Veterinary Surgery最新文献

Objective: To determine the prevalence of popliteal sesamoid displacement (PSD) in dogs with cranial cruciate ligament disease (CCLD) on radiographs, assess its reduction following tibial plateau leveling osteotomy (TPLO), and evaluate cranial tibial subluxation (CTS) pre- and postoperatively.

Study design: Retrospective radiographic observational study.

Sample population: A total of 163 client-owned dogs diagnosed with CCLD and treated with TPLO.

Methods: Pre- and postoperative 90° flexion radiographs were reviewed to assess CTS, tibial plateau angle (TPA), stifle opening angle, PSD, and osteotomy localization. Statistical analyses evaluated associations between PSD, CTS, TPA, and osteotomy location.

Results: A PSD was observed in 14.4% of cases preoperatively and was associated with significantly higher CTS. Popliteal sesamoid reduction was achieved in 100% of cases post-TPLO. The CTS persisted postoperatively in all dogs with preoperative subluxation (N = 82; 50.3%), though at significantly reduced levels. Osteotomy positioning did not significantly affect postoperative CTS. Postoperative TPA showed a weak negative correlation with residual CTS.

Conclusion: A PSD is an infrequent finding, typically associated with more pronounced preoperative CTS. This displacement reliably resolves after TPLO when CTS was minimal. Although postoperative CTS was frequently observed, it was generally mild and not significantly affected by the osteotomy location.

Clinical significance: The PSD occurs infrequently after CCLD but is associated with increased CTS. Popliteal sesamoid reduction was associated postoperatively with minimal CTS and appropriate TPA. Radiographic assessment of popliteal sesamoid reduction may provide an additional, objective parameter for detecting any residual cranio-caudal instability following TPLO.

Objective: To determine the accuracy and safety of two established landmark-based techniques and two novel techniques for stifle arthrocentesis in dogs.

Study design: Ex vivo prospective study.

Animals: A total of 32 paired canine cadaver pelvic limbs.

Methods: An electronic survey assessed technique prevalence among surgeons. Pelvic limbs (n = 32) were randomized to one of four techniques; lateral intercondylar notch (LINC), infrapatellar (INFRA), suprapatellar (SUPRA), or proximal lateral parapatellar pouch (POUCH) technique, with n = 8 per group. Repositions, attempts, and synovial fluid presence were recorded. Stifle arthrography assessed accuracy. India ink assay assessed iatrogenic articular cartilage injury (IACI). Omnibus tests were used (p < .05), with post hoc Bonferroni-correction (p < .0083).

Results: A total of 40 surgeons responded, with LINC most commonly used (35/40, 87.5%). All tested techniques were accurate (8/8, 100%, p > .9). INFRA and SUPRA required more needle repositions (median 3 and 2, respectively) than LINC and POUCH (median 1 for both), (p = .001). LINC and SUPRA produced no IACI, INFRA (6/8, 75%) and POUCH (3/8, 37.5%) (p = .007). Over half of IACI produced with INFRA exceeded 10 mm² in area, all on weightbearing cartilage (p = .041). POUCH injuries occurred exclusively on non-weightbearing cartilage (p = .041).

Conclusion: LINC and INFRA are currently used clinically and were accurate; however, INFRA required increased repositions and had high IACI rates on weightbearing cartilage. Two novel techniques were feasible and accurate; SUPRA was safe with no IACI, while POUCH had high IACI risk on non-weightbearing cartilage.

Clinical significance: SUPRA may be a safer alternative than current established techniques and warrants further clinical investigation. INFRA carries high IACI rates.

Objective: To describe the operative technique and outcome of free autologous omentum grafting (OG) for wound reconstruction on the distal limbs of dogs.

Study design: Retrospective case series.

Animals: A total of 10 client-owned dogs.

Methods: Medical records (2010-2023) were searched for dogs with open limb wounds distal to the stifle or elbow treated with OG for wound reconstruction. OG was harvested via celiotomy, then sutured to the wound bed and 0.4-1 cm subcutaneous tissue beneath surrounding dermis. Wounds were bandaged using a petroleum-coated primary layer to prevent graft desiccation for 1-2 weeks. Using ImageJ software, wound area and final unhaired scar area were analyzed and time to epithelialization, major and minor complications, and length of follow up were determined.

Results: Dogs with a mean age of 6.9 ± 4.2 years were identified with wounds (n = 13 wounds) measuring 25.96 ± 16.27 cm² at the time of OG. Wounds were healed in 59.5 ± 11.1 days. Minor complications included infection and swelling/discharge in two and 10 dogs, respectively. There were no major complications. By 30-days postoperatively, wounds were 18.85 ± 0.1% of the original size. All wounds healed with complete epithelialization, excellent cosmesis, no lameness and partial to complete hair regrowth.

Conclusion: OG may provide an alternative method for management of distal limb wounds in dogs, with minimal complications, excellent cosmesis and functional outcomes in 10 dogs.

Clinical significance: Free OG may offer an alternative method of wound management in dogs; however, further research with controlled prospective studies is indicated before recommending the method over other treatment options.

Objective: To evaluate three different jejunal transection angles for end-to-end jejunojejunostomies, comparing construction time, lumen size, and suture number.

Study design: Ex vivo cadaver study.

Sample population: Eight euthanized horses each had three mid-jejunal specimens harvested.

Methods: Jejunal segments were assigned to one of three groups (A30, A45, and A60) and transected at 30, 45, or 60°, respectively. Following transection, a standardized handsewn single-layer interrupted modified Lembert anastomosis was performed, and construction time and number of sutures placed were recorded. Anastomotic index (AI) was calculated. Statistical analysis was performed using a one-way ANOVA. Statistical significance was set at p < .05.

Results: Transected jejunal lengths increased as the transection angle decreased (p < .001). Anastomoses construction time was not different between groups (p = .301). The number of sutures required to complete the anastomosis was higher (p = .026) for A30 compared to A60 but was not different between A60 and A45 or A45 and A30 (p > .333). Mean AI were 93.37, 114.29, and 135.07 for groups A60, A45, and A30 and the AI increased as the transection angle decreased (p < .001).

Conclusion: A 60° transection angle reduced lumen size at the anastomosis but a 45 and 30° transection angle resulted in an increased lumen size at the anastomosis. The 45° angle did not increase the number of sutures required. The 30° angle significantly increased the number of sutures required.

Clinical significance: A 45° angle of transection does not result in increased surgical time or number of sutures placed. Further investigation is required to determine the ideal angle of transection.

Objective: To describe the angiosomes of the dorsal and ventral perineal arteries in dogs and identify landmarks for axial pattern flaps based on these vessels. To describe the differences between male and female dogs regarding their respective angiosomes. To present a case report demonstrating the successful use of the dorsal perineal artery skin flap to reconstruct a perianal wound.

Study design: Anatomic study.

Animals: Eight canine cadavers: four males and four females. One clinical canine case.

Methods: Nonselective barium sulfate angiography was performed via injection of the descending aorta. Skin excised from the perineum and thighs was evaluated via gross inspection and radiography to identify angiosomes. A single clinical case utilizing the dorsal perineal artery axial pattern flap was used to reconstruct a wound in a live dog.

Results: A primary cutaneous branch of the ventral perineal artery was identified consistently in all cadavers with positive contrast radiography. The ventral perineal artery cutaneous angiosome was subjectively more robust than the dorsal perineal angiosome. A cutaneous branch of the dorsal perineal artery was observed radiographically in all specimens. The primary cutaneous angiosomes of both arteries extended at least two-thirds of the length of the caudal thigh. In the clinical case, a perineal wound was repaired successfully with a dorsal perineal artery flap.

Conclusion: The ventral and dorsal perineal arteries possessed robust cutaneous angiosomes with apparently abundant vasculature and broad coverage on the caudal thigh, which were consistent in male and female cadavers.

Clinical significance: The dorsal and ventral perineal arteries provide a rich blood supply to the skin of the caudal thigh. Axial pattern skin flaps created within these angiosomes may survive consistently.

Objective: To describe a modified two-portal tenoscopic technique for proximal manica flexoria (MF) resection designed to preserve the mesotendons (MTs) of the deep digital flexor tendon (DDFT).

Study design: Prospective clinical study.

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

Methods: MF resection was performed in four steps: (1) Transection of the lateral attachment of the MF to the superficial digital flexor tendon (SDFT), staying abaxial to the lateral MT; (2) transection of the medial attachment of the MF to the SDFT between the flexor tendons from distal to proximal until reaching the level of the medial MT; (3) transection of the proximal medial attachment of the MF to the SDFT dorsal to the DDFT; and (4) fixation with a Kocher-Ochsner clamp, followed by rotation to disrupt the areolar tissue and extract the MF. Long-term follow-up (>6 months) was assessed by telephone interview.

Results: Proximal MF tears were located medially in 20/30 (66.7%), laterally in 7/30 (23.3%), and both medially and laterally in 3/30 (10.0%) cases. Hindlimbs were affected in 27/30 (90.0%), and forelimbs in 3/30 (10.0%). Nine of 11 sport horses (81.8%) and 12 of 17 leisure horses (70.6%) returned to the same or a higher level of work.

Conclusion: The MF was successfully resected in all horses irrespective of tear localization.

Clinical significance: This two-portal MF resection technique, described step by step, was developed to further limit surgical trauma with a specific focus on preserving the MTs and thereby maintaining the extrinsic blood supply to the flexor tendons.

Objective: To describe Endo GIA stapler use in open approach lung lobectomies. Endo GIA stapler use for open approach lung lobectomies has been validated in cadaveric studies; however, current veterinary literature lacks in vivo studies.

Study design: Retrospective study.

Sample population: A total of 33 dogs and four cats (37 cases, 46 lung lobectomies).

Methods: Records from November 2019 to September 2024 at a single institution were reviewed. Dogs and cats that underwent lung lobectomy via thoracotomy (intercostal, transdiaphragmatic) or median sternotomy using Endo GIA staplers were included. Pre-, intra-, and postoperative data were collected. Complications were assessed using the Cook Complication Grading System. Complication rate was analyzed to demonstrate use of Endo GIA staplers in open thoracic procedures. Cases included had a 14-day follow-up at minimum or at death.

Results: A total of 46 lung lobectomies (37 cases) were performed using an Endo GIA stapler via open thoracic procedures. No intraoperative complications were noted in 38/46 (82.6%) lung lobectomies. Minor intraoperative complications occurred in 8/46 (17.4%) lobectomies. No major complications occurred. Catastrophic complications occurred in 4/37 (10.8%) cases (4/46 [8.7%] lung lobectomies) postoperatively, likely due to comorbidities. Cases that reached 14-day follow-up, despite one minor postoperative complication of seroma formation, had no complications (32/33, 97%).

Conclusion: Endo GIA stapler use for open approach lung lobectomies proved to be a valid procedure with minimal complications. The unique properties of the Endo GIA stapler offered an alternative to traditionally used staplers for lung lobectomy.

Clinical significance: Endo GIA staplers can be used for open approach lung lobectomy as a beneficial alternative with minimal complications.

Objective: To develop a modified stapled (MS) jejunocecostomy (JC) in healthy horses.

Study design: In vivo experimental study.

Animals: Six healthy adult horses underwent ventral midline celiotomy, a jejunal resection, and an MS.

Methods: Time to complete anastomosis and anastomotic length at necropsy were recorded. Horses were assessed by physical examination every 6 h for 5 days after surgery, then once daily until euthanasia at 7 days. A group of seven horses that had a stapled side-to-side JC and were euthanized 28 days postoperatively was used as an historical control (SS).

Results: All MS horses recovered well, although one developed transient mild colic and another had a brief period of pyrexia and diarrhea. Postoperative heart rates returned to preoperative values shortly after surgery. At necropsy, the MS anastomoses appeared grossly to be healing well and formed a wide triangulated stoma. Times to complete the anastomosis (p = .49) and lumen size at necropsy (p = .32) were similar for both groups.

Conclusion: The MS method was performed with ease and appeared to function effectively. It produced a triangulated stoma that could facilitate flow and reduce the risk of impaction.

Clinical significance: This study supports the use of MS for JC in horses. Although the study size was small, the results compared favorably with historical data for a SS for JC in healthy horses. The elimination of oversewn ends simplifies the MS technique and allows a single application of the stapler, minimizing cost.

Objective: To compare outcomes of dogs with gastric dilatation-volvulus (GDV) treated with open right-sided barbed suture gastropexies (BSG) and standard right-sided incisional gastropexies (SIG).

Study design: Retrospective cohort study.

Animals: Client-owned dogs treated for GDV with BSG (n = 58) and SIG (n = 63).

Methods: Medical records were reviewed retrospectively. Suture type and size, surgery time, perioperative complications, and survival to discharge were recorded and compared between groups. Follow up was conducted by medical record evaluation, e-mail, or phone contact. Postoperative surgical complications, recurrence of gastrointestinal signs, gastric dilatation with or without volvulus, and survival time were recorded and compared. Categorical (χ² versus Fisher's exact test) and parametric versus nonparametric (paired t-test versus Wilcoxon Mann-Whitney test; one-way ANOVA versus Kruskal-Wallis) methods of comparison were applied as appropriate.

Results: Perioperative mortality rate was 5.79% (7/121) with no difference between SIG (5/63) and BSG (2/58) (p = .28). Barbed suture gastropexies resulted in shorter surgical times when compared to SIG when performed as the sole procedure (53.3 versus 62.6 min, p = .03). Perioperative and postoperative surgical complications (p = .12), recurrence of GDV (p = .22), or gastric dilatation without volvulus (p = .5) did not differ between groups. Postoperative gastrointestinal signs were reported in 23% of dogs with no difference between groups (p = .33).

Conclusion: Barbed suture gastropexy is a viable option for surgical management of GDV. Persistent gastrointestinal signs remain possible regardless of gastropexy technique.

Clinical significance: Barbed suture gastropexy can result in shorter surgical times with similar recurrence rates to previously reported gastropexy techniques.

Objective: To compare the comfort and functionality of three sizes of laparoscopic ring/finger loop handles during a laparoscopic cup biopsy task and determine which design feature was most associated with comfort.

Study design: Prospective, blinded, randomized three-way cross-over study.

Sample population: Participants (n = 120) at the 2022 American College of Veterinary Surgeons (ACVS) annual symposium.

Methods: Participants performed a laparoscopic cup biopsy task using three differently sized finger loop handles. Participants were blinded to the handles and randomized in their order of presentation. Each participant completed a demographic survey and a post-task four-question survey regarding handle characteristics and preferences.

Results: Female participants had a median glove size of six compared to males with a size seven. Female participants described the small handle as most comfortable (52/81, 64.2%); male participants preferred the medium and large handles equally. Participants glove size predicted the "most comfortable" handle size (p < .001). Both glove size and gender predicted the "least comfortable" handle size (p < .001, p < .045, respectively). Female participants reported that the characteristic "easier to turn dial" was the most important reason for comfort (31/81; 38.3%). Male participants reported that "fingers felt more comfortable in grips" as the most important reason for comfort (15/27, 55.6%).

Conclusion: Surgeons with smaller glove sizes (<6.5) and female surgeons experience more difficulty with commonly available laparoscopic handles. The most important design feature for laparoscopic equipment is dependent on glove size.

Clinical significance: Surgeons should review all available options for laparoscopic handles to improve ergonomics during laparoscopic surgery.