Veterinary Surgery最新文献

Objective: To report the use of a hybrid, transarticular external skeletal fixator and platelet-rich plasma injection without primary tenorrhaphy for management of partial calcanean tendon disruption in dogs.

Study design: Multi-institutional retrospective study.

Animals: A total of 11 client-owned dogs.

Methods: Medical records from two referral centers from 2019 to 2022 were reviewed for inclusion in the study. Dogs diagnosed with partial, non-traumatic calcanean tendon disruption treated with hybrid, transarticular external skeletal fixation and platelet-rich plasma injection were included in the study. Cases that did not include complete postoperative follow-up over 8-12 weeks and owner-reported outcomes at >6 months were excluded from the study. Dogs with traumatic laceration or those in which a primary tenorrhaphy was performed were also excluded.

Results: A total of 11 (n = 11) dogs met the inclusion criteria. Median follow-up time was 18.5 months (6 months-34 months). Mean time of fixation was 9 weeks (6 weeks-12 weeks). Five dogs returned to full, pain-free function (5/11 = 45%). Five dogs had an acceptable return to function (5/11 = 45%). One dog had an unacceptable outcome (1/11 = 9%). Pin tract complications occurred in five dogs (5/11 = 45%) and resolved with medical intervention.

Conclusion: The results of this study suggest that temporary tibiotarsal immobilization with a hybrid, transarticular external skeletal fixator and platelet-rich plasma injection without primary tenorrhaphy can lead to a successful outcome in dogs with partial calcanean tendon disruption.

Clinical significance: Temporary hybrid, transarticular external skeletal fixation and platelet-rich plasma injection without primary tenorrhaphy may play a role in the management of partial calcanean tendon disruption in dogs.

Objective: To describe sacroiliac luxation stabilization in cats using two screws and to report clinical and radiographic short-term outcomes.

Study design: Retrospective clinical cohort study.

Sample population: Cats (n = 67) with sacroiliac luxation.

Methods: Case records of cats presented for sacroiliac luxation stabilized using two screws per side affected, one lag and one positional, between 2014 and 2023 were reviewed. The percentage of sacral purchase (PoSP) for each screw, percentage of reduction (PoR), and pelvic canal width ratio (PCWR) were measured and calculated.

Results: Eighty-two sacroiliac luxations were stabilized. Two 2.0 mm screws were used in 69 cases; two 2.4-mm screws in nine cases, and one 2.4 mm with one 2.0 mm screw in four cases. The mean PoSPs for lag and positional screws were 46% ± 12 and 31% ± 11, respectively. The median PoR was 89% (41 to 100). The mean PCWR was 1.23 ± 0.11. Clinical follow up was available for 42 cats with 53 sacroiliac luxations at a median of 87 days (36 to 2503). The full function was noted in 34 patients (81%). Screw failure occurred in five sacroiliac joints (4.7%), including loosening (n = 3), and breakage (n = 2) of the positional screws (n = 1). Pelvic canal diameter was maintained in all cases.

Conclusion: Excellent functional and radiographic outcomes were obtained for cats with sacroiliac luxation stabilized with two sacroiliac screws.

Clinical significance: Feline sacroiliac luxation can be stabilized using two sacroiliac screws.

Objective: We aimed to study the antimicrobial and pro-healing potential of equine mesenchymal stromal cell secreted products (i.e. secretome), collected as conditioned media (mesenchymal stromal cell-conditioned media, MSC CM), in a novel in vivo model of methicillin-resistant Staphylococcus aureus (MRSA)-inoculated equine thorax wounds.

Study design: Prospective in vivo study.

Animals: Two Thoroughbred geldings.

Methods: Six full-thickness cutaneous wounds were created bilaterally on the dorsal thorax of two horses (n = 12 wounds/horse). Wounds on the left thoraces were inoculated with MRSA on day 0. All wounds were then treated with either mupirocin ointment, MSC CM, or vehicle control (n = 4 wounds per group) once daily for 3 days. Photographs were taken to quantify wound scores and sizes, as well as samples to determine bacterial colony forming units (CFUs), at days 0, 1, 2, 3, 7, 14, 21, and 28. The wound edge was biopsied on days 0, 7, and 28, and scored histologically.

Results: Inoculated wounds had more bacterial CFUs at day 1 (p < .0001) and were larger in size at day 28 (p = .0009) than noninoculated wounds. Mupirocin-treated wounds were smaller than MSC CM and vehicle control-treated wounds at day 28 (p = .003). Mesenchymal stromal cell-conditioned media did not affect CFU numbers in inoculated and noninoculated wounds. Moreover, MSC CM did not affect the parameters of wound size or gross or microscopic wound scores over time.

Conclusion: Mesenchymal stromal cell-conditioned media did not exhibit antimicrobial or pro-healing properties in the current study; however, the in vivo model of inoculated equine thorax wounds requires further optimization.

Clinical significance: This pilot study contributes to a growing understanding of the equine MSC secretome as an antimicrobial and pro-healing therapeutic for equine wounds.

Objectives: To evaluate the feasibility of correcting penile urethral strictures at the bulbus glandis using buccal mucosal graft (BMG) urethroplasty in dogs.

Study design: Prospective clinical trial.

Animals: Five male dogs with urethral strictures located at the bulbus glandis.

Methods: Urethrotomy was performed throughout the entire length of the urethral stricture including ~0.5 cm healthy urethra proximal and distal. The scarred tissue and unhealthy mucosa of the strictured urethra were completely excised. The graft was harvested from the buccal mucosa and tubularized at the stricture site using a urethral catheter as the skeleton. The catheter was maintained for 14 days after surgery and removed when no urethral leakage was identified on a positive-contrast retrograde urethrogram. The dogs were discharged after spontaneous urination was confirmed. Six months postoperative follow-up was completed for all dogs with repeated positive contrast urethrogram and an owner questionnaire to score urinary function and quality of life.

Results: The five dogs recovered well following surgery and only one dog experienced a minor complication. All dogs were able to urinate normally after catheter removal. No evidence of leakage was identified on a 14 day postoperative retrograde positive contrast urethrogram and clinically at a median follow-up time of 182 days (range, 182-186). All owners scored the urinary function as excellent and ranked their satisfaction very high 6 months after the procedure.

Conclusion: Buccal mucosal graft urethroplasty has positive outcomes for dogs with penile urethral strictures.

Objective: To describe the surgical technique and outcomes of arthroscopic treatment for talar osteochondritis dissecans (OCD) in dogs, using scope and instrument portals placed on the same side of the joint as the lesion.

Study design: Retrospective case series.

Animals: Fifteen client-owned dogs (19 tarsi).

Methods: The records of dogs with talar OCD lesions managed by arthroscopy using this modified approach to portal placement were reviewed. Signalment, owner-completed questionnaires-the Canine Brief Pain Inventory (CBPI) and a visual analog scale (VAS)-together with clinical and imaging data, surgical techniques, and postoperative complications were recorded. Mid- to long-term outcomes (over 6 months) were assessed using orthopedic examinations, osteoarthritis radiographic scores, and owner-completed questionnaires.

Results: Visualization of the affected articular structures was adequate in all cases. The multiple OCD fragments identified on CT scans were removed without intraoperative complication in 17 tarsi. Mini-arthrotomy was performed in one dog and mini-tenotomy of the deep digital flexor sheath was performed in another. Minor postoperative complications (synovial cysts) were reported in four cases. Mid- to long-term outcomes were good to excellent in 11 of the 14 dogs with substantial improvement in lameness, CBPI, and VAS scores compared with preoperative results. Degenerative joint disease progression was observed in 10 of the 14 cases.

Conclusion: The modified arthroscopic technique resulted in few complications, rapid clinical improvement, and full or acceptable function in most cases.

Clinical significance: This modified approach to portal placement is an appealing and suitable alternative to the approach described previously for managing tarsal OCD lesions.

Objective: To determine the impact of a two-stage rumen cannulation on the health and rumen function of lactating dairy cows.

Study design: Experimental study.

Animals: Six lactating Holstein cows.

Methods: We performed a two-stage rumen cannulation in six Holstein cows that were 49 ± 11 days in milk. The following clinical health parameters and digestion-associated variables were analyzed on seven measurement days, from before the first surgery until 28 days after the second surgery: body temperature, heart rate, respiratory rate, pain score, rumen fill score, fecal score, wet sieving, auscultation and palpation of the rumen, bodyweight, body condition score, and activity.

Results: The pain score of the cows was constantly zero. Similarly, the body temperature and respiratory rate remained within physiological ranges, whereas the heart rate was slightly higher immediately after the second surgery. No differences were observed in rumen fill (2.00-2.67; p = .10) and fecal consistency scores (2.17-2.67; p = .42). The fecal particle size distribution showed negligible differences. The cows lost approximately 43 kg of bodyweight during the experiment (p < .01), which was reflected in a 0.5-point body condition score loss (p < .01).

Conclusion: A temporary minimal negative effect of a two-stage rumenostomy on the health and body condition of early lactating Holstein cows was observed, whereas digestion was unaffected. Considering the limited sample size, further studies are required to substantiate these findings.

Clinical significance: Given that animals are appropriately medically managed, experimental rumenostomy of lactating dairy cows may not compromise their health or rumen function.

Objective: To assess outcomes of dogs with side-to-side portocaval extrahepatic portosystemic shunts (PC-EHPSS) and poor portal perfusion to the liver treated with medical management alone (MM) or surgical attenuation (SA).

Study design: Multi-institutional retrospective study.

Animals: A total of 21 dogs with PC-EHPSS (14/21 MM and 7/21 SA).

Methods: Medical records were reviewed, and data was collected on dogs <12 kg with PC-EHPSS treated with MM or SA between June 2008 to June 2021. Signalment, clinical signs, postoperative complications, bloodwork values, long-term clinical outcome, survival, and owner reported quality of life were recorded.

Results: Of 21 dogs included, 10 were mixed breeds and 14 were females. Median age at time of presenting clinical signs was 163 days. At final follow-up examination (median 1119 days), all SA and 6/14 MM dogs were alive, with a median survival time of 2138 days following treatment onset. In surviving MM dogs, outcome was fair in 3/6 and poor in 3/6. In SA dogs with long-term follow-up, outcome was fair in 5/6, and poor in 1/6. A greater proportion of SA dogs had improved bloodwork parameter values at final follow-up examination, and the mean relative change in final bloodwork values was higher when compared to MM dogs.

Conclusion: These findings demonstrate that SA has improved clinical outcomes to MM for PC-EHPSS; however, SA clinical outcomes appear worse than those previously reported for other EHPSS.

Clinical significance: This information may have implications for expected outcomes in other EHPSS subtypes associated with severely diminished portal perfusion.

Objective: To describe a combined transdiaphragmatic and caudal median sternotomy (TDCM) approach to the accessory lung lobe and to compare its accessibility with intercostal thoracotomy (ICT) and median sternotomy (MS).

Study design: Cadaveric study.

Animals: Twelve canine cadavers.

Methods: Cadavers underwent an accessory lung lobectomy using an articulating EndoGIA stapler via randomly assigned approach: ICT (n = 4), MS (n = 4) or TDCM (n = 4). The percentage of accessory lung tissue removed was measured in surface area and weight. Exposure was measured as area of cavitary or bicavitary exposure at maximal retraction, by tracing a line around the circumference of the exposed cavity using an imaging software. Staple line leak pressures were evaluated to 40 cmH₂O.

Results: The average area of exposure was larger in the TDCM approach (TDCM = 193.5 cm², MS = 106.5 cm², ICT = 73.5 cm²); (p = .01). Two of four ICT staple lines leaked at 40 cmH₂O or lower, and 1/4 MS resulted in iatrogenic damage to an adjacent lobe. There was no difference in the percentage of the lobe excised by weight or surface area between groups.

Conclusion: The transdiaphragmatic and caudal median sternotomy approach provided greater exposure, although the percentage of the lobe excised and the surgical time did not differ between approaches.

Clinical significance: All three approaches allowed for adequate excision of the accessory lung lobe (ALL) with similar surgical times; however, the TDCM approach provided a greater area of exposure, which could increase accessibility to the ALL.