First we perform a complete consultation that allows us to evaluate your pet. We perform a comprehensive physical exam to make sure there aren’t potential issues and to assess the overall health of your pet. It also allows us to ensure the safety of performing the surgery and administering anesthesia.
Evaluation
We will administer a sedative to evaluate their knees, without muscle tension, to confirm the diagnosis of a torn CCL/ACL (Cranial Cruciate Ligament/Anterior Cruciate Ligament).
Imaging
We obtain radiographs for personalized surgical planning.
Lab work
We obtain pre-anesthetic lab work to make sure there isn’t anything to be cautious about your pet’s liver and kidneys.
Pre-surgical medications
Antibiotics
We send home antibiotics to start 3 days before surgery and continue 2 weeks after. This allows us to perform the surgery if your pet already has a skin infection over the area of the incision; which can be hidden under the hair coat.
Sedatives/Anti-anxiety medications
To keep your pet calm, we send home sedatives/anti-anxiety medications to administer the night before and the morning of the procedure. This allows us to lower the anesthesia dose as high doses of anesthesia can be dangerous.
Anti-nausea/Anti-Vomiting medications
We send home an anti-nausea/anti-vomiting medication to administer the morning of the procedure to help your pet feel more comfortable and return to eating faster.
Pain Medications
We send home pain medications to keep your pain comfortable from the time that we diagnose the issue, to the surgery, and all the way through the recovery.
Antiseptic Shampoo
We send home an antiseptic shampoo that we have you apply to the injured leg the night before to help reduce the risk of postoperative infections.
Day of Surgery:
Comprehensive Pain Plan
Intravenous Pain Medications
We administer intravenous pain medications with a continuous infusion to keep your pet comfortable and decrease anesthetic risks
Local Anesthetics
We administer long acting local anesthetics to the femoral and sciatic nerves to completely block pain during surgery and that block continues for hours to days afterwards.
Personalized Anesthetic Plan
We review the physical exam, history, medications, and lab work and create a custom anesthetic plan to reduce risks for your pet.
Top of the line Anesthetic Monitoring
The entire time your pet is under anesthesia our highly trained and dedicated nurses monitor your pet using top of the line equipment which includes: blood pressure, pulse oximetry, end-title CO2, capillary refill time, electrocardiogram, airway pressure sensors, and the most important a stethoscope in a highly trained hand. We only use Sevoflurane as the gas maintenance anesthetic since this is the fastest responding gas anesthetic. If there are any issues with your pet then we are able to make adjustments quickly.
Intravascular Fluids and Medications
We determine the ideal fluid rate to maintain blood pressure and vital organ function during anesthesia.
Clean/Surgical Prep
We shave the leg and clean it with 3 different antiseptics to reduce the risk of infection. We perform sterile draping of the leg to ensure a clean environment and then apply an Ioban dressing. Ioban is an iodine infused sticky plastic that we apply to the leg to prevent the surgeon from making contact with the skin which no matter how many times the area is cleaned can still have a small amount of bacteria present.
Minimally Invasive Surgery
We perform a minimally invasive surgery. The incision is typically only 3 inches long and we close the skin using a monofilament absorbable sutures in an intradermal pattern to prevent infections. The intradermal suture pattern prevents any visible sutures when your pet goes home.
After Care
We cover the incision with a temporary bandage and send them home with antibiotics, sedatives/anti-anxiety medications, and ample pain control. We also send home an Elizabethan collar (cone) to prevent licking. The most important part of aftercare is preventing your pet from licking the incision as this can cause a serious infection even with all of our preventatives and antibiotics.
Tibial Plateau Leveling Osteotomy (TPLO)