After years of hard work, the Cutting Edge 03 is available for the wide world! Gert and I decided to make this edition free of rights for anyone that wants to download the book and use it for their personal benefit. If you hit the book button on top of the menu, you can directly download it. We do ask you to contact us if you want to print it for outside of personal use and for any requests for translations. we are so excited to be able to offer this to every one that is interested in veterinary surgery. Thank you to all our amazing contributors and especially the awesome Karen Parrott (kmparrott@gmail.com) for the beautiful make up and style of the book.
This rabbit’s fur was set on fire after applying an energy-based device in the presence of a surgical field still wet from an alcoholic disinfectant
Happy 2021! We just published our fourth chapter of the Cutting Edge. Dr Bart van Goethem and others discuss electro-, cryo-, and laser surgery.
In electrosurgery or diathermy, heat is generated in the patient’s tissue due to an electric current, with the aim of using this heat for hemostasis or for making incisions. Electric current is the flow of free charge carriers – electrons and ions – from a positive electrode (the source) to a negative electrode or ground.
Electrosurgery requires an electrosurgical generator that changes the standard 50 or 60 Hz, low frequency electrical current into a useable high frequency 200 kHz to 5 MHz current. Since the neuromuscular system becomes refractory to electrical stimulation beyond a frequency of 100 kHz, there is minimal stimulation when using these high frequencies. The spectrum mentioned falls within the electromagnetic spectrum of low radiofrequency bands (AM broadcast signals 550-1550 kHz). Some units go as high as 3-4 megahertz (MHz) and occur in the range between AM and FM radio broadcasting. These are referred to as radio wave radiosurgery units (Figure 1).
Figure 1. Most electrosurgical units operate in the low radiofrequency bandwidth (AM broadcast). Radio wave radio surgical units operate in the high radiofrequency bandwidth (FM broadcast).
When heat is applied to a biological system, the effect is temperature-related and also dependent on application time. Between 38-60°C, tissues will warm and weld without obvious visual signs. At 60-65°C irreversible damage resulting from coagulation necrosis and protein denaturation is visible as blanching. At 65-90°C protein denaturation resulting in white/greyish discoloration occurs. At 90-100°C tissues dry and show puckering. Above 100°C solid tissue vaporization results in steam and smoke, and temperatures of 350-450°C result in immediate carbonization and char formation.
The use of electrosurgical equipment has some inherent risks. Most operating room fires are caused by the use of electrosurgical equipment. Regular checks of insulation and grounding pads should therefore be performed. Smoke generated by these devices contains many carcinogenic compounds. A smoke evacuation system is therefore highly recommended.
Just before the new year, we have published the third chapter of ‘the Cutting Edge.’ This chapter describes the various and most common instruments you need as a surgeon. Please go to the menu and click the ‘Cutting Edge’ tab.
What kind of grip do you use when you hold your instruments? The ‘pencil grip‘ is used for short or sharply curved incisions. In this grip, the hand’s muscles and the upper arm are used to direct the scalpel, allowing small and accurate movements. As the scalpel is held almost vertical and mainly uses the blade’s tip, it is only in partial contact with the wound edges. This facilitates the making of curves and improves the accuracy of the incision.
The Pencil grip
The ‘fingertip grip’ or ‘palm grip‘ is used for long, slightly curved, or straight incisions. The scalpel is held more horizontally so that the blade is in contact with the tissue over a longer distance (using the blade’s belly). This grip stabilizes the scalpel and reduces the effect of the variable blade pressure on the incision’s depth.
The palm grip
In this grip, the scalpel is predominantly guided by the arm muscles. There is less radial deviation, which makes the grip less tense. The incision should be made with a fluid movement without removing the blade from the wound. This avoids the ragged edge of several subsequent incisions. When cutting through the skin, the free hand may pull the skin tight to control better the scalpel pressure and, hence, the incision’s depth.
In this episode, we have an extra-long interview with Dr. Peter Lotsikas from Skylos Sports Medicine. We discuss his latest publication about the combination of total hip replacement and amputation in dogs. Peter has a fascinating story about his surgery background and the article. He explains that THR has become very advanced and that dogs with amputation do really well with a THR if needed. We end the podcast with a neighboring article from the same journal, where a new technique for stenotic nares is described, call DOR. Want to know what it stands for? Listen to the podcast 🙂
It is happening at last! I have just finalized the copy for the Cutting Edge. Basic Surgery for the Veterinary Surgeon, 3rd edition. So what does this mean? I will send the whole thing to a graphic designer to make it beautiful, and as soon as that is done, it will be freely downloadable online on this website as a pdf. Did I say FREE? Yes, completely free. Better even is that I will publish the chapters here right on the website too. Please check our Cutting Edge page, where I will be adding chapters every week. I can’t wait to hear what you think of the project!
Global Veterinary Surgery 