March 15, 2022

Screwtail Resection: Go high or (continue to) wipe deep

March 2022

With spring comes the wonderful bloom of new puppies (aww, how cute!)…and the growing trend of more bulldogs and Frenchies and Bostons (um, well, mixed feelings…) Now, don’t get me wrong…a dog is a dog, and I serve them all from my heart! BUT…no pun intended…they are being built wrong to their own innocent detriment. And Screwtail is just one abnormality that is a silent hurt-er. Until they stink enough or scoot enough or snap enough, the depth of their smoldering screwtail abnormality is not appreciated by their owners.

I recently had the opportunity to help one of these kids who was fairly significantly impacted, so it is on my mind. The relief I believe surgery can impart is so substantial, it reaffirms why I do what I do. (We all need these little “atta girl” moments to buoy us up, don’t we?!)

The morbidity of the abnormality is on a continuum from minor (skin fold pyoderma problems) to severe (deep abscessation, fistulas and rectal perforation). Problems progress with age and the passage of time; obesity exacerbates the condition as deeper folds develop around the malformed tail remnant. Not all bulldogs, not all Frenchies, not all Bostons, certainly. BUT…critical veterinary evaluation at all stages of life (read: body condition changes!) are essential to identify those suffering with this silent hurt-er.

The recent photos below do not do it justice, but let me describe a couple of cases.

Left (first): The “screw” removed; standard configuration. No outward appreciation of the depth or health of the pocket under the “screw”.

Right (second): The “screw” removed; everted configuration. Under the “screw” is hairless, thinning, chronic fibrosis skin.

Case 1—morbidly obese bulldog; exam for “terrible odor near bum”. Under anesthesia, I was able to put my entire hand into the tail fold, under the “screw”, and deep into the tissues surrounding the dorsal rectum. The wound created by the “screw” pressing on the ventral skin in the fold had dissected cranially between sacrum and rectum…and my hand found its way in there up to my wrist. Shock and alarm were two adrenal emotions I had as I prepped this kid for surgery. Talk about a contaminated surgery site!!! He did fine. Well, better than fine, he did fabulously! The chronic pain and infection was gone…poof! I love my job.

Case 2—morbidly obese Boston; exam for draining wounds near bum, history of many “anal sac squeezing” for scooting. Under anesthesia, I was literally unable to get my fingers under the “screw” and into the cranial recess of the skin fold; lateral to the fold were exit wounds that connected to the most cranial wound in the skin fold…bad juju wanted out! By now, I was an old hat at these cases, and my adrenals stayed quiet. But again, the boy did finely fabulously. No more anal sac squeezes, no more muzzling. What a change in this dog’s daily life.

Again, not all dogs with a screwy coccyx has “screwtail”. When they pigtail outward, no fold is created, no dorsal bony pressure on top of the rectum. And even with some degree of inward turn, a dog with a normal/lean body condition may not have negative consequences. BUT…there are many, too many push-face dogs with screwtail bums waddling around out there just begging to be relieved of their coccyx. Please, please, oh please, mother may I?

Lara Marie Rasmussen, DVM, MS
Diplomate, American College of Veterinary Surgeons
Direct Veterinary Surgery, LLC