Veterinary Surgery最新文献

Objective: To report the clinical characteristics of traditional (TTC) and W-shaped tracheal collapse (WTC) and the long-term outcomes of continuous extraluminal tracheal prosthesis (CETP) placement in dogs with grade IV tracheal collapse (TC).

Study design: Retrospective case series.

Animals: A total of 69 client-owned dogs.

Methods: Medical records of dogs with grade IV TC, subclassified as TTC or WTC, treated using CETP between 2018 and 2021, were retrospectively reviewed. Clinical signs, diagnostic results, intraoperative findings, surgical complications, and clinical outcomes were analyzed.

Results: Of the 69 dogs, 45 had TTC and 24 had WTC. All were discharged after CETP placement. Preoperative stridor (p < .0001) and labored breathing (p = .0419) were more prevalent in patients with WTC than in those with TTC. The WTC group was 12.1 times more likely to require preoperative oxygen management than the TTC group (OR, 95% CI: 3.2-37.5). The 36-month postoperative survival rates were 75.7% and 90.9% in dogs with TTC and WTC, respectively. Postoperative laryngeal paralysis occurred in three dogs in the TTC group and two in the WTC group. Recurrent TC occurred in one dog in the TTC group and two in the WTC group. Seven of the eight dogs with postoperative complications required surgical intervention or intraluminal stent placement.

Conclusion: Although dogs with WTC showed more severe preoperative respiratory symptoms, their postoperative outcomes were comparable with those of dogs with TTC.

Clinical significance: CETP placement is a viable surgical treatment option for dogs with WTC, even those with severe respiratory symptoms.

Objective: To describe the equipment and accuracy of a table-bound reduction system and three-dimensional (3D) printed drill guide for fluoroscopically guided, minimally invasive sacroiliac luxation (SIL) reduction and stabilization by means of a single iliosacral lag screw in cats.

Study design: Retrospective case series.

Animals: A total of 17 cats (20 screws).

Methods: Medical records of a single institution were retrospectively reviewed for cats that underwent SIL reduction and stabilization as described in the above objective. Postoperative images were assessed for screw positioning, percentage of sacroiliac reduction, sacral width purchase, and craniocaudal and dorsoventral screw angulation.

Results: Sacral width purchase was 82.52% ± 10.67. Percentage of sacroiliac (SI) joint reduction was 94.25% ± 8.14. Craniocaudal screw angle was -1.22° ± 3.96. Dorsoventral screw angles was 0.7° ± 3.90. All screws were classed as being positioned within the sacral body (in).

Conclusion: Stabilization of SIL in cats by mean of a single iliosacral screw placed minimally invasively using intraoperative fluoroscopy and a table bound reduction system and 3D printed drill guide system, led to screws that were repeatably placed within the sacral body based on either computed tomography (CT) scan assessment or subjective radiographic assessment.

Clinical significance: The described technique and equipment allow placement of iliosacral screws in cats with repeatable accuracy.

Objective: To quantify the morphology of the humeral condyle in dogs with and without humeral intracondylar fissure (HIF).

Study design: Retrospective case control.

Sample population: A total of 171 elbows.

Methods: Computed tomography (CT) scans of elbows were retrospectively analyzed. The population comprised three groups; non-chondrodystrophic control dogs (n = 44), Springer Spaniel control dogs (n = 27), and humeral intracondylar fissure (HIF)-affected dogs (n = 100). A condylar template was constructed on three-dimensional (3D) surface-rendered images with measurement of 10 parameters by three observers.

Results: A total of 171 elbows were analyzed. Angle A, representing the axial surface of the medial humeral condyle and angle B, representing the axial surface of the lateral humeral condyle were both significantly greater in HIF-affected dogs (p < .001). Length a (p = .007) and b (p < .001), representing the vertical distance between the most proximal and most distal points of the medial and lateral humeral condyles respectively, were also significantly greater in HIF-affected dogs.

Conclusion: From the population sampled, HIF-affected dogs had both significantly greater vertical height as well as angulation of the axial surface of both the medial and lateral humeral condyle.

Clinical significance: Greater angulation of the axial surfaces of the humeral condylar articular surface could create an intracondylar shear force orthogonal to the orientation of the fissure, predisposing to HIF formation.

Objective: To describe and report clinical outcomes after transcutaneous guttural pouch (GP) catheterization (TGPC) in standing horses.

Study design: Ex vivo study and case series.

Animals: One cadaver head, records of 10 normal horses and 14 horses treated with TGPC.

Methods: Relevant anatomical landmarks were determined through dissection of one cadaveric specimen and 10 normal radiographic studies. Records of horses diagnosed with empyema or mycosis and treated with standing TGPC were reviewed for complications that occurred during or after the operation.

Results: Ex vivo and radiological studies identified the tissues crossed by the catheter and anatomical variations of the stylohyoid. TGPC performed on one (n = 13) or both (n = 1) GPs was successful in all cases. The balloon catheter placed in the parotid region allowed administration of oxygen and lavage solution and facilitated passive or active drainage. Complications included hemorrhage from the skin (3/15; 21%), catheter balloon rupture (1/15; 7%), cutaneous salivary fistula (1/15; 7%), abrasions under the fixation ring (15/15; 100%) and catheter dislodgement (3 of 500 treatment sessions). The balloon catheter remained in place for 4 to 17 days. Following catheter removal, sealing of the GP was achieved within 72 h; second-intention healing was complete in less than 10 days.

Conclusion: TGPC in standing horses was frequently associated with minor complications but allowed local treatment for up to 17 days.

Clinical significance: This study provides evidence to support the transcutaneous placement of a 20 Fr balloon catheter in the GP for local treatment.

Objective: To determine the evidence for the most effective surgical treatment for elbow osteoarthritis with the least harm in dogs.

Study design: Systematic review.

Sample population: Peer-reviewed, English-language articles describing surgical treatments for elbow osteoarthritis in dogs.

Methods: A literature search was completed using CAB Abstracts, PubMed/MEDLINE, Scopus, and Web of Science on August 19, 2024 for articles describing surgical treatments for elbow osteoarthritis and medial compartment disease in dogs. Inclusion criteria were applied, and the resulting articles were evaluated for level of evidence (Wright scale) and combinability by success rates, and major complications using the number needed to harm (NNH).

Results: Out of the 1231 unique articles, 15 were evaluated based on the inclusion criteria with five prospective studies, eight retrospective studies, and two case series studies. Success rates could not be combined because of variation in outcome reported. Canine unicompartmental elbow had the highest level of evidence for success (91%-98%) with the second best number needed to harm (NNH, 7.6). Sliding humeral osteotomy had the next best evidence with 43%-82% success and 9.5 NNH.

Conclusion: There is low evidence for any of the procedures, and the risk of harm is high.

Clinical significance: Although CUE had the highest level of evidence, there is low evidence overall for efficacy of surgical procedures to treat OA in the elbow. A validated outcome measure with consistent follow-up intervals to standardized comparisons would allow for better comparison of the outcomes of future studies.

Objectives: To describe the development of fragmentation of the medial coronoid process (FMCP) following antebrachial synostosis as a sequela to a radius ulna fracture in an adult dog.

Animal: A 6-year-old male neutered Siberian Husky.

Study design: Case report.

Methods: A male neutered Siberian Husky presented with bilateral complete fractures of the radius and ulna after being hit by a car. Bilateral antebrachial fracture repair was performed with dual plating. Unilateral radioulnar synostosis was identified 1 year post fracture repair. Acute progression of lameness occurred 3 years postoperative with elbow computed tomography (CT) and arthroscopy identifying FMCP.

Results: Limb function improved after arthroscopic removal of the fragmented medial coronoid process.

Conclusion: The pathogenesis of medial coronoid process disease remains unclear, with joint incongruity or instability considered most likely. This report describes the development of FMCP following synostosis of the radius and ulna in an adult dog.

Objective: To report the incidence, management, and outcomes of gossypibomas encountered in veterinary specialty hospitals.

Study design: Multi-institutional, retrospective study.

Animals: A total of 21 client-owned animals (18 dogs, 3 cats).

Methods: A spreadsheet was generated and distributed to veterinary specialty institutions for case recruitment and evaluation of animals with histopathologic diagnosis of a gossypiboma.

Results: A total of 15 of 21 animals were female, and 11/15 females had ovariohysterectomies resulting in their gossypiboma. Median time to representation after initial surgery was 13.5 days (IQR: 4-90). Duration of clinical signs prior to representation was a median time of 5 days (IQR: 1.5-11), and the clinical signs included pyrexia (10), abdominal discomfort (8), lethargy (7), and anorexia (7). The secondary surgery was performed on an urgent basis in 10/21 animals. Animals were hospitalized for a median time of 5 days (IQR: 1.5-11) postoperatively. Postoperative complications occurred in 4/21 animals and included sepsis (1), urinary and fecal incontinence (1), persistent anorexia (1), and aspiration pneumonia (1). A total of 19 of 21 animals survived to discharge.

Conclusion: Majority of animals had intraabdominal gossypibomas and frequently presented for non-specific clinical signs. Surgical treatment was commonly performed within 1 month prior to re-presentation. Surgical management yielded a good long-term prognosis but may need to be performed urgently. Postoperative complications may be associated with the gossypiboma or the additional surgical intervention required for removal.

Clinical significance: Gossypibomas are preventable postoperative complications that can result in high morbidity and mortality but carry a favorable long-term prognosis following surgical excision.

Objective: To evaluate the soft palate thickness in brachycephalic dogs 3 months after performing folded flap palatoplasty (FFP) or standard staphylectomy (STS).

Study design: Prospective, observational study.

Animals: Twenty client-owned dogs with brachycephalic obstructive airway syndrome undergoing corrective multilevel upper airway surgery.

Methods: Clinical examination consisted of an exercise tolerance test (ETT) and evaluation of the oropharynx and larynx. Computed tomography (CT) of the skull was performed to measure the length (LEN), rostral thickness (RTH), and middle thickness (MTH) of the soft palate, with calculations of the longitudinal cross-sectional area (CSA) and palatal volume (VOL). Dogs were assigned to undergo FFP (n = 10) or STS (n = 10). Examinations were repeated 3 months postoperatively.

Results: The ETT score 3 months postoperatively improved in 6/8 dogs in the FFP group and in 10/10 dogs in the STS group. Shortening of the soft palate resulted in reduction of the median LEN, CSA, and VOL after both FFP and STS. Median rostral thickness increased by 8.2% (IQR -2.0 to 20.6) after FFP and by 10.1% (IQR 1.0 to 15.7) after STS. Median middle thickness increased by 7.9% (IQR -5.0 to 20.9) after FFP and decreased by 16.9% (IQR -27.0 to -0.4) after STS.

Conclusion: Folded flap palatoplasty did not result in decreased soft palate thickness in the dogs in this study when evaluated by CT 3 months postoperatively.

Clinical significance: Folded flap palatoplasty and STS both resulted in postoperative clinical improvement. Future studies, including a CT immediately postoperatively, could indicate whether the soft palate is thinned immediately after FFP.

Objectives: To report and compare short- and long-term outcomes in dogs following surgery for brachycephalic obstructive airway syndrome (BOAS).

Study design: Longitudinal cohort study.

Sample population: Client owned dogs (n = 32).

Methods: Dogs that underwent BOAS surgery before 2019 with preoperative and short-term postoperative assessments were recruited for long-term follow up to obtain respiratory functional grades (RFG) and BOAS indices. Dogs that underwent a second airway surgery (33 of 117) were excluded. Comparisons of BOAS indices and RFGs among preoperative, short-term, and long-term postoperative time points were performed using Friedman's tests and post hoc Wilcoxon signed rank tests with Bonferroni corrections.

Results: There were 32 of 117 dogs available for long-term assessment. Median long-term postoperative assessments occurred at 1645 days after surgery (range 1208-2927 days). Long-term postoperative RFG and BOAS index values were improved compared with preoperative values. There was no difference between short-term and long-term postoperative assessments (p > .999 for RFG values, and p = .623 for BOAS index values). Owners reported a high degree of satisfaction with surgery: 55% believed their dogs no longer had breathing problems (long-term BOAS index 50.8 ± 17.6%) and 39% believed their dog still had breathing problems (long-term BOAS index 48.9 ± 20.5%).

Conclusion: Improvements in RFG and BOAS Indices seen following surgery were maintained over time.

Clinical significance: This is the first study with clinician-assessed objective long-term respiratory outcomes of BOAS surgery. The long-term improvements in RFG and BOAS indices support the long-term clinical benefit and durability of surgical intervention for BOAS.

Objective: To assess the effects of a first and second consecutive partial lateral corpectomy (PLC) on the passive range of motion (ROM) of canine lumbar spinal segments.

Study design: Controlled, ex vivo biomechanical study.

Sample population: Adult canine cadaveric spines (n = 10).

Methods: Ten canine lumbar spinal segments were embedded in cast resin and aluminium tubes at their respective ends and attached to a spine testing bench. The ROM was measured under a torque of 2 Nm in three movement directions before and after the first PLC at L2-L3 and the second PLC at L3-L4.

Results: In the sagittal plane, mean ROM increased by 2.4° after the first PLC and by an additional 1.1° after the second PLC. In the dorsal plane, mean ROM increased by 2.3° after a first PLC and by an additional 1.5° after a second PLC (p < .05). Differences in mean rotational ROM before and after one or two PLCs were not identified.

Conclusion: Each of the two PLCs resulted in a significant increase in ROM in the sagittal and dorsal planes (p < .05). The second PLC did not increase the ROM to a greater extent than the first.

Clinical impact: Performing each of two adjacent PLCs can lead to a reduction in the stability of the lumbar spine in dogs. However, in this study, the destabilizing effect of the second PLC was not greater than the effect of the first PLC.