesthesia multiple heavy-gauge sutures are passed around the sternum. The sutures are then passed through holes drilled in a splint placed along the underside of the chest. By tightening these sutures, the sternum is pulled into its best possible alignment, maximizing the expansion of the chest cavity, in order to allow the lungs to expand more normally and reduce the degree of impaired respiratory function.

Penile amputation: Typically performed for severe injuries, or to remove a malignancy. The entire penile shaft and prepuce are surgically removed. The urethral opening is then sutured to the skin, to allow normal urination.

Perianal mass removal: The entire perianal mass beside the anus is surgically removed, along with the involved region of anal sphincter musculature, rectal wall, and overlying skin. Sutures are then placed to reestablish the circular contour of the anal sphincter, to maintain proper fecal continence. The skin and rectal wall are then sutured closed.

Pericardial window/pericardiectomy: Fluid accumulation in the pericardium, due to the presence of a tumor or chronic inflammation, can cause serious impairment of heart function. Using a minimally invasive thoracoscopic technique, a portion of the pericardium (the sac surrounding the heart) is removed. This prevents fluid accumulation within the sac, thereby maximizing heart function.

Perineal hernia repair: A perineal hernia is a condition normally seen and intact male dogs to develop weakening/atrophy of their pelvic muscles, causing constipation and/or straining in urination. Through an incision on the side of the anus, the perineal region is surgically exposed. The abdominal fat (and prostate gland) which have herniated into this region are gently pushed back into the abdomen. A portion of the obturator muscle of the pelvis is then surgically repositioned, and sutured to the adjacent anal sphincter and musculature, to close the hernial opening. In some cases, synthetic mesh is also used to reinforce the area. Castration is also performed, to reduce the incidence of recurrence.

Perineal urethrostomy: To eliminate persistent obstruction, the lower portions of the penile and urethral tissues are surgically removed, enabling us to create a much wider opening of the urethra. The urethral edges are sutured to the skin, to achieve a permanently wide opening and thereby prevent any future obstruction.

Phallopexy: This procedure is performed to treat chronic paraphimosis (protrusion of the penile tip outside of the preputial sheath, causing excessive trying, inflammation, and discomfort of the penile tip). The prepuce is surgically incised, to expose the penile shaft. A small area of the mucosa (surface lining tissue) of the upper surface of the penile shaft, and the adjacent area of interior mucosa of the preputial cavity, is removed. These areas are then sutured together; this will create a permanent adhesion (“pexy”) of the penile shaft inside the prepuce, preventing the penile tip from becoming exteriorized.

Plate removal: In the great majority of patients, bone plates (such as those used to repair fractures, or to perform a TPLO surgery) remain in place permanently, without causing any discomfort. However, in a small number of patients, the patient may experience discomfort due to the presence of metal in the area, or infection may develop around the metal implants. Fortunately, once the bone has healed, these metal implants are no longer needed, and can safely be removed.

An incision is made over the plate, and the plate and screws are removed. A bacterial culture specimen is usually submitted from this region to help determine whether bacterial infection is present.

Portosystemic shunt closure: Prior to surgery, a digital helical CT scan is typically performed, to identify the precise location of the shunting vessel (an abnormal vessel which is allowing blood to bypass the liver, rather than being properly filtered through the liver). Then, the abdomen is surgically opened, and the shunting vessel is identified. An Ameroid constrictor ring is delicately placed around this vessel; the ring will slowly close during the next 3 months, forcing the blood to circulate properly to the liver. A liver biopsy specimen is typically submitted to the laboratory as well, to check for any concurrent disease conditions and/or microscopic blood vessel abnormalities.

Peritoneopericardial diaphragmatic hernia (PPDH) repair: In this congenital condition, a hernia (abnormal opening) is present from the peritoneum (the abdominal cavity) into the pericardium (the sac surrounding the heart). To surgically repair this opening, an incision is made on the underside of the abdomen, to gain access to the diaphragm. In some cases, the last several sternal bones are surgically cut, to improve access to the pericardial sac.

Then, the liver lobes, gallbladder, intestines, and/or abdominal fat which had herniated into the thorax are gently repositioned into the abdomen. The edges of the diaphragmatic hernia are then sutured closed.

Persistent right aortic arch transection: In this congenital abnormality, the ligamentum arteriosum (a band of tissue) encircles the esophagus, creating obstruction and preventing solid food from being swallowed. Through an incision between 2 ribs, the ligamentum arteriosum is ligated and then surgically cut, to alleviate the esophageal obstruction.

Prostatic cyst omentalization: Through an incision in the abdomen, one or more large fluid-filled prostatic cysts are surgically exposed and drained. The majority of the cyst wall is surgically removed, to the maximum extent possible without jeopardizing the nerves leading to the urinary sphincter. Then, the omentum (intra-abdominal fatty tissue) is surgically placed into the interior of the cyst, to improve circulation and minimize the chance of cysts developing again in the future.

Pyloroplasty: Typically performed for patients with pyloric hypertrophy (abnormal thickening of the outflow region of the stomach, where it connects to the small intestine). In order to eliminate outflow obstruction of the stomach, the abdomen is surgically opened. A full thickness incision is made in the pyloric region (the lower end of the stomach), extending into the duodenum (the uppermost portion of the small intestine). This incision is then sutured in a pattern which greatly widens the opening of the stomach into the intestine, to alleviate the obstruction. A biopsy specimen of the stomach is also obtained for laboratory analysis.

Pyometra ovariohysterectomy: Pyometra (infection within the uterus) is an emergency situation. The ovaries and the severely infected, pus-filled uterus are surgically removed, ligating all of the blood vessels using stainless steel clips and/or suture. (In healthy patients without uterine infection, an ovariohysterectomy is often referred to as a “spay”.)

Pyothorax thoracotomy: In some patients with a pyothorax (severe infection within the chest cavity), a thoracotomy (surgical exposure of the interior of the chest cavity) is performed. In most cases, a median sternotomy is performed, surgically cutting the bones of the sternum to gain access to the entire chest cavity. All the infected discharge is suctioned out, and the entire chest cavity is inspected to identify any foreign objects such as a grass awn (“foxtail”). Thoracostomy tubes (chest drains) are then placed on each side, to enable continuing removal of infected material during the immediate postoperative period. The bones of the sternum are then wired back together, and the incision is sutured closed.

Rectal mass removal: An incision is made just above the anus, beneath the tail base. The mass in the wall of the rectum is then delicately separated from the rectal mucosa (lining tissue), and removed. The tail base muscles and skin are then sutured, to close the incision.

Retrobulbar exploratory: Through an incision above and behind the eye, the retrobulbar region (the internal region of the eye socket, behind the globe of the eye) was surgically exposed. This is typically performed to drain an abscess, or to remove a foreign object such as a grass awn (“foxtail”).

Sacral fracture stabilization: Through a surgical incision, the fractured sacrum (the base of the spine) is realigned, and stabilized using bone screws and/or bone pins. This can often be accomplished through a minimally invasive approach, using a fluoroscope (motion-picture x-ray unit).

Sacroiliac luxation (dislocation) stabilization: Sacroiliac luxation is caused by blunt-force injury, most commonly when the patient has been struck by a car. The resulting instability creates pain and difficulty in weight-bearing. Through a small incision, the ilium (the largest bone of the pelvis) is realigned with the sacrum (the base of the spine) and reattached using 1 or 2 bone screws. This is usually accomplished through a minimally invasive approach, using a fluoroscope (motion-picture x-ray unit).

Scrotal urethrostomy: some patients with recurrent episodes of urethral obstruction (due to urinary stones) may develop scar tissue. To bypass this area of persistent, progressive obstruction, a new permanent opening (urethrostomy) is created, on the base of the penile shaft just ahead of the scrotum. An incision is made in the urethra, at the back edge of the penile shaft. Any urinary stones lodged within the urethra are extracted. The edges of the urethra are then delicately sutured to the skin, to provide a permanent, wide opening. On rare occasions, tumors of the urethra may also necessitate this procedure.

Shoulder luxation (dislocation): through an incision in the overlying skin and musculature, the shoulder joint is accessed. Then the biceps tendon is repositioned (or, alternatively, heavy-gauge sutures are placed) to stabilize the shoulder joint, preventing the luxation (dislocation) which had been occurring.

Sialocele (aka mucocele, or “salivary cyst”): In his condition, a large saliva-filled pocket developed on the underside of the jaw, due to leakage of saliva from the salivary ducts. Through an incision on the side of the neck, the combined mandibular and monostomatic sublingual salivary glands are removed in their entirety. This permanently eliminates accumulation of saliva in the tissues. Fortunately, since dogs and cats have multiple other salivary glands, this surgery does not create any insufficiency of salivation.

Soft palate resection: Using an electrosurgical cauterizing/cutting instrument, the excessively long portion of the soft palate (the flap of muscle separating the back portion of the oral and nasal cavities) was removed, to eliminate its interference with the epiglottis (the forwardmost cartilage of the larynx).

Spinal fracture stabilization: Through a surgical incision, the fractured vertebra is surgically exposed and realigned. Stabilization is then performed using either bone pins and bone cement, or a bone plate and screws, in order to rigidly stabilize the vertebral fracture.

Splenectomy: Typically performed when there is a tumor growing in the spleen; occasionally performed as part of the treatment of immune-mediated hemolytic anemia. The entire spleen is surgically removed, ligating all of the blood vessels. All other internal organs are visually inspected as well.

Sternotomy & lung lobectomy to alleviate spontaneous pneumothorax (air leakage within the chest cavity): The sternum (“breastbone”) was surgically cut, allowing access to the entire chest cavity. The source of air leakage is then located, and surgical stapling tools are used to remove the involve lobe (section of lung). All the other lung lobes are thoroughly inspected, to confirm that there are no other sources of air leakage. The sternal bones are then wired back together, and the incision is closed with sutures.

Stifle luxation (dislocation) stabilization: The severely displaced stifle (knee) joint is surgically exposed. The medial and lateral menisci (2 small cushions of cartilage within the joint) are inspected, and if they are damaged, partial or complete removal is performed. In addition, the torn remnants of cruciate ligament are removed. The medial collateral ligament on the inner edge of the joint, and the lateral collateral ligament on the outer edge of the joint, are also evaluated. Heavy gauge suture material is then placed on the sides of the joint, to achieve realignment and stability.
In many cases, an external fixator is then applied, placing bone pins through the femur and the tibia, above and below the joint. These pins are then attached to an external connecting bar, to maintain rigid stability of the joint as it heals.

Subtotal colectomy: To alleviate chronic recurrent constipation which has persisted despite medical treatment. Approximately 90% of the colon is surgically removed, preserving just enough at each end to allow the ends to be sutured together. After the ends are sutured together, the abdomen is lavaged with sterile solution to reduce the risk of infection, and the incision is closed.

Superficial digital flexor tendon luxation stabilization: an incision is made on the side of the calcaneal region (the point of the hock; in humans, this is the heel). The retinaculum (the fibrous tissue surrounding the tendon) is sutured, achieving excellent stability for the tendon. The incision is sutured, and a splint is placed to protect the area during the healing period.

Supraglenoid tubercle avulsion fracture stabilization: the fractured supraglenoid tubercle, on the front of the shoulder joint, is surgically exposed and realigned. A bone pin and a figure-of-8 orthopedic wire are placed, to provide rigid internal fixation and stability.

Tail amputation: Removal of most or all of the tail, typically in cases where the tail has been very severely injured, or paralyzed.

Tail amputation, for tail fold pyoderma: The severely malformed tail and all of the overlying chronically infected skin folds are surgically removed (leaving several coccygeal vertebrae undisturbed ahead of the point of transection, to ensure that none of the sacral nerves are damaged). The subcutaneous tissues and skin are then sutured, to create a smooth, comfortable surface, permanently eliminating infection and pain.

Tarsal arthrodesis (fusion): Performed if injury has created severe instability, arthritis, and pain at the tarsal (ankle) joint. Through an incision over the tarsus (ankle joint), the bones are surgically exposed and the joint surface cartilage is removed using a high-speed drill. Bone graft is then placed to promote healing, and a bone plate is attached with screws to maintain rigid internal stability and precise alignment. The incision is closed, and a cast is placed to protect the area during the initial healing period.

Tarsal shearing injury stabilization: Patients who have been struck by a car will occasionally have severe abrasion (shearing injury) of the skin, soft tissues, ligaments, and underlying bone at the tarsus (ankle joint). This creates a large open wound, and severe instability. Surgical treatment depends on the precise location and severity of the injury. Stability is restored by repairing or replacing damaged ligaments, using orthopedic implants; in severe cases arthrodesis (tarsal fusion) may be necessary. Severe loss of skin may necessitate skin grafts.

Tarsometatarsal arthrodesis: Through an incision on the front of the paw, the tarsometatarsal joint (just below the tarsal i.e. ankle joint) is surgically exposed and the joint surface cartilage is removed using a high-speed drill. A bone graft is then placed to promote healing, and stainless steel bone pins are placed to maintain rigid internal stability and precise, straight alignment. A splint is then placed to protect the area during the initial healing period.

Third eyelid gland prolapse (“cherry eye”): A small incision is made in the mucosa (surface lining tissue), at the base of the protruding third eyelid gland. Using dissolving suture material, sutures are delicately placed to pull the third eyelid gland back into its normal position.

Thoracic wall (chest wall) mass removal: Through an incision on the side of the chest, the mass (including a section of each of the involved ribs) is surgically removed, with the maximum possible surrounding margin of tissue. Polypropylene mesh is then sutured over the removed region to reinforce the area, and the overlying muscles and skin are sutured closed.

Thoracoscopic pericardial window/pericardiectomy: Fluid accumulation in the pericardium, due to the presence of a tumor or chronic inflammation, can cause serious impairment of heart function. Using a minimally invasive thoracoscopic technique, a portion of the pericardium (the sac surrounding the heart) is removed. This prevents fluid accumulation within the sac, thereby maximizing heart function.

Thymoma thoracotomy: The bones of the sternum are surgically cut along the midline, to gain access to the chest cavity. The thymoma (tumor originating from the thymus) is removed, ligating all of the attached blood vessels with stainless steel clips and/or suture. Orthopedic wire is then placed to stabilize each sternal bone, and the incision is closed.

Thyroid mass removal: The right or left thyroid gland containing the tumor, along with the maximum possible margin of tissue surrounding it and beneath it, is surgically removed. In order to obtain the widest possible margin of excision, it is often necessary to remove the muscles adherent to the tumor, as well as the involved region of the jugular vein and carotid artery.

Tibial tuberosity avulsion fracture stabilization: through an incision at the knee, the tibial tuberosity (the bony point of attachment of the patellar tendon) is manipulated back into its proper position. A stainless steel bone pin and a figure-of-8 orthopedic wire are placed to firmly stabilize the alignment.

Toe amputation: Removal of a toe, typically to eliminate a cancerous tumor, or in cases where the toe has been very severely injured.

Tonsillectomy: using an electrosurgical/cauterizing device, each of the tonsils was entirely removed, at the point where the tonsil attaches to the underlying tissues. There was no evidence of bleeding during the procedure, or after the tonsils had been removed.

Total ear canal ablation and bulla osteotomy (T.E.C.A.B.O.): Surgical removal of the entire ear canal, to eliminate severe chronic ear infection. This procedure is always performed in combination with a bulla osteotomy, surgically exposing the interior of the tympanic bulla (the bony chamber of the middle ear) to remove the infected lining tissue within. This procedure does not involve removal of the pinna (ear flap).

Total hip joint replacement: For patients with severe arthritis that is not responsive to medical management, surgical replacement of the hip joint is performed, using a titanium and polyethylene ball-and-socket implant. The prognosis for pain relief is excellent.

TPLO (Tibial plateau leveling osteotomy), to treat cranial cruciate ligament rupture: the tibia was surgically cut and realigned just below the joint surface, to stabilize the joint. A bone plate was attached with screws to maintain alignment as the bone heals.
In many patients with a cruciate ligament rupture, the medial meniscal cartilage (a cushion of cartilage within the joint) may also be torn. If so, a partial meniscectomy (removal of the torn portion) is performed. In other patients, if it is not yet torn, the surgeon may elect to perform a meniscal releasing incision (incising one attachment of the medial meniscal cartilage, so it will not tear in the future and require further surgery.)

Triple pelvic osteotomy: the bones supporting the hip socket were surgically cut, and the socket is rotated to a position of maximum stability. A bone plate is then attached with screws to maintain the alignment as the bone heals.

Tracheostomy (permanent): In patients with severe damage or malfunction of the larynx, occasionally a permanent tracheostomy is performed. In the middle region of the neck, the trachea is surgically exposed, and a section of the wall of the trachea is removed. The surrounding muscles, subcutaneous tissues, and skin are then sutured, to create a permanent opening of the trachea to the skin surface on the underside of the neck.

TTA (Tibial tuberosity advancement) to treat cranial cruciate ligament rupture: the tibial tuberosity (the bony point of attachment of the patellar tendon on the front of the knee) is surgically cut and re-positioned using specialized titanium implants, in order to stabilize the knee joint.

In many patients with a cruciate ligament rupture, the medial meniscal cartilage (a cushion of cartilage within the joint) may also be torn. If so, a partial meniscectomy (removal of the torn portion) is performed. In other patients, if it is not yet torn, the surgeon may elect to perform a meniscal releasing incision (incising one attachment of the medial meniscal cartilage, so it will not tear in the future and require further surgery.)

Ununited anconeal process: some medium and large-breed dogs may develop an ununited anconeal process (a large, loose bone fragment in the central portion of the joint).
In young dogs whose bones are still growing, an ulnar ostectomy can be performed: the ulna (the nonweightbearing bone of the front leg) is surgically exposed and a small section is cut and removed. This will allow the upper section of the ulna to improve its alignment with the radius (the main, weight-bearing bone of the front leg), and will give the best possible chance for the anconeal process (a bony projection of the ulna, within the elbow joint) to solidly fuse onto the underlying region of the ulna.
In older dogs whose bones are no longer growing, surgical removal of the loose fragment is performed, through an incision on the side of the elbow joint.

Ulnar ostectomy: the ulna (the nonweightbearing bone of the front leg) is surgically exposed and a small section is cut and removed. This will allow the upper section of the ulna to improve its alignment with the radius (the main, weight-bearing bone of the front leg). This will allow the bones to regain their best possible alignment at the elbow, giving the maximum possible degree of pain relief at the joint.

Urethral prolapse resection: A circumferential incision is made, to remove the protruding region of urethral mucosa (lining tissue). Fine-gauge sutures are then placed around the circumference, to reattach the urethral mucosa to the opening at the tip of the penis.

Vasectomy: Through an incision just ahead of the scrotum, a section of the right and left vas deferens (the ducts through which the sperm passes) are surgically removed, and the ends of each vas deferens are then ligated, to permanently eliminate any passage of sperm.

Vertical ear canal ablation: Although rarely performed, this technique can be useful in helping to alleviate recurrent otitis externa (infection of the external ear canal). The entire circumference of the vertical ear canal is surgically removed, down to the level of the horizontal ear canal. The skin edges are then sutured to the opening of the horizontal ear canal. This procedure allows the horizontal canal to open directly to the skin surface, maximizing ventilation and drainage. This will give the best possible chance of eliminating the persistent infection within the ear canal.
Since the ear canal itself is usually very thickened with chronic inflammation, it is more common to perform a total ear canal ablation & bulla osteotomy (T.E.C.A.B.O.).

Vulvar fold resection: the excessive skin and subcutaneous fat above (and on both sides of) the vaginal opening is surgically removed. The subcutaneous tissues and skin are then sutured, to create a smooth skin surface. This will eliminate the folds of skin which create chronic pyoderma (skin infection).

Zygomatic arch resection: The zygomatic arch (the ridge of bone just below and behind the eye, overlying the jaw musculature) is surgically exposed on each end. Using an oscillating saw, the entire length of the zygomatic arch is removed, to eliminate contact with the coronoid process of the mandible (the bony edge of the jaw which was striking the zygomatic arch and preventing the mouth from closing).