Veterinary Surgery最新文献

Objective: To evaluate the effect of a simple chest wall-lifting technique on thoracic volumes in cats.

Study design: Cadaveric study.

Animals: Feline cadavers (n = 8).

Methods: Animals underwent thoracic computed tomography (CT) scans after each treatment: in lateral recumbency, (1) no lift and (2) intercostal space lift, and in dorsal recumbency, (1) no lift and (2) sternal lift. Lifting was performed in lateral recumbency at the eighth intercostal space using a bent 2 mm Steinmann pin and in dorsal recumbency at mid-sternum using a Backhaus towel clamp, placed under thoracoscopic guidance until maximal effect was subjectively noted while recording the tension achieved on the device. Thoracic cavity volume (TCV), working space volume (WSV), and ventilation space volume (VSV) were determined on CT images and compared across treatments.

Results: The TCV increased by a median of 27% (range: 7%-72%), 54% (28%-64%), and 51% (37%-106%) in the dorsal, left lateral, and right lateral recumbencies, respectively. The WSV showed a median increase of 92% (-21%-1026%), 187% (113%-355%), and 271% (119%-422%) for the same positions. In contrast, the VSV decreased, and although statistically significant, the change was relatively minor, with a median decrease of 3% (range: -5%-19%), 7% (-1%-18%), and 7% (3%-11%) in the dorsal, left lateral, and right lateral recumbencies, respectively.

Conclusion: Chest wall lifting increased the WSV in feline cadavers with minimal impact on the VSV.

Clinical significance: This novel and simple technique could help in performing thoracoscopic procedures in cats.

Objective: The objective of the present study was to report the outcome of a novel technique of urethral intra-abdominal anastomosis after transabdominal wall passage of the penis in a dog with stent-related urethral obstruction.

Study design: Case report.

Animal: A seven-year-old neutered male Cocker Spaniel.

Methods: The dog was evaluated for urinary retention and overflow incontinence of approximately 1-year duration. The dog had a urethral self-expanding metallic stent placed 6 years prior as treatment for pelvic urethral stricture, secondary to severe pelvic trauma. Stent fracture and stent-related tissue hyperplasia were diagnosed leading to intrapelvic urethral obstruction and concomitant atonic bladder complicated by cystolithiasis and urinary tract infection. An intra-abdominal urethral anastomosis was performed to restore urethral patency, after passing the penis through the abdominal wall, into the inguinal area; the surgery was successful in bypassing the urethral obstruction.

Results: No contrast leakage was noted on positive contrast cystourethrography 10 days postoperatively. The urinary bladder was easily emptied by manual expression and bethanechol was started. At 6-months follow-up, the urinary bladder remained atonic but was easily emptied by manual expression, with mild urinary incontinence remaining. No signs of recurrent urinary tract infections were noted. Nine months after surgery the dog was euthanized for reasons unrelated to the surgery.

Conclusion: The transabdominal wall urethral anastomosis, after penile abdominal tunnelization resulted in bypassing the urethral obstruction in this dog, restoring urethral patency. The technique reported could be a viable surgical option for restoring urethral patency in dogs with severe pelvic urethral damage or obstructive lesions.

Objective: To report the successful complete resection of an extensive retroperitoneal sarcoma (RPS) with a caval thrombus using veno-venous bypass (VVB) to facilitate temporary caudal vena cava (CVC) occlusion.

Study design: Case report.

Animal: A 12-year-old neutered male Standard Poodle.

Methods: Computed tomography (CT) revealed an extensive mass originating from the right adrenal gland region with an associated caval thrombus extending into the thoracic CVC. A preemptively planned en bloc resection, including the right kidney and caval thrombus, was performed. VVB and a Pringle maneuver were used to minimize hemorrhage and maintain hemodynamic stability.

Results: Surgery was successfully completed without major complications. The operative time was 161 min, with Pringle maneuver duration of 4 min 8 s and a caval occlusion time of 44 min 43 s. The dog's general condition stabilized the following day with no decline in renal function. The histopathologic examination confirmed the diagnosis of RPS. The dog remained in good health with no recurrence or metastasis at the 1-year follow-up.

Conclusion: This is the first report of a clinical application of VVB during temporary caval occlusion to achieve complete en bloc resection of an extensive adrenal RPS with ipsilateral kidney and caval thrombus, followed by repair of a CVC incision. VVB may be a valuable technique for maintaining hemodynamic stability and reducing hemorrhage during complex oncological surgeries requiring temporary caval occlusion.

Objective: To report the long-term outcomes of continuous decompression for repairing a unicameral bone cyst in a dog.

Study design: Case report.

Animal: A 1-year-old Maltese-Poodle mixed breed dog presented with left forelimb lameness.

Methods: A well-defined cyst in the left humeral condyle was detected on radiography and computed tomography. A lateral surgical approach revealed the cyst in the distal metaphysis of the left humerus. The attained cyst fluid and incisional biopsy led to the diagnosis of unicameral bone cyst. To prevent cyst expansion and recurrence, aspiration, open curettage, ethanol cauterization, and continuous decompression using introducer needles were performed.

Results: The dog recovered from surgery, and a Robert Jones bandage was retained for 2 weeks. The follow-up at 1 month showed resolution of lameness. At 12 months post-surgery, radiographs revealed increased cortical thickness and no recurrence of the cyst or lameness.

Conclusion: Continuous decompression using introducer needles could be used to repair unicameral bone cysts. Small diameter introducer needles were especially useful, as the lesion was located at the joint. The procedures described in this report could be applied before other salvage procedures to promote healing and prevent recurrence.

Objective: To document the prevalence and incidence rate of infection in dogs undergoing partial tarsal arthrodesis (PTA). For context, findings were compared with the prevalence of infection following tibial plateau leveling osteotomy (TPLO) at the same institution. Independent variables associated with infection were also identified.

Study design: Case-control study.

Animals: Eighty-nine dogs underwent PTA; 292 dogs underwent TPLO.

Methods: Medical records for dogs that underwent PTA from 2017 to 2023 and dogs that underwent TPLO between January 2022 and December 2022 were reviewed. The prevalence, incidence rate, odds and incidence rate ratio of infection were calculated.

Results: The prevalence of infection following PTA was 43%; following TPLO it was 13%. The incidence rate of infection was 0.00276 (95% CI: 0.00198-0.00375) and 0.00010 (95% CI: 0.00007-0.00013) infections per dog-week, respectively. The odds ratio and incidence rate ratio for infection following PTA were 5.0 (95% CI: 3.1-9.0) and 28.2 (95% CI: 17.7-45.0), respectively.

Conclusion: The prevalence and incidence rate of infection were higher following PTA than TPLO. Dogs that underwent PTA were five times more likely to develop infection than dogs that underwent TPLO, and developed infection at 28 times the rate of dogs that underwent TPLO. Dogs with open wounds, no postoperative bandage, and treated with a combined medial and lateral approach, had a higher point prevalence of infection.

Objective: To report the lifelong outcome of a redo mitral valve repair performed under repeat cardiopulmonary bypass (CPB) in a dog.

Study design: Case report.

Animal: An 11-year-old, 4.0-kg neutered male Chihuahua, previously treated with surgical mitral valve repair for myxomatous mitral valve disease at the age of eight, presented with recurrent left heart failure caused by worsening residual mitral regurgitation (MR) following the initial repair.

Methods: Redo mitral valve repair was performed 2 years and 7 months after the initial surgery. The procedure, conducted under hypothermic CPB, involved adding and adjusting eight artificial chordae to align with the reconstructed mitral annular plane.

Results: The redo surgery successfully reduced MR, improved cardiac function, and resulted in more than 5 years of survival without MR recurrence.

Conclusion: This case demonstrates the feasibility of redo mitral valve repair in managing recurrent MR in dogs, highlighting its potential to improve long-term outcomes in veterinary surgery and cardiology.

Objective: To present fracture cases selected for plate fixation (PF), describe surgical techniques and assess their association with postoperative complications and return-to-work outcomes in horses undergoing PF for small metacarpal/metatarsal (SMCT) fractures.

Study design: Multicenter retrospective study.

Animals: A total of 27 horses.

Methods: Horses treated with PF of a SMCT fracture between 2008 and 2023 across three hospitals were included. Medical records and imaging were reviewed. Long-term outcomes were established by readmission to the hospital, telephone interviews, and/or race records. Univariable and multivariable regression models evaluated variables associated with return to intended use.

Results: PF of fractures was performed in 27 horses. Fractures were all in the proximal SMCT, with 20/27 (74.1%) articular, 22/27 (96.3%) comminuted, and 24/27 (81.5%) displaced. Of horses with follow-up, 19/25 (76%) returned to prior work level. Postoperative complications occurred in 9/27 (33.33%) horses. No individual explanatory variable was significantly associated with return to use in the univariable analysis. Racehorse earnings per start were lower postoperatively compared to preoperatively (p = .02).

Conclusion: Most horses treated for SMCT fractures with PF returned to prior work level, although postoperative complications were common. None of the explanatory variables were significantly associated with return to use.

Clinical significance: PF for proximal SMCT fractures is effective, yielding high return-to-work rates and better outcomes than previously reported case series.

Objective: To describe clinical application and outcomes following stabilization of traumatic long-bone fractures in dogs using an I-Loc angle stable interlocking nail (AS-ILN).

Study design: Retrospective study.

Sample population: A total of 243 client-owned dogs.

Methods: The medical records of dogs with long-bone fractures stabilized with an I-Loc AS-ILN were reviewed. Data collected included signalment, affected bone, fracture pattern and whether fractures were open/closed. Surgical details included nail parameters, customization, use of ancillary implants and number of missed bolts. Complications were classified as major or minor depending upon requirement for revision surgery. Time to clinical union was documented.

Results: A total of 243 fractures affected the femur (138/243), tibia (71/243), humerus (27/243) or radius/ulna (7/243). Most were diaphyseal (183/243) and comminuted (151/243). The 8, 7, 6, 5, 4 and 3 mm nails were used in dogs weighing an average of 41, 30, 26, 21, 13 and 5 kg, respectively. Ancillary implant use was uncommon (50/243). Nails were shortened in 40/243 cases and prebent in 55/243. The postoperative missed bolt rate was 8/852. Radiographic follow-up was achieved in 189 cases, with a median duration of 57.5 days. Mean time to clinical union was 8.3 weeks. Major and minor postoperative complications were encountered in 13/243 and 22/243 of cases, respectively.

Conclusion: Use of the I-Loc system was associated with positive results across a wide range of presentations including epi-/metaphyseal fractures.

Clinical significance: The low complication rates associated with the I-Loc system indicate potential benefits to patients compared to plate-rod systems, non-angle-stable nails or other AS-ILNs.

Objective: To describe the additional information provided by computed tomography (CT) in planning and assisting repair of comminuted fractures of the middle phalanx (MP) in Warmblood horses.

Study design: Case series.

Animals: Six adult Warmblood horses.

Methods: The case records of horses undergoing CT examination prior to internal fixation of comminuted MP fractures were reviewed. All horses underwent radiographic and preoperative CT examination. A standardized fast protocol (SFP) to assess CT images was used. Surgical repair consisted of fracture repair and proximal interphalangeal joint arthrodesis using two dorsally located plates under general anesthesia. Long-term follow-up was obtained from the clinical records and/or referring veterinary surgeons.

Results: In all cases, CT provided information that could not have been obtained from radiographic examination. Four horses were alive at >6 months follow up and presented with a mild 3/5 AAEP lameness.

Conclusion: The SFP provided additional information regarding fracture configuration that could not have been obtained during radiographic examination in all cases. In two cases it allowed identification of a small navicular bone fracture at the level of its dorsal cortex within the distal interphalangeal joint. In one case it allowed identification of deep digital flexor tendon (DDFT) rupture. Preoperative CT scans helped in planning the positioning of two or more independent 4.5/5.5 mm cortical lag screws to improve construct stability.

Clinical significance: The use of the CT SFP provides surgeons with precise fracture configuration, enables identification of concurrent pathology and optimizes surgical planning, thereby improving construct stability.

Objective: To report and compare two surgical approaches to the feline radial diaphysis and outline optimal techniques to maximize surgical exposure.

Study design: Ex vivo experimental comparative study.

Sample population: Left and right antebrachia of three feline cadavers.

Methods: Six feline antebrachia were collected from cadavers submitted for research purposes. Each limb was sequentially dissected for both craniomedial and craniolateral surgical approaches totalling 12 surgical approaches, or 24 when including and excluding the supinator muscle. Following each approach, photographs were taken and inserted into an image measuring software, to obtain the area of surgical exposure. The datum was then analyzed to ascertain which approach afforded the greatest exposure and whether the difference was statistically significant.

Results: The mean surface area for the craniolateral approach, including and excluding the supinator muscle, was 4.13 cm² and 2.63 cm², respectively. The mean surface area for the craniomedial approach, including and excluding the supinator muscle was 3.84 cm² and 2.45 cm², respectively. The difference observed between the two approaches was not statistically significant (p > .05).

Conclusion: Surgical exposure achieved via the craniolateral and craniomedial approaches to the feline radial diaphysis is comparable.

Clinical significance: This study validates the use of the craniolateral surgical approach to the feline radial diaphysis.