Veterinary Surgery最新文献

Objective: To determine the prevalence and risk factors of surgical site infection (SSI) following internal fixation in ruminants.

Study design: Retrospective multicenter study across five veterinary teaching hospitals.

Animals: A total of 81 ruminants undergoing internal fixation for orthopedic disease.

Methods: Medical records over a 13-year period were analyzed for ruminants presenting with orthopedic disease that was surgically managed with internal fixation. Patient signalment, limb affected and type of injury, surgical method, orthopedic implants used, total anesthetic duration, antimicrobial use, development of SSI as well as short- and long-term survival were reported.

Results: The incidence of SSI was 17.3% (14/81). Overall, 92.6% (75/81) of cases survived to discharge; 85.7% (12/14) of cases with SSI and 94% (63/67) of cases that did not develop SSI. Increased duration of antimicrobial use (p = .004) and fractures distal to the tarsus/carpus (p = .04) were associated with an increased risk of SSI but had no effect on overall survival. The use of intramedullary pins for surgical repair was associated with a reduced likelihood of survival to discharge (p = .008).

Conclusion: In conclusion, the SSI incidence in ruminants following internal fixation was comparable to the infection risk in horses and camelids. SSI had a higher incidence in fractures distal to the tarsus/carpus and in animals that were administered antibiotics for a prolonged period.

Clinical significance: The use of orthopedic implants in ruminants is associated with a good outcome with 92.6% of cases surviving to discharge and a comparable incidence of surgical site infection as other large animal species.

Objective: To describe specific methods of plate application and to report outcomes for patients treated with the OrthoLine^TM system.

Study design: Retrospective case series.

Animals: A total of 65 dogs, and six cats.

Methods: Medical records of dogs and cats treated with the OrthoLine^TM system were reviewed. Cases with <12 weeks follow-up, significant comorbidities, a revision procedure, or those receiving the study implant in combination with another system were excluded. Construct application characteristics (plate span [%], plate span ratio, screw hole density, and plate working length [cm]) were calculated and compared between fracture locations. Patient outcomes included fracture healing, owner assessed outcome (telephone interview) and reported complications from owner interviews and medical records.

Results: A total of 75 fractures in 71 cases were treated with 77 plates. Clinical union was noted in 57/61 fractures (93.4%) at a range of 1.7-19.7 weeks. Owner assessed outcome (n = 51) was graded as full or acceptable for all cases. Major complications included implant failure (n = 1), implant infection (n = 2), and intraoperative malreduction with revision (n = 1). Plate span of radial (46.6%) and ulnar (33.0%) constructs were both lower compared to femoral (73.3%) (p < .001) constructs, and ulnar constructs were also lower compared to tibial (61.7%) constructs (p = .004).

Conclusion: The OrthoLine^TM system produced acceptable radiographic healing, complication rates, and owner assessed outcomes. Shorter plate spans in the radius and ulna were well tolerated.

Clinical significance: The OrthoLine^TM system is a promising alternative for fracture repair in dogs and cats.

Objective: To evaluate the feasibility of minimally invasive integrated endoscopic mini-hemilaminectomy and thoracolumbar lateral corpectomy at six intervertebral disc spaces in the canine thoracolumbar vertebral column.

Study design: Experimental, randomized cadaveric study.

Animals: Eight cadaver dogs euthanized for reasons unrelated to this study.

Methods: Preoperative computed tomography (CT) scans were performed for surgical planning. Using an endoscopic system, mini-hemilaminectomy and thoracolumbar lateral corpectomy were performed from the T11-12 through L3-4 intervertebral disc spaces, with cadavers in sternal recumbency or positioned at a 30°-60° angle. Postoperative CT scans were used to measure corpectomy dimensions as a percentage of total vertebral dimensions.

Results: Median ± interquartile range (IQR) corpectomy dimensions were 23.07% ± 16.47% of vertebral body length, 46.76% ± 21.7% of vertebral body height, and 74.44% ± 47.37% of vertebral canal diameter. Targeted dimensions were achieved at all surgical sites from T11-12 through L3-4.

Conclusion: Integrated endoscopic thoracolumbar lateral corpectomy was successfully performed at all intervertebral disc spaces from T11-12 through L3-4 using an endoscopic system, although thoracic sites required more practice.

Clinical significance: This pilot study will guide further clinical applications of minimally invasive neurosurgery in small animal patients.

Objective: To evaluate the effect of a simple chest wall-lifting technique on thoracic volumes in cats.

Study design: Cadaveric study.

Animals: Feline cadavers (n = 8).

Methods: Animals underwent thoracic computed tomography (CT) scans after each treatment: in lateral recumbency, (1) no lift and (2) intercostal space lift, and in dorsal recumbency, (1) no lift and (2) sternal lift. Lifting was performed in lateral recumbency at the eighth intercostal space using a bent 2 mm Steinmann pin and in dorsal recumbency at mid-sternum using a Backhaus towel clamp, placed under thoracoscopic guidance until maximal effect was subjectively noted while recording the tension achieved on the device. Thoracic cavity volume (TCV), working space volume (WSV), and ventilation space volume (VSV) were determined on CT images and compared across treatments.

Results: The TCV increased by a median of 27% (range: 7%-72%), 54% (28%-64%), and 51% (37%-106%) in the dorsal, left lateral, and right lateral recumbencies, respectively. The WSV showed a median increase of 92% (-21%-1026%), 187% (113%-355%), and 271% (119%-422%) for the same positions. In contrast, the VSV decreased, and although statistically significant, the change was relatively minor, with a median decrease of 3% (range: -5%-19%), 7% (-1%-18%), and 7% (3%-11%) in the dorsal, left lateral, and right lateral recumbencies, respectively.

Conclusion: Chest wall lifting increased the WSV in feline cadavers with minimal impact on the VSV.

Clinical significance: This novel and simple technique could help in performing thoracoscopic procedures in cats.

Objective: The objective of the present study was to report the outcome of a novel technique of urethral intra-abdominal anastomosis after transabdominal wall passage of the penis in a dog with stent-related urethral obstruction.

Study design: Case report.

Animal: A seven-year-old neutered male Cocker Spaniel.

Methods: The dog was evaluated for urinary retention and overflow incontinence of approximately 1-year duration. The dog had a urethral self-expanding metallic stent placed 6 years prior as treatment for pelvic urethral stricture, secondary to severe pelvic trauma. Stent fracture and stent-related tissue hyperplasia were diagnosed leading to intrapelvic urethral obstruction and concomitant atonic bladder complicated by cystolithiasis and urinary tract infection. An intra-abdominal urethral anastomosis was performed to restore urethral patency, after passing the penis through the abdominal wall, into the inguinal area; the surgery was successful in bypassing the urethral obstruction.

Results: No contrast leakage was noted on positive contrast cystourethrography 10 days postoperatively. The urinary bladder was easily emptied by manual expression and bethanechol was started. At 6-months follow-up, the urinary bladder remained atonic but was easily emptied by manual expression, with mild urinary incontinence remaining. No signs of recurrent urinary tract infections were noted. Nine months after surgery the dog was euthanized for reasons unrelated to the surgery.

Conclusion: The transabdominal wall urethral anastomosis, after penile abdominal tunnelization resulted in bypassing the urethral obstruction in this dog, restoring urethral patency. The technique reported could be a viable surgical option for restoring urethral patency in dogs with severe pelvic urethral damage or obstructive lesions.

Objective: To report the successful complete resection of an extensive retroperitoneal sarcoma (RPS) with a caval thrombus using veno-venous bypass (VVB) to facilitate temporary caudal vena cava (CVC) occlusion.

Study design: Case report.

Animal: A 12-year-old neutered male Standard Poodle.

Methods: Computed tomography (CT) revealed an extensive mass originating from the right adrenal gland region with an associated caval thrombus extending into the thoracic CVC. A preemptively planned en bloc resection, including the right kidney and caval thrombus, was performed. VVB and a Pringle maneuver were used to minimize hemorrhage and maintain hemodynamic stability.

Results: Surgery was successfully completed without major complications. The operative time was 161 min, with Pringle maneuver duration of 4 min 8 s and a caval occlusion time of 44 min 43 s. The dog's general condition stabilized the following day with no decline in renal function. The histopathologic examination confirmed the diagnosis of RPS. The dog remained in good health with no recurrence or metastasis at the 1-year follow-up.

Conclusion: This is the first report of a clinical application of VVB during temporary caval occlusion to achieve complete en bloc resection of an extensive adrenal RPS with ipsilateral kidney and caval thrombus, followed by repair of a CVC incision. VVB may be a valuable technique for maintaining hemodynamic stability and reducing hemorrhage during complex oncological surgeries requiring temporary caval occlusion.

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.