Here is a thread that I found

Here is a thread that I found on VIN.

These cases may have been post surgery so I don’t know if it is pertinent. 

I must admit that I always remove the falciform when I do surgery. Just seems to get in the way.

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Board: Vet-to-Vet

Folder: Surgery – Soft Tissue

Discussion: Falciform fat necrosis post-abdominal surgery – two cases

Address (URL): http://www.vin.com/Link.plx?ID=7523114

 

 

 

1. Posted by Julie Baise on 04-29-15 18:22 ET

(26976.1472833494)

 

I have had two cases (one recently and another 9 years ago) of falciform fat necrosis occurring 4-5 days after abdominal surgery. 

I am wondering if it is possible that I inadvertently caused this complication and was hoping for some insight. 

 

The first case was a 4-year old Labrador after a foreign body surgery in which a gastrotomy/enterotomy was performed.   

About 5 days after surgery, the dog stopped eating and the cranial aspect of his incision was hard/warm to the touch and he was running a mild fever. 

On exploratory, the entire falciform fat was a hard and necrotic.   

I removed it, began antibiotics and he recovered fine.   

Afterwards, looking back on my surgical technique, I do remember thinking I would remove the falciform fat (and chickened out, since I was a newer grad) and at one point clamped one side of it (along the body wall) thinking I would remove it, and decided not to.   

By clamping one side, did I hinder blood supply of the entire falciform, resulting in necrosis? 

 

The second case was a 6-year old Shih Tzu under surgery for a liver biopsy (due to a rising ALP). 

The dog was BAR with normal bile acids and acting fine.  About 4 days after surgery, she came back in for similar signs as the case I had years ago (febrile, anorexic, firm/hard underneath cranial aspect of incision).   

Once again, on re-explore, the entire falciform fat was necrotic/hard and fluid within the abdomen looked like it was heading towards purulent (a culture is pending).  I removed the falciform, and the dog is doing ok the next day (so far).  She is on antibiotics and fluids currently.  

This second case, I realized that I did tear part of the falciform away from one side of the body wall for better exposure to the liver. 

 

So, do you think the falciform fat could have necrosed due to these two scenarios?   I have never had this happen any other time in 10 years (but then again, I can’t remember having to remove/clamp/clear away the falciform in any other surgery. 

 

I feel awful, like this could have been prevented, and was just hoping for clarification from a surgeon.  

Thank for any advice/input you can share! 

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2. Posted by Michael McFadden on 04-30-15 11:11 ET

(26976.1472833494)

 

hard to say if the scenarios you describe had anything to do with the complication. I remove the falciform fat on every case. takes 10 seconds, gives better exposure, and then cases like what you describe are a non issue. 

 

Michael S. McFadden, M.S., D.V.M. 

Diplomate ACVS 

North Houston Veterinary Specialists 

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3. Posted by Julie Baise on 04-30-15 19:41 ET

(26976.1472833494)

 

I guess it is hard to say whether potentially compromising half of the blood supply is enough to turn it necrotic, I always assumed it had enough collateral circulation, but I guess we do t’t know for sure?? 

I know from here on out I will always remove it, but was curious if anyone else has had this happen to them? 

 

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4. Posted by Abigail Lockwood on 05-04-15 10:40 ET

(26976.1472833494)

 

Nope, never happened to me. I always remove it. Think most people do. No reason to leave it in.

 

Abby Lockwood, MS, DVM 

Diplomate ACVS 

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