Surgical Removal of Screw Tail in Bulldogs

Case Report
Tank is a 7 year old male castrated English bulldog that presented for chronic skin fold dermatitis secondary to screw tail conformation.(Fig.1) 

Fig. 1: Tank, a 7 year old male castrated English Bulldog

The dog was showing signs of pruritis and pain in the tail area for several months. Physical examination revealed patchy partial alopecia of the lateral trunk and evidence of pyoderma in the skin folds associated with an ingrown tail.(Fig.2)

Fig. 2: The tail on Tank showing the typical screw  tail conformation

Preoperative thoracic radiographs showed no significant abnormalities. A radiograph of the caudal spine showed a typical abnormal tail anatomy common in bulldogs.
(Fig. 3) 

Fig. 3: Lateral radiograph of the caudal vertebrae on Tank showing the
abnormal coccygeal vertebrae. (arrow)

Pre-anesthetic CBC and serum chemistry profile on Tank were within normal limits. 

Surgical Procedure
Under general anesthesia, Tank was placed in sternal recumbency and the tail and adjacent skin was clipped and prepared for aseptic surgery. The anal sacs were expressed and a purse string suture was placed in the anus to prevent fecal contamination of the surgical site. Intravenous cephazolin was administered as a prophylactic antibiotic. 

The surgery was begun by making a cranial to caudal incision dorsally over the base of the tail.(Fig. 4) 

Fig. 4: The caudectomy on Tank began with an incision over the  dorsal aspect of the tail.

The tissues were dissected down to the bone by blunt and sharp dissection. After the soft tissues were dissected off, the coccygeal vertebrae were severed with a bone cutter and rongeurs.(Fig. 5)

Fig. 5: Appearance of surgical site after severing the coccygeal vertebrae. Arrow
indicates the cut edge of the vertebrae on the portion of tail to be removed.

The tail was then removed by extending the skin incisions ventrally on each side until the tail was no longer attached to the body.(Fig. 6)

Fig. 6: Surgical site after complete removal of the tail. Note the  cut
edge of the coccygeal vertebrae on the body (white arrow), and cut
edge of the coccygeal vertebrae on the excised tail (black arrow).

Care was taken not to injure the rectum which is just ventral to the tail. A Jackson-Pratt closed suction drain was placed in the deep aspect of the incision prior to closure. For more information on Jackson Pratt drains see: https://drstephenbirchard.blogspot.com/2014/03/jackson-pratt-drains-for-wounds-in-dog.html Excess skin was removed, and the surgical wound was closed in several layers: deep tissues with 2-0 PDS simple interrupted, subcutaneous tissues with 3-0 Monocryl simple interrupted, and the skin with 3-0 Monocryl simple interrupted. The purse string suture was removed. (Fig. 7)

Completed caudectomy on Tank including placement of the Jackson-Pratt drain.

Postoperatively Tank was given supportive care consisting of intravenous fluids, analgesic therapy, incision care and drain maintenance. Tank was discharged from the hospital the following day. Tank’s drain was removed 3 days postoperatively, and examination by the referring veterinarian 10 days postoperatively found satisfactory healing of the incision and improvement of his clinical signs. A follow-up phone call to the owner 1 month after surgery found Tank to continue doing well with no further pruritis or evidence of infection in the tail area.

Discussion
Intertriginous dermatoses, or skin fold pyoderma, is a well recognized disorder caused by excessive skin folds in various regions in dogs, such as nasal, lip, perivulvular, and the secondary to the screw-tail, or ingrown tail abnormality in bulldogs. Redundant skin in these areas leads to skin friction, excessive moisture, and poor air circulation. Trapped skin secretions are fertile ground for surface bacteria and yeast to establish infection. 

Medical treatment consisting of hair clipping, medicated soaps and shampoos, and topical and systemic antibiotics may improve the condition, but surgical resection of the excessive skin is necessary to achieve successful long-term resolution. In bulldogs with ingrown tail, amputation of the tail is the most effective method of treating this form of intertriginous dermatoses. However, detailed descriptions of the technique for removal of the very abnormal bulldog tail are not widely available in the veterinary literature. 

Postoperative complications after caudectomy for ingrown tail were analyzed in one clinical study of 17 dogs. (1) Short-term complications were rare but included postoperative wound infection and changes in defecation behavior. Long-term complications were not seen and the authors stated that the procedure effectively resolved clinical signs in the dogs studied. 

References
1. Knight SM1, Radlinsky MG, Cornell KK, Schmiedt CW. Postoperative complications associated with caudectomy in brachycephalic dogs with ingrown tails. J Am Anim Hosp Assoc. 2013 Jul-Aug;49(4):237-42.