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 Contributors

Christopher A. Adin, DVM, DACVS Stephen J. Baines, MA, VetMB, PhD, CertVR, CertSAS,
Associate Professor DECVS, DipClinOnc, MRCVS
Veterinary Clinical Sciences European Specialist in Small Animal Surgery
North Carolina State University RCVS Specialist in Small Animal Surgery
Raleigh, North Carolina RCVS Specialist in Veterinary Oncology
Vagina, Vestibule, and Vulva Head of Surgery
Adrenal Glands Willows Veterinary Centre & Referral Service
Shirley, Solihull, United Kingdom
Matthew J. Allen, Vet MB, PhD, MRCVS Rectum, Anus, and Perineum
Professor of Small Animal Surgery
Department of Veterinary Medicine Joseph W. Bartges, DVM, PhD, DACVIM (Small Animal
University of Cambridge Internal Medicine), DACVN
Cambridge, United Kingdom Professor of Medicine and Nutrition
Total Knee Replacement in the Dog Department of Small Animal Medicine and Surgery
College of Veterinary Medicine
Davina M. Anderson, MA, VetMB, PhD, DSAS (Soft Internist and Nutritionist
Tissue), DECVS, MRCVS Veterinary Medical Center
RCVS Recognised Specialist in Small Animal Surgery (Soft The University of Georgia
Tissue) Athens, Georgia
European Veterinary Specialist in Small Animal Surgery Metabolism and Nutritional Needs of Surgical Patients
Anderson Moores Veterinary Specialists
Winchester, Hampshire, United Kingdom Benjamin J. Bayer, DVM, DACVS
Surgical Hemostasis Staff Surgeon
Dallas Veterinary Surgical Center
Gregory M. Anderson, DVM, DACVS Dallas, Texas
Professor and Chief, Section of Small Animal Surgery Delayed Unions, Nonunions, and Malunions
Veterinary Clinical Sciences
University of Minnesota Robert N. Bearden, PhD
Saint Paul, Minnesota Department of Small Animal Clinical Sciences
Soft Tissues of the Oral Cavity College of Veterinary Medicine
Texas A&M University
Lillian R. Aronson, VMD, DACVS College Station, Texas
Professor of Surgery Stem Cells and Regenerative Medicine
Clinical Studies Platelet-Rich Plasma and Autologous Conditioned Sera
University of Pennsylvania
Philadelphia, Pennsylvania Marian E. Benitez, DVM, MS, DACVS-SA
Rectum, Anus, and Perineum Clinical Assistant Professor, Small Animal Surgery
Vascular Surgery Department of Small Animal Clinical Sciences
Renal Transplant Virginia Maryland College of Veterinary Medicine
Blacksburg, Virginia
Nicholas J. Bacon, MA, VetMB, CertVR, CertSAS, DECVS, Principles and Use of Energy Sources in Small Animal Surgery:
DACVS, FRCVS Electrosurgery and Laser Applications
ACVS Founding Fellow, Surgical Oncology
Fitzpatrick Referrals Oncology and Soft Tissue Allyson C. Berent, DVM, DACVIM
Guildford, Surrey, United Kingdom; Staff Veterinarian; Director Interventional Endoscopy
Professor, Surgical Oncology Services
University of Surrey School of Veterinary Medicine Interventional Radiology/Endoscopy
Guildford, Surrey, United Kingdom The Animal Medical Center
Introduction to Oncologic Surgery for the General Surgeon New York, New York
Pinna and External Ear Canal Hepatic Vascular Anomalies

John Berg, DVM, DACVS

Professor of Surgery
Department of Clinical Sciences
Cummings School of Veterinary Medicine
Tufts University
North Grafton, Massachusetts
Mandibulectomy and Maxillectomy

v
vi Contributors

Niklas Bergknut, DVM, PhD Gert J. Breur, DVM, MS, PhD, DACVS
North Downs Specialist Referrals Professor of Small Animal Orthopedic Surgery
Bletchingley, United Kingdom Director of the Center for Comparative Translational
Degenerative Lumbosacral Stenosis Research
College of Veterinary Medicine
Judith Bertran, Ldo Med Vet, MS Purdue University
Small Animal Surgical Oncology Fellow West Lafayette, Indiana
Veterinary Clinical Sciences Miscellaneous Orthopedic Conditions
The Ohio State University Osteochondrosis
Columbus, Ohio
Total Knee Replacement in the Dog Lisa Brownlee, DVM, MS, DACVIM (Small Animal
Medicine)
Stuart Bliss, DVM, PhD, DACVS, CCRP Clinical Faculty
Staff Surgeon Animal Cancer Center
Port City Veterinary Referral Hospital Colorado State University
Portsmouth, New Hampshire Fort Collins, Colorado
Tissues of the Musculoskeletal System Thyroid and Parathyroid Glands

Mark W. Bohling, DVM, PhD, DACVS Bonnie Grambow Campbell, DVM, PhD, DACVS
Chief of Surgery Clinical Associate Professor of Small Animal Surgery
Regional Institute for Veterinary Emergencies and Referrals Department of Veterinary Clinical Sciences
Chattanooga, Tennessee College of Veterinary Medicine
Skin Grafts Washington State University
Burns Pullman, Washington
Bandages and Drains
Harry W. Boothe, DVM, MS, DACVS
Professor of Soft Tissue Surgery Jennifer Campbell, DVM, DACVECC
Department of Clinical Sciences Critical Care Specialist
College of Veterinary Medicine Animal Emergency and Specialty Center
Auburn University Parker, Colorado
Auburn, Alabama Fluid Therapy
Instrumentation
Instrument and Tissue Handling Techniques Luis Campoy, LV, CertVA, DECVAA, MRCVS
Penis and Prepuce Associate Clinical Professor of Anesthesiology and Analgesia
Section Chief Anesthesiology and Analgesia
Sarah Elizabeth Boston, DVM, DVSc, DACVS College of Veterinary Medicine
ACVS Founding Fellow of Surgical Oncology Cornell University
Associate Professor of Surgical Oncology Ithaca, New York
Small Animal Clinical Sciences Anesthesia for Intracranial Surgery
University of Florida
Gainesville, Florida Stuart Carmichael, BVMS, MVM, DSAO, MRCVS
Musculoskeletal Neoplasia and Limb-Sparing Surgery Director
Joint Adventures Ltd.
Peter Böttcher, DECVS Ash House, Ross Loan
Professor of Small Animal Surgery Professional Veterinary Consultancy Services
Small Animal Clinic Gartocharn, Scotland;
Faculty of Veterinary Medicine Professor of Veterinary Science
Freie Universität Berlin University of Surrey
Berlin, Germany Surrey, England
Surgical Diseases of the Elbow Tarsus and Metatarsus
Muscle and Tendon Disorders
Randy J. Boudrieau, DVM, DACVS, DECVS
Professor of Surgery and Section Head, Small Animal Dorothy Cimino Brown, MS, DVM, DACVS (inactive)
Surgery Professor of Surgery, School of Veterinary Medicine
Department of Clinical Sciences Director, Veterinary Clinical Investigation Center
Cummings School of Veterinary Medicine Associate Scholar, Clinical Epidemiology & Biostatistics,
Tufts University School of Medicine
North Grafton, Massachusetts University of Pennsylvania
Stifle Joint Philadelphia, Pennsylvania
Mandibular and Maxillofacial Fractures Small Intestine

Benjamin M. Brainard, VMD, DACVAA, ACVECC Stéphanie Claeys, DMV, PhD, Dipl ECVS
Edward H. Gunst Professor of Small Animal Critical Care Assistant Professor in Small Animal Surgery
College of Veterinary Medicine University of Liège
University of Georgia Liège, Belgium
Athens, Georgia Sterilization
Anesthesia Principles and Monitoring
Anesthesia Practice for Existing Conditions
 Contributors vii

Dylan N. Clements, BSc, BVSc, PhD, DipECVS, DSAS Loïc M. Déjardin, DVM, MS, DACVS, DECVS
(Orth), FHEA, MRCVS Professor-Head of Orthopaedic Surgery
Senior Lecturer in Small Animal Orthopaedics Small Animal Clinical Sciences
The Royal (Dick) School of Veterinary Studies and The Michigan State University
Roslin Institute East Lansing, Michigan
The University of Edinburgh Bone Biomechanics and Fracture Biology
Roslin, Midlothian, United Kingdom Internal Fracture Fixation
Molecular and Cellular Biology: Genomics Overview of Minimally Invasive Osteosynthesis Principles
Total Elbow Replacement in Dogs
Dalis E. Collins, DVM Fractures of the Femur
Clinical Veterinarian
Baylor College of Medicine Peter J. Dickinson, BVSc, PhD, DACVIM (Neurology)
Center for Comparative Medicine Professor Neurology/Neurosurgery
Houston, Texas Department of Surgical and Radiological Sciences
Inflammatory Response School of Veterinary Medicine
University of California, Davis
Karen Cornell, DVM, PhD, DACVS Davis, California
Associate Dean for Professional Programs Cranial Surgery
College of Veterinary Medicine & Biomedical Sciences
Texas A&M University Jillian M. DiFazio, DVM, DACVECC
College Station, Texas Criticalist
Wound Healing Emergency and Critical Care
Stomach Veterinary Emergency and Referral Group
Pancreas Brooklyn, New York
Bleeding and Hemostasis
Laura C. Cuddy, MVB, MS, DACVS-SA, DECVS,
DACVSMR, MRCVS Maria A. Fahie, DVM, MS, DACVS
Staff Surgeon Professor, Small Animal Surgery
Vets Now Emergency and Specialty Hospital College of Veterinary Medicine
Whitefield, Manchester, United Kingdom Western University of Health Sciences
Urethra Pomona, California;
Staff Surgeon
Ronaldo Casimiro da Costa, DMV, MSc, PhD, DACVIM Yorba Regional Animal Hospital
(Neurology) Anaheim, California
Professor and Service Head of Neurology and Neurosurgery Primary Wound Closure
Department of Veterinary Clinical Sciences
The Ohio State University James P. Farese, DVM, DACVS
Columbus, Ohio ACVS Founding Fellow, Surgical Oncology
Cervical Vertebral Column and Spinal Cord Staff Surgeon
North Bay Veterinary Surgical
Brett G. Darrow, DVM San Francisco Bay Area, California
Surgery Resident Introduction to Oncologic Surgery for the General Surgeon
Small Animal Clinical Sciences
University of Tennessee Derek B. Fox, DVM, PhD, DACVS
Knoxville, Tennessee Professor
Thoracic Cavity Veterinary Medicine and Surgery
University of Missouri
Jacqueline R. Davidson, DVM, MS, DACVS, DACVSMR Columbia, Missouri
Clinical Professor Principles of Angular Limb Deformity Correction
Small Animal Clinical Sciences Radius and Ulna
Texas A&M University
College Station, Texas Samuel P. Franklin, MS, DVM, PhD, DACVS, DACVSMR
Feeding Tubes Assistant Professor of Small Animal Orthopedic Surgery
University of Georgia
Charles E. DeCamp, DVM, MS, DACVS Athens, Georgia
Staff Surgeon Platelet-Rich Plasma and Autologous Conditioned Sera
Animal Surgical Center of Michigan Arthroscopy
Flint, Michigan;
Professor Emeritus Boel A. Fransson, DVM, PhD, DACVS, ACVS Founding
Michigan State University Fellow, MIS
East Lansing, Michigan Associate Professor, Small Animal Surgery
Fractures of the Pelvis Veterinary Clinical Sciences
Washington State University
Pullman, Washington
Ovaries and Uterus
viii Contributors

Tanya Garcia-Nolen, BS, MS April M. (Durant) Haynes, DVM, DACVS-SA

Research Engineer Staff Surgeon
JD Wheat Veterinary Orthopedic Research Laboratory MedVet Medical & Cancer Center for Pets
University of California, Davis Dayton, Ohio
Davis, California Trachea and Bronchi
Carpus, Metacarpus, and Digits
Diane V.H. Hendrix, DVM, DACVO
Michelle A. Giuffrida, VMD, MSCE, DACVS-SA Professor of Ophthalmology
Assistant Professor of Surgery Small Animal Clinical Sciences
School of Veterinary Medicine University of Tennessee
University of California, Davis Knoxville, Tennessee
Davis, California Basic Ophthalmic Surgical Procedures
Small Intestine
Erik H. Hofmeister, DVM, DACVAA, DECVAA, MA
Carl A. Gregory, BS, PhD Chair and Professor of Anaesthesia
Associate Professor Department of Surgery
Department of Molecular and Cellular Medicine College of Veterinary Medicine
Institute for Regenerative Medicine Midwestern University
Texas A&M Health Science Center Glendale, Arizona
Texas A&M University Anesthesia Principles and Monitoring
College Station, Texas Anesthesia Practice for Existing Conditions
Stem Cells and Regenerative Medicine
David E. Holt, BVSc, DACVS
Janet A. Grimes, DVM, MS, DACVS-SA Professor of Surgery
Assistant Professor Department of Clinical Studies
Department of Small Animal Medicine and Surgery University of Pennsylvania School of Veterinary Medicine
College of Veterinary Medicine Philadelphia, Pennsylvania
The University of Georgia Palate
Athens, Georgia
Biopsy General Principles Giselle Hosgood, BVSc, MS, PhD, FACVSc, DACVS
Professor, Small Animal Surgery
Reunan P. Guillou, DVM, DACVS College of Veterinary Medicine
Orthopedic Surgeon, Co-Chief Bone and Joint Center Murdoch University
ACCESS Specialty Animal Hospitals Murdoch, Western Australia, Australia
Culver City, California Open Wounds
Overview of Minimally Invasive Osteosynthesis Principles
Total Elbow Replacement in Dogs Jennifer L. Huck, DVM, DACVS-SA
Clinical Assistant Professor of Small Animal Surgery
Laurent P. Guiot, DVM, DACVS, DECVS Clinical Sciences
Orthopedic Surgeon, Co-Chief Bone and Joint Center University of Pennsylvania
ACCESS Specialty Animal Hospitals Philadelphia, Pennsylvania
Culver City, California Esophagus
Overview of Minimally Invasive Osteosynthesis Principles
Fractures of the Femur Geraldine B. Hunt, BVSc, PhD, FACVSc (Small Animal
Surgery)
Susan G. Hackner, BVSc, MRCVS, DACVIM (Small Animal Emeritus Professor of Small Animal Surgery
Internal Medicine), DACVECC Veterinary Surgical and Radiological Sciences
Chief Medical Officer & Chief Operating Officer University of California, Davis
Cornell University Veterinary Specialists Davis, California
Stamford, Connecticut Local or Subdermal Plexus Flaps
Bleeding and Hemostasis Diaphragmatic Hernias
Thoracic Wall
Allison C. Haley, DVM, MRCVS, DACVIM (Neurology)
The Animal Neurology & Imaging Center John F. Innes, BVSc, PhD, CertVR, DSAS (Orth), FRCVS
Phoenix, Arizona Referrals Director, CVS Vets, CVS (UK) Ltd.
Neurologic Examination and Neuroanatomic Diagnosis Honorary Professor, University of Liverpool
Medical Conditions of the Vertebral Column and Spinal Cord ChesterGates Veterinary Specialists
Chester, United Kingdom
Kei Hayashi, DVM, PhD, DACVS, DJCVS Arthritis
Associate Professor
College of Veterinary Medicine Gayle H. Jaeger, DVM, MSpVM, DACVS-SA
Cornell University Surgeon
Ithaca, New York Veterinary Referral Center
Carpus, Metacarpus, and Digits Malvern, Pennsylvania
Fractures of the Tibia and Fibula External Skeletal Fixation
 Contributors ix

Nick D. Jeffery, BVSc, PhD, MSc, DECVS, DECVN, FRCVS Karl Herbert Kraus, DVM, MS, DACVS
Professor, Neurology and Neurosurgery Chief of Surgery
Department of Small Animal Clinical Sciences Department of Veterinary Clinical Science
Texas A&M University College of Veterinary Medicine
College Station, Texas Iowa State University of Science and Technology
Pathogenesis and Physiology of Central Nervous System Ames, Iowa
Disease and Injury Vertebral Fractures, Luxations, and Subluxations
Delayed Unions, Nonunions, and Malunions
Kenneth A. Johnson, MVSc, PhD, FACVSc, DACVS, Bone Grafts and Substitutes
DECVS
Professor of Veterinary Orthopaedics Ursula Krotscheck, DVM DACVS
Sydney School of Veterinary Science Associate Professor
University of Sydney Department of Clinical Sciences
Sydney, New South Wales, Australia Cornell University
Diaphragmatic Hernias Ithaca, New York
Surgical Diseases of the Elbow
Amy S. Kapatkin, DVM, MS, DACVS
Professor of Small Animal Orthopedic Surgery and Section Andrew E. Kyles, BVMS, PhD, MRCVS, DACVS
Chief Surgeon
VM: Department of Surgical and Radiological Sciences BluePearl Veterinary Specialists
University of California, Davis New York, New York
Davis, California Esophagus
Carpus, Metacarpus, and Digits
Fractures of the Tibia and Fibula Nicolaas E. Lambrechts, BVSc, MMedVet (Surgery),
DECVS, DACVSMR
Georga T. Karbe, [Link], MRCVS, DACVS-SA Associate Professor
Honorary Associate Professor University of Nottingham Veterinary Clinical Sciences
Dick White Referrals College of Veterinary Medicine and Biomedical Sciences
Cambridgeshire, United Kingdom Colorado State University
Pathogenesis, Diagnosis, and Control of Canine Hip Dysplasia Fort Collins, Colorado
Osteochondrosis
Sharon C. Kerwin, DVM, DACVS, DACVIM (Neurology)
Professor Sorrel J. Langley-Hobbs, MA BVetMed, DSAS(O), DECVS,
Veterinary Small Animal Clinical Sciences FHEA, MRCVS
College of Veterinary Medicine Professor of Small Animal Orthopaedic Surgery
Texas A&M University European & RCVS Specialist in Small Animal Surgery
College Station, Texas School of Veterinary Sciences
Thoracolumbar Vertebral Column University of Bristol
Langford, Bristol, United Kingdom
Barbara M. Kirby, DVM, MS, DACVS, DECVS Fractures of the Humerus
Professor
Veterinary Clinical Sciences Otto I. Lanz, DVM, DACVS
University College Dublin Professor, Small Animal Clinical Sciences
Dublin, Ireland Virginia-Maryland College of Veterinary Medicine
Peritoneum and Retroperitoneum Blacksburg, Virginia
Axial Pattern and Myocutaneous Flaps
Jolle Kirpensteijn, DVM, PhD, DACVS, DECVS
Chief Professional Relations Officer Jessica Leasure, BVMS, MRCVS
Hill’s Pet Nutrition Skylos Sports Medicine
Topeka, Kansas Surgery
Specific Disorders of the Skin and Subcutaneous Tissues Ellicott City, Maryland
Scapula Fractures
Kelvin Kow, DVM, MS, MRCVS, DACVIM
Medical Oncologist Richard A. LeCouteur, BVSc, PhD, DACVIM (Neurology),
Port City Veterinary Referral Hospital DECVN
Ethos/IVG Professor Emeritus, Neurology & Neurosurgery
Portsmouth, New Hampshire School of Veterinary Medicine
Introduction to Oncologic Surgery for the General Surgeon University of California, Davis
Davis, California
Michael P. Kowaleski, DVM, DACVS, DECVS Neurodiagnostics
Professor of Orthopedic Surgery
Department of Clinical Sciences Eldin A. Leighton, PhD
Cummings School of Veterinary Medicine Jane H. Booker Chair in Canine Genetics (Ret)
Tufts University The Seeing Eye, Inc.
North Grafton, Massachusetts Morristown, New Jersey;
Stifle Joint President
Canine Genetic Services, LLC
Great Falls, Virginia
Pathogenesis, Diagnosis, and Control of Canine Hip Dysplasia
x Contributors

Jonathan M. Levine, DVM, DACVIM (Neurology) Steven A. Martinez, DVM, MS, DACVS, DACVSMR
Professor, Neurology/Neurosurgery Associate Professor, Small Animal Orthopedic Surgery and
Helen McWhorter Chair Sports Medicine
Head of Small Animal Clinical Sciences Department of Veterinary Clinical Sciences
Texas A&M University College of Veterinary Medicine
College Station, Texas Washington State University
Thoracolumbar Vertebral Column Pullman, Washington
Bone Grafts and Substitutes
Victoria J. Lipscomb, MA, VetMB, CertSAS, FHEA,
DECVS, MRCVS, RCVS & European Specialist in Kyle Mathews, DVM, MS, DACVS
Small Animal Surgery Professor
Associate Professor of Soft Tissue Surgery Department of Clinical Sciences
Clinical Sciences and Services College of Veterinary Medicine
Royal Veterinary College North Carolina State University
University of London Raleigh, North Carolina
Hatfield, Hertfordshire, United Kingdom Ureters
Bladder
Philipp D. Mayhew, BVM&S, DACVS
Julius M. Liptak, BVSc, MVetClinStud, FACVSc, DACVS, Associate Professor of Small Animal Soft Tissue Surgery
DECVS Department of Surgical and Radiological Sciences
ACVS Founding Fellow, Surgical Oncology University of California, Davis
VCA Canada—Alta Vista Animal Hospital Davis, California
Ottawa, Ontario, Canada Fundamentals of Laparoscopy and Thoracoscopy
Introduction to Oncologic Surgery for the General Surgeon Liver and Biliary System

Cassie N. Lux, DVM, DACVS-SA Aidan B. McAlinden, MVB, CertSAS, DECVS, MRCVS
Assistant Professor of Surgery Assistant Professor, Veterinary Surgery
College of Veterinary Medicine University Veterinary Hospital
University of Tennessee University College Dublin
Knoxville, Tennessee Dublin, Ireland
Sphincter Mechanism Incontinence Urethra

Joseph M. Mankin, DVM, DACVIM (Neurology) Mischa B. McDonald-Lynch, DVM, DACVS

Clinical Assistant Professor Staff Surgeon
Texas A&M University Veterinary Specialty Hospital of the Carolinas
College Station, Texas Cary, North Carolina;
Thoracolumbar Vertebral Column Adjunct Faculty
Department of Clinical Sciences
Denis J. Marcellin-Little, DEDV, DACVS, DACVSMR North Carolina State University
(Charter) Raleigh, North Carolina
Professor, Orthopedic Surgery Pathogenesis, Diagnosis, and Control of Canine Hip Dysplasia
Department of Clinical Sciences
College of Veterinary Medicine Erin McGowan, VMD, DACVECC
North Carolina State University Criticalist
Raleigh, North Carolina BluePearl Veterinary Partners
Bandaging, External Coaptation, and External Devices for Waltham, Massachusetts
Companion Animals Fluid Therapy

William G. Marshall, BVMS, DECVS Ron McLaughlin, DVM, DVSc, DACVS

Clinician in Orthopaedic Surgery Professor of Surgery
Small Animal Hospital Associate Dean for Administration
School of Veterinary Medicine Mississippi State University
University of Glasgow Mississippi State, Mississippi
Glasglow, Scotland, United Kingdom Hip Luxation
Tarsus and Metatarsus
Muscle and Tendon Disorders Eoin P. McNeill, MSc
Graduate Student
Manuel Martin-Flores, MV, DACVAA Institute of Regenerative Medicine
Assistant Professor of Anesthesiology Texas A&M Health Science Center
Department of Clinical Sciences College Station, Texas
College of Veterinary Medicine Stem Cells and Regenerative Medicine
Cornell University
Ithaca, New York Björn P. Meij, DVM, PhD, DECVS
Anesthesia for Intracranial Surgery Professor of Small Animal Surgery
Department of Clinical Sciences of Companion Animals
Faculty of Veterinary Medicine
Utrecht University
Utrecht, The Netherlands
Degenerative Lumbosacral Stenosis
 Contributors xi

Ralph P. Millard, DVM, MS, DACVS-SA E. Christopher Orton, DVM, PhD

Staff Surgeon Professor
BluePearl Veterinary Partners Department of Clinical Sciences
Overland Park, Kansas Colorado State University
Open Fractures Fort Collins, Colorado
Cardiac Surgery
Noël M.M. Moens, DVM, MSc, DACVS, DECVS
Associate Professor, Small Animal Surgery Cynthia M. Otto, DVM, PhD, DACVECC, DACVSMR, CCRT
Ontario Veterinary College Associate Professor of Critical Care
University of Guelph Department of Clinical Studies
Guelph, Ontario, Canada University of Pennsylvania
Fractures of the Pelvis Philadelphia, Pennsylvania;
Executive Director
Eric Monnet, DVM, PhD, FAHA, DACVS, DECVS Penn Vet Working Dog Center
Professor University of Pennsylvania
Clinical Sciences Philadelphia, Pennsylvania
Colorado State University Shock
Fort Collins, Colorado
Larynx Augusta Pelosi, DVM, DACVS, DACVIM (Cardiology)
Lungs Medical Director and Head of Cardiac Surgery
Pericardial Surgery North American Veterinary Heart Center
Jupiter, Florida
Michael R. Moreno, PhD The Operating Room
Assistant Professor Cardiac Surgery
Department of Mechanical Engineering
Department of Biomedical Engineering Heidi Phillips, VMD, DACVS
Department of Small Animal Clinical Sciences Assistant Professor, Small Animal Surgery
Texas A&M University Department of Veterinary Clinical Medicine
College Station, Texas; College of Veterinary Medicine
Director of Biomechanics Research and Engineering University of Illinois
Department of Orthopedics and Sports Medicine Urbana, Illinois
Houston Methodist Hospital Vascular Surgery
Houston, Texas Renal Transplant
Bone Biomechanics and Fracture Biology
Simon R. Platt, BVM&S, MRCVS, DACVIM (Neurology),
Richard W. Nelson, DVM, DACVIM DECVN
Professor Emeritus Professor of Neurology
Department of Medicine and Epidemiology Small Animal Medicine and Surgery
School of Veterinary Medicine College of Veterinary Medicine
University of California, Davis University of Georgia
Davis, California Athens, Georgia
Adrenal Glands Cervical Vertebral Column and Spinal Cord

Jean A. Nemzek, DVM, MS, DACVS Antonio Pozzi, MS, DACVS, DECVS, DACVSMR
Clinical Associate Professor Department of Small Animal Surgery
Assistant Director of Research Services Vetsuisse Faculty
Unit for Laboratory Animal Medicine University of Zurich
University of Michigan Zurich, Switzerland
Ann Arbor, Michigan Stifle Joint
Inflammatory Response
Donna M. Raditic, DVM, DACVN, CVA
Nicole Northrup, DVM, DACVIM (Oncology) Nutrition and Integrative Medicine Consulting
Associate Professor Athens, Georgia
Small Animal Medicine and Surgery Metabolism and Nutritional Needs of Surgical Patients
College of Veterinary Medicine
University of Georgia MaryAnn G. Radlinsky, DVM, MS, DACVS
Athens, Georgia General Surgeon
Neoplasms of the Vertebrae and Spinal Cord VetMed
Cave Creek, Arizona
Natasha J. Olby, Vet MB, PhD, MRCVS, DACVIM Thoracic Cavity
(Neurology)
Professor of Neurology/Neurosurgery Alexander M. Reiter, Dipl. Tzt., DrMedVet., DAVDC,
Department of Clinical Sciences EVDC
College of Veterinary Medicine Professor of Dentistry and Oral Surgery
North Carolina State University Department of Clinical Sciences and Advances Medicine
Raleigh, North Carolina School of Veterinary Medicine
Pathogenesis and Physiology of Central Nervous System University of Pennsylvania
Disease and Injury Philadelphia, Pennsylvania
Dentistry for the Surgeon
Palate
xii Contributors

Walter C. Renberg, DVM, MS, DACVS Kurt S. Schulz, DVM, MS, DACVS
Professor and Head, Small Animal Surgery Peak Veterinary Referral Center
Department of Clinical Sciences Ethos Veterinary Health
Kansas State University Williston, Vermont
Manhattan, Kansas Arthroscopy
Sterilization
Bernard Séguin, DVM, MS, DACVS, ACVS Founding
Marina C. Richter, DACVS, DVM MS Fellow Surgical Oncology
Staff Surgeon Associate Professor
DoveLewis Emergency Animal Hospital Flint Animal Cancer Center
Portland, Oregon Colorado State University
Spleen Fort Collins, Colorado
Amputations
Matthew J. Ritter, DVM, DACVS Thyroid and Parathyroid Glands
Veterinary Surgeon
Acacia Mobile Veterinary Surgery Rachel Seibert, DVM, DACVS, CCRP
Greer, South Carolina Small Animal Surgeon
Salivary Glands Southwest Veterinary Surgical Service
Phoenix, Arizona
Duane Robinson, DVM, PhD, DACVS-SA Trachea and Bronchi
BluePearl Veterinary Partners Sphincter Mechanism Incontinence
Seattle, Washington
Osteomyelitis and Implant-Associated Infections Deborah C. Silverstein, DVM, DACVECC
Associate Professor of Critical Care
Mark C. Rochat, DVM, MS, DACVS Department of Clinical Sciences and Advanced Medicine
Clinical Professor of Small Animal Surgery Ryan Veterinary Hospital
Department of Veterinary Clinical Sciences University of Pennsylvania
College of Veterinary Medicine Philadelphia, Pennsylvania
Purdue University Fluid Therapy
West Lafayette, Indiana
The Shoulder Ameet Singh, DVM, DVSc, DACVS-SA
Associate Professor, Small Animal Surgery
Simon C. Roe, BVSc, PhD, DACVS Department of Clinical Studies
Professor Ontario Veterinary College
Small Animal Orthopaedic Surgery University of Guelph
Veterinary Medical Center Guelph, Ontario, Canada
North Carolina State University Wound Infections and Antimicrobial Use
Raleigh, North Carolina
Internal Fracture Fixation Daniel D. Smeak, DVM, DACVS
Chief of Surgery and Dentistry
W. Brian Saunders, DVM, PhD, DACVS College of Veterinary Medicine and Biomedical Sciences
Associate Professor, Small Animal Orthopedic Surgery Colorado State University
Department of Small Animal Clinical Sciences Fort Collins, Colorado
Texas A&M University Abdominal Wall Reconstruction and Hernias
College Station, Texas
Stem Cells and Regenerative Medicine Gail K. Smith, VMD, PhD
Platelet-Rich Plasma and Autologous Conditioned Sera Director of AIS PennHIP
Bone Biomechanics and Fracture Biology Irvine, California;
Professor Emeritus of Orthopaedic Surgery
Scott J. Schatzberg, DVM, PhD, DACVIM (Neurology) Department of Clinical Studies
Chief Medical Officer School of Veterinary Medicine
The Animal Neurology & Imaging Center University of Pennsylvania
Algodones, New Mexico; Philadelphia, Pennsylvania
Affiliate Professor Pathogenesis, Diagnosis, and Control of Canine Hip Dysplasia
Department of Clinical Sciences
College of Veterinary Medicine Maria M. Soltero-Rivera, DVM, DAVDC
Colorado State University Veterinary Specialist and Co-Medical Director
Fort Collins, Colorado VCA San Francisco Veterinary Specialists
Neurologic Examination and Neuroanatomic Diagnosis Dentistry and Oral Surgery
Medical Conditions of the Vertebral Column and Spinal Cord San Francisco, California;
Adjunct Assistant Professor
Chad W. Schmiedt, DVM, DACVS Dentistry and Oral Surgery
Professor University of Pennsylvania—Penn Vet
Department of Small Animal Medicine and Surgery Philadelphia, Pennsylvania
College of Veterinary Medicine Dentistry for the Surgeon
The University of Georgia
Athens, Georgia
Suture Material, Tissue Staplers, Ligation Devices, and Closure
Methods
Nasal Planum, Nasal Cavity, and Sinuses
 Contributors xiii

Bryden J. Stanley, BVMS, MACVSc, MVetSc, DACVS Bryan T. Torres, DVM, PhD, DACVS-SA
Section Chief of Surgery Assistant Professor, Small Animal Orthopedic Surgery
College of Veterinary Medicine Department of Veterinary Medicine and Surgery
Michigan State University College of Veterinary Medicine
East Lansing, Michigan University of Missouri
Wound Healing Columbia, Missouri
Tension-Relieving Techniques Gait Analysis
Salivary Glands
Heather A. Towle Millard, DVM, MS, DACVS-SA
Giacomo Stanzani, DVM, MVetMed, DACVECC, Staff Surgeon
DECVECC, MRCVS BluePearl Speciality and Emergency Medicine for Pets
PhD Student in Experimental and Personalised Medicine Overland Park, Kansas
Division of Medicine Open Fractures
University College London Miscellaneous Orthopedic Conditions
London, United Kingdom Testes, Epididymides, and Scrotum
Shock
Sebastiaan A. van Nimwegen, DVM, PhD, DECVS
Beverly K. Sturges, DVM, MS, MaS, DACVIM Assistant Professor
(Neurology) Department of Clinical Sciences of Companion Animals
Professor, Clinical Neurology/Neurosurgery Faculty of Veterinary Medicine
Department of Surgical & Radiological Sciences Utrecht University
University of California, Davis Utrecht, The Netherlands
Davis, California Specific Disorders of the Skin and Subcutaneous Tissues
Cranial Surgery
Aldo Vezzoni, DVM, DECVS
Patricia A. Sura, DVM, DACVS Clinica Veterinaria Vezzoni srl
Staff Surgeon Cremona, Italy
Dallas Veterinary Surgical Center Surgical Management of Hip Dysplasia
Dallas, Texas
Trachea and Bronchi Jason Villano, DVM, MSc, MS, DACLAM
Clinical Assistant Professor
Steven F. Swaim, DVM, MS Unit for Laboratory Animal Medicine
Professor Emeritus University of Michigan
College of Veterinary Medicine Ann Arbor, Michigan
Auburn University Inflammatory Response
Auburn, Alabama
Skin Grafts Dirsko J.F. von Pfeil, [Link], DVM, DACVS, DECVS,
DACVSMR
Amy S. Tidwell, DVM, DACVR Staff Surgeon
Private Veterinary Imaging Consultant Friendship Surgical Specialists at the Friendship Hospital for
Louisville, Kentucky Animals
Imaging of the Neurologic System Washington, District of Columbia;
Adjunct Assistant Professor
D. Michael Tillson, DVM, MS, DACVS Department of Small Animal Clinical Sciences
Arthur & Louise Oriole Professor in the College of College of Veterinary Medicine
Veterinary Medicine East Lansing, Michigan
Department of Clinical Sciences Internal Fracture Fixation
College of Veterinary Medicine
Auburn University Daniel A. Ward, DVM, PhD
Auburn, Alabama Professor of Ophthalmology
Kidneys Small Animal Clinical Sciences
University of Tennessee
Rory Todhunter, BVSc, MS, PhD, DACVS Knoxville, Tennessee
Professor of Surgery Emergency Ophthalmic Surgery
Department of Clinical Sciences
Cornell University Jennifer L. Wardlaw, DVM, MS, DACVS
Ithaca, New York Concierge Surgeon, Owner
Tissues of the Musculoskeletal System Gateway Veterinary Surgery
St. Louis, Missouri;
James L. Tomlinson, BS, DVM, MVSci, DACVS Adjunct Professor
Professor, Small Animal Orthopedic Surgery Department of Clinical Sciences
Department of Veterinary Medicine and Surgery Mississippi State University
College of Veterinary Medicine Mississippi State, Mississippi
University of Missouri Hip Luxation
Columbia, Missouri Axial Pattern and Myocutaneous Flaps
Principles of Angular Limb Deformity Correction
xiv Contributors

J. Scott Weese, DVM, DVSc, DACVIM D. Colette Williams, PhD

Professor Electrodiagnostic Consultant
Pathobiology Vet EDX
Centre for Public Health and Zoonoses Winters, California
University of Guelph Neurodiagnostics
Guelph, Ontario, Canada
Wound Infections and Antimicrobial Use John M. Williams, MA VetMB, LLB, CertVR, DECVS,
Monitoring for Surgical Infection FRCVS
National Surgical Lead
John Michael Weh, DVM, DACVS-SA Vets Now 24/7 Emergency and Specialty Hospital
Staff Surgeon Whitefield, Manchester, Great Britain;
BluePearl Veterinary Partners Honorary Professor
Renton, Washington Faculty of Veterinary Science
Vertebral Fractures, Luxations, and Subluxations University of Liverpool
Internal Fracture Fixation Liverpool, Great Britain
Colon
Chick Weisse, VMD, DACVS
Staff Surgeon Marc A. Wosar, DVM, MSpVM, DACVS
Director, Interventional Radiology Service Director
Animal Medical Center Mountain Animal Specialists Center
New York, New York Blue Ridge, Georgia
Fundamentals of Interventional Radiology and Interventional External Skeletal Fixation
Endoscopy
Liver and Biliary System Steve Zambrano, PhD-c
Research Engineer
Hans D. Westermeyer, DVM, DACVO Biomedical Engineering
Assistant Professor of Ophthalmology Texas A&M University
Department of Clinical Sciences College Station, Texas
College of Veterinary Medicine Bone Biomechanics and Fracture Biology
North Carolina State University
Raleigh, North Carolina
Basic Ophthalmic Surgical Procedures

Richard A.S. White, BVetMed, PhD, DSAS, DVR, FRCVS,

DACVS, DECVS
ACVS, European and RCVS Veterinary Specialist in Small
Animal Surgery
RCVS Recognized Specialist in Veterinary Oncology
ACVS Founding Fellow, Surgical Oncology Professor
Dick White Referrals
Newmarket, Cambridge, Great Britain
Prostate
Middle and Inner Ear
 To the students who seek to develop their understanding and skills,
to the colleagues who share their expertise and desire to advance the art
and science of surgery, and to all who gain satisfaction in the quest
to understand and perform a procedure perfectly.

Spencer A. Johnston

To our readers:

“Twenty years from now you will be more disappointed by the things that you
didn’t do than by the ones you did do. So throw off the bowlines.
Sail away from the safe harbor. Catch the trade winds in your sails.
Explore. Dream. Discover.” —MARK TWAIN

To Jacob and Jessica Tobias, my two wonderful offspring:

“Your living is determined not so much by what life brings to you as by the attitude
you bring to life; not so much by what happens to you as by the way your mind looks
at what happens.” —KHALIL GIBRAN

“Two roads diverged in a wood, and I—I took the one less traveled by.
And that has made all the difference.” —ROBERT FROST

Karen M. Tobias
This page intentionally left blank
 Preface

Out of clutter, find simplicity. From discord, find harmony. In the knowledge throughout their careers, and they communicate
middle of difficulty lies opportunity. their knowledge and ideas to others, inspiring future genera-
—Albert Einstein (1879-1955) tions to develop new techniques and improve upon old ones.
The authors of Veterinary Surgery: Small Animal, Edition 2,

I
n 1948, Albert Einstein was admitted to Jewish Hospital have compiled the wisdom and knowledge of many great
in Brooklyn, New York to undergo intestinal cyst removal veterinary surgeons, anatomists, physiologists, internists, radi-
and was unexpectedly diagnosed with an aneurysm of his ologists, and other specialists. And they have added their own
abdominal aorta. In an effort to induce fibrosis and prevent wisdom and experiences as they detail the techniques and
further expansion of the aneurysm, the great surgeon Dr. technical challenges of various procedures. We are so grateful
Rudolph Nissen wrapped the weakened vessel with cello- for their commitment to furthering the art and science of
phane, saving Einstein’s life.1 This pioneering technique, devel- veterinary surgery. In addition, we would like to recognize the
oped by Harrison and Chandy in 1943,1 was eventually input of our readers, particularly those hardy souls who pored
replaced by surgically placed grafts and, more recently, endo- over the first edition in preparation for board certification.
vascular implants. However, surgical procedures based on the Based on that input we added new topics, improved consis-
principles of this technique, such as cellophane banding of tency between chapters, corrected errors, redrew figures, and
congenital portosystemic shunts in dogs, are still in practice clarified content. As you will see, this textbook is a true col-
today. laboration of surgical devotees. We hope the contents of this
What makes a great surgeon? Great surgeons are thinkers book will serve not only to educate you, but to inspire you to
and doers, creative problem solvers and risk takers. They are become the thinker, the doer, the innovator, the great surgeon.
passionate, focused, and dedicated, and they learn from their
mistakes. Great surgeons are compassionate to their patients Spencer A. Johnston
and those who love them. Great surgeons continue to acquire Karen M. Tobias

1. Lesney, Mark (January 24, 2012). “Einstein’s Aneurysm: Of Cello-

phane and Rudolph Nissen”. Vascular Specialist. January 24, 2012
[Link]
steins-aneurysm-cellophane-and-rudolph-nissen Retrieved February 10,
2017.

xvii
This page intentionally left blank
 Contents

15 Principles and Use of Energy Sources in Small

VOLUME 1 Animal Surgery: Electrosurgery and Laser
Applications, 200
Marian E. Benitez
SECTION I
16 Suture Material, Tissue Staplers, Ligation Devices,
Surgical Biology and Closure Methods, 210
Chad W. Schmiedt
1 Inflammatory Response, 1
Jason Villano, Dalis E. Collins, and Jean A. Nemzek 17 Instrument and Tissue Handling Techniques, 225
Harry W. Boothe
2 Molecular and Cellular Biology: Genomics, 15
Dylan N. Clements 18 Surgical Hemostasis, 238
Davina M. Anderson
3 Stem Cells and Regenerative Medicine, 29
W. Brian Saunders, Carl A. Gregory, 19 Bandages and Drains, 246
Robert N. Bearden, and Eoin P. McNeill Bonnie Grambow Campbell
4 Platelet-Rich Plasma and Autologous Conditioned 20 Biopsy General Principles, 256
Sera, 40 Janet A. Grimes
W. Brian Saunders, Robert N. Bearden,
and Samuel P. Franklin 21 Anesthesia Principles and Monitoring, 266
Benjamin M. Brainard and Erik H. Hofmeister
5 Fluid Therapy, 48
Deborah C. Silverstein, Erin McGowan, 22 Anesthesia Practice for Existing Conditions, 288
and Jennifer Campbell Benjamin M. Brainard and Erik H. Hofmeister
6 Shock, 79 23 Fundamentals of Interventional Radiology and
Giacomo Stanzani and Cynthia M. Otto Interventional Endoscopy, 309
Chick Weisse
7 Bleeding and Hemostasis, 100
Susan G. Hackner and Jillian M. DiFazio 24 Fundamentals of Laparoscopy and
Thoracoscopy, 317
8 Metabolism and Nutritional Needs of Surgical Philipp D. Mayhew
Patients, 127
Joseph W. Bartges and Donna M. Raditic 25 Introduction to Oncologic Surgery for the General
Surgeon, 325
9 Wound Healing, 132 James P. Farese, Nicholas J. Bacon, Julius M. Liptak,
Bryden J. Stanley and Karen Cornell and Kelvin Kow
10 Wound Infections and Antimicrobial Use, 148
Ameet Singh and J. Scott Weese
SECTION III
SECTION II Neurosurgery
Surgical Methods and Perioperative Care 26 Neurologic Examination and Neuroanatomic
Diagnosis, 347
11 Sterilization, 157 Scott J. Schatzberg and Allison C. Haley
Walter C. Renberg and Stéphanie Claeys
27 Neurodiagnostics, 362
12 Instrumentation, 165 Richard A. LeCouteur and D. Colette Williams
Harry W. Boothe
28 Imaging of the Neurologic System, 378
13 The Operating Room, 177 Amy S. Tidwell and Marc Kent
Augusta Pelosi
29 Pathogenesis and Physiology of Central Nervous
14 Monitoring for Surgical Infection, 192 System Disease and Injury, 402
J. Scott Weese Natasha J. Olby and Nick D. Jeffery
xix
xx Contents

30 Medical Conditions of the Vertebral Column and 48 Bone Grafts and Substitutes, 783
Spinal Cord, 417 Karl Herbert Kraus and Steven A. Martinez
Allison C. Haley and Scott J. Schatzberg
49 Scapula Fractures, 794
31 Cervical Vertebral Column and Spinal Cord, 438 Jeffrey N. Peck and Jessica Leasure
Simon R. Platt and Ronaldo Casimiro da Costa
50 The Shoulder, 800
32 Thoracolumbar Vertebral Column, 485 Mark C. Rochat
Sharon C. Kerwin, Jonathan M. Levine, and
Joseph M. Mankin 51 Fractures of the Humerus, 820
Sorrel J. Langley-Hobbs
33 Degenerative Lumbosacral Stenosis, 514
Björn P. Meij and Niklas Bergknut 52 Surgical Diseases of the Elbow, 836
Ursula Krotscheck and Peter Böttcher
34 Vertebral Fractures, Luxations, and
Subluxations, 529 53 Total Elbow Replacement in Dogs, 885
John Michael Weh and Karl Herbert Kraus Loïc M. Déjardin and Reunan P. Guillou

35 Cranial Surgery, 549 54 Radius and Ulna, 896

Beverly K. Sturges and Peter J. Dickinson Derek B. Fox

36 Anesthesia for Intracranial Surgery, 570 55 Carpus, Metacarpus, and Digits, 920
Luis Campoy and Manuel Martin-Flores Amy S. Kapatkin, Tanya Garcia-Nolen,
and Kei Hayashi
37 Neoplasms of the Vertebrae and Spinal
Cord, 579 56 Fractures of the Pelvis, 938
Marc Kent and Nicole Northrup Noël M.M. Moens and Charles E. DeCamp

SECTION IV 57 Hip Luxation, 956

Jennifer L. Wardlaw and Ron McLaughlin
Musculoskeletal System
58 Pathogenesis, Diagnosis, and Control of Canine Hip
38 Tissues of the Musculoskeletal System, 601 Dysplasia, 964
Stuart Bliss and Rory Todhunter Gail K. Smith, Eldin A. Leighton, Georga T. Karbe,
and Mischa B. McDonald-Lynch
39 Bone Biomechanics and Fracture Biology, 613
Michael R. Moreno, Steve Zambrano, 59 Surgical Management of Hip Dysplasia, 992
Loïc M. Déjardin, and W. Brian Saunders Aldo Vezzoni and Jeffrey N. Peck

40 Open Fractures, 649 60 Fractures of the Femur, 1019

Ralph P. Millard and Heather A. Towle Millard Laurent P. Guiot and Loïc M. Déjardin

41 Internal Fracture Fixation, 654 61 Stifle Joint, 1071

Spencer A. Johnston, Dirsko J.F. von Pfeil, Michael P. Kowaleski, Randy J. Boudrieau,
Loïc M. Déjardin, Simon C. Roe, and and Antonio Pozzi
John Michael Weh
62 Total Knee Replacement in the Dog, 1168
42 External Skeletal Fixation, 691 Matthew J. Allen and Judith Bertran
Gayle H. Jaeger and Marc A. Wosar
63 Fractures of the Tibia and Fibula, 1176
43 Overview of Minimally Invasive Osteosynthesis Kei Hayashi and Amy S. Kapatkin
Principles, 721
Laurent P. Guiot, Loïc M. Déjardin, 64 Tarsus and Metatarsus, 1193
and Reunan P. Guillou Stuart Carmichael and William G. Marshall

44 Bandaging, External Coaptation, and External 65 Amputations, 1210

Devices for Companion Animals, 737 Bernard Séguin
Denis J. Marcellin-Little
66 Dentistry for the Surgeon, 1224
45 Delayed Unions, Nonunions, and Malunions, 752 Alexander M. Reiter and Maria M. Soltero-Rivera
Karl Herbert Kraus and Benjamin J. Bayer
67 Mandibular and Maxillofacial Fractures, 1240
46 Principles of Angular Limb Deformity Randy J. Boudrieau
Correction, 762
Derek B. Fox and James L. Tomlinson 68 Arthritis, 1265
John F. Innes
47 Osteomyelitis and Implant-Associated
Infections, 775 69 Miscellaneous Orthopedic Conditions, 1299
Duane Robinson Heather A. Towle Millard and Gert J. Breur
 Contents xxi

70 Muscle and Tendon Disorders, 1316 SECTION VII

Stuart Carmichael and William G. Marshall
Digestive System
71 Arthroscopy, 1323
Samuel P. Franklin and Kurt S. Schulz 87 Soft Tissues of the Oral Cavity, 1637
Gregory M. Anderson
72 Musculoskeletal Neoplasia and Limb-Sparing
Surgery, 1347 88 Salivary Glands, 1653
Sarah Elizabeth Boston Matthew J. Ritter and Bryden J. Stanley

73 Osteochondrosis, 1372 89 Mandibulectomy and Maxillectomy, 1663

Gert J. Breur and Nicolaas E. Lambrechts John Berg

74 Gait Analysis, 1385 90 Esophagus, 1677

Bryan T. Torres Andrew E. Kyles and Jennifer L. Huck

91 Stomach, 1700
Karen Cornell

92 Small Intestine, 1730

Michelle A. Giuffrida and Dorothy Cimino Brown
VOLUME 2
93 Colon, 1761
John M. Williams
SECTION V 94 Rectum, Anus, and Perineum, 1783
Skin and Reconstruction Stephen J. Baines and Lillian R. Aronson

75 Primary Wound Closure, 1397 95 Liver and Biliary System, 1828

Maria A. Fahie Philipp D. Mayhew and Chick Weisse

76 Open Wounds, 1410 96 Hepatic Vascular Anomalies, 1852

Giselle Hosgood Allyson C. Berent and Karen M. Tobias

77 Tension-Relieving Techniques, 1422 97 Pancreas, 1886

Bryden J. Stanley Karen Cornell and Karen M. Tobias

78 Local or Subdermal Plexus Flaps, 1446 98 Feeding Tubes, 1901

Geraldine B. Hunt Jacqueline R. Davidson

79 Axial Pattern and Myocutaneous Flaps, 1457

Jennifer L. Wardlaw and Otto I. Lanz
SECTION VIII
80 Skin Grafts, 1473 Respiratory System
Mark W. Bohling and Steven F. Swaim
99 Nasal Planum, Nasal Cavity, and Sinuses, 1919
81 Burns, 1495 Chad W. Schmiedt
Mark W. Bohling
100 Palate, 1935
82 Specific Disorders of the Skin and Subcutaneous Alexander M. Reiter and David E. Holt
Tissues, 1508
Sebastiaan A. van Nimwegen and Jolle Kirpensteijn 101 Larynx, 1946
Eric Monnet and Karen M. Tobias

SECTION VI 102 Trachea and Bronchi, 1963

April M. (Durant) Haynes, Rachel Seibert, and
Abdomen Patricia A. Sura
83 Spleen, 1551 103 Lungs, 1983
Marina C. Richter Eric Monnet
84 Abdominal Wall Reconstruction and Hernias, 1564
Daniel D. Smeak
SECTION IX
85 Diaphragmatic Hernias, 1592
Geraldine B. Hunt and Kenneth A. Johnson Thorax
86 Peritoneum and Retroperitoneum, 1603 104 Thoracic Wall, 2001
Barbara M. Kirby Geraldine B. Hunt
xxii Contents

105 Thoracic Cavity, 2019 117 Urethra, 2234

Karen M. Tobias, Brett G. Darrow, Laura C. Cuddy and Aidan B. McAlinden
and MaryAnn G. Radlinsky
118 Sphincter Mechanism Incontinence, 2254
Cassie N. Lux and Rachel Seibert
SECTION X
119 Renal Transplant, 2263
Cardiovascular System Lillian R. Aronson and Heidi Phillips

106 Cardiac Surgery, 2049

Augusta Pelosi and E. Christopher Orton SECTION XII
107 Pericardial Surgery, 2084 Endocrine System
Eric Monnet
120 Adrenal Glands, 2281
108 Vascular Surgery, 2093 Christopher A. Adin and Richard W. Nelson
Heidi Phillips and Lillian R. Aronson
121 Thyroid and Parathyroid Glands, 2291
Bernard Séguin and Lisa Brownlee
SECTION XI
Urogenital System SECTION XIII
109 Ovaries and Uterus, 2109 Ear
Boel A. Fransson
122 Pinna and External Ear Canal, 2309
110 Vagina, Vestibule, and Vulva, 2130 Nicholas J. Bacon
Christopher A. Adin
123 Middle and Inner Ear, 2328
111 Testes, Epididymides, and Scrotum, 2142 Richard A.S. White
Heather A. Towle Millard

112 Penis and Prepuce, 2158 SECTION XIV

Harry W. Boothe
Eye
113 Prostate, 2168
Richard A.S. White 124 Basic Ophthalmic Surgical Procedures, 2341
Hans D. Westermeyer and Diane V.H. Hendrix
114 Kidneys, 2184
Karen M. Tobias and D. Michael Tillson 125 Emergency Ophthalmic Surgery, 2370
Daniel A. Ward
115 Ureters, 2202
Kyle Mathews

116 Bladder, 2219

Victoria J. Lipscomb
 SECTION I
Surgical Biology

CHAPT E R 1
Inflammatory Response
Jason Villano, Dalis E. Collins, and Jean A. Nemzek

I
nflammation is a fundamental early defense mechanism blood flow and local delivery of soluble mediators and inflam-
against infection and the initiator of basic tissue repair. In matory cells.81 Vasodilation is induced by vascular smooth
sharp contrast, prolonged, uncontrolled inflammation may muscle changes mediated by nitric oxide, histamine, leukotri-
have detrimental effects, including excessive pain, immuno- enes, prostaglandins, and complement factors. Concurrently,
suppression, organ dysfunction, and death. This suggests that lymphatic vessels proliferate to accommodate drainage of
patient well-being is heavily dependent upon an appropri- edema6 and serve as an avenue for microbes to reach local
ately balanced inflammatory response. Inflammation may lymph nodes. Although these initial responses may be benefi-
affect every aspect of clinical decision making and surgical cial, an imbalance of mediators may promote widespread
patient management. The timing of surgical intervention may vasodilation, systemic hypotension, and even shock, as seen in
be determined by the amount of local or systemic inflamma- severe sepsis.252
tion present. Intraoperative selection of various approaches,
techniques, and even materials often hinges on attempts to Permeability Vasodilation is followed by an increase in
minimize trauma and inflammation. In the immediate post- vascular permeability caused by various mechanisms. An
operative period, the inflammation experienced by a patient increase in the number and size of intracellular endothelial
will dictate therapeutic decisions and even prognosis. Finally, gaps in the venules is mediated by histamine and serotonin.
long-term recovery will be affected by residual inflammation These transcytoplasmic channels (vesiculovacuolar organ-
and any concurrent inflammatory conditions. Therefore it is elles) allow transcytosis of plasma products to the site of
imperative that surgeons have in-depth knowledge of the trig- inflammation.84 However, some molecules cannot traverse
gers and mediators, as well as the innate compensatory mech- these channels and thus use other mechanisms. For example,
anisms and therapeutic targets that regulate the inflammatory interendothelial gaps, which are used by very large plasma
response. molecules and mediators,84 may form, and endothelial cell
retraction may occur; both processes are stimulated by
hypoxia, endothelial injury, cytokines, or other inflammatory
ACUTE INFLAMMATION mediators.84,171,245 Vascular permeability is also increased by
direct trauma and leukocyte-mediated endothelial damage.171
The classic macroscopic signs of acute inflammation include Increased vascular permeability is accompanied by serum
rubor (redness, erythema), calor (heat), dolor (pain), and protein loss, resulting in decreased intravascular osmotic pres-
tumor (swelling, edema), resulting in loss of function. These sure, increased blood viscosity, and subsequent increases in
signs are the manifestations of increased localized blood flow interstitial osmotic pressure. These pathophysiologic changes,
and exudation of protein-rich fluid that occur within minutes combined with early increases in hydrostatic pressure, lead
of exposure to an inflammatory stimulus to promote the to edema fluid accumulation in the interstitial space.153,252
cleanup and repair of damaged tissue. This pathophysiologic Edema facilitates the delivery of beneficial soluble factors
response is regulated and counterregulated by a complex (antibodies and acute phase proteins) to the site of inflam-
orchestra of mediators that will be the focus of this text. mation. However, along with alterations in tissue pH and
oxygenation, edema induces localized pain and may precipi-
The Acute Vascular Response tate loss of function.
Vasodilation Upon initial injury, local arterioles may
undergo rapid, inconsistent, and transient vasoconstriction to Stasis Fluid loss leads to hemoconcentration, described
provide some immediate hemostasis. Vasoconstriction is stim- as an increased erythrocyte concentration in the local vascu-
ulated by vasoactive agents such as catecholamines, serotonin, lature. Combined with decreased hydrostatic pressure, hemo-
bradykinin, and prostaglandins that are released from sur- concentration leads to congestion and intravascular stasis,
rounding tissues and by norepinephrine released by the sym- which allows increased contact time among erythrocytes, leu-
pathetic nervous system.153 Within minutes, vasodilation and kocytes, and the vascular endothelium, leading to the next
the opening of new capillary beds occur, leading to increased stage of acute inflammation.252

1
2 SECTION I • Surgical Biology

Integrin activation Migration through

Rolling Stable adhesion
by chemokines endothelium
Leukocyte Sialyl-Lewis X–modified glycoprotein

Integrin (low-affinity state)

Integrin (high-
affinity state)
PECAM-1
(CD31)

P-selectin E-selectin Integrin ligand

Proteoglycan (ICAM-1)

Chemokines
Cytokines Macrophage
(TNF, IL-1) with microbes
Fibrin and fibronectin
(extracellular matrix)

Figure 1.1 Neutrophil extravasation. Leukocyte extravasation is a multistep process orchestrated

by both hemostatic and cell–cell interactions. Margination and rolling of leukocytes along the
vascular endothelium are mediated through interactions between endothelial selectins with their
corresponding leukocyte ligands. Chemokines stimulate increased expression and enhanced binding
affinity of leukocyte integrins, leading to firm adherence to endothelial cell integrins (e.g., intercel-
lular adhesion molecule [ICAM]-1). Leukocyte diapedesis is facilitated by the adhesion molecule,
platelet-endothelial cell adhesion molecule (PECAM)-1, and leukocytes follow chemokine gradi-
ents to the site of injury. IL-1, Interleukin-1; TNF, tumor necrosis factor. (From Kumar V, Abbas
A, Fausto N, et al.: Robbins and Cotran pathologic basis of disease, ed 8, Philadelphia, 2009,
Saunders/Elsevier.)

Leukocyte Extravasation As hemostasis develops, leu- molecule (ICAM)-1 on endothelial cells interacts with the
kocytes begin to marginate along the blood vessel walls to integrins, lymphocyte function-associated antigen-1 (LFA-1,
interact with endothelial cells, primarily in the systemic post- also known as CD11a/CD18), and macrophage antigen-1
capillary venules and the pulmonary capillaries (Figure (Mac-1, also known as CD11b/CD18). Overall, adherence
1.1).252 This intimate association promotes weak, transient halts the progression of leukocytes within the circulation,
interactions between the glycoprotein cell adhesion mol- making them available for recruitment to the site of inflam-
ecules called selectins on endothelial cells and their corre- mation. Genetic deficiencies in adhesion molecules inhibit
sponding ligands on inflammatory leukocytes, for example, local leukocyte recruitment during inflammation, leading to
the carbohydrate ligand Sialyl-Lewis X.4 The three most com- recurrent bacterial and fungal infections accompanied by
monly described are designated E-, P-, and L-selectins accord- peripheral leukocytosis.166
ing to their surface expression on endothelial cells, platelets, Once adhered, leukocytes migrate through a process
and leukocytes, respectively. In particular, E-selectins are termed diapedesis. Although transcellular migration is possi-
upregulated by proinflammatory cytokines and bind receptor ble, diapedesis occurs through the interendothelial junctions
molecules on slow-moving, marginated leukocytes.113 Initially of postcapillary venules, facilitated by endothelial cell retrac-
the weak endothelial-leukocyte interactions are susceptible tion and cell adhesion molecules.223,241 In response to molecu-
to shear stress from blood flow. As the leukocytes roll along lar stimuli, adhesion molecules (e.g., ICAM-2) are expressed
the endothelium at a velocity proportionate to blood flow, at concentrated levels near interendothelial cell junctions,
the affinity of their interactions with endothelium increases where they interact with leukocyte integrins and facilitate
as the weak bonds break and re-form.252 Leukocyte adhesion transmigration.131 In addition, platelet-endothelial cell adhe-
to the vascular wall occurs through high affinity bonds formed sion molecule (PECAM)-1, which resides on endothelial cells,
by integrins on the leukocyte surface. Integrins, proteins com- facilitates leukocyte transendothelial migration and transmi-
posed of α (CD11a, CD11b, CD11c) and β (CD18) sub- gration through the basement membrane (see Figure 1.1).
units,252 have expression and binding affinity that are increased Once through the endothelial barrier, leukocytes must pene-
by proinflammatory mediators.75 Corresponding adhesion trate the basement membrane through a complex process
molecules on endothelial cells are normally expressed at low involving both adhesive and proteolytic events.277
levels but are upregulated after exposure to inflammatory After reaching the interstitial space, leukocyte migration
mediators, including cytokines, coagulation factors, and hista- occurs along chemical gradients of exogenous (bacterial
mine.22 As a specific example, the intercellular adhesion byproducts) and/or endogenous (complement components,
 CHAPTER 1 • Inflammatory Response 3

chemokines) chemoattractant agents. To achieve this, leuko- increase their life span by delaying apoptosis. This priming
cytes bind to extracellular matrix and secrete degradative phenomenon may be a critical component of neutrophil-
enzymes that aid directed movement toward the chemoat- mediated tissue injury.87,125,128,284
tractant agents.272 Once at the target site, they perform mul- Once in tissue, the short-lived neutrophil typically under-
tiple functions to clean the area and repair damaged tissue. goes necrosis, apoptosis (programmed cell death), or is
Several aspects of leukocyte recruitment are potential sloughed from the wound bed.205 Apoptotic neutrophils are
therapeutic targets for controlling harmful inflammation. Cur- phagocytosed and removed by macrophages.182,249 During this
rently, antagonists of integrins, selectins, and chemokines are process, macrophages begin to release antiinflammatory medi-
available or in clinical trials. However, similar to the effects of ators and decrease production of proinflammatory cytokines,
genetic deficiencies in adhesion molecules, targeting leukocyte including the neutrophil chemoattractants. Neutrophil popu-
recruitment may have complications, including secondary lations are largely replaced by macrophages within 24 to 48
infections.166 hours. However, sepsis and other extreme inflammatory con-
ditions may actually delay neutrophil apoptosis, prolonging
Cellular Components the proinflammatory state and promoting tissue damage.
The acute inflammatory response described earlier is often
perceived as a product of neutrophil function. However, many Macrophages and Monocytes Macrophages are integral
immunocytes, including monocytes, lymphocytes, mast cells, to the inflammatory response, wound debridement, and tissue
natural killer cells, and dendritic cells, are activated during the repair. There are two types of macrophages: tissue-resident
inflammatory response. Cellular actions are choreographed by macrophages and monocyte-derived macrophages. Tissue
the activity of multiple mediators generated by these immu- macrophages are constitutively present, sentinel cells that arise
nocytes and other cell types like vascular endothelium and early in embryogenesis, independent of monocytes. Tissue-
parenchymal cells. In response, the cells are responsible for the resident macrophages are responsible for early recognition of
production of additional mediators functioning to enhance, inflammatory stimuli and are a major, early source of proin-
sustain, and/or resolve the inflammatory response. Although flammatory cytokines.53,163 A conditional source of macro-
entire volumes have been written about each of these cellular phages, circulating monocytes can extravasate in response to
components, this chapter aspires to give a brief description of chemotaxins, including cytokines, fibronectin, elastin, comple-
only a few. ment factors (C3a, C5a), thrombin, and growth factors (e.g.,
platelet-derived growth factor [PDGF], transforming growth
Neutrophils In the majority of mammalian species, neu- factor-beta [TGF-β]).21 Once in the tissue, monocytes can
trophils are the most numerous circulating leukocyte and a differentiate into macrophages and reside in the provisional
primary participant in inflammatory reactions. Typically neu- fibrin-based extracellular matrix at a site of inflammation.21,106
trophils are the first migratory cells to arrive and take a pre- Monocyte-derived macrophages can constitute the main mac-
dominant role in acute inflammation, with peak populations rophage type in inflammatory conditions. In addition to their
present during the first 24 to 48 hours.21,153 Numerous che- production of macrophages, monocytes serve as short-lived
moattractants (cytokines, complement components, bacterial effector cells that promote vascular regrowth in tissues.14
products) recruit neutrophils to the site of injury148 and may Macrophage polarization refers to the ability of macro-
also activate the neutrophils to perform several functions.21 phages to assume two distinct functional phenotypes: M1 and
Neutrophils provide local killing and degradation of bacterial M2. M1 macrophages are classically activated by infectious
macromolecules via phagocytosis, release of superoxide radi- agents or proinflammatory cytokines (interferon-gamma
cals and other toxic molecules, and the formation of neutro- [IFN-γ] or TNF-α). They debride the affected site by phago-
phil extracellular traps.21,38 Neutrophil extracellular traps are cytosis of foreign material, pathogens, and damaged cells. Acti-
composed of cell-free DNA and other antimicrobial peptides, vated M1 macrophages produce proinflammatory cytokines
including histones, which trap microorganisms, ensuring a (IL-1β, IL-6, and TNF-α) and prostaglandins, enhancing the
local high concentration of granule enzymes for destruction.115 inflammatory response. Conversely, M2 macrophages are acti-
Evidence also suggests that neutrophil extracellular traps vated in response to antiinflammatory cytokines (IL-4, IL-13,
promote clotting through platelet-dependent and platelet- and IL-10). They aid in wound repair and healing by secreting
independent mechanisms.108 growth factors like PDGF or TGF-β, which stimulate fibro-
Within the neutrophil, there are multiple types of granules. blasts to produce collagen, further dampening the inflamma-
The most prominent granule type used to identify neutrophils tory response. Both M1 and M2 macrophages secrete enzymes
microscopically is the large azurophil (primary) granule, like collagenases and elastases to dissolve the extracellular
which contains microbicidal polypeptides such as myeloper- matrix, facilitating phagocytosis and remodeling, respectively.
oxidase, defensins, lysosome hydrolases, and neutral proteases. Although the classification is useful conceptually, the reader
Smaller, specific (secondary) granules contain metalloprote- should be aware that the M1/M2 classification concept is an
ases. Gelatinase (tertiary) granules and secretory vesicles oversimplification of a continuum of macrophage phenotypes
contain preformed receptors for enhanced cellular communi- and expression profiles.133,172
cation.74,112 In addition, neutrophils produce several proin- Similar to macrophages, monocytes also have heteroge-
flammatory cytokines (interleukin [IL]-1-alpha [IL-1-α], neous subpopulations with discrete cytokine profiles that
IL-1-β, IL-6, and tumor necrosis factor-alpha [TNF-α]) that serve to modulate the inflammatory environment.107 If not
stimulate further inflammation.21 In circulation, neutrophils appropriately stimulated for extravasation and differentiation,
are in a resting state, which prevents accidental release of toxic monocytes in circulation are relatively short-lived and undergo
intracellular contents causing tissue damage. In an inflamma- spontaneous apoptosis on a daily basis.82 By comparison, tissue
tory environment, neutrophils become primed by a two-stage macrophages are more persistent with life spans ranging from
process. Within minutes of stimulation by bacterial products, months to years. Alterations or dysregulations in subpopula-
cytokines, or chemokines, mobilization of tertiary granules and tions of either have been implicated in numerous disease
secretory vesicles occurs to increase cell surface receptors.284 conditions in people, including sepsis, chronic inflammatory
Simultaneously, stimulation of de novo expression of recep- lung disease, and atherosclerosis.32,146,242 In addition to their
tors and cytokines is induced. Both processes allow primed role in debridement and tissue remodeling, macrophages also
neutrophils to exhibit markedly enhanced release of reactive influence the adaptive immune system as antigen presenting
oxygen species and other inflammatory mediators and to cells that interact with lymphocytes.
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 Journalism - Study Plan
Spring 2023 - School

Prepared by: Prof. Smith

Date: July 28, 2025

Conclusion 1: Practical applications and examples

Learning Objective 1: Theoretical framework and methodology
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Learning Objective 2: Research findings and conclusions
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 3: Fundamental concepts and principles
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Learning Objective 4: Key terms and definitions
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 5: Interdisciplinary approaches
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Literature review and discussion
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Ethical considerations and implications
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Historical development and evolution
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Practical applications and examples
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 9: Diagram/Chart/Graph]
Important: Study tips and learning strategies
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Abstract 2: Theoretical framework and methodology
Note: Literature review and discussion
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Key terms and definitions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Learning outcomes and objectives
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Example 13: Comparative analysis and synthesis
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Ethical considerations and implications
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Critical analysis and evaluation
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 16: Research findings and conclusions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Critical analysis and evaluation
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Fundamental concepts and principles
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Statistical analysis and interpretation
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Conclusion 3: Research findings and conclusions
Example 20: Current trends and future directions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Statistical analysis and interpretation
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Comparative analysis and synthesis
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 23: Current trends and future directions
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 24: Diagram/Chart/Graph]
Important: Literature review and discussion
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Learning outcomes and objectives
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Ethical considerations and implications
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Key terms and definitions
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Problem-solving strategies and techniques
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Problem-solving strategies and techniques
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Module 4: Literature review and discussion
Important: Statistical analysis and interpretation
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Learning outcomes and objectives
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 32: Diagram/Chart/Graph]
Key Concept: Fundamental concepts and principles
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 33: Diagram/Chart/Graph]
Definition: Key terms and definitions
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 34: Diagram/Chart/Graph]
Important: Case studies and real-world applications
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Comparative analysis and synthesis
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 36: Fundamental concepts and principles
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Assessment criteria and rubrics
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Statistical analysis and interpretation
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 39: Diagram/Chart/Graph]
Key Concept: Assessment criteria and rubrics
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Abstract 5: Statistical analysis and interpretation
Key Concept: Ethical considerations and implications
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Research findings and conclusions
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Comparative analysis and synthesis
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Remember: Interdisciplinary approaches
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 44: Statistical analysis and interpretation
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 45: Diagram/Chart/Graph]
Note: Learning outcomes and objectives
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 46: Interdisciplinary approaches
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Ethical considerations and implications
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Historical development and evolution
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 49: Diagram/Chart/Graph]
Note: Interdisciplinary approaches
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Conclusion 6: Experimental procedures and results
Definition: Literature review and discussion
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Best practices and recommendations
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Current trends and future directions
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Statistical analysis and interpretation
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Comparative analysis and synthesis
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 55: Diagram/Chart/Graph]
Note: Literature review and discussion
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 56: Diagram/Chart/Graph]
Practice Problem 56: Experimental procedures and results
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Learning outcomes and objectives
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 58: Diagram/Chart/Graph]
Key Concept: Assessment criteria and rubrics
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Best practices and recommendations
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 60: Diagram/Chart/Graph]
Review 7: Statistical analysis and interpretation
Example 60: Critical analysis and evaluation
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Comparative analysis and synthesis
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
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