Soft Tissue Surgery Rotation
The past 3 weeks of my life have been quite busy. I was at school almost every day by 7a, usually before. We usually finished rounding and patient care around 7 p. I was not very thrilled with this rotation’s work schedule. I had a case for over 2 weeks who had a rostral maxillary soft tissue avulsion (everything in her nasal passages to the gums that attach above her teeth had been ripped off and you could flip it up over her whole head) which needed daily debridements, nasal cannula placement and maintenance, then got aspiration pneumonia on top of that. The smell of that necrosis was just… indescribably bad. The main point is that I was there taking care of this dog for about 19 days straight… 19 days of work was horrendous.
We alternated receiving appointments and performing scheduled surgeries daily. Emergency surgeries fell anywhere in-between. As a student, I was responsible for patient care, seeing new appointments, assisting in surgery. Every weekday there was a late student that took any case after 5 pm for on call duties and did nightly treatments on any patient staying overnight in our STS ward.
Amazingly, I had many people on my rotation, so we each had to take only 3 on-call nights. I even managed a Saturday evening without getting called in somehow. That was truly miraculous.
So, what all did I learn?
·Tie-over bandages are your wound bread and butter right after lavaging wounds.
· When in doubt, never close a high tension wound and manage it open. It’s not as pretty, but that’s not my fault.
· Periwound skin takes time to declare itself aka is it dead? Not yet, but tomorrow? Maybe!
· The number of things you can do to wounds is amazing!
o Wound vacuums are amazing and I will never have one in private practice because they are so costly to get all the little one-use parts.
o Medical grade honey is amazing! The hyperosmolarity, the glucose oxidase enzymes work wonders.
o Most of my rotation was working with chronic wounds and the smells I smelled… mm.
· Though it feels like screaming into the void, DO NOT LET CATS OUTSIDE UNSUPERVISED. On one 3 week rotation I saw:
o Cats attacked by feral cats
o A kitten mauled by a raccoon
o A kitten who sustained injuries leaving its skull exposed over 50% of its surface who I had to watch suffer and die because the owners did not believe in euthanasia and ‘thought this could be a miracle story’
o Saw 3 cats hit by cars, one with a collar whose owner was never found and who unfortunately passed away.
· Unleashed dogs are just as uncool as outdoor unsupervised cats. The dog bite wounds I have seen on this rotation is astounding.
· The most frequent emergency surgery was intestinal foreign bodies! FYI, pick up your socks, hair ties. If it’s small enough that your pet can fit it in their mouth, then they should not have access to it unsupervised. If they chew things up, they shouldn’t be left alone with these things.
o A lot of these instances were very preventable.
· Second most frequent emergency surgery was hemoabdomens, mostly from bleeding splenic masses, less so from the liver.
· Never assume a wound isn’t bad on looks. You really need a sterile probe. We had a case with a ‘superficial’ wound that a clinician thought to probe with a gloved hand. Riiiight up until they felt the heart against their fingers… No one likes emergency thoracotomies!
· My craziest case was a dog with a rostral maxillary soft tissue avulsion. So the gum tissue that is normally attached just above your teeth, the inside of the nose attached to the upper jaw was all ripped away from the bone. I could stretch this dog’s nose up over the whole front of her face. This little Pekingese had had another dog grab her face and presented with flail face.
o The smell of tissue necrosis was something else. Daily general anesthesia and debridement was intense.
o We eventually reconstructed her face, including her facial fold by drilling through her maxilla and tacking her face with those with suture.
o Her nasal passages had to be maintained with cannulas and still are since I saw her yesterday.
o She got pneumonia
I had a lot of fun with the staff on this rotation despite the hours being completely not conducive to having a life outside of school. Some of the staff told me they wished I was staying with them and I kind of did too. I have moved on to my oncology rotation and I hope I have some good things to share about it in a couple weeks with y’all.
