This is Annie – a very sweet, eleven-year old bloodhound. Her front end is just lovely…
…back end, not so much…
Annie’s had this tumor for about 2 years; her owners were told elsewhere “not to bother” with it; however, it had grown to the point where it was open and draining. Not only is this messy, but come springtime, it would be a magnet for flies. Annie is a very spry senior citizen – her quality of life is great, as was her pre-operative bloodwork, so the decision was made to try and remove or at least “debulk” the mass.
If it’s a big ol’ tumor..then when it’s gone there will be a big ol’ hole. Each of those metal hemostats is clamping off a blood vessel that was going to the tumor. Nothin’ left to do now but busy-work – each vessel gets ligated (tied off) with suture so it won’t continue to bleed. The next task is to close the wound.
In case you’re wondering, usually somewhere about this point in a big tumor surgery I’m going “holy smokes, NOW WHAT?” These gaping holes can be a little intimidating!
“Nature hates a dead space” we were always told in vet school, which means that if there’s a large enough cavity, it’ll fill with…something. Usually fluid. So to prevent the formation of a big serum pocket ( a seroma), I willl place a penrose drain once the vessels are ligated. This will allow any fliud to drain out instead of accumulating. The next step is to suture the subcutaneous tissue together and make the hole a little smaller….I hope!
Yeah….that’s more like it. The hole is shaped like a golf club, with the club part facing left. This means I’ll have an L-shaped incision instead of a straight one, but that’s all right. The forceps in my left hand will grab the penrose drain and pull it out the top hole, and I’ll make an identical hole below the incision for the bottom of the drain. Feeling a little better about that hole at this point but still concerned about how much tension will be placed on the skin sutures. But here goes…
Uh-huh… Pretty happy with this. The skin is not too tight, and closes neatly. So Annie goes home on plenty of pain meds; she also will get a dose of antibiotics, due to the fact that the base of the tumor had already opened and her white blood cells were higher than normal on her pre-op bloodwork indicating some degree of infection.
Three days post op, the owners report that she is definitely feeling better. We will remove the drain tomorrow and the sutures in another week or so.
As it happens I am making a daily house-call to help the owners with their other bloodhound, who’s recovering from back surgery, so I am able to check on Annie’s progress every day as well.
So how about some post-op thoughts? Well…the tumor was wrestled into a container and sent off to the lab for a biopsy; provided it doesn’t leap out and attack some helpless pathologist, I’m guessing it will be identified as belonging to a family of soft tissue sarcomas – none of which are good news – so I’m keeping my fingers crossed that I’m wrong (In some cases I LOVE to be wrong!). It is likely that I didn’t achieve clean surgical margins (in other words, I probably didn’t “get it all”) because these types of tumors often have microscopic streamers of cancerous tissue coming off the main body of the tumor. However, some of them are pretty slow growers if they do recur, so at least between now and the time we have to deal with it again, Annie should have some months (and hopefully years) of time when she can sit comfortably without a draining mass following her around.