Veterinary Surgery最新文献

Objective: To evaluate postoperative racing performance of a population of Standardbred racehorses following arthroscopic removal of an osteochondrosis dissecans (OCD) lesion of the femoropatellar joint.

Study design: Retrospective study.

Sample population: A total of 45 client-owned Standardbred racehorses.

Methods: OCD lesions were measured and graded using the length of the subchondral bone defect from preoperative radiographs. Postoperative racing results were obtained from the United States Trotting Association, and follow-up owner surveys were conducted. A control group of contemporaneous paternal siblings free of OCD lesions was selected for comparison of racing performance. Regression analysis was used to determine associations between presence or grade of OCD lesions and performance parameters with sex and gait covariates.

Results: There was no significant difference in proportion of horses starting a race based on OCD lesion grade. Affected racehorses had fewer starts at 3 years of age (IRR = 0.84 [95% CI: 0.74-0.96], p = .012) but not at 2 years of age, when compared to unaffected siblings. There was also no difference in race wins or earnings between affected and unaffected horses.

Conclusion: Arthroscopy remains an effective treatment for OCD lesions of the femoropatellar joint in Standardbred racehorses, when performed prior to the start of intensive training, and lesions treated in this manner have no major impact on racing potential. Limitations included a small number of affected individuals especially with higher grades of OCD lesions and there was no conservative treatment group.

Clinical significance: OCD lesions within the femoropatellar joint in Standardbred racehorses resulted in minimal impact on postoperative racing performance when removed arthroscopically.

Objective: To report perioperative morbidity and mortality in dogs and cats undergoing total lung lobectomy using a hilar circumferential ligature (HCL).

Study design: Retrospective clinical study.

Sample population: Client owned dogs (n = 65) and cats (n = 15).

Methods: Medical records were searched for dogs and cats undergoing surgery for total lung lobectomy using a HCL, consisting of either a commercial pre-tied ligature loop (CPLL) or handtied circumferential ligature (HTCL). Cases were collected between 2017 and 2022 from six different hospitals and included signalment and perioperative data.

Results: A total of 94 lung lobes were removed, 59 with CPLL and 35 with HTCL, in 80 dogs and cats. The HTCL group comprised seven sliding, 25 modified Miller's and three Roeder knots. Intraoperative hemorrhage occurred in 4/94 (4.3%) lung lobectomies using 2/59 (3.4%) CPLL and 2/7 (28.6%) sliding knots. There was no association between hemorrhage and use of CPLL versus HTCL (p > .99), knot type (p = .09), or number of sutures per pedicle (p = .30). One dog died intraoperatively from tumor extrusion into the bronchus. One dog required revision surgery for pneumothorax eight days postoperatively.

Conclusion: The overall incidence of intraoperative complications was low. Our findings support the use of CPPLs, handtied Roeder and modified Miller's knots for total lung lobectomy in dogs and cats with clinical disease. Sliding knots should be used with caution.

Clinical significance: The low complication rate, together with the ease of use and cost efficiency of HCL, makes this technique a promising option for total lung lobectomy.

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 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.

Objective: To determine the ideal location of a medial tenoscopic portal in the equine carpal flexor tendon sheath (CFTS) using contrast computed tomography (CT).

Study design: Experimental cadaver study.

Animals: A total of 20 entire forelimbs from adult Standardbred horses.

Methods: Contrast media diluted in saline was injected into the CFTS from a lateral approach before manually flexing and extending the limb 20 times to disperse the contrast solution. The limbs were placed in lateral recumbency and a capped 21-gauge 1.5 inch needle was placed approximately 5 mm proximal and 32 mm caudal to the palpable distal medial radial physis into the medial aspect of the CFTS. Contrast CT was performed followed by tenoscopy using the conventional lateral approach. Gross dissection was then performed to determine if any damage was caused by needle placement. CT images were reviewed for impingement of intrathecal structures, the cephalic vein (CV) and the flexor carpi radialis tendon (FCRT).

Results: Neither intrathecal nor macroscopic superficial damage was caused by needle placement. Impingement of the FCRT and CV, identified on CT, occurred in seven specimens (35%) and one specimen (5%), respectively.

Conclusion: The location for a medial tenoscopic portal was identified in the current study.

Clinical significance: Establishment of the location of a medial tenoscopic portal may help surgeons improve triangulation, egress and visualization of structures within the carpal sheath.

Objective: The aim of this retrospective study was to investigate the relative frequency of R0 margin classification following excision of canine apocrine gland anal sac adenocarcinoma (AGASACA). Secondary aims were to establish if R0/R1 margins, or other dog or tumor characteristics, were prognostic.

Study design: Retrospective cohort study.

Sample population: Seventy-four dogs that underwent AGASACA excision.

Methods: Each tumor margin was classified as R0 or R1 from the histopathology report. Additional data relating to primary tumor characteristics, preoperative assessment, local recurrence, metastases and survival were collated from the medical record.

Results: The rate of R0 margin classification following AGASACA excision was 75.7%. An R1 margin classification was associated with increased risk of local recurrence (OR 23, p < .0001). Overall median survival time following surgery was 25 months (95% CI 21-33). Survival time was reduced in dogs with preoperative hypercalcemia (7.5 months, p = .012), presence of metastatic disease (17 months, p = .005) and lymphovascular invasion on histopathology (21 months, p = .021). Mitotic count (p = .0069) and absence of adjunct therapy (p = .0247) also reduced survival time.

Conclusion: The R margin classification was clinically useful in predicting local recurrence. Preoperative hypercalcemia, lymphovascular invasion on histopathology, presence of metastatic disease, mitotic count, and absence of adjunct therapy all negatively affected survival.

Clinical impact: Achieving complete margins was feasible in most dogs undergoing AGASACA excision and reduced the risk of local recurrence. The R margin classification scheme was clinically useful when reporting histopathology of canine AGASACAs.

Objective: To report the complications and outcomes following surgical management of common calcaneal tendon (CCT) pathology in dogs.

Study design: Retrospective cohort study.

Sample population: A total of 80 dogs with CCT pathology underwent 89 surgeries.

Methods: Retrospective data were reviewed from five veterinary referral centers for dogs with CCT pathology that underwent surgical treatment (January 2011 to December 2021). Clients completed a Liverpool Osteoarthritis in Dogs (LOAD) questionnaire to assess long-term outcomes.

Results: Tendon repair with tarsocrural immobilization was performed in 46/89 limbs (51.7%), with three-loop pulley the most common suture pattern, used in 19/46 tendon repairs (41.3%). Pantarsal arthrodesis was performed in 32/89 limbs (36%) and temporary tarsocrural immobilization without tendon repair in 11/89 limbs (12.3%). Median time from surgery to final follow-up at the referral center was 10 weeks (range: 6-256 weeks). There was no difference in complication rate between tendon repair (56.5%) and pantarsal arthrodesis (42.8%) (p = .543). Tendon repair with tarsocrural immobilization had a significantly higher catastrophic complication rate (26.1%) than pantarsal arthrodesis (0%) (p = .005). A total of 23 LOAD questionnaires were returned. There was no difference in mildly affected dogs between the three surgical groups (p = .493).

Conclusion: Pantarsal arthrodesis and CCT repair surgeries had comparable short-term outcomes and complication rates. However, there is a greater risk of complications requiring revision surgery following temporary tarsocrural immobilization, with or without tendon repair, compared to pantarsal arthrodesis.

Clinical significance: The increased risk of revision surgery should be discussed with owners, considering the potential financial and treatment implications for their dogs.

Objective: To evaluate the feasibility, complications and outcomes of thoracoscopic resection of cranial mediastinal masses in cats.

Study design: Multi-institutional retrospective study.

Animals: A total of 17 client-owned cats.

Methods: Data collected from medical records of cats that underwent thoracoscopic surgery for cranial mediastinal masses between January 2019 and December 2024 included signalment, history, clinicopathologic features, preoperative diagnostic imaging and tumor measurement, anesthesiologic and surgical procedures, complications, and short- or long-term follow-ups.

Results: The most common clinical sign was dyspnea. All cats started with thoracoscopic surgical exploration. Non-emergent conversion to an open procedure (sternotomy or video-assisted procedures [VATS]) was necessary in six of 17 (35.29%) cats, with conversions primarily occurring in cases with masses larger than 5 cm. The median maximal tumor diameter was 6 cm (range: 2.2-8.1 cm). The most common tumor type was thymoma, identified in 12 of 17 (70.59%) cats. All cats survived the perioperative period and were alive at the short-term follow-up. Mean survival time was 390.62 days.

Conclusion: The presence of larger tumor sizes and adhesions were associated with higher conversion rates to open or VATS procedures, underscoring the importance of tumor dimensions in surgical planning.

Clinical significance: Thoracoscopic surgery for cranial mediastinal masses in cats is technically feasible, with favorable short-24 and long-term outcomes. Conversion rates were lower in cats with smaller masses without adhesions in this study.

Objectives: To describe a surgical stabilization technique and immediate postoperative care for traumatic lateral shoulder luxation in a dog as well as report long-term clinical outcome.

Animals: One dog.

Study design: Case report.

Methods: Following failed closed reduction, the surgical stabilization of traumatic, acute, lateral shoulder luxation included three, figure-of-eight 40 # fluorocarbon sutures. On one end, all three sutures were passed through a 2.7 mm screw anchor placed in the scapula neck, craniodistal to the acromion. The free ends of two sutures were passed through two drilled bone tunnels in the greater tubercule. The third figure-of-eight suture was looped around a 2.7 mm cortical screw and washer placed in the caudolateral aspect of the humeral metaphysis. A spica splint was placed and maintained for 4 weeks postoperatively and changed weekly.

Results: There were no major nor minor complications within the 9 months follow-up. By 6 weeks, only mild grade 1/5 lameness was reported on orthopedic examination. At the last two rechecks at 19 and 40 weeks postoperatively, orthopedic examination revealed minimally decreased shoulder flexion and extension with pain-free range of motion (ROM) and no clinical lameness.

Conclusion: The novel surgical stabilization technique described in this report to address lateral shoulder luxation in a dog is technically straightforward and, in our case, provided good, lameness-free clinical outcome.

Objective: To increase awareness of black thyroid in dogs and to prevent unnecessary total thyroidectomy. A benign condition called "black thyroid" has been documented in greater than 250 people on chronic minocycline therapy, and rarely in animals. To our knowledge this is the first report of black thyroid in an animal secondary to doxycycline therapy.

Study design: Case report.

Animal: One 10 year-old female spayed Collie-cross dog.

Methods: A dog on long-term doxycycline underwent a right parotid sialoadenectomy and left thyroidectomy to remove associated tumors. Black pigmentation of both thyroid lobes was observed intraoperatively. The left thyroid gland and associated nodule were excised, leaving the right lobe intact.

Results: Histopathology of the left thyroid nodule and right parotid salivary gland were consistent with thyroid follicular-compact cell carcinoma with metastasis. Finely granular brown pigment was present multifocally within the cytoplasm of many of the thyroid follicular cells and extracellularly within the colloid as irregular gray to brown glassy aggregates. The pigment was negative for iron and calcium and had minimal to no immunoreactivity for melanin.

Conclusion: These findings aligned with those reported for the condition black thyroid in humans. At this time, there is no evidence that performing a thyroidectomy is necessary or appropriate for black thyroid. Veterinary surgeons should be aware that dogs on long-term doxycycline therapy may have this discoloration, so unnecessary total thyroidectomy can be prevented in affected animals.