Small Animal Soft Tissue Surgery

By the end of this module, the learner will be able to:

• Summarise the phases of wound healing and describe how surgical and non-surgical interventions can enhance or impair healing. 
• Identify patient-related factors that influence wound repair and integrate these into the planning of surgical interventions. 
• Classify wounds based on contamination status and formulate context-appropriate management plans for acute, chronic, and infected wounds. 
• Recognise common complications of wound healing and propose evidence-based treatment strategies for each phase. 
• Apply Halsted’s principles and aseptic technique throughout all stages of wound care and surgical preparation. 
• Describe and implement the appropriate use of surgical dressings, drains (active/passive), and electrosurgical tools, including potential complications. 
• Perform and justify the use of basic suture techniques (hand ties, finger trap sutures) and select materials according to wound type. 
• Demonstrate correct identification, handling, and use of surgical instruments in the context of wound closure and debridement. 
• Outline anaesthetic and analgesic considerations for surgical patients, including ASA classification and pain scoring in dogs and cats. 
• Develop a perioperative pain management plan for patients with traumatic wounds, incorporating local and systemic strategies. 
• Construct and justify the use of a surgical safety checklist, promoting a culture of safety in the operating theatre. 
• Define and apply non-technical surgical skills such as communication, decision-making, and leadership in the clinical setting. 

By the end of this module, the learner will be able to:

• Describe the anatomy and vascular supply of the skin, and explain their relevance in reconstructive decision-making. 
• Compare primary, secondary, and delayed wound closure techniques, identifying appropriate scenarios for each. 
• Apply tension-reducing strategies, including undermining, walking sutures, and tension-relieving incisions, to optimise wound closure. 
• Plan and execute local skin flaps (advancement and transposition) with consideration for vascular integrity and tension lines. 
• Evaluate the indications and limitations of axial pattern flaps and identify commonly used examples (e.g., thoracodorsal, caudal superficial epigastric). 
• Outline the principles of full-thickness skin grafting (FTSG), including graft take, complications, and postoperative assessment. 
• Identify and manage surgical site infections (SSI), including non-antibiotic-based approaches to infected wounds. 
• Recognise and address factors contributing to delayed or abnormal healing, including pseudo-healing in cats. 
• Formulate a comprehensive perioperative care plan for reconstructive patients, including analgesia, anaesthesia, and wound monitoring. 
• Justify suture and closure material choices based on wound location, patient factors, and healing goals. 
• Develop a surgical plan for complex reconstructions near sensitive structures (e.g., eyes), anticipating and mitigating potential complications. 
• Demonstrate reflective decision-making when multiple reconstruction strategies are viable, including when to refer cases beyond one’s skill set

By the end of this module, the learner will be able to:

• Apply the principles of oncologic surgery, including resection margins, tissue plane dissection, and early vascular control, to optimise patient outcomes. 
• Select and perform appropriate biopsy techniques (FNA, incisional, excisional), considering diagnostic yield and surgical planning. 
• Explain the risks associated with operating on undiagnosed masses and communicate these effectively to caregivers. 
• Formulate a structured diagnostic and staging approach to patients presenting with cutaneous or subcutaneous tumours. 
• Describe the biological behaviour, grading systems, and treatment recommendations for mast cell tumours, soft tissue sarcomas, and mammary neoplasms. 
• Evaluate the role of imaging (radiography, ultrasound, CT, MRI) in diagnosis, staging, and surgical planning for neoplastic conditions. 
• Plan surgical resections with appropriate margin strategies (metric, barrier, or compartmental), tailored to tumour type and location. 
• Interpret pathology reports on surgical margins and incorporate results into follow-up treatment planning. 
• Identify feline-specific oncologic presentations (e.g., FISS, feline MCT) and adapt management accordingly. 
• Discuss the principles, indications, and limitations of adjunct therapies such as chemotherapy and radiotherapy in small animal oncology. 
• Evaluate the anaesthetic, analgesic, and fluid considerations specific to oncologic surgeries and integrate them into perioperative care. 
• Determine when referral to a specialist is indicated based on tumour complexity, anatomical location, and surgeon competence

By the end of this module, the learner will be able to:

• Identify the anatomical differences between canine and feline ear structures and explain their relevance to disease development and surgical planning. 
• Investigate chronic otitis externa using a structured diagnostic approach, including otoscopy, imaging, and sampling techniques. 
• Describe surgical techniques for lateral wall resection and vertical canal ablation, including indications, procedure steps, and common complications. 
• Outline the principles, indications, and potential complications of Total Ear Canal Ablation (TECA) and determine when referral is warranted. 
• Diagnose and manage common aural conditions such as cholesteatoma, ceruminous hyperplasia, and aural neoplasia using imaging and cytology. 
• Plan and perform procedures such as pinnectomy and tonsillectomy, understanding the indications and expected outcomes. 
• Recognise and manage oropharyngeal injuries, including acute stick injuries and soft palate trauma, using endoscopy and surgical repair techniques. 
• Evaluate the role of nasopharyngeal polyp removal in cats and identify cases requiring imaging for middle ear involvement. 
• Describe the use of regional nerve blocks in ENT procedures and construct multimodal analgesia plans for patients undergoing head and neck surgery. 
• Formulate comprehensive preoperative and postoperative care plans, including fluid therapy, transfusion protocols, and pain assessment. 
• Integrate diagnostic imaging into the decision-making process for ENT conditions and surgical intervention planning. 
• Justify surgical choices in complex ENT cases and identify when to defer or refer based on case complexity and surgeon experience. 

By the end of Day 1, the learner will be able to:

• Perform secure hand-ties using one- and two-handed techniques (square, surgeon’s, slip knots). 
• Execute the “finger trap” suture effectively for securing tubes and drains. 
• Select appropriate surgical instruments for skin suturing and demonstrate correct handling and needle control. 
• Apply gentle tissue manipulation principles during suturing to minimise trauma and ensure optimal healing. 
• Close large skin wounds using subdermal flap techniques with proper respect for tissue planes and tension lines. 
• Perform tension-relieving techniques including undermining, walking sutures, and tension incisions. 
• Plan and verbally justify reconstructive strategies using advancement and transposition flaps. 
• Demonstrate technical competence in creating and securing local skin flaps. 
• Place and secure a Penrose drain correctly, ensuring optimal placement for drainage. 
• Identify and apply suitable dressings and bandaging strategies, including tie-over dressings for complex wound locations. 
• Perform advanced knot techniques such as sliding knots and the Modified Miller’s knot, ensuring security and precision in deep cavities.

By the end of Day 2, the learner will be able to:

• Perform a regional mastectomy and mammary strip procedure with appropriate vascular control and anatomical awareness. 
• Identify and remove subcutaneous masses with oncologic margins and plan for effective closure. 
• Recognise and articulate key non-technical skills (situational awareness, decision-making, leadership, communication) as critical to surgical success. 
• Apply principles of contextualised care in evaluating and managing mammary tumours with varying clinical presentations. 
• Utilise perioperative checklists and closed-loop communication to enhance surgical team safety and reduce errors.

By the end of Day 3, the learner will be able to:

• Perform a lateral wall resection and vertical canal ablation with respect for neurovascular structures and surgical planes. 
• Execute a pinnectomy and tonsillectomy with attention to haemostasis and postoperative considerations. 
• Carry out a soft palate incision and repair procedure, recognising tissue layers and suture techniques required. 
• Administer regional nerve blocks (auriculotemporal, greater auricular) accurately to enhance analgesia for ENT procedures. 
• Interpret radiographic and CT imaging related to otitis, aural masses, and oropharyngeal trauma.

By the end of this module, the learner will be able to:

• Describe the regional anatomy of the neck in dogs and cats, with emphasis on neurovascular structures relevant to surgery. 
• Differentiate between diagnostic approaches for cervical masses, including imaging and tissue sampling techniques. 
• Plan and perform surgical management of feline hyperthyroidism, comparing bilateral and staged thyroidectomy techniques. 
• Explain the role of medical management in hyperthyroid cats and evaluate the risks and benefits of surgical versus non-surgical approaches. 
• Recognise and diagnose canine thyroid tumours and formulate a surgical or referral plan based on presentation and location. 
• Diagnose and surgically manage salivary mucoceles, choosing appropriate approaches for mandibular and sublingual gland excision. 
• Perform oesophagostomy tube placement and design a care plan for nutritional support. 
• Describe the indications, technique, and aftercare of temporary tracheostomy in patients requiring upper airway bypass. 
• Anticipate and manage potential complications associated with tracheostomy placement and maintenance. 
• Evaluate anaesthetic and perioperative considerations specific to neck surgeries, including fluid therapy, analgesia, and ASA classification. 
• Integrate imaging findings into the diagnostic and surgical planning process for neck pathologies. 
• Reflect on the decision-making process for surgical timing, procedure selection, and appropriate referral for complex cases.

By the end of this module, the learner will be able to:

• Describe the anatomical and physiological differences between canine and feline gastrointestinal tracts and apply this knowledge in clinical decision-making. 
• Interpret diagnostic imaging (radiography, ultrasound, CT) to identify GI abnormalities including obstruction, intussusception, and neoplasia. 
• Plan and perform an exploratory laparotomy using a systematic approach for abdominal assessment. 
• Execute surgical techniques on the stomach, including gastrotomy, partial gastrectomy, and gastropexy, with attention to safe closure and anatomical orientation. 
• Perform enterotomy, intestinal biopsy, and enterectomy procedures, utilising augmentation methods such as serosal patching and omentalisation. 
• Identify and surgically treat intussusception, recognising when additional interventions such as resection or plication are necessary. 
• Outline and apply techniques for mesenteric lymph node biopsy during abdominal exploration. 
• Recognise, diagnose, and manage postoperative complications such as peritonitis, ileus, and pancreatitis using clinical and diagnostic criteria. 
• Formulate perioperative care plans for GI surgery patients, including pain control, fluid therapy, nutritional support, and early complication detection. 
• Select appropriate suture materials and closure techniques for GI surgery based on location, tissue type, and risk factors. 
• Interpret blood gas and electrolyte results to guide fluid resuscitation and metabolic stabilisation in GI patients. 
• Describe and perform anal sac surgery and discuss diagnosis and treatment options for anal furunculosis. 
• Make evidence-based decisions regarding surgical techniques (e.g., gastropexy approach) and justify the choice based on individual patient factors. 
• Determine when referral is appropriate for complex GI cases or unstable patients.

By the end of this module, the learner will be able to:

• Formulate a prioritised surgical plan for acute abdominal emergencies, including visceral rupture and haemodynamic instability, incorporating principles of stabilisation and triage. 
• Plan and perform splenectomy, identifying clinical indications such as trauma, torsion, or neoplasia, and manage intraoperative haemorrhage effectively. 
• Execute liver lobectomy with appropriate vascular control techniques and assess when hepatic surgery is indicated based on diagnostic findings. 
• Describe indications, surgical approaches, and perioperative management for nephrectomy, adrenalectomy, and pancreatic surgery, including potential complications. 
• Interpret imaging studies (ultrasound, radiography, CT) relevant to parenchymal organ pathology and integrate findings into operative planning. 
• Anticipate and manage complications of parenchymal organ surgery, including bleeding, coagulopathies, pancreatitis, and peritonitis. 
• Construct comprehensive perioperative management plans for patients undergoing complex abdominal procedures, including transfusion strategies, nutritional support, and pain control.
• Apply structured intraoperative decision-making frameworks to multi-organ or complex surgical presentations under emergency conditions. 
• Define and distinguish between types of hernias (inguinal, umbilical, perineal, hiatal, diaphragmatic), understanding their anatomical features and clinical implications. 
• Diagnose and surgically repair inguinal and umbilical hernias, selecting the most appropriate technique based on patient size, age, and hernia contents. 
• Perform perineal hernia repair, including internal obturator transposition, and appraise alternative methods such as muscle flaps or mesh repair. 
• Diagnose and surgically manage diaphragmatic hernias, understanding indications for emergency versus elective repair and perioperative challenges. 
• Recognise and interpret imaging findings of hiatal hernias, and determine when surgical correction is required versus medical management. 
• Identify cases of hernia or parenchymal organ disease that require specialist referral and justify the referral decision.

By the end of this module, the learner will be able to:

• Describe the pathophysiology of Brachycephalic Obstructive Airway Syndrome (BOAS) and its clinical implications across breeds. 
• Perform a thorough upper airway assessment including oropharyngeal, nasal, and laryngeal structures under anaesthesia. 
• Plan and perform surgical correction of stenotic nares using wedge or punch techniques. 
• Execute soft palate resection using appropriate techniques (e.g., scalpel, scissors, CO₂ laser) and identify ideal resection margins. 
• Recognise and manage laryngeal abnormalities associated with BOAS, including everted saccules and laryngeal collapse. 
• Interpret preoperative imaging and endoscopic findings in BOAS patients to guide surgical and anaesthetic planning. 
• Develop anaesthesia and recovery protocols specifically adapted to brachycephalic patients, with emphasis on airway protection and postoperative monitoring. 
• Evaluate the surgical options and outcomes for acquired laryngeal paralysis and justify the choice of unilateral arytenoid lateralisation (tie-back) versus other approaches. 
• Describe the surgical approach, indications, and complications of temporary and permanent tracheostomy. 
• Manage emergencies related to upper airway obstruction, including decision-making under pressure and rapid surgical intervention. 
• Implement perioperative care strategies to minimise postoperative complications such as aspiration, oedema, or dyspnoea. 
• Educate clients on prognosis, quality of life considerations, and the risks and benefits of airway surgery in brachycephalic breeds.
• Describe the indications, basic principles, and anatomical approaches to common thoracic surgical procedures, including lung lobectomy, lung biopsy, and pericardiectomy.
• Explain the surgical anatomy and procedural considerations for complex vascular interventions such as PDA ligation and correction of vascular ringanomalies.
• Outline the indications and key steps involved in thoracic duct ligation and thymectomy in dogs and cats.
• Discuss the technique, indications, and clinical considerations for performing a median sternotomy and chest wall reconstruction.
• Recognise the perioperative management and common complications associated with thoracic surgery, including respiratory compromise, pneumothorax, and haemorrhage.
• Demonstrate awareness of patient selection and preoperative assessment specific to thoracic surgery, including imaging and anaesthetic risks.
• Evaluate cases to determine when referral to a specialist is appropriate based on clinical presentation and surgical risk.
• Summarise the role of thoracic surgery within small animal practice and reflect on the general practitioner’s responsibility in advising owners and coordinating referral when needed.

By the end of Day 1, the learner will be able to:

• Perform oesophagostomy tube placement and formulate postoperative nutritional support plans. 
• Execute the emergency placement of a temporary tracheotomy tube and describe key aftercare protocols. 
• Conduct a midline neck exploration, identifying normal anatomy and recognising common abnormalities. 
• Perform mandibular/sublingual sialadenectomy for the treatment of salivary mucoceles, selecting the appropriate surgical approach. 
• Perform thyroidectomy with attention to gland preservation, haemostasis, and postoperative monitoring. 
• Safely isolate and loop a carotid artery, demonstrating fine dissection and vascular handling techniques.

By the end of Day 2, the learner will be able to:

• Perform a complete exploratory laparotomy and systematically evaluate the pancreas, liver, adrenal glands, GI and urinary tracts. 
• Conduct a gastrotomy and a pyloric incisional gastropexy; perform a partial gastrectomy via invagination. 
• Excise and biopsy mesenteric lymph nodes safely, with appropriate anatomical orientation. 
• Close the abdominal wall using correct suture layers and material selection. 
• Perform enterotomy and hand-sutured enterectomy procedures, applying serosal patching and other augmentation techniques where needed. 
• Recognise technical errors in intestinal surgery and respond appropriately to demonstrator feedback during the session. 
• Observe and evaluate stapled enterectomy technique. 
• Perform intestinal biopsy and interpret its role in diagnostic and surgical planning.

By the end of Day 3, the learner will be able to:

• Recall the splenic vascular anatomy and perform both hilar and major vessel ligation splenectomy techniques. 
• Execute liver biopsy using multiple methods (e.g. guillotine, punch, wedge) with minimal tissue trauma. 
• Perform diaphragmatic hernia repair, including air evacuation from the thoracic cavity and closure of the defect. 
• Identify inguinal anatomy and perform a simulated inguinal hernia repair. 
• Perform a tenotomised internal obturator flap for perineal hernia repair and justify flap selection. 
• Carry out an anal sacculectomy, recognising anatomical landmarks and avoiding key complications.

By the end of Day 4, the learner will be able to:

• Consolidate and refine technical execution of procedures covered in Practical Blocks 1 and 2, including: from hand-ties (basic and advanced) through to a range of the more clinically relevant soft tissue surgicla procedures covered to date., skin closures with subdermal flaps, tension-relieving techniques, Penrose drain placement, regional mastectomy, subcutaneous mass excision, lateral wall resection, vertical canal ablation, pinnectomy, tonsillectomy, soft palate incision and repair, oesophagostomy tube placement, emergency tracheotomy, thyroidectomy, neck exploration, salivary gland removal, full exploratory laparotomy, gastrotomy, enterotomy, enterectomy, mesenteric lymph node biopsy, splenectomy, liver biopsy, diaphragmatic hernia repair, inguinal hernia repair, perineal hernia repair, and anal sacculectomy. 
• Integrate flap planning, instrument selection, and gentle tissue handling principles into more advanced surgical contexts. 
• Demonstrate improved fluency in operative flow, efficient instrument use, and anatomical respect across all rehearsed procedures. 
• Repeat complete surgical procedures with minimal supervision, actively correcting prior errors using demonstrator feedback. 
• Maintain consistent aseptic technique, surgical rhythm, and intraoperative decision-making throughout. 
• Reflect on technical progress and set personal goals for continued improvement.

By the end of this module, the learner will be able to:

• Describe the anatomy and physiology of the urinary and reproductive systems in dogs and cats and relate this knowledge to surgical planning. 
• Diagnose and manage urolithiasis, and perform cystotomy and urethrotomy procedures with appropriate stone retrieval and closure techniques. 
• Explain the surgical management of urethral obstruction in male cats, including indications and technique for perineal urethrostomy. 
• Plan and perform scrotal urethrostomy in the dog, identifying anatomical landmarks and managing haemostasis effectively. 
• Interpret imaging and urinalysis findings to guide surgical intervention in urinary tract obstruction or trauma. 
• Recognise the indications, technique, and complications associated with ectopic ureter correction in dogs. 
• Describe surgical options for urinary incontinence, including colposuspension and urethropexy, and evaluate their clinical outcomes. 
• Perform standard and modified ovariohysterectomy (e.g., laparoscopic-assisted or ovarian pedicle ligation techniques) safely. 
• Execute routine and scrotal castrations, and explain the rationale for each approach depending on species, age, and testicular pathology. 
• Identify and surgically manage cryptorchidism, including abdominal and inguinal approaches, and discuss timing of intervention. 
• Evaluate and surgically treat reproductive neoplasms (e.g., testicular tumours, ovarian cysts), integrating histopathological and clinical decision-making. 
• Recognise and manage complications associated with urogenital surgery, including urinary leakage, infection, and haematuria. 
• Develop perioperative plans for urogenital surgical patients, including fluid therapy, analgesia, and urinary catheter management. 
• Identify when referral is indicated for complex urogenital cases (e.g., urethral trauma, reoperations, neoplastic obstruction).

By the end of Day 1, the learner will be able to:

• Perform a surgical tracheostomy and describe appropriate postoperative management and complication prevention. 
• Execute a frontal sinusotomy (sinus approach) and identify key anatomical landmarks and surgical risks. 
• Perform wedge rhinoplasty for stenotic nares, demonstrating tissue planning and cosmetic alignment. 
• Place thoracostomy tubes using both trocar and Seldinger techniques, and explain indications and complications. 
• Conduct an ovariectomy or ovariohysterectomy safely, selecting the appropriate technique based on patient factors. 
• Perform cystotomy for removal of uroliths, with appropriate closure and leak testing. 
• Perform urethral catheterisation in male and female dogs, understanding anatomical variations and techniques to minimise trauma.

By the end of Day 2, the learner will be able to:

• Perform nephrectomy, including vascular ligation and ureteral transection, and discuss indications and contraindications. 
• Conduct an episiotomy with attention to reproductive tract and perineal anatomy. 
• Execute a preputial advancement procedure to address preputial displacement or injury. 
• Perform prescrotal urethrotomy in the male dog and describe closure and catheterisation techniques. 
• Place a cystostomy tube and plan for long-term urinary diversion and care. 
• Insert abdominal drains using open or closed methods and justify their use in specific surgical contexts. 
• Surgically approach the prostate gland and discuss common indications such as abscesses, cysts, or neoplasia.

By the end of Day 3, the learner will be able to:

• Perform thyroidectomy in the cat and describe perioperative considerations including hypocalcaemia prevention. 
• Execute feline enucleation and identify differences from the canine approach. 
• Manage feline wounds with appropriate closure techniques and considerations for skin fragility. 
• Perform enterotomy and enterectomy procedures in the cat, with feline-specific handling and repair strategies. 
• Repair diaphragmatic rupture in cats, managing thoracic entry and ensuring secure closure. 
• Diagnose and repair prepubic tendon rupture, including reconstruction techniques and postoperative care. 
• Recognise and adapt surgical plans based on feline anatomical and physiological differences compared to dogs.

By the end of this module, learners will be able to:

• Communicate surgical plans and prognoses effectively to clients, adjusting language and tone based on urgency, emotional load, and caregiver expectations. 
• Apply techniques of active listening and emotional intelligence to navigate challenging discussions such as consent, complications, and unexpected outcomes. 
• Recognise early indicators of compassion fatigue and stress specific to surgical practice, and implement strategies to support personal wellbeing and decision-making clarity. 
• Use the Conversational AI simulator to practise and refine communication in high-stakes surgical scenarios, including preoperative consent and postoperative complication management. 
• Reflect on the psychological and ethical complexities of surgical care, including client pressure, time-sensitive decisions, and the emotional impact of surgical loss or success.