Veterinary Surgery最新文献

Objective: To report the long-term outcomes of continuous decompression for repairing a unicameral bone cyst in a dog.

Study design: Case report.

Animal: A 1-year-old Maltese-Poodle mixed breed dog presented with left forelimb lameness.

Methods: A well-defined cyst in the left humeral condyle was detected on radiography and computed tomography. A lateral surgical approach revealed the cyst in the distal metaphysis of the left humerus. The attained cyst fluid and incisional biopsy led to the diagnosis of unicameral bone cyst. To prevent cyst expansion and recurrence, aspiration, open curettage, ethanol cauterization, and continuous decompression using introducer needles were performed.

Results: The dog recovered from surgery, and a Robert Jones bandage was retained for 2 weeks. The follow-up at 1 month showed resolution of lameness. At 12 months post-surgery, radiographs revealed increased cortical thickness and no recurrence of the cyst or lameness.

Conclusion: Continuous decompression using introducer needles could be used to repair unicameral bone cysts. Small diameter introducer needles were especially useful, as the lesion was located at the joint. The procedures described in this report could be applied before other salvage procedures to promote healing and prevent recurrence.

Objective: To document the prevalence and incidence rate of infection in dogs undergoing partial tarsal arthrodesis (PTA). For context, findings were compared with the prevalence of infection following tibial plateau leveling osteotomy (TPLO) at the same institution. Independent variables associated with infection were also identified.

Study design: Case-control study.

Animals: Eighty-nine dogs underwent PTA; 292 dogs underwent TPLO.

Methods: Medical records for dogs that underwent PTA from 2017 to 2023 and dogs that underwent TPLO between January 2022 and December 2022 were reviewed. The prevalence, incidence rate, odds and incidence rate ratio of infection were calculated.

Results: The prevalence of infection following PTA was 43%; following TPLO it was 13%. The incidence rate of infection was 0.00276 (95% CI: 0.00198-0.00375) and 0.00010 (95% CI: 0.00007-0.00013) infections per dog-week, respectively. The odds ratio and incidence rate ratio for infection following PTA were 5.0 (95% CI: 3.1-9.0) and 28.2 (95% CI: 17.7-45.0), respectively.

Conclusion: The prevalence and incidence rate of infection were higher following PTA than TPLO. Dogs that underwent PTA were five times more likely to develop infection than dogs that underwent TPLO, and developed infection at 28 times the rate of dogs that underwent TPLO. Dogs with open wounds, no postoperative bandage, and treated with a combined medial and lateral approach, had a higher point prevalence of infection.

Objective: To report the lifelong outcome of a redo mitral valve repair performed under repeat cardiopulmonary bypass (CPB) in a dog.

Study design: Case report.

Animal: An 11-year-old, 4.0-kg neutered male Chihuahua, previously treated with surgical mitral valve repair for myxomatous mitral valve disease at the age of eight, presented with recurrent left heart failure caused by worsening residual mitral regurgitation (MR) following the initial repair.

Methods: Redo mitral valve repair was performed 2 years and 7 months after the initial surgery. The procedure, conducted under hypothermic CPB, involved adding and adjusting eight artificial chordae to align with the reconstructed mitral annular plane.

Results: The redo surgery successfully reduced MR, improved cardiac function, and resulted in more than 5 years of survival without MR recurrence.

Conclusion: This case demonstrates the feasibility of redo mitral valve repair in managing recurrent MR in dogs, highlighting its potential to improve long-term outcomes in veterinary surgery and cardiology.

Objective: To present fracture cases selected for plate fixation (PF), describe surgical techniques and assess their association with postoperative complications and return-to-work outcomes in horses undergoing PF for small metacarpal/metatarsal (SMCT) fractures.

Study design: Multicenter retrospective study.

Animals: A total of 27 horses.

Methods: Horses treated with PF of a SMCT fracture between 2008 and 2023 across three hospitals were included. Medical records and imaging were reviewed. Long-term outcomes were established by readmission to the hospital, telephone interviews, and/or race records. Univariable and multivariable regression models evaluated variables associated with return to intended use.

Results: PF of fractures was performed in 27 horses. Fractures were all in the proximal SMCT, with 20/27 (74.1%) articular, 22/27 (96.3%) comminuted, and 24/27 (81.5%) displaced. Of horses with follow-up, 19/25 (76%) returned to prior work level. Postoperative complications occurred in 9/27 (33.33%) horses. No individual explanatory variable was significantly associated with return to use in the univariable analysis. Racehorse earnings per start were lower postoperatively compared to preoperatively (p = .02).

Conclusion: Most horses treated for SMCT fractures with PF returned to prior work level, although postoperative complications were common. None of the explanatory variables were significantly associated with return to use.

Clinical significance: PF for proximal SMCT fractures is effective, yielding high return-to-work rates and better outcomes than previously reported case series.

Objective: To describe clinical application and outcomes following stabilization of traumatic long-bone fractures in dogs using an I-Loc angle stable interlocking nail (AS-ILN).

Study design: Retrospective study.

Sample population: A total of 243 client-owned dogs.

Methods: The medical records of dogs with long-bone fractures stabilized with an I-Loc AS-ILN were reviewed. Data collected included signalment, affected bone, fracture pattern and whether fractures were open/closed. Surgical details included nail parameters, customization, use of ancillary implants and number of missed bolts. Complications were classified as major or minor depending upon requirement for revision surgery. Time to clinical union was documented.

Results: A total of 243 fractures affected the femur (138/243), tibia (71/243), humerus (27/243) or radius/ulna (7/243). Most were diaphyseal (183/243) and comminuted (151/243). The 8, 7, 6, 5, 4 and 3 mm nails were used in dogs weighing an average of 41, 30, 26, 21, 13 and 5 kg, respectively. Ancillary implant use was uncommon (50/243). Nails were shortened in 40/243 cases and prebent in 55/243. The postoperative missed bolt rate was 8/852. Radiographic follow-up was achieved in 189 cases, with a median duration of 57.5 days. Mean time to clinical union was 8.3 weeks. Major and minor postoperative complications were encountered in 13/243 and 22/243 of cases, respectively.

Conclusion: Use of the I-Loc system was associated with positive results across a wide range of presentations including epi-/metaphyseal fractures.

Clinical significance: The low complication rates associated with the I-Loc system indicate potential benefits to patients compared to plate-rod systems, non-angle-stable nails or other AS-ILNs.

Objective: To report and compare two surgical approaches to the feline radial diaphysis and outline optimal techniques to maximize surgical exposure.

Study design: Ex vivo experimental comparative study.

Sample population: Left and right antebrachia of three feline cadavers.

Methods: Six feline antebrachia were collected from cadavers submitted for research purposes. Each limb was sequentially dissected for both craniomedial and craniolateral surgical approaches totalling 12 surgical approaches, or 24 when including and excluding the supinator muscle. Following each approach, photographs were taken and inserted into an image measuring software, to obtain the area of surgical exposure. The datum was then analyzed to ascertain which approach afforded the greatest exposure and whether the difference was statistically significant.

Results: The mean surface area for the craniolateral approach, including and excluding the supinator muscle, was 4.13 cm² and 2.63 cm², respectively. The mean surface area for the craniomedial approach, including and excluding the supinator muscle was 3.84 cm² and 2.45 cm², respectively. The difference observed between the two approaches was not statistically significant (p > .05).

Conclusion: Surgical exposure achieved via the craniolateral and craniomedial approaches to the feline radial diaphysis is comparable.

Clinical significance: This study validates the use of the craniolateral surgical approach to the feline radial diaphysis.

Objective: To describe the additional information provided by computed tomography (CT) in planning and assisting repair of comminuted fractures of the middle phalanx (MP) in Warmblood horses.

Study design: Case series.

Animals: Six adult Warmblood horses.

Methods: The case records of horses undergoing CT examination prior to internal fixation of comminuted MP fractures were reviewed. All horses underwent radiographic and preoperative CT examination. A standardized fast protocol (SFP) to assess CT images was used. Surgical repair consisted of fracture repair and proximal interphalangeal joint arthrodesis using two dorsally located plates under general anesthesia. Long-term follow-up was obtained from the clinical records and/or referring veterinary surgeons.

Results: In all cases, CT provided information that could not have been obtained from radiographic examination. Four horses were alive at >6 months follow up and presented with a mild 3/5 AAEP lameness.

Conclusion: The SFP provided additional information regarding fracture configuration that could not have been obtained during radiographic examination in all cases. In two cases it allowed identification of a small navicular bone fracture at the level of its dorsal cortex within the distal interphalangeal joint. In one case it allowed identification of deep digital flexor tendon (DDFT) rupture. Preoperative CT scans helped in planning the positioning of two or more independent 4.5/5.5 mm cortical lag screws to improve construct stability.

Clinical significance: The use of the CT SFP provides surgeons with precise fracture configuration, enables identification of concurrent pathology and optimizes surgical planning, thereby improving construct stability.

Objective: To describe the surgical procedure for pancreaticoduodenectomy with choledochoduodenostomy and pancreaticojejunostomy for carcinoids of the common bile duct (CBD) in a cat and to report its outcomes.

Study design: Case report.

Animal: A 6-year-old neutered male Munchkin cat.

Methods: A small tissue plug causing CBD obstruction was surgically removed from a cat. The obstructive plug was diagnosed histopathologically as carcinoid. Nine months after initial surgery, the cat developed anorexia and vomiting. Diagnostic imaging revealed dilation of both the CBD and pancreatic duct, and the cat underwent a second surgery 11 months after the initial procedure. En bloc resection of the pancreatic body and duodenum, including the site of the CBD obstruction, was performed. Following the duodenal reconstruction with end-to-end anastomosis, the biliary system was rebuilt with end-to-side anastomosis, connecting the CBD's resected end to the duodenum. Pancreatojejunostomy of the distal end of the left pancreatic lobe and jejunum was performed to reconstruct the pancreatic duct.

Results: No postoperative complications such as bile leakage, pancreatic fluid leakage, or pancreatitis were observed. Toceranib therapy was initiated postoperatively. The cat showed good general condition 524 days after the second surgery and exhibited favorable progress at the time of writing.

Conclusion: This is the first report of a successful reconstructive surgery with choledochoduodenostomy and pancreatojejunostomy after en bloc resection of the pancreatic body and proximal duodenum in a cat with recurrent carcinoid-induced ductal obstruction. Pancreatic body duodenectomy may be a viable and effective option for managing pancreatic duct obstruction in cats.

Objective: To determine whether structured and supervised cadaveric surgical training improves technical skills in expert and self-assessments and enhances self-perception of surgical trainees.

Study design: Prospective observational study.

Sample population: Seven small animal ECVS residents and surgical interns.

Methods: A cadaveric orthopedic training program, consisting of six supervised training sessions, weekly self-directed training, and one one-to-one training session with direct feedback, was conducted over 3 months. Each participant performed a set of surgical procedures on feline cadavers before and after the training period. The procedures were videotaped and subsequently evaluated by three board-certified surgeons (expert assessment [EA]) and the participants themselves (self-assessment [SA]) using the objective structured assessment of technical skills (OSATS) global rating scale (GRS). OSATS GRS scores were analyzed using the Wilcoxon signed-rank test, Kruskal-Wallis test, and Cohen's kappa coefficient (Κ).

Results: Comparing pre- and post-training assessments, median EA scores increased from 17/35 to 23/35 (p = .001). Median SA scores increased from 17/35 to 25/35 (p = .018). There was slight to substantial inter-assessor agreement (Κ = 0.04-0.65) and poor agreement between SA and EA (Κ = 0).

Conclusion: Trainee surgeons improved their technical skills in expert and self-assessments. However, the interassessor agreement was strong for only two of the three assessors. Despite limitations, the OSATS GRS enhanced the objectivity of technical surgical skills assessment.

Clinical significance: This study represents the first step in devising a meaningful training outside the operating room for veterinary surgical residents. The OSATS GRS as an assessment tool warrants further investigation.

Objective: To describe the use of the lateral caudal axial pattern flap in cats for reconstructing caudodorsal trunk defects in cats, and to report complication types, complication rates, and flap outcomes.

Study design: Retrospective study.

Animals: Fourteen client-owned cats.

Methods: Medical records of cats that underwent reconstruction of caudodorsal defects using a lateral caudal axial pattern flap were reviewed retrospectively. Recorded data included signalment, cause, and dimensions of the defect, flap dimensions (length, width, percentage of tail length), intraoperative and short-term postoperative complications, and flap outcomes.

Results: The flap was used to cover defects following tumor excision in 85.7% of cats. The mean flap length relative to tail length was 61.3%. Intraoperative complications occurred in 1/14 cats (7.1%), and postoperative complications in 7/14 cats (50%). The most common complications were partial flap dehiscence (14.2%), seroma (14.2%), and edema (14.2%). In 8/14 cats (57.1%), flap healing was uncomplicated, and in 6/14 cats (42.8%), only minor complications were observed.

Conclusion: The lateral caudal axial pattern flap appears to be a valid option for closing defects in the caudodorsal region of the trunk in cats. The flap length relative to tail length was similar to values reported in dogs. Although the overall complication rate may be higher in cats, the majority of cats experienced either no complications or only minor ones.

Clinical significance: This axial pattern flap constitutes a reliable and effective reconstructive technqiue for the closure of cutaneoaus defects located in the caudodorsal region of the feline trunk.