Veterinary Surgery最新文献

Objective: To describe the use of virtual surgical planning (VSP) and three-dimensionally (3D) printed surgical guides for corrective osteotomies stabilized with an interlocking nail in a dog with a multiplanar femoral deformity.

Study design: Case report.

Animals: An 8-year-old male neutered mixed breed dog weighing 44 kg.

Methods: A dog was presented for a right grade 3 lateral patellar luxation secondary to a multiplanar femoral deformity due to a suspected femoral malunion. A computed tomography (CT) scan was obtained to create virtual femoral models. Corrective osteotomies were simulated with VSP. Custom osteotomy guides and reaming guides were designed to facilitate the correction and the placement of an interlocking nail. The preoperative femoral model, virtually aligned femoral model, custom osteotomy guides, and reaming guides were 3D printed, sterilized, and utilized intraoperatively. A CT scan was performed postoperatively to assess femoral length and alignment.

Results: Custom osteotomy and reaming guides were used as intended by the VSP. Postoperative femoral length as well as frontal, sagittal, and axial plane alignment were within 0.7 mm, 2.2°, 0.5°, and 1.6°, respectively, of the virtually planned femoral model. Two months postoperatively, the dog was sound on visual gait examination, and the patella tracked in the trochlear groove throughout stifle range of motion and was unable to be manually luxated. Radiographs obtained 2 months postoperatively revealed static femoral alignment and implants. Both osteotomies were discernable with callus bridging.

Conclusion: Virtual surgical planning and custom osteotomy and reaming guides facilitated complex femoral corrective osteotomies and interlocking nail placement.

Objective: The aim of the study was to describe the surgical technique and outcome of a combined forequarter amputation and hemilaminectomy (FAHL) for excision of canine peripheral nerve sheath tumors (PNSTs) of the brachial plexus extending into the vertebral canal.

Study design: Retrospective case series.

Animals: Nine client-owned dogs.

Methods: Dogs which underwent FAHL for resection of a brachial plexus PNST extending into the vertebral canal were included. Data from medical records including signalment, clinical findings, MRI data, histopathology reports, interval between appearance of the clinical signs and surgical intervention, affected spinal nerves and nerve roots, time to ambulate postoperatively, survival time, tumor grade and completeness of surgical margins were collected.

Results: In seven of nine cases the PNST affected the eighth cervical nerve root. Five of the nine cases were ambulatory within the first 3 days postoperatively and in one case unassisted ambulation was delayed and achieved 28 days postoperatively. The median survival time was calculated to be 317 days and the mean 522 days (range 120-1620 days). Four of nine dogs were euthanized 120, 270, 306 and 317 days postoperatively, because of suspected tumor recurrence. In one of those four cases the histological margins were reported as complete.

Conclusion: FAHL appeared to be a reliable technique for excision of PNSTs of the brachial plexus invading the spinal canal, with similar outcomes to previously reported for PNSTs not extending into the vertebral canal.

Objective: To report the use of a pericardial patch graft to repair a post-traumatic caudal vena cava cicatrix in a dog.

Study design: Case report.

Animals: A 1 year-old Rottweiler presenting with ascites following presumed blunt thoracic trauma.

Methods: Kinking of the caudal vena cava and resultant Budd-Chiari-like syndrome was diagnosed on echocardiography and computed tomographic angiography (CTA). Surgical exploration via right sixth intercostal thoracotomy was performed. Release of the cicatrix was unsuccessful in reducing the pressure gradient and a pericardial patch graft repair of the thoracic caudal vena cava was therefore performed to relieve the obstruction.

Results: The dog recovered from surgery and was discharged after 3 days. Follow-up at 6 weeks showed resolution of ascites and all clinical signs. Owner telephone follow-up at 24 months post-surgery confirmed that the dog remained clinically normal.

Conclusion: A pericardial patch graft technique can be used successfully to reconstruct the thoracic caudal vena cava, in cases of traumatic kinking where dissection of the fibrotic band alone fails to reduce caudal caval pressure.

Objective: To describe the successful treatment of traumatic nasal avulsion injury resulting in dynamic nasal stenosis and rostroventral deviation of the nasal cartilage.

Animals: A 6-year-old spayed female pug presented with traumatic nasal avulsion injuries.

Study design: Case report.

Methods: The initial surgical intervention involved facial reconstructive surgery to repair a maxillary lip avulsion. Following the diagnosis of stenosis in both common nasal meatuses resulting in respiratory distress a week after the initial surgery, balloon dilatation of the nasal passages and rhinoplasty were additionally performed. Ten weeks after the traumatic event, the diagnosis of dynamic nasal stenosis and rostroventral nasal cartilage deviation secondary to dorsal and lateral nasal ligament injuries was made. Balloon dilatation was repeated, along with nasal skin fold resection and realignment of the nasal passages. To stabilize nasal alignment, dorsal and lateral nasal ligaments were reconstructed to stabilize the alignment. Bilateral temporary endonasal stents were inserted into the nasal meatuses to maintain alignment and patency of the dilated passage during recovery.

Results: No complications were observed after the final surgery. The stents were subsequently removed 4 weeks after placement. An 8-month follow-up examination following the final surgical procedure revealed improved and subjectively normal airflow through both nares. The dog died 2 years after the last surgery due to severe bronchitis. Until her death, the dog tolerated exercise well and maintained good breathing even at night without snoring during sleep.

Conclusion: This case report describes the successful surgical treatment of traumatic nasal avulsion injury in a brachycephalic dog.

Objective: The aim of the study was to describe laparoscopic ultrasound (LUS) to guide microwave ablation (MWA) of hepatocellular carcinoma (HCC) in a dog.

Animals: A 13-year-old female spayed Husky.

Study design: Case report.

Methods: The dog was referred for laparoscopic MWA of a caudate lobe HCC measuring 2.7 cm × 1.9 cm× 2.3 cm. Laparoscopic ultrasound was used to guide percutaneous placement of a MWA probe within the caudate lobe mass. LUS was used to determine the tumor margins for placement of the probe within the medial and lateral aspects as well as the center of the mass. Additionally, LUS allowed visualization of vessels within the tumor so they could be avoided during probe placement.

Results: Safe ablation was accomplished, and the dog recovered uneventfully with no complications. Follow-up computed tomography (CT) 3- and 12-months postoperatively revealed complete ablation of the caudate lobe mass. However, progressive increase in size of the right medial lobe mass occurred. Right medial liver lobectomy was performed 13 months after MWA, with a histopathologic diagnosis of HCC. The dog was euthanized 777 days post MWA and 1445 days post initial left lateral lobectomy for HCC.

Conclusion: Laparoscopic ultrasound was useful in guiding complete and safe MWA of an HCC in this dog. Laparoscopic ultrasound should be considered when performing laparoscopic MWA of liver lesions in dogs.

Objective: To report the technique and outcome of proximal ulnar autograft transplantation to achieve ipsilateral radial lengthening in a dog with premature closure of both proximal and distal radial physes.

Study design: Case report.

Animals: An 8-month-old female spayed Border Collie.

Methods: The dog was presented for a grade III/IV left thoracic limb lameness localized to the elbow. Orthogonal radiographs of both forelimbs revealed a 7% length deficit of the left radius and elbow subluxation indices indicative of left elbow incongruity due to suspect premature closure of both radial physes. Radial lengthening consisted of a proximal ulnar ostectomy, a radial osteotomy, and transplantation of the ulnar autograft into the radial osteotomy site secured with an eight-hole dynamic compression plate. Orthopedic examinations were conducted at 2 weeks, 4 weeks, and 3 years postoperatively. Radiographic examinations were completed preoperatively, immediately postoperatively, and at 4 weeks and 3 years postoperatively.

Results: Lameness improved with a grade II/IV lameness at 4 weeks postoperatively and complete resolution at 3 years postoperatively. Radiographic examination at 4 weeks showed persistent radial lengthening of 1 cm, and a decreased humeroradial index (HRI), humeroulnar index (HUI), and radioulnar index (RUI) compared with preoperative values. At the 3 year examination, the HRI and HUI had increased indicating progression of elbow incongruity. The patient remained clinically unaffected.

Conclusion: In dogs with radial shortening and elbow incongruity, use of an ipsilateral proximal ulnar autograft with rigid internal fixation can be an effective treatment for radial lengthening to improve elbow congruity and resolve lameness.

Objective: To investigate if weekend surgery is associated with poorer outcomes in dogs with acute thoracolumbar intervertebral disc extrusion (IVDE) undergoing decompressive thoracolumbar hemilaminectomy.

Study design: Retrospective observational cohort study.

Sample population: A total of 460 consecutive cases were reviewed, with 401 dogs undergoing weekday surgery (Cohort WD), and 59 dogs undergoing weekend surgery (Cohort WE).

Methods: Medical records of a surgical referral center in the UK were reviewed. Preoperative patient demographic and clinical data, and postoperative outcome data were collected with a minimum 28-day follow-up period. Multivariable logistic regression analysis was used to model the odds of a negative outcome.

Results: Cohort WE had a higher preoperative proportion of nonambulatory dogs (p = .0115) but there were no significant differences between the nonambulatory (p = .3762) and deep-pain negative subgroups (p = .6199). Cohort WE had a higher risk of not recovering ambulation compared to Cohort WD [79.2% vs. 91.6% recovery; adjusted OR 3.010 (95% CI: 1.259-7.190); p = .0132] and had a higher risk of postoperative morbidity [32.2% vs. 17.2%; adjusted OR 2.015 (95% CI: 1.089-3.729); p = .0257]. There were no significant differences in other outcome measures between cohorts.

Conclusion: Weekend surgery in canine decompressive thoracolumbar hemilaminectomy may be associated with poorer patient outcomes, specifically higher postoperative morbidity and a poorer rate of recovery of ambulation.

Clinical significance: This study demonstrates a weekend effect in veterinary surgery, which may be important in surgical decision-making in acute thoracolumbar IVDE. Further scrutiny of the patient's journey through the veterinary healthcare system is warranted.

Objective: To describe and report the outcome of a cricotracheostomy (CT) technique for the creation of a permanent upper airway ventral cervical stoma in dogs.

Study design: Short case series.

Animals: Eight client-owned dogs.

Methods: Upper airway obstruction due to various disease processes was confirmed via upper airway examination and appropriate imaging. Medical records were reviewed to assess complications experienced during and following permanent CT. Owner questionnaires regarding quality of life (QoL) following permanent CT were performed.

Results: All dogs experienced a routine recovery. The CT provided a robust dorsolateral. wall to the stoma from the cricoid cartilage. The stomata did not show any evidence of dorsal wall collapse or stenosis. Four dogs required further skin fold resection. The high position of this stoma also appears to be appropriate functionally with bilateral cervical skin fold resections. The owner questionnaires reported high satisfaction in the postoperative QoL.

Conclusion: CT was feasible and led to a reliable outcome for surgical patients and improvement in QoL. Comparative clinical investigation of the CT technique with traditional permanent tracheostomy techniques is indicated to definitively prove the validity and any superiority of the CT technique.

Objective: To report a capital physeal fracture as the result of a bone infarction with subsequent neoplastic transformation 4 years following total hip replacement.

Study design: Case report.

Animals: Five-year-old female spayed golden retriever.

Methods: The dog was initially presented for evaluation of a 2 week history of spontaneous right hind-limb lameness. Pelvic radiographs demonstrated a displaced capital epiphysis and proximal femur changes consistent with a bone infarction. A cementless total hip replacement was performed, and limb function returned to normal until 51 months after surgery. A radiolucency adjacent to the femoral stem at the greater trochanter, partial calcar resorption, and stable implants were present on pelvic radiographs acquired 52 months after surgery. Surgical exploration of the surgical site for tissue collection for histopathology and bacteria culture was performed 58 months following surgery. No bacterial growth occurred and histologic findings were nonspecific. A right hind-limb amputation was performed 61 months after total hip replacement due to the dog's progression to a non-weight-bearing lameness, Additional tissue samples were taken from the femur for histopathologic examination.

Results: Histopathologic examination was consistent with a pleomorphic sarcoma. No metallic or polyethylene particulate debris was present. Nine months after surgery there was evidence of regional and distant spread of the neoplasia.

Conclusion: In similar cases, submitting the femoral head for histopathologic examination should be considered at the time of the hip replacement surgery. If bone infarction is diagnosed as a causative agent, given the possibility of malignant transformation, long-term serial radiographic monitoring should be given serious consideration.

Objective: To describe the approach for placement of a transcerebellar fourth ventriculoperitoneal shunt for management of presumed fourth ventricle arachnoid diverticulum and secondary obstructive hydrocephalus of a dog. To describe the outcome of this procedure.

Study design: Case report.

Animals: Male entire English springer spaniel, 3 years 9 months of age.

Methods: The dog was initially presented for management of acute, progressive, and multifocal brainstem and forebrain dysfunction. Magnetic resonance imaging revealed internal obstructive hypertensive hydrocephalus. The dog was managed via ventriculoperitoneal shunting from the left lateral ventricle and made an excellent recovery. The dog acutely deteriorated 18 months after initial discharge and follow-up magnetic resonance imaging confirmed the ventricular shunt remained in situ with normal-sized lateral ventricles but revealed a cystlike lesion within the fourth ventricle, presumed to be a fourth ventricle arachnoid diverticulum. The diverticulum was causing mass effect and resultant compression of adjacent neuroparenchyma. A second ventriculoperitoneal shunt was subsequently placed into the fourth ventricle via the caudal cranial fossa and cerebellum. This was attached to a three-way connector, to which the existing shunt (within the left lateral ventricle) was also attached, and then secured to the existing medium-pressure valve.

Results: Postoperatively, the dog immediately developed mild vestibular-cerebellar ataxia, with a marked improvement after 3 months. There were no shunt-associated complications. Long-term follow up at 40 months after the second surgical procedure revealed a normal neurological examination.

Conclusion: Transcerebellar ventriculoperitoneal shunt placement for treatment of a presumed fourth ventricle arachnoid diverticulum was performed and was associated with a favorable long-term outcome.