Veterinary Surgery最新文献

Objective: To compare strength of left paramedian colopexies using various techniques in equine ex vivo models.

Study design: Experimental study.

Sample population: Equine cadavers euthanized for nongastrointestinal pathology (36 specimens derived from 9 horses).

Methods: Colopexies were performed after euthanasia. Suture pattern (horizontal mattress vs. cruciate) and incorporation of dorsal sheath of the rectus abdominis (partial-thickness) versus incorporation of dorsal and ventral sheath of the rectus abdominis (full-thickness) were evaluated. Single cycle load to failure, work to peak load, stiffness, and mode of failure of colopexy tissue constructs were assessed.

Results: Mean load to failure of all constructs ranged from 102.26 to 166.38 N. Partial-thickness bites demonstrated a mean load to failure and standard deviation (SD) of 111.91 (35.88) N and 102.26 (30.06) N (p < .05) which was significantly lower than the mean and SD of full-thickness bites (166.3 [72.42] N and 163.21 [51.40 N]), respectively. All full-thickness bites regardless of suture pattern and over half of partial-thickness bites failed at the colonic wall. There was no significant difference in load to failure compared to mode of failure.

Conclusion: A stronger colopexy was achieved with a full-thickness bite regardless of the suture pattern. The most common mode of failure was the colon wall.

Clinical significance: Incorporating ventral and dorsal fascia of the rectus abdominus provided a stronger colopexy structure, which may necessitate a second incision or subcutaneous palpation of the needle when performing a colopexy. The lateral band of the colon failed in most constructs (77%) regardless of technique, which could weaken the colonic wall and risk colonic rupture.

Objective: The objectives of the study were to describe a standing percutaneous adhesion induction model in the digital flexor tendon sheath (DFTS) of horses and to evaluate the effect of intrathecal administration of the angiotensin-converting enzyme (ACE) inhibitor enalapril on tendon healing and adhesion formation.

Study design: Randomized, blinded, controlled experimental study.

Animals: Eight healthy horses.

Methods: A collagenase-induced adhesion model was implemented in the deep digital flexor tendon (DDFT) of both forelimbs under standing ultrasonographic guidance. Daily intrathecal injections of 5 mg enalapril (the treatment condition) were administered to a randomly assigned forelimb for 5 days, with the contralateral limb receiving an equivalent volume of 0.9% NaCl (the control). Lameness and limb circumference were recorded weekly. Horses were euthanized after 8 weeks and evaluated for gross digital flexor tendon sheath (DFTS) adhesions. Tendons were collected for histopathologic scoring of DDFT healing. Paired data were analyzed using a one-sided alternative sign test and longitudinal regression.

Results: Multiple DFTS adhesions were formed in control limbs of all horses. The median number of gross DFTS adhesions in treated limbs was less than in control limbs (p = .0039). The average reduction in limb circumference and lameness scores over time occurred faster in treated versus control limbs (p < .025). There were no differences in DDFT histopathologic scores between groups.

Conclusion: The standing percutaneous DFTS adhesion induction model demonstrated that intrathecal enalapril reduced DFTS adhesion formation, lameness scores, and limb circumference over time.

Clinical significance: Intrathecal enalapril administration may reduce morbidity in horses with naturally occurring tendon injuries.

Equine minimally invasive surgical techniques are frequently utilized in the treatment of a variety of conditions. Standing sedated endoscopic surgery is commonly selected in horses, requiring specialized facilities, anesthetic protocols, and surgeon and assistant expertise. This review examines current methods and potential strategies in equine soft tissue surgery, in which there is an emphasis on laparoscopic urogenital and gastrointestinal diagnostic and therapeutic procedures. Thoracoscopy is less frequently reported in horses and may be underutilized. Optimizing procedures and outcomes in soft tissue surgery relies on innovation and interdisciplinary collaboration. Modern advances in surgical equipment and emerging medical technologies support development in these fields. Participation in continuing education is effective in acquiring and sustaining knowledge and skills and improving clinical practice. Forums with an integrated approach could rapidly expand knowledge across species.

Objective: To describe the surgical technique for removal of hoof wall masses in horses under standing sedation (SS) and local anesthesia (LA), and to report complications and long-term outcome following surgery.

Study design: Observational retrospective study.

Animals: Client-owned horses (n = 30).

Methods: Horses undergoing keratoma removal under SS and LA in a single equine hospital between August 2016 and July 2023 were included in the study. Signalment, affected foot, history of lameness and/or foot abscesses, degree of lameness on admission, imaging findings (radiography and magnetic resonance imaging [MRI] when available), location of the mass, surgical technique, remedial farriery, postoperative care, complications and outcome were recorded. Long-term follow-up information was obtained by telephone questionnaire.

Results: A total of 30 horses met the inclusion criteria. Duration of lameness ranged from 1 to 289 days (mean 90 days). The degree of lameness varied from absent to grade 4/5 (AAEP) (mean grade 3/5). All horses underwent preoperative radiographic examination and 14/30 underwent MRI. All horses underwent partial hoof wall resection. The surgery was performed safely in all cases. Postoperative complications included marked lameness in the early postoperative period in 3/30 horses and exuberant granulation tissue formation in 2/30 horses. Long-term (>6 months) follow-up information was available for 28 horses, and 26/28 horses returned to previous levels of exercise. Recurrence was suspected in 1/30 horses.

Conclusions: The complication rate was lower than previously reported for keratoma removal under general anesthesia (GA).

Clinical significance: Removal of hoof wall masses under SS and LA can be considered as an alternative to removal under GA.

Objective: To determine the effect of the Vertek aiming device (VAD) on the surgical accuracy of navigated drilling of the distal sesamoid bone (DSB).

Study design: Experimental cadaveric study.

Sample population: A total of 30 paired equine cadaveric limbs from 15 horses.

Methods: Each specimen was placed in a purpose-built frame (PBF). Preoperative cone beam computed tomography (CBCT) images were acquired with an imaging unit coupled with a surgical navigation system. In the DSB of each specimen, a 4.5 mm glide hole and a 3.2 mm thread hole were drilled under navigation guidance, to simulate drilling for the repair of a mid-sagittal DSB fracture. In the VAD group navigated drilling was assisted by using the VAD. In the free-hand drilling group navigated drilling was performed without the VAD. Pre-and postoperative CBCT scans were merged and surgical accuracy aberrations (SAA) between the planned drill corridor and the created bone tunnel were measured. Descriptive statistics and repeated-measures analyses of variance (rep.-meas. ANOVA) were performed to compare SAA measurements between the study groups.

Results: The SAA measurements ranged from 0 to 2.9 mm in the free-hand group and from 0 to 2.8 mm in the VAD group. The median overall SAA was lower in the VAD group than in the free-hand navigated group (0.6 mm ± [0.5-0.7] vs. 0.8 mm ± [0.7-1], rep.-meas. ANOVA p = .007).

Conclusion: The additional use of the VAD in the described set-up for navigated drilling significantly improved surgical accuracy.

Clinical significance: The combined use of the VAD and PBF may help improve surgical accuracy in navigated lag screw repair of DSB fractures.

Objective: To determine the prevalence of incidentally found pulmonary bullae and blebs (PBBs) in a population of dogs undergoing thoracic computed tomography (CT) for reasons other than presence of pneumothorax and to determine the prevalence of subsequent spontaneous pneumothorax (SP) development.

Study design: Retrospective study.

Animals: A total of 30 dogs.

Method: A total of 2221 CT studies of the sample population were retrospectively assessed for the presence of incidental PBBs between April 2013 and April 2019. Inclusion criteria were complete thoracic CT studies from dogs obtained from the hospital database. Exclusion criteria were concurrent presence of a pneumothorax or severe pulmonary disease preventing assessment for PBBs, an air-filled space related to a pathological process, for example, neoplasm, incomplete CT studies, or no available follow-up. Long term outcome was evaluated using a questionnaire to determine the occurrence of SP post CT examination.

Results: Incidental PBBs were identified in 30 out of 2178 (1.4%) CT studies that met the inclusion criteria. None of the dogs subsequently developed clinical evidence of SP (median follow-up time 1255 days, range: 147 to 2363 days). One dog died suddenly of unknown cause and as no post-mortem was performed SP could not be ruled out.

Conclusion: There was a low prevalence of incidentally found PBBs in dogs. None of the dogs followed over a long period subsequently developed SP.

Clinical significance: Based on this study, prophylactic removal of lung tissue containing incidentally found PPBs is not justified.

Objective: To compare three measurement methods for acetabular sizing and evaluate the influence of osteoarthritis (OA) on the accuracy of measurements.

Study design: Observational study.

Sample: Radiographic images of 73 hip joints from 60 dogs with cementless cups.

Methods: Radiographs were anonymized and measured independently by three observers. One observer measured 12 sets of radiographs three times. A best-fit acetabular circle (AC) and cranial-caudal acetabular line (AL) were measured on ventral-dorsal (VD) radiographic view and open leg lateral (OLL) view. A best-fit femoral head circle (FHC) was measured on VD, OLL, and craniocaudal horizontal beam (CCHB) views. Two observers scored the OA in each hip joint. Intra- and interobserver consistency and repeatability and bias relative to implanted cup size were calculated and analyzed.

Results: Intraobserver consistency and repeatability were excellent for all measurements. Interobserver consistency was excellent (ICC > 0.9) for AC_VD and AC_OLL and was good (0.75 < ICC ≤ 0.9) for all other methods. Bias was small for AC and AL measurements (range, -0.46 to 0.45 mm) and large for FHC measurements (-3.58 to -2.42 mm). OA score significantly influenced bias for all acetabular measurement methods (p < 0.05).

Conclusion: All acetabular measurement methods were highly consistent within an observer. Interobserver consistency was highest for AC_VD and AC_OLL. FHC measurements underestimated cup size. Higher OA scores decreased the accuracy of all acetabular measurement methods.

Clinical significance: Superimposing a circle on the acetabulum seen on VD radiographic view accurately measures the acetabulum before cementless cup placement.

Objective: To assess the use of a newly developed aiming compression device (ACD) for screw insertion in non-fractured navicular bones (NB) in cadavers.

Study design: Cadaveric study.

Sample population: A total of 10 cadaveric front limbs of adult horses.

Methods: Placement of a 3.5 mm cortical screw in non-fractured NB under radiographic guidance was performed in 10 cadaver limbs in a standing position. An ACD was used to stabilize the NB and to guide the drilling process. Preparation and surgical time as well as the number of radiographic images were noted. A postoperative scoring system was used to assess screw placement by cone beam computed tomography (CBCT) and gross examination by two evaluators.

Results: The total procedure time was 25-62 min (median 33.5). During the procedure, 11-21 radiographs (median 18.5) were taken. The postoperative gross examination revealed an excellent screw placement in nine NB and poor in one. This could not be reliably assessed with post-procedure CBCT.

Conclusion: The described technique achieves an excellent screw placement in 9/10 bones without disrupting the articular or flexural surface of the NB and with no protrusion of the screw head or tip, in a median procedure time of under 35 min.

Clinical significance: Adequate screw placement is paramount for NB fracture repair. The described approach under radiographic guidance allows adequate screw placement using the ACD to stabilize the NB by lateral to medial compression. This technique facilitates adequate screw placement within the NB without the use of advanced imaging techniques.

Objective: The aim of the present study was to report the outcomes and complications of minimally invasive tarsal arthrodesis (MITA) in dogs.

Study design: Bi-institutional retrospective study.

Sample population: A total of 15 client-owned dogs.

Methods: Medical records of dogs undergoing MITA were reviewed to determine outcome and complications. Radiographs were recommended every 4 weeks until clinical union and reviewed to evaluate tibiotarsometatarsal alignment, implant position, subsequent osseous union of the debrided articulations. Time to clinical union and complications were recorded. Clinical union was defined as functional weightbearing limb use with at least 50% of osseous union. Final limb function was defined as full, acceptable, or unacceptable.

Results: Partial tarsal arthrodesis was performed in 10 cases and pantarsal arthrodesis in five cases. Postoperative swelling was minimal. Most complications, 26% major and 40% minor, were implant-related, and explant was required in three dogs. No catastrophic complications occurred. Mean (±sd) radiographic follow-up was 11.4 (±13.1) months Mean (±sd) time to radiographic osseous union was 1.8 (±0.5) months. Mean (±sd) time to clinical union was 3.7 (±0.8) months. Physiological alignment was restored in 12/15 dogs. Complete radiographic union occurred in 46% while in the remaining 54% obtained partial radiographic union, but clinical instability was not observed. Limb function was considered full in six and acceptable in eight dogs. Function was unacceptable in one dog, but the cause was not related to MITA.

Conclusion: MITA resulted in restoration of alignment, which was accomplished using MITA techniques. Furthermore, MITA appeared to result in faster healing times and reduced soft tissue complications compared to conventional open approach arthrodesis.

Clinical significance: MITA may be considered as an option to obtain functional arthrodesis in dogs.

Objective: To describe the feasibility, efficiency, and extent of thoracoscopic pericardiectomy (TP) on a ventilated dog with an intercostal approach in lateral recumbency (ILR), in comparison with the traditional transdiaphragmatic paraxiphoid approach in dorsal recumbency (PDR).

Study design: Randomized experimental study.

Animals: Twenty canine cadavers (n = 10 per group).

Methods: Thoracoscopic pericardiectomy was performed on mechanically ventilated cadavers to remove the largest pericardial fragment possible using either the ILR or PDR technique. Approach and procedure time were recorded, and surgical extent (cardiac exposure/exteriorization, pericardial fragment area) was assessed. Procedural difficulty and intraoperative visibility were also assessed to evaluate feasibility.

Results: Total surgical time (sum of approach and pericardiectomy time) did not differ between groups, although PDR pericardiectomy took longer (p = .045) by an average of 5.2 min. Exteriorization of the heart from the pericardial sac was achieved for all trials. Pericardial fragments from PDR trials were larger than those of ILR (p = .004), with a mean difference of 23.21 cm². Cardiac exposure and operative visibility scores were greater for PDR procedures.

Conclusion: The ILR approach with bilateral ventilation was a feasible alternative for performing partial pericardiectomies, which did not require more total surgical time when compared with the PDR approach.

Clinical significance: The ILR approach for TP warrants further evaluation in live dogs as it may hold promise for treating causes of pericardial effusion that do not require subtotal pericardiectomy and improving efficiency when paired with other ILR procedures such as thoracic duct ligation.