Soft tissue surgery
Success in soft tissue surgery depends on the expertise of the surgeon, the support of the medical service, and unwavering care from the nursing team.
What is soft tissue surgery?
Soft tissue surgery refers to surgery performed for the treatment of diseases that are not associated with the skeleton, joints or nervous system. This includes surgery of most internal organs such as the stomach, intestines, liver, spleen, kidneys, bladder, lungs, heart and blood vessels. It also includes reconstructive surgery for trauma or wounds, deep infections or abscesses, along with surgery for airway problems affecting the nose, tonsils, palate and larynx.
Our soft tissue surgeons have extensive experience in reconstructive, head and neck (including ear, nose and throat), genitourinary, endocrine, thoracic, abdominal and gastrointestinal surgery. In many cases, their specialisation in surgical oncology and the availability of our colleagues in medical oncology is a major advantage, as many soft tissue surgery cases turn out to have underlying cancers, allowing for a rapid change of direction should the need arise.
The soft tissue surgeons manage a wide variety of conditions affecting almost all parts of the body
Common soft tissue surgery conditions
BOAS (brachycephalic obstructive airway syndrome)
The term “Brachycephalic Obstructive Airway Syndrome” (BOAS) refers to a group of conditions observed in dogs with short noses (brachycephalic dogs). BOAS can impact on all aspects of a brachycephalic dog’s life. Not all brachycephalic dogs require surgery, and a careful assessment of their lifestyle and expression of clinical signs is an important part of the evaluation.
There can be a wide spectrum of signs with BOAS. At the mild end, patients may simply show regurgitation or vomiting (often associated with excitement, exercise or stress) whilst the more affected dogs will show various degrees of respiratory distress or digestive troubles, ranging from being occasionally short of breath to collapsing on moderate exercise. Some dogs will suffer from sleep apnoea and are chronically sleep-deprived.
Noisy breathing, snoring, regurgitation and heat stress are often seen in the pug, bulldog and other short-nosed dogs. However, just because these signs are common, it does not make them normal.
Some animals are experiencing considerable distress which is impacting both quality and length of life.
The body has a tremendous capacity for healing. While many wounds on the body may heal successfully with relatively simple care, some wounds benefit from expert attention.
Open wounds, or wounds that will not heal
Dogs and cats can develop wounds for a variety of reasons, including trauma, infection or as a consequence of previous surgery.
The ideal outcome in these cases is to cover the defect with mature haired skin, allowing the patient to return to normal day to day physical activity.
In both dogs and cats, a wide variety of options exist for managing skin defects that may occur. Examples include complex skin flaps, skin grafts, open wound management or innovative reconstructive techniques. With their background in cancer surgery, the surgeons at AURA are experts in reconstructive surgery, aiming to optimise both return to function and overall cosmetic appearance.
Head and Neck
Some of the more common surgical conditions of the head and neck are detailed below::
Laryngeal paralysis: The larynx (voice box) normally opens and closes with each breath, allowing air to enter the lungs. In older dogs, the nerves to the larynx slow down or are damaged, meaning the larynx no longer works normally. The dog becomes breathless with activity, and will tire more quickly. These signs are often attributed to ‘old age’, ‘joint problems’ or ‘heart disease’
Laryngeal paralysis may cause signs such as slowing down or reluctance to exercise, harsh sounds when beathing, a soft cough, gagging or retching when eating or drinking, and a change or loss of voice. It is also possible for animals to collapse after a period of excitement, exercise or in hot weather and present as a life-threatening emergency. Surgery involves a procedure to widen the voice-box and hold the airway open with suture material. Patients can experience a near-immediate improvement in breathing and quality of life.
Ear surgery: Surgery can make a significant improvement to painful and persistent ear infections, offering relief from an often chronically debilitating and frustrating condition. The AURA surgeons regularly lecture and teach ear procedures around the world, and publish research papers and book chapters on techniques and outcomes. Their aim to for the surgery to be associated with few (if any) side-effects
Pharyngeal stick injuries and foreign bodies of the head: Dogs playing with sticks and running with them in their mouths often leads to penetrating injuries around the tongue and the back of the throat. More severe injuries are seen when the stick is thrown by the owner and the dogs run onto them at speed. In addition to the initial puncture wounds, fragments of wood or large pieces of stick can break off and remain embedded. These cases are true emergencies and priority is given to a rapid admittance, assessment, and delivery of treatment.
A variety of other foreign bodies can enter the tissues of the head from the mouth or throat such as grass seeds, or splinters when chewing pieces of bone or wood. This foreign material can lead to deep infections or abscesses that need surgery to explore and clean.
Injuries to the mouth, throat and neck from sticks, bones or other sharp objects can cause potentially life-threatening infections, abscesses or persistently draining wounds
Cats are most susceptible to traumatic injury of the diaphragm when they are younger and more inquisitive of the outdoors. Sometimes the injury event is unknown, with cats developing signs of a diaphragmatic hernia months or year later.
Hernia repair
Diaphragmatic hernia: A diaphragmatic hernia is a tear in the muscle separating the abdomen from the lungs and heart, and as a result the intestines and other organs travel into the chest cavity and make it harder for the lungs to inflate. It is a relatively common condition that may occur following trauma such an accident on the road or falling from a height. Although most animals present as an emergency with breathing difficulties or other injuries, a proportion (about 20%) will present many weeks to months after injury, having been apparently normal during the intervening period. Some animals are even born with this defect and have lived with the intestines and other organs in the chest cavity for many years. Some of these animals surprisingly may not develop signs until they are middle-aged or older.
Perineal hernia: A perineal hernia is a weakness of the muscles around the anus and rectum that make it more difficult for the animal to pass stools without straining and discomfort. This sort of progressive muscle weakness occurs almost exclusively in the male dog who has not been castrated. Rare cases are reported in the female dog, and in cats. Surgery is required to reinforce the muscles either side of the anus, giving the patient a solid wall to push against. The success rate when performed by experienced surgeons should be over 90% with a normal return to function expected. Dogs will typically need to be castrated at the same time.
Abdominal surgery
Surgery on organs in the abdomen is one of the more common activities for the surgeons at AURA. This may include surgery on the bowel, liver, spleen, pancreas, kidneys and urinary tract.
Gastrointestinal surgery: The intestinal tract can develop a variety of conditions, but the most serious are those causing a blockage or perforation of the bowel. Common causes include eating something foreign that cannot pass (clothes, bones, toys are common), a growth (cancer or abscess), trauma to the abdomen, or twisting of the intestine. In dogs and cats, surgery to open the bowel to remove foreign material is commonly performed, but sometimes removal of sections of bowel is required if affected by a mass. The nursing team at AURA are very experienced in the care required to support patients after surgery, encourage them to eat, and keep the patients as comfortable as possible.
Liver, gall-bladder and pancreatic surgery: The liver is a large organ in the front of the abdomen responsible for producing sugars and proteins for life, and removing toxins from the blood. The gall bladder is a small sac of liquid bile nestled in the liver that slowly releases the bile into the intestine to help with digesting food. The pancreas produces enzymes, chemicals and hormones to help with digestion and maintaining blood sugar level, and between them these three organs are vitally important to maintain body weight and overall health. Soft tissue surgeons can operate on these organs in cases of inflammation, infection, rupture or trauma. The bile system can also be obstructed and this can cause jaundice requiring immediate treatment.
Urinary tract: Two kidneys produce urine which travels down two ureters to be collected and stored in the urinary bladder near the pelvis. Urine exits the bladder via the urethra and leaves the body through the penis or vulva. The urinary tract is prone to obstruction at any point along its length from mineralised stones, growths, scar tissue or from trauma, all of which will need corrective surgery to return the flow of urine to normal. Soft tissue surgeons treat ruptures of the urinary tract as well as blockages, plus many conditions animals are born with including malformed internal anatomy and weak bladder sphincters.
Dogs will ingest a variety of objects, some of which can become lodged in the stomach or intestines. Obstruction of the bowel can cause a sudden and severe illness. Abdominal surgery is often required to remove the offending object.
The thoracic organs such as the heart, lungs, and the largest blood vessels in the body are of such importance they are protected behind the rib cage.
Thoracic surgery
Conditions within the chest that might require a soft tissue surgeon include infected fluid building up around the lung, air leaking from a lung lobe, infected lung tissue (pneumonia), twisted lungs, and foreign bodies (typically large pointy bone fragments) becoming lodged in the thoracic oesophagus. The surgeons at AURA have extensive experience in thoracic surgery and work closely with the clinical team in diagnostic imaging, anaesthesia, and nursing, to ensure the best chance is given to each patient undergoing chest surgery.
Cancer surgery
At AURA, we believe cancer surgery is a speciality in its own right, and collectively we have the most experienced cancer surgery team in the UK. The expertise in successfully deciphering subtle symptoms, laboratory tests, and complex imaging studies comes from decades of treating thousands of cats and dogs diagnosed with cancer.
Cancer is a complex disease, and new discoveries are being made almost every day. If your own animal has cancer, you can be certain of receiving the best care and advice possible from the world-leading expertise available at AURA.
Cancer can affect any part of the body. The experience and expertise of the AURA surgical team ensure they can provide a realistic assessment of the situation and the best next step.
AURA Stories
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Anal sac infections and abscesses may not be the most pleasant of topics to discuss, but to the dog affected it can be an ongoing daily struggle. Our team are regularly asked to see patients with this painful problem and talk about the treatment options.
Anal glands are two small pouches on either side of the anus. The oily, brown fluid they secrete helps dogs identify each other and mark their territory; it is almost like an olfactory fingerprint – this is why dogs often smell each other’s back ends when they first meet!
Normally, when anal glands are healthy, the glands get naturally expressed when dogs pass their stools and a small amount of fluid coats and ‘marks’ the stool. When they are not completely emptied however this is when problems arise. Over time, a build-up of this fluid can lead to impaction, which can result in both infections and abscesses. Symptoms for chronically infected anal glands can include scooting, licking or biting the rear end, a fishy smell, constipation or pain when sitting or passing stools.
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