One of my patients, Maple, is a four year old spayed female. She has a history of chronic urinary tract infections. When they started up again a few months ago, we did multiple urinalysis, urine cultures and extended antibiotic trials. It seemed that no matter what we did, we couldn’t get it resolved. Maple kept licking herself through it all.
Finally, I decided on plan e. The e stands for episioplasty. Maple had an excessive amount of skin folding over her vulva. This created a warm, wet environment resulting in her reoccurring urinary tract infections. This surgery removes the excess skin and fatty tissue from around the vulva.
Basically, the surgery involves making two crescent-shaped incisions around the vulva. As this is a very vascular (many vessels) area, one must take the time to ligate all bleeders. I am now looking into getting an electrocautery unit. Rather than having to ligate the bleeders by suturing them, I could just bloody zap them all! The subcutaneous tissue is sutured back together and finally a simple interrupted pattern is used to close the skin.
After the surgery, Maple's owners had to make sure she wore an Elizabethan collar at all times. She was given NSAIDs to control the pain and they also hot packed the incision to make her feel more comfortable. Apparently, she soon learned those sessions were very soothing.
The top picture is the pre-surgical view. You can’t even see the vulva for all the extra skin. The lower picture was just taken last night. We are about 3 weeks post-op.
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