Veterinary Surgery最新文献

Objective: To describe surgical repair of an orbital wall fracture communicating with the caudal maxillary sinus using a three dimensional (3D)-printed, patient-specific implant (PSI).

Study design: Case report.

Animal: A 25-year-old Haflinger mare (370 kg).

Methods: The mare presented with severe chemosis and emphysema of the left upper and lower eyelid of 2-weeks duration due to a fracture of the ventral floor and inner wall of the left orbit that communicated with the caudal maxillary sinus. Computed tomographic (CT) data were used to design a PSI replicating the inner surface of the unfractured orbit. The data were converted to an STL file and 3D-printed using polylactic acid (PLA) filament. Surgical access was obtained via a concho-frontal sinus flap combined with sinoscopy. To reconstruct and seal the orbit, the PSI was lined with porcine small intestinal submucosa and secured to the inner orbital wall using two 3.0 mm titanium locking screws and synthetic, non-absorbable transosseous fiber loops.

Results: The emphysema resolved postoperatively, and ocular function was unrestricted by the implant. Infection developed subcutaneously adjacent to the transosseous suture fixation at the maxillary bone but resolved with conservative management. Follow-up CT at 11 weeks and owner reports after 18 months confirmed a favorable cosmetic and functional outcome, with only minimal residual ptosis of the left upper eyelid.

Conclusion: Application of a PSI axially to the left orbit successfully reconstructed the orbital wall and resolved the communication with the caudal maxillary sinus.

Clinical significance: Patient-specific implants represent a novel surgical option for the repair of complex orbital wall fractures in horses.

Objective: Hepatic arteriovenous malformations (HAVM) are complex congenital vascular anomalies associated with liver dysfunction. Due to surgical morbidity, alternative treatments including medical management, transarterial glue embolization (TAE), and dominant outflow vein (DOV) occlusion have been pursued. The goal of this study was to compare outcomes in terms of patient survival following medical and surgical techniques.

Study design: Retrospective study.

Sample population: A total of 46 client-owned animals.

Methods: Medical records from an Interventional Radiology (IR) service were reviewed for all HAVM patients treated over a 20-year period. Information collected included patient signalment, presenting clinical signs, diagnostic imaging and biochemical findings, medical, surgical/interventional managements pursued with associated complications, and patient outcomes including medication requirements and median survival times (MST). Patients were excluded from the study if final follow-up information was less than 1 year.

Results: A total of 43 dogs and three cats were identified. In dogs, medical management alone in four animals yielded a MST of 567 days (d) while surgery provided a MST of 1942d. While surgical complications and MST were not significantly different between the surgical treatment groups, the TAE group was significantly more likely to have remaining HAVM blood flow immediately after treatment (44% vs. 5%) and experience HAVM recurrence (53% vs. 15%) prompting additional treatments compared to the DOV group.

Conclusion: Patients with HAVM may have improved outcomes following surgical treatment. TAE and DOV occlusion have similar overall outcomes but different recurrence rates.

Clinical impact: Surgical management of HAVM can be safe and effective. The advantages of individual techniques require further investigation.

Objective: To determine whether a secondary plate on the caudolateral aspect of the scapula increases stiffness and reduces primary plate strain compared to a single plate along the cranial scapula spine in a comminuted fracture gap model.

Study design: Ex vivo mechanical study.

Sample population: A total of 14 paired canine scapulae.

Methods: A comminuted fracture gap model was created. A 2.4 mm plate was secured along the cranial aspect of the scapula spine in 28 scapulae. A secondary 2.0 mm plate was secured on the caudolateral border of 14 scapulae. Scapula were sinusoidally loaded from -20 to -200 N for 7200 cycles at 2 Hz. The displacement was measured, and stiffness calculated. Digital image correlation calculated primary plate surface strain. A two-way ANOVA assessed displacement and stiffness. Primary plate strain was assessed with a paired t-test. Statistical significance was set at p < .05.

Results: Mean displacement was higher in the single plate group, -0.81 mm (± 0.14) compared to the double plate group, -0.48 mm (± 0.08) (p < .0001). Mean stiffness was lower in the single plate group, 392.8 N/mm (± 13.72) compared to the double plate group, 563.7 N/mm (± 5.89) (p <.0001). There was no difference in primary plate surface strain between the two groups.

Conclusion: Double plate fixation improved stiffness in a comminuted scapula fracture gap model compared to single plate fixation.

Clinical significance: The placement of an additional plate placed on the caudolateral aspect of the scapula improves stiffness in comminuted scapula body fractures.

Objective: To describe the complications of medial retropharyngeal, axillary, and ilio-sacral lymphadenectomy in dogs with malignant tumors, and to identify possible risk factors.

Study design: Retrospective cohort study.

Animals: A total of 140 surgical accesses (86 axillary, 27 ilio-sacral, 27 retropharyngeal) in 127 dogs.

Methods: Dogs with cutaneous/subcutaneous cancer undergoing staging, lymph node (LN) mapping and extirpation of medial retropharyngeal, axillary, and/or ilio-sacral LNs, with a minimum follow-up of 1 month, were included. Retrieved information included signalment, tumor histotype, LN characteristics, excision of contiguous LNs, anesthesia duration, intra- and postoperative complications. Data were statistically analyzed to identify risk factors for complication development.

Results: Intraoperative complications were registered in 3/140 (2%) procedures, including hemorrhage during medial iliac lymphadenectomy (2/27, 7%) and difficulty locating the axillary LN (1/86, 1%). Postoperative complications occurred in 32/140 (23%) cases, with rates of 41% (11/27) following ilio-sacral lymphadenectomy, 26% (7/27) after medial retropharyngeal lymphadenectomy, and 16% (14/86) following axillary lymphadenectomy. Ilio-sacral lymphadenectomy presented a higher risk of intraoperative (p = .033) and postoperative complications (p = .020). Enlarged (p = .030) or metastatic (p = .030) LNs were more prone to develop intraoperative complications. No risk factor retained significance on multivariate analysis. Median follow-up, conducted through physical examination, was 225 days (range, 30-1735).

Conclusion: Medial retropharyngeal and axillary lymphadenectomies were generally safe, associated with minor and easily manageable complications. Conversely, ilio-sacral lymphadenectomy carried a higher risk of intraoperative complications, particularly in cases with enlarged LNs, and postoperative complications, potentially related to the caudal laparotomic approach.

Clinical significance: Lymphadenectomies of medial retropharyngeal, axillary, and ilio-sacral lymph nodes present relatively low complication rates.

Objective: To compare leakage pressure and ligation time of bronchial sealing using barbed sutures, stapling devices, or traditional sutures during total lung lobectomy in dogs.

Study design: Experimental ex vivo study with randomized order of procedures.

Sample population: A total of 30 lung lobes from five canine cadavers weighing 10-13 kg.

Methods: The lobe samples were randomly allocated to the stapling device (ST), traditional suture ligation (TR), or barbed suture ligation (BA) group (n = 10 each). Bronchial ligation time was recorded for each procedure. Each bronchial stump was tested for air leakage for pressures up to 80 cmH₂O.

Results: The median air leakage pressure was 45.0 cmH₂O (range: 30.0-80.0) for the ST, 47.5 cmH₂O (range: 36.0-80.0) for the TR, and 57.5 cmH₂O (range: 25.0-80.0) for the BA (p = .36). No group showed leakage at physiological airway pressures (< 20 cmH₂O). At pressures up to 80 cmH₂O, leakage was observed in nine of 10 bronchial stumps in the ST, eight of 10 in the TR, and six of 10 in the BA (p = .43). The mean bronchial ligation time was 2.4 ± 0.5 min for the ST, 14.1 ± 3.4 min for the TR and 10.7 ± 1.6 min for the BA (p < .01).

Conclusion: Barbed sutures for bronchial closure provided comparable leakage pressure to stapling devices and traditional sutures and reduced suturing time compared to traditional sutures.

Clinical significance: Barbed suture ligation might be a viable alternative for canine total lung lobectomy.

Objective: To assess the accuracy of intraoperative identification of the tibial intercondylar eminence (TIcE) in the sagittal plane in dogs.

Study design: Ex vivo experimental study.

Animals: A total of 20 stifles from 10 dogs (weight range: 20-30 kg; n = 20).

Methods: Stifles were positioned for a mediolateral radiographic projection with a hypodermic needle placed at the center of the medial collateral ligament (MCL) (C), immediately cranial (Cr), and caudal (Cd) to the ligament. Variables were assessed at the stifle flexions of 90° and 135° with both intact cranial cruciate ligament (CCL-In) and after mechanical transection (CCL-MT). Three evaluators measured the distance (d) between the TIcE and needle center. Statistical analysis involved a linear mixed model, with the Bonferroni test (p < .0125).

Results: Analyses of CCL-In and CCL-MT groups revealed statistically significant differences between needle positions and stifle flexion angles. In the CCL-In group, the C-90° position was closest to the stifle center (d = 0.45 ± 2.39). For the CCL-MT group, the C-135° position was nearest (d = 0.11 ± 2.18).

Conclusion: The center of the MCL in the sagittal plane, at 135° of stifle flexion, served as a reliable anatomical reference for identifying the TIcE in dogs with CCL disease.

Clinical significance: A meticulous intraoperative identification of the TIcE can improve the accuracy of tibial osteotomies, potentially optimizing tibial plateau leveling osteotomy outcomes.

Objective: The aim of this study was to develop and internally validate a machine-learning algorithm, PROSPECT (Predicting Risk Of Surgical complications aftEr CCWO and TPLO), using clinical variables to predict postoperative complications in dogs undergoing high tibial osteotomy for cranial cruciate ligament disease (CrCLD).

Study design: Retrospective multivariable prediction model development.

Sample population: Stifles (n = 670) and dogs (n = 555).

Methods: Complication data with a minimum follow up of 28 days were collected. Clinical variables were preprocessed for machine learning and interaction features were engineered. A multioutput eXtreme Gradient Boosting model was trained on 80% of the sample to predict minor, surgical, and medical complications independently. The trained PROSPECT model was then tested on the independent test set. Model performance was evaluated qualitatively and quantitatively.

Results: Complications occurred in 134/670 (20.0%) stifles, with 50 (7.5%) minor complications, 69 (10.3%) surgical complications, and 26 (3.4%) medical complications. The PROSPECT model achieved Brier scores and accuracies of 0.06379 ± 0.009100 and 91.9% for minor complications, 0.05481 ± 0.008589 and 92.3% for surgical complications, and 0.04102 ± 0.008194 and 94.3% for medical complications.

Conclusion: The PROSPECT model can predict postoperative complications accurately and in a probabilistic fashion following high tibial osteotomy for CrCLD.

Clinical significance: Machine learning may facilitate an individualized approach to risk management with the potential to enhance patient safety and promote safer surgery.

Objective: To develop and describe a minimally invasive surgical (MIS) approach to access, identify, and extirpate lymph nodes within the iliosacral lymph node center following sentinel lymph node mapping (SLNM).

Study design: Experimental canine cadaveric study.

Animals: Six canine cadavers.

Methods: Preoperative computed tomography (CT) with indirect CT-lymphography (CTL) was followed by MIS SLNM utilizing a near-infrared (NIR) fluorescent dye with iliosacral nodal dissection and extirpation. Each cadaver was positioned in supported sternal recumbency for all procedures. Ports were placed bilaterally in the dorsal flank. All findings and complications were recorded.

Results: All sentinel lymph nodes (SLNs) identified on CTL were identified on laparoscopic SLNM and were amenable to dissection and extirpation. In total, 37/40 iliosacral nodes identified on CT were also identified via the MIS approach. A median of 3.5 lymph nodes (range: 2-4) were extirpated per dog. No intraoperative complications occurred.

Conclusion: The MIS approach enabled identification and extirpation of lymph nodes within the iliosacral nodal center, with incorporation of SLNM of the anal sac via NIR imaging. Positioning in supported sternal recumbency with cannulas placed within the dorsal flanks allowed for effective access to all iliosacral lymph node locations.

Clinical significance: Further evaluation of SLNM via MIS in supported sternal recumbency in clinical dogs with apocrine gland anal sac adenocarcinoma is warranted in an effort to provide optimized staging information with a minimally invasive approach as compared to open surgery.

Objective: To describe the clinical and diagnostic imaging findings of pet pigs with osteoarthritis and determine the efficacy of intra-articular (IA) injections in managing lameness.

Study design: Retrospective observational study.

Animals: A total of 16 pet pigs diagnosed with osteoarthritis and treated with non-steroidal medications and IA injections.

Methods: Cases, diagnostic imaging, and clinical data were collected from the medical records of Purdue University. The owners were interviewed by telephone to collect follow-up data regarding the degree of lameness following joint treatment.

Results: A total of 13 of 16 pigs presented for lameness evaluation. A diagnosis of osteoarthritis was determined with computed tomography (CT) (n = 10) or digital radiography (n = 7). In all, 24 joints were treated with triamcinolone. Following injection, 13 of 16 (81%) pigs showed improvement in lameness, as measured by decreases in lameness scores assigned by the owner (p = .0183). The duration of the effect ranged from a few weeks to several months. Those with no or minimal improvement tended to have advanced osteoarthritis in joints other than those treated. There were no complications reported. The use of CT for injection guidance did not show a significant difference in outcomes over the use of radiographic guidance.

Conclusion: With an accurate diagnosis, IA injections seemed to be a beneficial therapy for pet pigs.

Clinical relevance: The use of IA corticosteroids to treat lameness due to osteoarthritis in pigs represents an effective therapy that reduces lameness.

Objective: To evaluate the feasibility of achieving bronchial blockade using a vascular balloon catheter under low-cost semi-flexible borescope guidance in dogs.

Study design: Cadaveric pilot study.

Sample population: Canine cadavers (n = 7) weighing between 12.2 and 63 kg.

Methods: Two participants attempted four different techniques to achieve bronchus blockade using a 10 Fr Coda catheter or an EZ-blocker (EZ) under borescopic (B) or endoscopic (E) guidance. Placement success was confirmed via thoracoscopy. Success rate, procedure duration, and reasons of failure were recorded.

Results: B-Coda catheter placement was possible on dogs intubated with a minimum 8.5 mm size endotracheal tube (ETT). E-EZ was unsuccessful with an 8.5 ETT and below and on some dogs bigger than 30 kg. Excluding the failures due to size limitations of the devices, success rate during first attempt for the left side was 50% for B-EZ and 75% for all other techniques. Right-sided success was 50% for B-EZ, 33% for B-Coda, 66% for E-EZ and 62% for E-Coda. Malpositioning of the devices occurred twice as commonly under borescopic guidance. The techniques were all successful after up to two additional attempts. Time to achieve blockade was faster using endoscopic guidance.

Conclusion: The catheter allowed bronchial occlusion in larger canine cadavers. The borescope allowed guidance without the size limitation of the endoscope.

Clinical relevance: The Coda catheter had no size limitation in comparison to the EZ blocker and could be analternative to it. A sterilized borescope may be an option when bronchoscope size is inappropriate for a patient.