Veterinary Surgery最新文献

Objective: To describe fluid dispersal and retrieval patterns in an infusion-retrieval system across various configurations and locations in a cadaveric canine model.

Study design: Cadaveric study.

Animals: Four large breed canines.

Methods: Four full-thickness wounds (10 × 10 cm) were created bilaterally in four canine cadavers (shoulder, thorax, flank, and thigh). A wound infusion catheter and active suction drain were placed in four configurations (diagonal, opposite, parallel, and perpendicular) and the incisions were closed. Diluted methylene blue was instilled, allowed to dwell for 10 min, and quantified after retrieval. A 14 × 14 cm full-thickness skin segment, including the initial 10 × 10 cm wound, was removed. Images of the removed skin and cadaver wound bed were taken to calculate surface area (SA) and to evaluate fluid dispersion. A mixed-effects linear regression model was used for statistical analysis.

Results: Fluid retrieval did not differ by configuration (p = .92) or location (p = .32), although the perpendicular configuration resulted in the highest retrieval (11.35 ± 6.1 mL) (56.8 ± 30% volume instilled) and the flank location resulted in the lowest (7.2 ± 6.4 mL) (35.9 ± 32% volume instilled). Configuration influenced SA coverage of the wound bed (p < .01), whereas location did not (p = .10). The parallel configuration had the greatest SA coverage (83.4 ± 11.6%). No difference existed for leakage of methylene blue (MB) beyond the borders for configuration (p = .74) or location (p = .10).

Conclusion: The parallel configuration maximized the fluid dispersion within the cadaveric wound bed in comparison with other configurations (p < .01).

Clinical significance: An infusion-retrieval system could be considered during wound closure to administer topical solutions and remove excess free fluid.

Objective: To compare dehiscence rates, and evaluate incisional outcome, between the use of polydioxanone (PDS) versus poliglecaprone 25 (Monocryl) suture for skin closure in dogs undergoing a variety of clean orthopedic procedures associated with the stifle.

Study design: Randomized, prospective, cross-sectional design.

Animals: Client owned dogs with cranial cruciate disease deemed appropriate surgical candidates for tibial plateau leveling osteotomy (TPLO) or other clean orthopedic stifle procedure (N = 232).

Methods: Dogs undergoing a TPLO, or other clean orthopedic procedure were randomly assigned to one of three groups using different closure materials. Incisional dehiscence rate in the absence of infection was analyzed against multiple variables. Infection and dehiscence were characterized based on previously published descriptions.

Results: A total of 232 dogs were analyzed with 72 in Group 1, 85 in Group 2, and 75 in Group 3. A total of 137/232 (59.05%) of dogs received postoperative antibiotics. Overall, 22/232 (9.48%) of dogs showed dehiscence without evidence of infection during the follow up period. Postoperative antibiotic use (p = .023) and signs of infection (p < .001) were statistically different between the healed and dehisced groups. The mean weight, body condition score, and incision length were not different between groups.

Conclusion: There is no difference in dehiscence rate in the absence of infection following a clean orthopedic procedure when comparing skin closure with PDS versus Monocryl.

Clinical significance: Either PDS or Monocryl may be used for skin closure following a clean orthopedic procedure.

Objective: This study aimed to assess and compare the recovery of ponies and horses following general anesthesia in two different settings: a recovery box with an inflexible, adjustable ceiling, and free recovery without restraints. Our primary objective was to evaluate the effect of adjustable ceilings on the prevention of premature attempts to rise during recovery. The secondary aim was to compare the physiological stress indicators during recovery.

Study design: Prospective, randomized, experimental study.

Animals: Six healthy ponies and 10 healthy horses.

Methods: This study used a crossover design with two settings: an inflexible, adjustable ceiling and free recovery. Recovery was scored using a quality scoring system. Heart rate, and lactate, glucose, and cortisol levels were analyzed and compared between the animals and recoveries.

Results: All animals had a higher recovery quality (p = .026) with an adjustable ceiling than with free recovery. No differences were observed in glucose level or heart rate between the two settings. However, horses had higher blood lactate, 2.9 ± 1.2 mmol/L versus 1.6 ± 0.7 mmol/L (p = .025), and serum cortisol, 184 ± 81 nmol/L versus 93 ± 20 nmol/L (p = .031) in restricted recovery than free recovery, respectively.

Conclusion: An inflexible, adjustable ceiling improved the quality of recovery and prevented premature rising attempts; however, it was associated with increased lactate and cortisol levels, indicating an increased level of stress.

Clinical significance: Limiting premature rising attempts with an adjustable ceiling during recovery phase has the potential to improve the quality of recovery in horses. Further research is needed to draw conclusions for clinical use.

Objectives: To report the management and outcomes of five horses with ear skin defects treated with the use of full-thickness mesh grafts and full-thickness Meek micrografts.

Animals: Five horses with acute or granulating pinna skin wounds.

Study design: Short case series.

Methods: A full-thickness graft was harvested from the pectoral region under general anesthesia. The sheet graft was stretched on a sterile plastic board with the epidermal side facing down. The subcutaneous fat and fascia were removed by sharp dissection. The skin graft was then meshed by hand or using a block mesher, or manually cut into micrografts, and transferred to the ear wounds. Cyanoacrylate glue or staples were used to fixate the graft. Immobilization was achieved with a thermoplastic splint, stockinette and an adhesive elastic bandage.

Results: A full-thickness meshed sheet graft was used in two horses to cover a fresh or granulating degloving wound, and in two horses to cover a fresh skin defect after excision of a cutaneous neoplasm. A full-thickness Meek micrograft was used in one horse to cover a granulating degloving wound. Complete acceptance of the graft was achieved in all five cases within 2 weeks after grafting, with a good to excellent cosmetic appearance and retained function of the pinna.

Conclusion: Full-thickness meshed sheet grafts or full-thickness Meek micrografts provide an effective treatment for ear skin defects with an excellent outcome regardless of etiology.

Objective: To report clinical outcomes of skeletally immature dogs with antebrachial deformities secondary to premature closure of the distal radial physis (PCDRP) treated with angular corrections and distraction osteogenesis using circular external skeletal fixation (CESF).

Study design: Retrospective multi-institutional case series.

Animals: A total of 12 client-owned dogs with premature distal radial physeal closure.

Methods: Medical records from four hospitals between 2009 and 2022 were reviewed. Preoperative and final radiographic measurements of limb alignment and osteoarthritis were compared. Long-term outcomes were obtained using an owner questionnaire.

Results: Mean ± SD age and bodyweight were 7.5 ± 1.7 months and 12.8 ± 11.1 kg. Distal radial corrective osteotomies and distraction osteogenesis were performed in all dogs. Mean ± SD time between surgery and fixator removal was 78 ± 20 days. Uncomplicated osseous union was documented in 9/12 dogs. Final mean affected limb anatomic lateral distal radial angle (aLDRA) of 85.6° was higher than preoperative values 71.6° and within reported normal ranges. A total of 10 of 12 dogs had mild non-progressive elbow osteoarthritis at final follow up, including two dogs with mild residual elbow incongruity. Major complications occurred in two dogs and included permanent carpal flexor contracture and radial fracture through a pin tract. Minor complications including persistent loss of carpal extension, radioulnar synostosis, and pin tract drainage occurred in 10/12 dogs. Owner questionnaires were obtained from 8/12 dogs and all reported good to excellent function.

Conclusion: Angular correction and lengthening using CESF can achieve target alignment and improved clinical function with moderate complications in growing dogs with PCDRP.

Clinical significance: Distraction osteogenesis and angular corrections can be considered as a treatment option for PCDRP in skeletally immature dogs.

Objective: To determine if prestretching (PS) of the abdominal wall provided improved working space during elective laparoscopic procedures in dogs.

Study design: Prospective cohort study.

Animals: Fifty client-owned dogs undergoing elective laparoscopic procedures.

Methods: Skin markings were used to evaluate stretching of the abdominal wall. The distance from the subumbilical port to the caudal aspect of the gallbladder was measured as a proxy for intra-abdominal working length (IWL). Prestretching was performed by insufflating to an intra-abdominal pressure (IAP) of 10 mmHg for 3 min. The abdomen was desufflated back to 6 mmHg for the remainder of the procedure. A computed volumetric value utilizing skin measurements and IWL was used as a proxy for intra-abdominal working space (IWS). Percentage changes in IWL and IWS were compared.

Results: Increasing the IAP from 6 to 10 mmHg increased the IWL by 7% (IQR 9.5%) and the IWS by 10.4% (IQR 13.8%) (p = .004 and .005, respectively). Returning to 6 mmHg after prestretching resulted in a median increase in IWL of 4.4% (IQR 5.7%) and IWS of 6.9% (IQR 5.4%) compared with the initial 6 mmHg IAP measurements (p < .001 for both). Intra-abdominal working length and IWS were similar at the end of surgery compared with post-PS 6 mmHg IAP measurements.

Conclusion: Prestretching resulted in improved IWL and IWS, although not to the extent achieved by higher insufflation pressures. The effects of PS persisted throughout the laparoscopic procedures performed in this study.

Clinical significance: Prestretching can provide additional laparoscopic IWL and IWS at a lower IAP.

Objective: To assess the influence of age on perioperative stem-associated complications when total hip replacement (THR) was performed with a BFX lateral bolt stem.

Study design: Retrospective (2017-2022).

Sample population: A total of 197 client-owned dogs.

Methods: Medical records of dogs that underwent THR with a lateral bolt stem were reviewed. Perioperative complications were recorded. Stem and femoral features were measured on postoperative and follow-up radiographs. The population was divided into juveniles (6-10 months), adults (>10 months to <7 years), and older dogs (≥7 years old). Association between groups and perioperative complications was assessed.

Results: Two-hundred and fifty five THRs were recorded: 139 unilateral and 58 bilateral. Intraoperative and early postoperative stem complication rates were 8.6% and 2%, respectively. Juveniles were at increased risk of developing intraoperative fissures. Age was not associated with early postoperative stem complications. German shepherd dogs were associated with postoperative fractures. Subsidence was weakly, but positively, associated with weight and canal flare index.

Conclusion: Juveniles were at increased risk of developing fissures. There was no difference in postoperative stem complications among age groups. German shepherds were at increased risk of postoperative fracture despite the use of a lateral bolt stem. More studies are required to assess the effect of giant breeds on the risk of subsidence, as well as the effect of young age on fissure development.

Clinical significance: Age influenced the development of intraoperative, but not postoperative, stem complications with a lateral bolt stem. Prophylactic cerclage application could be considered in juvenile and German shepherd dogs.

Objective: To evaluate the accuracy of ventral slot creation in canine cadavers with a three-dimensional (3D)-printed drill guide compared to the freehand technique.

Study design: Ex vivo study.

Sample population: Eight canine cadavers (23.4-39.8 kg).

Methods: Computed tomography (CT) data was used to create patient-specific 3D-printed surgical guides for ventral slot creation. Intervertebral sites were randomized to undergo either a guided (n = 12) or freehand (n = 12) ventral slot by a novice surgery resident. Postoperative CT images were used to compare ventral slot dimensions, shape, and position.

Results: Free-hand ventral slots were significantly shorter than the intended dimensions (p < .01). Dimensions of the guide-assisted ventral slots were not statistically different from the planned dimensions (p = .88, p = .72). Use of the guides resulted in improved accuracy for ventral slot positioning relative to midline and slot shape (difference in coefficient of variations, 32%, and 40%, respectively).

Conclusion: Ventral slot dimensions were more accurate when created with the patient-specific 3D-printed guide compared to the freehand technique.

Clinical significance: Use of a 3D-printed patient specific surgical guide improves accuracy of ventral slot creation in canine cadavers and improves surgical precision when used by a single novice surgical resident. The results of this study support evaluation of the guides in small breed cadavers and live patients.

Objective: To report the technique and outcomes of utilizing chest wall lift to perform thoracoscopic surgery in two cats.

Study design: Short case series.

Animals: Client-owned cats (n = 2).

Methods: A geriatric cat was referred for pleural effusion secondary to a left cranial lung lobe mass. A thoracoscopic exploration of the left hemithorax was planned with a lift device used for laparoscopy and attached to a ceiling mount. A young cat was referred for a foreign body lodged in the right caudal bronchus. Attempted bronchoscopic retrieval was unsuccessful. Thoracoscopic lung lobectomy was planned using a bent Steinmann pin as a lift device placed at the eighth intercostal space, along one of the cannula.

Results: Thoracic lift was achieved with the patient in right lateral recumbency for the first cat, leading to immediate improvement in the oxygenation and ventilation status of the patient while simultaneously allowing for continued thoracoscopic exploration of the hemithorax. With two additional ports, thoracoscopic dissection of the adhesions was performed prior to thoracoscopic assisted lung lobectomy at the fourth intercostal space. For the second cat, thoracic lift was performed with the patient in left lateral recumbency and allowed successful 3-port thoracoscopic lung lobectomy. No complication related to the use of either lift device was noted.

Conclusion: Chest wall lift improved anesthesia respiratory status in one cat and increased the working space to perform thoracoscopic procedures in both cats.

Clinical significance: This novel and simple technique could increase working space without anesthesia impairment, allowing thoracoscopic procedures in selected feline patients.

Objective: To determine if surgical skills instructors' experience and qualifications influence students' learning of small animal ovariohysterectomy on a model (mOVH).

Sample population: Second-year veterinary students (n = 105).

Methods: Students were randomized to three groups, taught by: (1) residency-trained surgeons with over 3 years' experience teaching mOVH, (2) general practitioners with over 3 years' experience teaching mOVH (GP >3), and (3) general practitioners with under 3 years' experience (GP <3). Students completed four 3-h laboratories where they performed mOVH under the supervision of one of the three types of instructors. Students were assessed performing mOVH using a validated 22-item rubric and completed a survey about their experience.

Results: GP <3 group students achieved lower total rubric scores than GP >3 group students (p = .021). Surgeon-taught students' scores did not differ from those taught by GP >3 (p = .685) or GP <3 (p = .052). GP <3 group students were more likely to require remediation than those taught by surgeons (p = .001); there were no differences between the other groups (surgeons vs. GP >3 p = .44; GP <3 vs. GP >3 p = .11). Students reported similar satisfaction with their instruction. Instructors with over 3 years' experience teaching mOVH had better student learning outcomes compared to instructors with under 3 years of experience. While mOVH teaching experience did influence learning, the instructor's completion of a surgical residency did not.

Conclusion: The results of the study indicate a need for more extensive training for new surgical skills instructors and demonstrates that GPs with experience teaching surgical skills are suitable instructors for teaching ovariohysterectomy on a model.

Clinical relevance: This study indicates a need for more extensive training for new surgical skills instructors and demonstrates that GPs with experience teaching surgical skills are suitable instructors for teaching ovariohysterectomy on a model.