SMALL ANIMAL SURGERY. The head and neck Volume 1

PRESENTATION

Volume 1

Small animal surgery

BROCHURE

Small animal surgery José Rodríguez (Editor) Jorge Llinás Roberto Bussadori

Skin lesions

Surgery atlas, a step-by-step guide

The head and neck

Oesophagus Trachea Thyroid gland Pinna Ear canal Diagnostic techniques

Surgery atlas, a step-by-step guide

The head and neck Volume 1

Volume 1

eBook available

Small Animal Surgery. The head and neck addresses the diseases that affect the head and neck structured by anatomical location, and the surgical procedures that are usually used to solve them.

The diseases and surgical techniques are described in detail and the information provided is accompanied by numerous high-quality images and illustrations. The book also includes QR codes linked to videos for further information and to aid in the understanding of the techniques.

Small animal surgery Volume 1

José Rodríguez (Editor) Jorge Llinás Roberto Bussadori

Skin lesions Oesophagus

The head and neck

The head and neck

Surgery atlas, a step-by-step guide

SMALL ANIMAL SURGERY

Small animal surgery

Trachea Thyroid gland Pinna Ear canal Diagnostic techniques

Surgery atlas, a step-by-step guide

The head and neck Volume 1

TARGET AUDIENCE: Small animal vets. Surgery Veterinary students

RETAIL PRICE

€90

FORMAT: 23 × 29.7 cm.

NUMBER OF PAGES: 280 pages.

NUMBER OF IMAGES: 600 approx.

BINDING: Hardcover.

ISBN: 978-84-17640-38-5

Authors JOSÉ RODRÍGUEZ Full professor of animal surgery and medicine in the Department of Animal Pathology at the University of Zaragoza, Spain.

JORGE LLINÁS Director and surgeon at the Valencia Sur veterinary hospital, Valencia, Spain.

ROBERTO BUSSADORI European PhD in veterinary medicine. Cardiovascular and thoracic surgeon at the Gran Sasso veterinary clinic, Milan, Italy. Surgeon at the Valencia Sur veterinary hospital, Valencia, Spain

KEY FEATURES:

➜ Book structured by anatomical location and organ system. ➜ Detailed, practical information. ➜ Contains a wealth of pictures, diagrams, and QR codes linked to videos.

The head and neck

Presentation of the book To do his best, one needs a confidence that says: “I can do anything, and if I can’t do it, I know how to get help.”

Benjamin Carson (paediatric neurosurgeon) The neck, and particularly the craniocervical region, contains structures that are vital for animals to breathe and eat. That is why both the diseases that can affect these areas and the surgical procedures that may be used to treat them can significantly impair their quality of life. However, if the planning and execution of the procedure are correct, on most occasions the surgical treatment is successful.

In this book, the authors share their clinical experience in the treatment of these patients to provide a new source of information for veterinary surgeons wishing to perform this type of surgery.

The information has been organised by anatomical structure for an improved knowledge of the anatomical sites and a better location of the problems. Good anatomical and functional knowledge is essential to understand the patient’s problem and how the surgical procedure must be planned to reduce the lesion as much as possible and promote a fast recovery.

This book is mainly intended for veterinary surgeons who perform craniocervical surgery on a routine or occasional basis. The purpose is to provide them with a comprehensive, useful and practical resource, based on the authors’ experience and the techniques they use. The information given will also be of interest to all the staff in charge of the patients’ recovery and hospitalisation, since postoperative care must be meticulous due to the difficulties in breathing and swallowing these patients have until they are discharged.

A large number of images, illustrations and videos have been included to facilitate the understanding of the contents. This way, readers will be able to better identify and understand the problems, which will help them decide on the best therapeutic approach and contribute to an increased likelihood of treatment success and optimal recovery.

The authors José Rodríguez, Ldo. Vet., PhD Veterinary degree and PhD from the Complutense University of Madrid (1982 and 1985) Full professor in animal medicine and surgery at the Department of Animal Pathology at the University of Zaragoza Degree in ophthalmological pathology and surgery at the Autonomous University of Barcelona Author and coordinator of the series Small animal surgery, Surgical atlas, a step-by-step guide, which includes the books: The pelvic area, The caudal abdomen, The cranial abdomen, The thorax, Bloodless surgery, Basic principles and techniques, The gastrointestinal tract – Clinical cases, Surgical techniques and Errors and complications in surgery, which have been translated into several languages including English, French, German, Italian, Japanese, Chinese and Korean.

The head and neck

Jorge LlinĂĄs, Ldo. Vet. Veterinary degree from the University of Zaragoza Diploma of advanced studies from the University of Zaragoza University specialist in maxillofacial surgery Director and surgeon of the Valencia Sur veterinary hospital (Valencia, Spain) President of the Spanish Society of Veterinary Laser and Electrosurgery Co-author of the books Bloodless surgery and Basic principles and techniques of the series Small animal surgery, Surgical atlas, a step-by-step guide

Roberto Bussadori, Med. Vet., PhD Veterinary degree from the University of Milan European PhD

Master’s degree in microsurgery, experimental surgery and transplantation Surgeon at the Valencia Sur veterinary hospital (Valencia, Spain) Co-author of the books Bloodless surgery and Basic principles and techniques of the series Small animal surgery, Surgical atlas, a step-by-step guide

hkeita/shutterstock.com

Soft tissue surgeon (thorax, cardiovascular and respiratory systems) at the Gran Sasso veterinary clinic of Milan, Italy

Collaborators Cristina Bonastre, Lda. Vet., PhD

Carolina Serrano, Lda. Vet., PhD

Degree in veterinary medicine from the University of Zaragoza.

Degree and PhD in veterinary medicine from the University of Zaragoza.

PhD in veterinary medicine from the University of Cáceres.

Internship in small animal medicine and surgery at the Veterinary Teaching Hospital of the University of Zaragoza.

Assistant professor at the Department of Animal Pathology, University of Zaragoza.

Amaya de Torre, Lda. Vet. Degree in veterinary medicine from the University of Zaragoza.

Internship in small animal medicine and surgery at the Veterinary Teaching Hospital of the University of Zaragoza.

Director of the Hispanidad veterinary clinic (Zaragoza).

Associate professor at the Department of Animal Pathology, University of Zaragoza.

Luis García, Ldo. Vet. Degree in veterinary medicine from the University of Zaragoza.

Director of the Ejea veterinary clinic (Zaragoza).

Vice-president of the Spanish Society for Veterinary Laser and Electrosurgery.

Alicia Laborda, Lda. Vet., PhD Degree and PhD in veterinary medicine from the University of Zaragoza.

Member of the Research Group in Minimally Invasive Surgery Techniques of the University of Zaragoza.

Associate professor at the Department of Animal Pathology, University of Zaragoza.

Member of the Research Group in Minimally Invasive Surgery Techniques of the University of Zaragoza.

Assistant professor at the Department of Animal Pathology, University of Zaragoza.

Manuel Alamán, Ldo. Vet. Degree in veterinary medicine from the University of Zaragoza.

Internship in small animal medicine and surgery at the Veterinary Teaching Hospital of the University of Zaragoza.

Veterinary surgeon at the Valencia Sur veterinary hospital.

Associate professor at the Department of Animal Pathology, University of Zaragoza

Juan Ramón Arrazola, Ldo. Vet., Ldo. Biol.

Degree in veterinary medicine from the University of Zaragoza.

Degree in biology from the Complutense University of Madrid.

Member of the Research Group in Minimally Invasive Surgery Techniques of the University of Zaragoza.

Veterinary surgeon at the Valencia Sur veterinary hospital.

Maria Anna Gregori, Lda. Vet. Degree in veterinary medicine from the Autonomous University of Barcelona, Spain.

Head of the Hospitalisation Unit at the Veterinary Teaching Hospital of the Alfonso X el Sabio University, Madrid.

Head of the Hospitalisation Unit at the Valencia Sur veterinary hospital.

The head and neck

Amaia Unzueta, Lda. Vet. Degree in veterinary medicine from the University of Zaragoza.

Head of the Radiology and Endoscopy Service at the Veterinary Teaching Hospital of the University of Zaragoza.

Associate professor of the Imaging Diagnosis module at the Faculty of Veterinary Medicine of Zaragoza.

Juan José Esteban, Ldo. Vet. Degree in veterinary medicine from the University of Zaragoza.

Master’s degree in small animal clinics. Associate professor in the Department of Animal Pathology, Faculty of Veterinary Medicine of Zaragoza.

Internships at the Valencia Sur veterinary hospital and Catholic University of Valencia Veterinary Hospital.

Patricio Torres, Ldo. Vet. Degree in veterinary medicine from the University of Lyon, France.

Director and owner of the small animal hospital Instituto Quirúrgico Veterinario Dr. Patricio Torres.

Vicente Cervera, Ldo. Vet., Dipl.

ACVR, Dipl. ECVDI Degree in veterinary medicine from the Cardenal Herrera-CEU University (Valencia, Spain).

María Teresa Mangas, Lda. Vet.

Diplomate of the European College of Veterinary Diagnostic Imaging (ECVDI) and of the American College of Veterinary Research (ACVR).

Degree in veterinary medicine from the University of Extremadura, Spain.

Head of the Diagnostic Imaging Unit at the Valencia Sur veterinary hospital.

Anaesthesiologist at the Jesús Usón Minimally Invasive Surgery Centre, Cáceres.

Carlota Marras, Lda. Vet.

Veterinary clinician at the Cifuentes veterinary clinic.

Head of the Anaesthesiology Service at the Valencia Sur veterinary hospital.

Lola Alférez, Lda. Vet. Degree in veterinary medicine from the University of Córdoba, Spain.

Intern in the Internal Medicine and Critical Care of the University of Glasgow Small Animal Hospital .

Veterinary consultant at Vetoclock.

Cristina Lorente Lda. Vet. Degree in veterinary medicine from the University of Murcia, Spain.

Clinician in the Surgery Service of the Valencia Sur veterinary hospital.

Degree in veterinary medicine from the Cardenal Herrera-CEU University.

Senior veterinary surgeon at the Diagnostic Imaging Unit, Valencia Sur veterinary hospital.

Antón Costas, Ldo. Vet. Degree in veterinary medicine from the University of Zaragoza.

Master’s degree in small animal clinics from the University of Zaragoza.

Internship in small animal medicine and surgery at the Veterinary Teaching Hospital of the University of Zaragoza.

Pierantonio Battiato, Med. Vet.

Sheyla Domínguez, Lda. Vet.

Degree in veterinary medicine from the University of Messina, Italy.

Degree in veterinary medicine from the University of Zaragoza.

Senior veterinary surgeon at the Diagnostic Imaging Unit, Valencia Sur veterinary hospital.

Table of contents 1. Introduction

Tracheostomy

General principles of neck surgery Anaesthetic overview Before anaesthesia During anaesthesia After anaesthesia

Anaesthetic and surgical considerations Temporary tracheostomy Permanent tracheostomy

5. Thyroid Overview

Surgical overview

Placement of a central venous catheter Subcutaneous venous access port Feeding tubes Shoehorn technique

Postoperative recovery and intensive care Postoperative care Oxygen supplementation Management of patients with a tracheostomy tube Enteral nutrition in critical patients Complications

2. Skin lesions

Overview Feline injection-site sarcoma Clinical signs Diagnosis Treatment Surgical technique Prevention

Physiology

Anaesthetic considerations Stabilising the patient Anaesthetic induction Anaesthetic maintenance

Feline hyperthyroidism Treatment

Thyroid tumours Treatment Prognosis

6. Pinna and ear canal Overview

Surgical considerations

Anaesthetic considerations Locoregional anaesthetic techniques

Aural haematoma Treatment

Wounds and tumours Wounds Tumours

3. Oesophagus Overview

Oesophageal diseases Surgical considerations

Anaesthetic considerations

Cholesteatoma Clinical signs Surgical treatment Prognosis

Pre-anaesthetic assessment Complications associated with malnutrition Gastro-oesophageal reflux, oesophagitis and aspiration pneumonia Complications associated with oesophageal rupture Vasovagal reflex Pain control

Resection of the vertical ear canal

Treatment

Tympanic bulla osteotomy

Treatment

Lateral bulla osteotomy Ventral bulla osteotomy

Cricopharyngeal dysphagia

Foreign bodies in the cervical oesophagus Oesophageal stricture Oesophageal diverticula Treatment

4. Trachea Overview

Surgical considerations

Anaesthetic considerations Anaesthetic induction

Tracheal rupture

Clinical signs Diagnosis Anaesthetic considerations Treatment

Surgical preparation Technique Postoperative complications

Overview

Radiology Fluoroscopy Endoscopy Computed tomography

Radiography

Cervical part of the oesophagus Cervical trachea Pharynx and larynx

Endoscopy

Rhinoscopy Otoscopy Laryngoscopy/tracheoscopy Oesophagoscopy

Computed tomography

Clinical signs Diagnosis Treatment

Editorial Servet

Total ear canal ablation

7. Diagnostic techniques

Treatment

Tracheal collapse

Surgical preparation Zepp procedure Vertical ear canal ablation Vertical canal incision

Overview Indications

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Plaza Antonio Beltrán Martínez, 1 Centro Empresarial El Trovador planta 8, oficina 50002 Zaragoza, Spain

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+34 976 461 480

Small animal surgery José Rodríguez (Editor) Jorge Llinás Roberto Bussadori

Skin lesions Oesophagus Trachea Thyroid gland Pinna Ear canal Diagnostic techniques

Surgery atlas, a step-by-step guide

The head and neck Volume 1

The head and neck

Cricopharyngeal dysphagia

José Rodríguez, Luís García

Cricopharyngeal dysphagia is a swallowing disorder in which the anterior oesophageal sphincter does not open during the cricopharyngeal phase, blocking normal passage of the food bolus into the oesophagus.

These patients do not eat well, have difficulties ingesting food that sometimes drops out of their mouths, and excessive salivation. They may have respiratory problems of the upper tract and aspiration pneumonia, and are frequently cachectic despite having a ravenous appetite.

View video Clinical signs of cricopharyngeal dysphagia

Diagnosis is based on clinical signs and on a fluoroscopic study of the anterior cervical region during the swallowing of food mixed with a positive contrast medium.

These patients do not have problems forming a food bolus, but the lack of relaxation of the cricopharyngeal sphincter impairs swallowing. The bolus is retained in the pharynx and only a part of the food passes into the oesophagus (Fig. 1), the rest is regurgitated, forced out through the nose or is aspirated into the trachea.

Fig.1. The contrast bolus is retained in the pharynx and partially passes into the

oesophagus and a little into the trachea.

View video Fluoroscopy

Treatment Treatment is surgical and consists of the myotomy and resection of the cricopharyngeus muscle.

72

It is important to differentiate cricopharyngeal dysphagia from pharyngeal dysplasia, which is caused by weakness of the pharyngeal constrictor muscles. Surgical intervention in the latter case would worsen the clinical signs.

Surgical treatment The cricopharyngeus muscle originates on the lateral side of the cricoid cartilage, crosses the dorsal surface of the oesophagus and is attached to the lateral side of the contralateral cricoid cartilage (Fig. 2).

M. thyropharyngeus

M. cricopharyngeus M. sternothyroideus

M. hypopharyngeus

Oesophagus

M. thyropharyngeus Midline M. cricopharyngeus

Oesophagus

Trachea

M. thyrohyoideus M. sternohyoideus

Fig. 2. Anatomical diagram of the location of the cricopharyngeal muscles.

Trachea

Oesophagus / Cricopharyngeal dysphagia

The patient is placed in dorsal recumbency and the rostral part of the neck is accessed through the midline, separating the sternohyoideus muscles (Fig. 3).

To approach the dorsal part of the oesophagus, it is rotated clockwise 180° and a traction suture is placed in the dorsal part of the thyroid cartilage (Figs. 4–5).

Before rotating the larynx, the anaesthetist should disconnect the endotracheal tube and deflate the cuff to avoid injury of the larynx or trachea. It is also advisable to introduce a tube into the oesophagus to identify it.

The fibres of the cricopharyngeus muscle run obliquely across the oesophagus and blend with it in the dorsal midline (Fig. 2).

Two myotomies are performed parallel on either side of the midline and at least 2–3 cm of muscle is resected from the central area.

When doing so, extreme care should be taken not to perforate the oesophageal wall (Figs. 6–7).

The cricopharyngeal muscles are not sutured and the minor bleeding that occurs is controlled by compression with a gauze swab.

The larynx and trachea are replaced in their anatomical position, the muscles are sutured in the midline and the skin is closed.

In the absence of complications, patient recovery is good in 49 % of cases. Failures are associated with an incorrect diagnosis (pharyngeal or oesophageal dysfunction), fibrosis or muscle contraction in the surgical area, aspiration pneumonia or laryngeal paralysis.

73

Fig. 3. The approach is through the midline of the

Fig. 4. In order to gain access to the dorsal part of the

Fig. 5. By rotating the larynx clockwise, access is

neck, separating the sternohyoideus muscles.

oesophagus, the larynx should be rotated clockwise.

To maintain this position, a traction suture is placed in the left dorsal part of the thyroid cartilage.

gained to the dorsal area of the oesophagus, where the cricopharyngeal muscles can be identified.

View video Myectomy of the cricopharyngeal muscles

Fig. 6. On either side of the midline, the

Fig. 7. Sectioning the cricopharyngeal muscles

cricopharyngeal muscles are sectioned over a length of around 2.5 cm.

will reduce the risk of recurrence due to scar tissue formation in the surgical area.

The head and neck

Foreign bodies in the cervical oesophagus The oesophagus is a tubular structure that transports food from the mouth to the stomach, but plays no role in digestion. It has the ability to increase its diameter by up to four times to allow the passage and progression of a food bolus. However, this distension is limited in three locations: at the thoracic inlet, the oesophageal hiatus and the base of the heart (Fig. 1).

Oesophageal obstruction by foreign bodies is a very common problem in dogs (bones and fish hooks in particular) but less common in cats.

José Rodríguez, Carolina Serrano, Amaya de Torre, Cristina Bonastre, Alicia Laborda

Most oesophageal obstructions occur with foreign bodies that have an irregular surface such as fish hooks that get stuck in the wall, or bones that, either because of insufficient lubrication or excessive size, are prevented from passing through the anatomical barriers described above.

Oesophageal obstructions nearly always produce nonspecific clinical signs: loss of appetite, lethargy, hypersalivation and regurgitation (often described by owners as vomiting shortly after eating).

a

b

c

d

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Fig. 1. Oesophageal foreign body obstructions are usually located in one of the three locations where oesophageal distension is limited: at the thoracic inlet by the first ribs (a and

b), at the base of the heart, by the aorta, pulmonary artery and trachea (c), and at the level of the oesophageal hiatus in the diaphragm (d).

Oesophagus / Foreign bodies in the cervical oesophagus

Regurgitation is the most important clinical sign associated with oesophageal disorders.

If a patient shows regurgitation, the possibility of aspiration pneumonia should be suspected. In these cases, the food accumulated in the oesophagus can enter the respiratory tree when the animal is lying down or sleeping.

In 90 % of cases of oesophageal obstruction the cause is a foreign body, which can be visualised on radiographs of the neck and thorax (Fig. 2).

See Oesophagoscopy

pages 219–220

75

Fig. 2. Localisation and extraction of a fish hook from

the caudal part of the cervical oesophagus.

Endoscopy of the oesophagus is the diagnostic and therapeutic method of choice in these cases (Fig. 3), as it permits removal of the foreign body, assessment of injuries to the mucosa and oesophageal wall and rules out other causes of obstruction.

Fig. 3. Removal of a foreign body stuck in the cervical oesophagus at the thoracic inlet.

The head and neck

Treatment

Endoscopic treatment

Before planning endoscopic or surgical treatment, the general condition of the animal should be assessed. If there is no urgency to remove the obstruction, the pneumonia and malnutrition should be addressed first by adequate therapy and placement of a feeding tube in the stomach if necessary.

See Case 2 /Gastrostomy.

Paracostal laparotomy In the book The cranial abdomen

pages 336–339

76

Fig. 4. A rigid oesophagogastroscope allows the

introduction of grasping forceps through the working channel, with a jaw strong enough to remove the foreign body with a good chance of success.

Surgical treatment Surgery is performed if it is not possible to remove the foreign body in a retrograde manner or if the oesophagus has been severely injured.

The patient is placed in dorsal recumbency with the neck in extension. To facilitate this position, a rolled towel is placed under the neck (Fig. 5).

Fig. 5. A roll made of surgical drapes has been placed

under the neck to allow hyperextension and facilitate the surgical approach.

For the removal of oesophageal foreign bodies rigid scopes are easier to use as they allow the passage of powerful forceps to firmly grasp the foreign body and extract it safely (Figs. 3–4).

If an oesophageal perforation occurs due to the pressure of a foreign body on the wall, it normally heals on its own within 72 hours if the passage of food and drink is prevented during this period.

For this purpose, a feeding tube should be placed in the stomach.

In the case of more significant lesions or localised infection, the oesophagus requires surgery to remove any necrotic tissue, repair the lesion and place a drain.

Oesophagus / Foreign bodies in the cervical oesophagus

A long skin incision is made over the midline, separating the sternocephalicus and sternohyoideus muscles in order to dissect and gently move aside the trachea (Fig. 6).

Fig. 6. After the skin incision, the sternocephalic

muscles (white arrows) and sternohyoideus muscles (blue arrows) are separated over the midline (green arrow).

The trachea is moved to the right and the area is protected with gauze pads or compresses soaked in lukewarm saline, always avoiding injury to the neurovascular bundle that runs alongside it.

To simplify the intraoperative location and dissection of the oesophagus, an oesophageal stethoscope or feeding tube is inserted into the oesophagus.

After locating the area of obstruction, the sides of the oesophagus are protected with surgical gauze to prevent contamination of the area in case of any spillage of oesophageal contents.

The incision is made in an unaffected area of the oesophagus and can be longitudinal or transverse, depending on the location of the foreign body and how it is to be removed (Fig. 7). At the same time, the oesophageal contents are aspirated to avoid contamination of the surgical field.

77

Fig. 7. After adapting the incision to the size of the foreign body, it is gently removed, taking care not to tear or injure the oesophagus.

The head and neck As in all cases of obstruction of the digestive tract, extraction of the foreign body must be carried out with care (Fig. 7). In the case of the extraction of fish hooks by surgery, it is less traumatic to pass them completely through the oesophageal wall (Fig. 8). In this way, the direction of movement of the hook corresponds to the design of its barb (trying to pull it out in the opposite direction may cause further damage and a tear in the oesophageal wall).

Fig. 8. Fish hooks attached to the wall are pushed

through so that the barb passes through the entire thickness of the oesophagus.

After removing the foreign body, the entire length of the oesophagus should be inspected to rule out other injuries. If an area is suspected of being ischaemic or necrotic, it should be removed and sampled for microbiological analysis.

78

The oesophagus is closed in one or two layers, using a continuous or interrupted suture pattern (Fig. 9) with monofilament absorbable material mounted on a round-tip needle.

Sutures should be placed 2–3 mm from the oesophageal wound edge at a similar interval. It is necessary to include the submucosal layer for greater resistance.

To check the security of the sutures, the oesophagus is occluded cranially and caudally to the incision with dissecting forceps after which saline is injected into the oesophageal lumen under moderate pressure; there should be no leakage of liquid through the suture (Fig. 10).

Fig. 10. Check if wound closure is hermetic by injecting saline into the oesophagus.

Fig. 9. The oesophagus can be closed with simple interrupted sutures that include all

layers of the oesophagus.

Oesophagus / Foreign bodies in the cervical oesophagus Finally, the area is copiously flushed with sterile saline at moderate pressure to eliminate any food and bacteria that might have contaminated the surgical field. Then, the muscular planes are closed with continuous sutures using absorbable material.

If the oesophageal wall has been lacerated or if aspiration pneumonia has occurred after extraction of the foreign body (whether by surgery or endoscopy), ranitidine or omeprazole should be administered as well as an antibiotic.

Food is withheld from the patient for 1–2 days after removal of the foreign body. Next, the patient is given a liquid diet; frequent, small amounts of soft food are then gradually introduced over a period of seven days.

If the oesophageal lesion is severe, it is advisable to place a gastric feeding tube (Figs. 11–13).

Fig. 11. Surgical approach using a left paracostal laparotomy is simple. After skin incision, the subcutaneous tissue and muscular planes are dissected following the fibres until the peritoneal cavity is reached. Next, the stomach is attached to the abdominal wall with a continuous purse-string suture (arrow).

See Case 2 /Gastrostomy.

Paracostal laparotomy. In the book The cranial abdomen

pages 336–339

79

Fig. 12. An incision is made in the stomach with a no. 11 blade. A Foley catheter is placed in the stomach through a previously prepared tunnel in the subcutaneous tissue.

Fig. 13. The skin is closed and the feeding tube is secured using a Chinese finger-trap suture.

The publishing strength of Grupo AsĂ­s Editorial Servet, a division of Grupo AsĂ­s, has become one of the reference publishing companies in the veterinary sector worldwide. More than 15 years of experience in the publishing of contents about veterinary medicine guarantees the quality of its work. With a wide national and international distribution, the books in its catalogue are present in many different countries and have been translated into nine languages to date: English, French, Portuguese, German, Italian, Turkish, Japanese, Russian and Chinese.

Its identifying characteristic is a large multidisciplinary team formed by doctors and graduates in Veterinary Medicine and Fine Arts, and specialised designers with a great knowledge of the sector in which they work. Every book is subject to thorough technical and linguistic reviews and analyses, which allow the creation of works with a unique design and excellent contents.

Servet works with the most renowned national and international authors to include the topics most demanded by veterinary surgeons in its catalogue. In addition to its own works, Servet also prepares books for companies and the main multinational companies in the sector are among its clients.

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