Veterinary Surgery最新文献

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.

Objective: To determine the ability of abdominal ultrasound (AUS) to correctly identify gastrointestinal foreign body (GIFB) type, location, size and shape; and to determine the success rate of laparoscopic-assisted GIFB removal with GIFB of various characteristics.

Study design: Prospective clinical study.

Animals: Client-owned dogs (30) that underwent laparoscopic-assisted intestinal surgery (LAIS).

Methods: Dogs with GIFB obstruction underwent an AUS performed by a boarded radiologist. GIFB type, location within the gastrointestinal tract, size, and shape were recorded, as well as the presence or absence of peritoneal fluid, pneumoperitoneum, or mural changes. LAIS was attempted in all dogs. Surgical findings were compared to ultrasound findings.

Results: AUS was able to correctly determine the type, location, and shape of GIFB 96.8%, 77.42%, and 93.5% of the time, respectively. AUS had moderate accuracy (80%), at identifying adhesions, and underestimated GIFB size. LAIS was successful in 16/30 (53.3%) of cases, including 2/7 (28.6%) linear, 14/23 (60.9%) non-linear, and 1/1 (100%) gastric foreign bodies, but was not successful for GIFB near the caudal duodenal flexure (0/2, 0%).

Conclusion: Preoperative AUS was accurate in determining the type, location, and shape of GIFB. Specific linear foreign bodies were amenable to laparoscopic-assisted removal. GIFB located at the caudal duodenal flexure were not successfully removed by LAIS.

Clinical significance: Preoperative AUS is a useful diagnostic to aid in determining the suitability of a dog to undergo LAIS.

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 compare the effect of two continuous intradermal suture patterns (modified Allgower-Donati [mAD] vs. horizontal mattress [SP]) on acute changes in cutaneous perfusion following closure of the skin incision in cats undergoing ovariohysterectomy.

Study design: Within animal randomized controlled trial conducted at three animal shelters.

Animals: A total of 32 cats.

Methods: Adult cats receiving elective ovariohysterectomy underwent standardized skin incisions closed with two intradermal suture patterns (mAD or SP) randomly assigned to the cranial or caudal half. All procedures were performed by an ACVS board certified surgeon. Incisional margin cutaneous perfusion was measured using a laser Doppler perfusion imager at baseline and following closure. Baseline perfusion was subtracted from post-suturing perfusion at each region obtaining a delta effect for each pattern. Incisional complications in the 30 days following surgery were also recorded.

Results: Mean (±SD) surgical time was 19.3 ± 4.1 min. Cutaneous perfusion increased by a mean of 59.7 ± 124.1 blood perfusion units (BPU) from baseline with the mAD pattern, compared with a decrease of 20.2 ± 119.9 BPU from baseline for the standard suture pattern (p < .01). No cats re-presented for incisional complications.

Conclusion: The mAD pattern resulted in improved wound margin perfusion compared with the SP pattern.

Clinical significance: The mAD pattern offers an alternative to the current standard of care intradermal pattern, maintaining the advantages of a buried pattern while improving perfusion to the wound margin.

Objective: To describe the surgical technique and report the clinical outcomes of using locking plates applied transversely across the sternum as part of sternal repair after large sternectomy.

Animals: Two client-owned dogs.

Study design: Short case series.

Methods: One dog with chest wall hemangiosarcoma and one dog with chronic extensive thoracic pyogranulomatous lesion caused by Actinomyces spp. were treated by thoracic wall resection including partial sternectomy. The defect was reconstructed with multiple techniques including a locking plate secured with screws in two opposite ribs.

Results: There were no complications related to the surgical reconstruction or implants. The first dog was euthanized at 8 months postoperatively following sudden deterioration. The second dog developed self-limiting serosanguinous discharge from 3 to 6 days postoperatively but otherwise had an uneventful recovery. No recurrence was reported 15 months post-surgery.

Conclusion: Use of a locking plate to span two opposite ribs in conjunction with other reconstructive techniques was a safe and effective method of treating large sternal wounds in these two dogs. This new surgical technique yielded excellent functional and cosmetic outcomes. Transverse locking plate application is a straightforward and promising option for large thoracic wall or sternal defects.