Veterinary Surgery最新文献

Objective: To compare leakage pressures of stapled partial and total lung lobectomies using thoracoabdominal (TA) staplers in canine cadaveric specimens.

Study design: Ex vivo experimental study.

Sample population: A total of 29 lung lobes from six canine cadavers.

Methods: Lower respiratory tracts were harvested from canine cadavers >15 kg. Lung lobes were randomized to groups: total lobectomy with a TA30-V3 (TL-30), partial lobectomy with two TA30-V3 cartridges in a wedge configuration (PL-30), and partial lobectomy with a TA60-3.5 mm (PL-60). The leakage pressure (pressure at which air bubbles were first seen from submerged tissue) was assessed, and groups were compared.

Results: All nine PL-30 and all nine PL-60 sites leaked at median pressures of 10 cm H₂O (range 10-15) and 18 cm H₂O (range 10-20), respectively. Only 1/11 TL-30 site leaked during testing at a pressure of 22 cm H₂O. PL-30 and PL-60 sites were more likely to leak at 20 (OR: 437; 95% CI: 7.9-24 171; p = .003) and 30 (OR: 133; 95% CI: 4.8-3674.2; p = .003) cm H₂O compared to TL-30 sites, and the leakage pressure was greater for TL-30 as compared to PL-30 (marginal effect: -46.14; 95% CI: -55.9 to -36.38; p < .001) and PL-60 (marginal effect: -41.2; 95% CI: -51.73 to -30.67; p < .001) sites. PL-60 leakage pressures were greater than those of PL-30 (marginal effect: 4.94; 95% CI: 1.43-8.44; p = .006).

Conclusion: In canine cadaveric lung, total lobectomies with a TA30-V3 were less likely to leak at physiological pressures than partial lobectomies with either TA30-V3 or TA60-3.5 mm staplers.

Clinical significance: These results suggest a greater potential risk for air leakage at physiologically relevant pressures following partial as compared to total lobectomies with the TA stapling devices and techniques used commonly in veterinary surgery.

Objective: To report breakage of press-fit cementless femoral stems in dogs after total hip arthroplasty (THA).

Study design: Retrospective case series.

Animals: Thirteen dogs (14 stems).

Methods: Medical records were obtained for client-owned dogs that underwent THA between 2013 and 2023. Demographic data, implant type and size, time to stem breakage, and radiographic assessment of implant size were recorded. Implant size was compared with the manufacturers' guidelines based on body weight. Treatment-associated complications and overall outcomes were also recorded.

Results: Fourteen broken stems were reported in 13 dogs. Thirteen were size #5, #6, or #7 Biologic Fixation (BFX) lateral bolt stems and one was a size #5 standard BFX stem. A +9 head was used in 5 of 11 cases with 17 mm diameter heads. The median time from THA to stem breakage was 522 days (interquartile range, 330-905 days). Ten of the 14 stems were radiographically undersized. The weights of 10 of 13 dogs were at, or exceeded, weight-limit guidelines. Eleven stems were revised with a new stem, two were explanted, and one was partially explanted. Major complications of revision included stem rebreakage, periprosthetic fracture, and pin and tension band-fixation failure. Full function was achieved in 9 of 10 dogs with revised stems based on owner and surgeon assessment.

Conclusion: Most of the stems that broke were BFX lateral bolt stems and were undersized both radiographically and in comparison with weight-limit guidelines. Revision can be successful, although the complication rate is high.

Clinical significance: The use of small, undersized BFX lateral bolt stems should be avoided.

Objective: To determine the biomechanical properties of pedicle screw and rod (PSR) constructs alone and with an interbody fusion device (PSRIFD) for equine ventral cervical vertebral stabilization.

Study design: Cadaveric ex vivo biomechanical analysis.

Sample population: A total of 14 (n = 14) adult equine cervical vertebral columns.

Methods: Cervical vertebral columns were stabilized by PSR alone (n = 6) or PSRIFD (n = 5). Three columns were left unaltered as controls. Non-destructive biomechanical testing showed the kinematic range of motion (ROM), compliance, and neutral zone of each spinal unit in the three main kinematic directions (flexion-extension, lateral bending and axial rotation). Destructive testing was performed to identify mode of failure and stiffness in flexion. Non-destructive and destructive biomechanical data were compared by ANOVA between experimental groups.

Results: In flexion-extension, PSR and PSRIFD had significantly lower ROM, compliance and neutral zone than controls (all p < .05). ROM, compliance and neutral zone were not different between PSR and PSRIFD groups. In axial rotation, the neutral zone of PSR was lower than PSRIFD (p = .013) and both were lower than controls (p < .0001 and p < .02, respectively). Stiffness and moment failure between PSR and PSRIFD groups were not different. All constructs failed through articular process joint dislocation, though the PSRIFD group also had ventral IFD migration.

Conclusion: PSR and PSRIFD groups have similar biomechanical properties and modes of failure, though PSRIFD had higher catastrophic injury potential.

Clinical significance: These findings support that PSR constructs provide comparable biomechanical stability to PSRIFD, reducing time and potential complications associated with IFD placement.

Objective: To develop and optimize a tenoscopic technique for resection of the manica flexoria utilizing a radiofrequency probe.

Study design: Experimental study.

Animals: Eighteen cadaver limbs and two experimental horses.

Methods: Tenoscopic-guided resection of the manica flexoria using radiofrequency energy proceeded sequentially by transection of the medial, lateral and proximal borders. The technique was performed in ex vivo limbs and then in vivo to replicate clinical scenarios. Time to complete resection of the manica flexoria (mean ± SD) and complications was recorded. Limbs were dissected and scored for features of transection and collateral injury on a 15-point scale (15 was optimal). Tenocyte viability and histology were performed on tissues from the in vivo procedures.

Results: Transection of the manica flexoria was achieved in all limbs (18/18 ex vivo and 8/8 in vivo). Surgery time was 30.6 ± 12.7 minutes (ex vivo) and 26.1 ± 7.5 minutes (in vivo). Limb scores representing iatrogenic damage and resection borders revealed an average ex vivo score of 14.3 ± 0.67 and live horse score of 14.8 ± 0.43. Histology and live/dead staining did not identify changes in tissue architecture and revealed minimal cell death following radiofrequency exposure.

Conclusion: The described technique, utilizing radiofrequency energy, is a successful approach for safe transection of the manica flexoria. The procedure allowed for complete symmetric resection of the manica flexoria with minimal iatrogenic damage to surrounding tissues.

Clinical significance: Resection of a torn manica flexoria may be technically challenging and utilization of sharp instrumentation risks accidental iatrogenic damage. Resection using radiofrequency represents a feasible alternative technique.

Objective: To determine the influence of fixation method (internal vs. external) on short-term postoperative complications of closed diaphyseal tibial fractures in skeletally immature dogs.

Study design: Retrospective observational multicenter study.

Animal population: Skeletally immature dogs stabilized with internal fixation (IF) via plate osteosynthesis (n = 59) and external skeletal fixation (ESF) (n = 36).

Methods: Medical records from skeletally immature dogs with closed tibial diaphyseal fractures were reviewed. Data collected included signalment, fracture morphology, etiology, fixation technique, surgeon status, complications, time to discharge and time to final discharge.

Results: The total complication rate for IF was lower at 20.3% (p < .001, CI: 11.0-32.8) compared to ESF at 55.6% (CI: 38.1-72.1). A total of 95% of complications were considered major for external fixation versus 75% for internal fixation. Multivariable analysis revealed decreased odds of a postoperative short-term complication when a closed tibial diaphyseal fracture was stabilized with IF compared to ESF (p = .004, OR: 0.2, CI: 0.09-0.63). The median time to final discharge for ESF was 4 weeks (range: 2-13) and for IF was 6 weeks (range: 4-32) (p = .01).

Conclusion: ESF had a higher rate of short-term complications than IF, primarily due to pin-tract morbidity. The complication rate was 35.3% higher for ESF than for IF.

Clinical significance: Surgeons should consider the use of IF over ESF for skeletally immature dogs to reduce the risk of major complications.

Objective: (1) To evaluate the feasibility of needle tenoscopy of the digital flexor tendon sheath (DFTS) using basisesamoid (BS) and proximolateral (PL) approaches in a standing equine cadaver model. (2) To report visualization of intrathecal DFTS anatomy via both approaches. (3) To determine the efficacy of needle scope-guided palmar/plantar annular ligament (PAL) desmotomy. (4) To report any iatrogenic damage associated with the procedure.

Study design: Ex vivo experimental.

Sample population: Ten equine cadaver limbs.

Methods: Limbs were placed in a Kimzey leg-saver splint and needle tenoscopy was performed using the BS and PL approaches. Two European College of Veterinary Surgeons (ECVS) Diplomates assessed and categorized intrathecal site visualization as poor, partial, or excellent. Needle scope-guided PAL desmotomy was performed after DFTS exploratory needle tenoscopy. Limbs were dissected and examined for the presence of iatrogenic damage and completeness of PAL desmotomy. A Wilcoxon signed-rank test was used to compare visualization scores for both approaches.

Results: Needle tenoscopy of the DFTS in a standing model was feasible from both BS and PL approaches. Excellent visualization of clinically significant intrathecal anatomy within the fetlock canal was achieved from both approaches (p ≤ .001), with minimal iatrogenic damage. The PL approach allowed more structures to be visualized than the BS approach (p = .025). All PAL desmotomies were completed without associated iatrogenic damage.

Conclusion: Needle tenoscopy of the DFTS in a standing model provided excellent visualization of intrathecal sites within the fetlock canal. It facilitated complete PAL desmotomy.

Clinical significance: Needle ten0oscopy can be used to assess the DFTS and to guide PAL desmotomy in a standing horse.

Objective: To describe a portal venotomy technique and outcome for tumoral thrombus removal in a dog with insulinoma invading the portal vein.

Study design: Case report.

Animals: A 9-year-old entire male West Highland White Terrier.

Methods: The dog was referred for further investigation of recurrent collapsing episodes and weakness. An abdominal ultrasound revealed a pancreatic mass. Biochemical tests were consistent with insulinoma. A dynamic (4D) contrast-enhanced computed tomography (CT) perfusion study showed a large pancreatic mass originating from the left lobe of the pancreas invading both the portal and splenic veins directly. The portal vein was 80% occluded between the gastroduodenal and splenic vein entry points. The dog underwent partial pancreatectomy, splenectomy, and portal venotomy. Following identification of the thrombus by direct visualization and palpation, Rummel tourniquets were used to isolate the segment of the portal vein, and portal venotomy was performed over the thrombus. The venotomy was repaired with primary closure. Intraoperative hemorrhage was absent following the release of the vascular isolation.

Results: Histopathology was consistent with insulinoma. The dog was discharged 4 days after surgery. Short-term follow up revealed an absence of postoperative complications. The dog was started on adjuvant therapy, and the re-examination 3 months after surgery showed an absence of the clinical signs and a good quality of life. One year after surgery, the dog is still alive with confirmed metastatic disease.

Conclusion: Portal venotomy was successful for thrombus removal and this dog tolerated temporary occlusion of the portal vein well. Careful preoperative CT planning is crucial for good surgical outcomes.

Objective: To determine the accuracy and safety of two landmark-guided techniques for shoulder arthrocentesis and injection.

Study design: Ex vivo prospective study.

Animals: A total of 36 paired canine cadaver forelimbs.

Methods: An electronic survey was used to assess the prevalence of injection technique amongst surgeons in clinical practice. Thoracic limbs were randomized to technique for shoulder arthrocentesis and injection (subacromial [SA], n = 18, or supratubercular [ST], n = 18). Repositions, attempts, and the acquisition of synovial fluid was recorded. After the needle was placed, contrast was injected into the joint to determine accuracy of position. The radiographic presence of intra-articular contrast was judged as an accurate injection. Shoulders were disarticulated and India ink assay performed to assess for iatrogenic articular cartilage injury (IACI).

Results: Both SA and ST techniques were not accurate. Completely accurate injection was identified in 50% SA and 44% ST (p = .80). IACI was identified in 50% SA versus 11% ST (p = .027). There were no significant differences in repositions, attempts, presence of synovial fluid (p = .5, p = .6, p = .7).

Conclusion: Landmark-guided shoulder injections performed via SA and ST approaches in cadaveric dog shoulders are overall inaccurate. If performing landmark-guided shoulder injection, ST technique carries a lower risk of IACI than SA in cadaveric shoulders.

Clinical significance: Landmark-guided shoulder injections are inaccurate in dogs and may result in treatment failure. A ST approach may be considered preferable due to the lower risk of cartilage damage. Future studies should assess ultrasound-guided techniques to improve accuracy and safety.

Objective: To investigate the occurrence, degree, and risk factors associated with arthroscopic stifle joint synovitis in dogs with cranial cruciate ligament (CCL) disease.

Study design: Retrospective, observational study.

Sample population: Canine CCL disease (n = 163) from 149 dogs and their arthroscopic video recordings.

Methods: Arthroscopic video recordings were reviewed. A synovitis severity (0-5) and a modified Outerbridge cartilage classification system score were assigned, along with recording the presence or absence of a medial meniscal bucket handle tear. Medical records were reviewed for age, sex, limb, and duration of clinical signs. Univariate analyses were performed via a Fisher's exact test for categorical independent variables, and ordered logistic regression was used for continuous variables. Multivariable ordered logistic regression considered independent variables with a p-value <.2 on univariate analyses. p-value <.05 was considered statistically significant.

Results: Synovitis was identified in 100% of the stifles examined. The most frequent synovitis severity score was 3/5. Univariate analysis showed a significant association between synovitis severity score and bodyweight (p = .005), median cartilage score (p = .002), and being female (p = .032). On multivariable analysis, the synovitis severity score was significantly associated with median cartilage score (p = .042) and duration of clinical signs (p < .001).

Conclusion: Synovitis was arthroscopically always identified in stifles with CCL disease. The severity of synovitis was associated with more progressive damage to the articular cartilage and a longer duration of clinical signs.

Clinical significance: Earlier intervention in dogs with CCL disease may be warranted to decrease synovitis and progression of osteoarthritis.

Objective: To describe the outcome of metacarpophalangeal (MCPJ) and proximal interphalangeal joint (PIPJ) arthrodesis using a locking compression-distal femur plate (LCP-DFP) in Thoroughbred racehorses with traumatic disruption of the suspensory apparatus (TDSA) at risk of PIPJ subluxation.

Study design: Multicenter retrospective study.

Animals: Twenty-six Thoroughbred racehorses.

Methods: Records of Thoroughbred racehorses with TDSA that had undergone MCPJ and PIPJ arthrodesis using an LCP-DFP at three referral hospitals between 2020 and 2024 were reviewed for inclusion. The preoperative data collected included signalment, affected limb, and type of injury. All postoperative complications were recorded. Long-term outcomes were obtained from medical records and telephone interviews.

Results: Nine females, 14 geldings, and three intact males with TDSA were treated via double arthrodesis using an LCP-DFP. The most common postoperative complications included support limb laminitis, incisional drainage, implant infection with osteomyelitis, and distal interphalangeal joint subluxation. No horses developed PIPJ subluxation. Twenty (76.9%) horses developed short-term complications. Thirteen (50%) horses survived long term (>6 months, range 6-32 months) and were reported to be pasture sound without receiving any analgesic or antiinflammatory medication.

Conclusion: Metacarpophalangeal and PIPJ arthrodesis using an LCP-DFP in racehorses resulted in a stable construct with no horses developing subluxation of the PIPJ joint postoperatively. Arthrodesis using an LCP-DFP was associated with a fair prognosis for pasture soundness.

Clinical significance: Application of an LCP-DFP may prevent subluxation of the PIPJ; however, the prognosis is still affected by the high prevalence of other complications and associated mortality among horses that suffer TDSA.