Monday, January 21, 2008

Monday Medicine & Surgery #1

I thought it might be fun to document an interesting case now and then.
I do understand that topics I find fun and interesting as a veterinarian may not be your idea of a good time. If surgical pictures bother you, this may be the time to visit another site. I promise not to do this often.

I didn't think of having pictures taken of this one until the tech had him on the prep table and I was feeling a bit of a challenge presenting itself.

This adult Boxer was diagnosed with a lipoma on his neck 2 years ago. A small one. Not a problem, as lipomas are generally benign fatty tumors that usually cause no problems, unless they grow... and grow.... and grow.... He came in recently for his vaccine boosters and an exam of the lump. It had grown so large he had trouble turning his neck. He is a real sweetheart of a dog and the owners wanted to know if something could be done. I wish I had a picture of him standing so you could see the extent of that mass, it extended from his mandible to his shoulder blade (or scapula to you anatomy buffs).

He is under anesthesia and is being shaved and scrubbed for surgery.

The surgical site is draped, the skin incision is made, I begin bluntly dissecting the lipoma away from the subcutaneous tissue.

Luckily (for me), this lipoma is nicely encapsulated in it's own little sac. It is deep and large, manually separating the tumor from normal tissue is done by hand and by instrument.

Bit by bit the tumor emerges from the incision. The goal is to keep it intact as one piece, it is easier to remove and that helps control hemorrhage.

This lipoma has quite a healthy blood supply. Look at the size of those vessels. Hemostats and suture material are used to tie off bleeders as needed. See how it glistens? The outer surface slips and slides like melted crisco has been poured on.

Slowly the lipoma is being separated from the attached surrounding tissue and eased out of the cavity it resided, grew and thrived in for the past 2 years. It wasn't leaving easily. It actually extended deep beneath the scapula, quite a 'hole' to work in and tie off blood vessels.

An hour after the initial incision, the dog is lipoma-free, at last. That thing is huge and just globs off over my hands.

We place it on the scale. 3# of pure fat... Ugh. I started a diet then and there.


Kellan said...

Hi Kathy - it is a GOOD thing that my father happens to be a Veterinarian - otherwise, I might just have fainted! I also watch a lot of medical TV - have a pretty strong stomach. That is some huge glob!! Poor thing. Very impressed with your handywork!

Very nice to meet you - so glad you stopped by. Hope to see you again soon. Kellan

Courtney said...

Okay that was a little gross and a whole lot interesting. I'm sorta glad you shared. Have a good day.

Anonymous said...

Oh MY!!! That was HUGE!!! I feel a little bit sick...

Lynette said...

Oh Kathy! This is better than those "reality" shows! I've got to get my twelve year old daughter to see these pictures. The bloodier the better for her. She's a major fan of Mystery Diagnosis, et. Hope the big guy is feeling better!

Jenn said...

Thank you for sharing! I am forever impressed by what you can do with a scalpel. I'll bet that pup is happy to be able to move comfortably again. I can't imagine what it must have felt like to have that huge lump taking up so much room.

I don't even want to think about what my extra fat looks like dissected out and on a scale. Ewww. Gross me out!

Anonymous said...

it'd be nice if my fat was just one huge lump that could be cut out!

Laura said... Poor baby to have had to deal with that. And yay that you were able to get it out in one piece.

Anonymous said...

COOL......... DAVID

Flea said...

That was really cool, but I had to ask my son to go stir dinner. I don't think I'm going back in the kitchen for awhile.

Anonymous said...


I found your blogger on Google image search. We really want to bring our dog to see a surgeon like you. He has a large lipoma. Where can we find you in the Bay Area? Can you e-mail me your info, or any referral? We live in the East Bay.

Thanks, Jane