Reconstrução prepucial com uso de enxerto combinado em cães / Preputial reconstruction combined with graft in dogs

Background: Preputial injuries are significant in the clinical routine. Traumas, conditions, and mass excision result in extensive and full-thickness defects that lead to chronic penile exposure and consequential injuries. Severe injuries may require preputial reconstructive surgery to restore function and aesthetics. The objective is to report the use of the preputial reconstruction technique using the caudal superficial epigastric axial standard flap associated with a single-stage, full-thickness oral mucosa graft in 3 dogs where the loss of the prepuce was significant. Cases: Three dogs were admitted to the Veterinary Teaching Hospital of UFMT with preputial lesions of different etiologies. All cases were referred for preventive reconstruction using a flap in the caudal axial epigastric pattern associated with a single-stage oral mucosa graft. In the 3 reported cases, changes that compromised surgical success, such as suture dehiscence, necrosis, or infection, were not observed during hospitalization. Cutaneous stitch dehiscence, however, was observed in all 3 cases. Dog 1. A small point of dehiscence and tissue necrosis was found and treated with chemical debridement and healed by second intention, which proved to be sufficient on the 30th day. Dog 2. A half-moon rotation flap was performed, which closed the defect. Dog 3. A new procedure using the reporting theme technique was necessary in order to cover the cranial portion of the foreskin. The dehiscence present in dogs 2 and 3 was significant. Flap retraction was observed in all 3 cases. In dogs 1 and 3, the retraction was slight, and the exposure of a small portion of the penile glans were observed, showing no changes that required intervention. In dog 2, retraction was important, leading to partial stenosis of the preputial ostium. A larger ostium was obtained by suturing the mucosa to the edge of the wedge. Considering the possibility of adhesion formation, "captons" were made in sterile silicone tubes, and sutures were placed in the dorsal and ventral aspects to prevent adherence of the oral mucosa graft located on the inside of the new foreskin. The captons were removed on the tenth post-operative day, revealing a good opening of the preputial orifice and adequate penile exposure. Discussion: The absence of a foreskin caused by trauma or surgical excision leads to chronic penile exposure, dryness, and ulcerations. The simple covering of the skin with an axial-type flap of the caudal superficial epigastric region tends to fail since only the graft edges are sutured into the abdominal skin. In these circumstances, the subcutaneous region on the penis is exposed and comes in direct contact with urine and the penile mucosa, causing the flap skin to grow to exacerbated retraction. The transplantation of a free-lip mucosa graft allows the subcutaneous region of the transposed skin flap to create adhesions in the fenestrated regions of the lip tissue through the formation of granulation tissue buds, which is performed in a single stage. The permanence of the penis protects the lower urinary system from the occurrence of infections relative to what is normally observed in cases where partial or total penile amputation is practiced in combination with adjunctive scrotal urethrostomy. Given the observations of the 3 cases described here, the technique of pre-facial reconstruction with an axial skin flap of the caudal superficial epigastric region, combined with free-labial mucosa graft, was found to be feasible for the single-stage foreskin technique, but that paraphimosis remanagement may be necessary when cutaneous portions of the penile skin caudal to the glans are removed.

Hip dislocation in a calf - treatment with iliofemoral suture

Background: Coxofemoral dislocation is uncommon in large animals, due to anatomical particularities that provide greater stability to this joint. The most common causes of hip dislocation in large animals are related to hypocalcemia, mount trauma, sudden falls on hard surfaces or dystocia. Treatment can be performed by closed reduction, but the reported results are not satisfactory with complications. Several surgical techniques have already been described and successfully used in small animals in the treatment of hip dislocation. The present work aims to describe the technique and the result of the iliofemoral suture in the treatment of hip dislocation in a Girolando heifer. Case: A heifer was attended with a history of difficulty in getting up. According to the owner, the clinical manifestation was sudden, after remaining in a paddock with other animals of different age groups. The calf had reduced skin sensitivity on the croup, and it was impossible to remain in the quadrupedal position, often remaining in sternal recumbency with the left pelvic limb in extension. From the clinical examination, spinal cord injury was suspected and clinical treatment was instituted with dexamethasone, vitamins B1, B12 and dimethylsulfoxide. At the end of the clinical treatment, the animal did not show a favorable evolution, so radiographic examination of the coxofemoral region was performed, revealing dislocation of the left femoral head, indicating surgical correction. Xylazine was administered as pre-anesthetic medication, followed by anesthetic induction with midazolam associated with ketamine, followed by orotracheal intubation. Anesthetic maintenance was instituted with isoflurane and monitoring was performed with a multiparameter monitor. An epidural block was performed with bupivacaine and morphine. A craniolateral approach to the left hip joint was performed. After the dislocation was reduced, sutures were used to better stabilize the joint in question. Following the evolution of the surgical procedure, it was possible to confirm that the femoral head remained in place. After 15 days, the skin stitches were removed and the animal was discharged from the hospital and returned to its original property. The calf was asked to remain in the stall for at least 60 days, gradually releasing it into larger spaces and only after 120 days could it remain in the paddock with other animals. During three months, the tutor was consulted about the evolution of the condition, reporting that the animal was clinically well, being able to get up and walk without difficulty and with a mild degree of lameness, thus suggesting the success of the surgical procedure. Discussion: There are few studies of successful surgical treatments of hip dislocation in large animals, and that number is even smaller when considering cattle alone. It is believed that this is due to difficulties related to the surgical technique and to postoperative handling, given the animal's weight. The iliofemoral suture technique performed on the animal in the present study is commonly employed in small animals, and excellent results have been observed. However, reports on the use of this technique in large animals have not been found. The iliofemoral suture technique has advantages over other reported surgical techniques in cattle. When compared to the femoral head and neck resection, the iliofemoral suture has several advantages, as it allows preservation of the joint and achievement of superior biomechanical results. When compared to the technique of reinforcement of the joint capsule with synthetic material, also reported in cattle, the iliofemoral suture appears to be faster, simpler and more economic, and provides similar stability. We conclude that the iliofemoral suture proved to be a satisfactory alternative for the treatment of hip dislocations in young cattle.

Coloboma eyelid in cats - treatment with carbon dioxide cryosurgery

Background: Eyelid colobomas are congenital and developmental disorders. Generally, they affect the temporal portion of the upper eyelids of cats, bilaterally. This ocular defect is accompanied by trichiasis associated with pain and ulcerative keratitis. Any breed can be affected and it has been reported in Domestic Shorthair, Persian, Burmese, Mongrel cats and captive felids. The objective of this case report is to describe the technique of dioxide carbon cryosurgery for the treatment of eyelid coloboma in felines. Cases: Seven mongrel cats (14 eyes) with bilateral eyelid coloboma were included in this study, 5 females and 2 males, with a median age of 5 months (range 6-8 months). The patients presented with blepharospasm, bilateral mucopurulent ocular discharge and eyelid coloboma extension of 30-50% in the upper eyelid, resulting in severe trichiasis of both eyes. In 5 cats, 1 or both eyes were diagnosed with keratitis and superficial corneal ulcers. Surgical treatment with general anaesthesia was applied. The pre anaesthesia protocol included acepromazine 0.05 mg/kg with methadone 0.2 mg/kg, followed by intravenous propofol and maintenance with isoflurane and oxygen. An ophthalmological cryocautery unit was utilised with carbon dioxide as the cryogenic agent and a retinal cryoprobe of 3.2 mm diameter tip, reaching -50ºC for the procedure. The method used was a double cycle of freezing and thawing for 60 s in the margins of eyelid agenesis. Epilation of hairs was made after freezing with eyelash tweezers. Immediately after the surgical procedure, an Elizabethan collar was placed to safeguard the area and anti-inflammatory therapy with meloxicam 0.1 mg/kg once daily for 3 days was prescribed. Antibiotic ointment every 6 h (chloramphenicol and associations) was also prescribed for topical application. Two weeks post-operatively, hyperaemia, oedema and skin wounds at the margins were observed. After 30 days these clinical signs were minimal. No signs of pain were observed post-operatively. The follow-up was 90 days and the trichiasis was resolved in all cats. Discussion: Usually, young cats are affected with eyelid colobomas. The age of the patients in this study was between 6-8 months. Eyelid colobomas are repaired with a variety of blepharoplastic procedures and the choice depends on the size and position of the defect. Generally, larger defects require more extensive reconstructive procedures. All techniques can have post-operative complications. Suture dehiscence, skin flap necrosis and facial deformation can occur with traditional surgical techniques. Furthermore, posterior hair growth in the margins can lead to new trichiasis. Cryosurgery was chosen and performed as the temperature of -20°C is sufficient to destroy hair follicles, without surgical incisions, avoiding scar formation. Hence, sutures are not necessary in cryosurgery procedures. Carbon dioxide is a good cryogenic agent for the purpose of this procedure. In the cases described, no recurrence of hair growth was observed in the follow-up period of 90 days. Nevertheless, a good aesthetic appearance was maintained. Therefore, the use of carbon dioxide cryosurgery is an effective and safe alternative for treatment of eyelid coloboma in cats. To our knowledge, no paper has described the use of carbon dioxide cryosurgery for the correction of palpebral agenesis in felines and other species as a single treatment. This technique is easy to perform, has good aesthetic and functional results and can be considered a treatment option for this congenital condition.

Estabilização zigomática e retalho de avanço facial lateral em canino filhote / Zygomatic stabilization and lateral facial advancement flap in a puppy dog

O trauma é frequentemente relatado na rotina clínica de pequenos animais, podendo gerar fraturas de componentes ósseos e lesões de tecidos moles adjacentes. No presente trabalho, objetivou-se relatar o caso de um canino, macho, sem raça definida, de sete meses de idade, vítima de trauma craniomaxilofacial decorrente de mordedura, diagnosticado com fratura e deslocamento de osso zigomático, além de importante laceração de pele. O tratamento estabelecido baseou-se no debridamento da ferida, estabilização cirúrgica de arco zigomático com fios de Nylon e na sutura dos ferimentos de pele causados. Em um segundo tempo cirúrgico, foi realizada enucleação e recobrimento do defeito na órbita com malha cirúrgica de polipropileno, além de remoção de tecido exuberante e confecção de retalho subdérmico de avanço facial lateral para recobrimento do defeito cutâneo. A complicação evidenciada na primeira intervenção cirúrgica foi a deiscência das suturas de pele, enquanto no segundo tempo cirúrgico, não houve sinais de complicações. No pós-operatório, o paciente apresentou evolução clínica satisfatória, recebendo alta médica 21 dias após o segundo procedimento cirúrgico realizado. Tendo em vista a adequada evolução clínica, bem como os reduzidos efeitos colaterais, sugere-se que a conduta clínica e técnicas cirúrgicas adotadas para tratamento do paciente em questão foram efetivas.

Trauma is frequently reported in the small animal clinics, and can lead to fractures of cranial bone components and injuries to the adjacent soft tissues. In the present study, the objective was to report the case of a seven-month-old male mongrel dog, that had a craniomaxillofacial trauma resulting from a bite, characterized by zygomatic bone fracture and displacement, in addition to a major skin laceration. The stablished treatment was based on wound debridement, surgical stabilization of the zygomatic arch with nylon threads and in the suturing of skin wounds. In a second surgical procedure, enucleation was performed and a surgical polypropylene mesh was applied to cover the orbital defect, exuberant tissue was removed and a subdermal advancement flap was used to cover the skin defect. The complication observed in the first surgical intervention was dehiscence of the skin sutures, while in the second surgical procedure, there were no signs of complications. Postoperatively, the patient had a satisfactory clinical recovery, being discharged 21 days after the second surgical procedure. Considering the adequate clinical evolution and the reduced complications, it issuggestedthat the clinical conduct and surgical techniques adopted for the treatment of the patient in question were effective.

Evaluation of barbed suture for celiorrhaphy and subcutaneous closure in bitches with pyometra submitted to ovariohysterectomy

ABSTRACT Purpose To evaluate the use of barbed sutures over the surgical time, the leukogram, the tissue thickness in which the sutures were employed (ultrasonography), the costs, and the possible complications in bitches with pyometra submitted to ovariohysterectomy (OH). Methods Convectional 2.0 polyglyconate suture was used in the control group (CG n = 10) and 2.0 barbed polyglyconate suture in the barbed group (BG n = 10) to perform celiorrhaphy (simple continuous pattern) and subcutaneous closure (continuous intradermal pattern). Data were assessed using paired (leukogram between 24 and 48 h within the same group) and unpaired (leukogram, surgical time, tissue thickness, and costs) Student's t-test. The Fisher exact test was used to assess the occurrence of seroma between groups (p < 0.05). Results are shown as mean ± standard error of mean. Results The time spent to perform the celiorrhaphy (195.30 ± 17.37 s vs. 204 ± 16.00 s), subcutaneous closure (174.0 ± 15.86 s vs. 198.0 ± 15.62 s), and the total surgical time (24.30 ± 1.44 min vs. 23.00 ± 1.30 min) did not differ between BG and CG, respectively (p > 0.05). Leukogram at 48 h post-surgery did not differ between groups (p = 0.20). No differences were observed in the subcutaneous and the abdominal wall thickness (cm) assessed by ultrasonography at 48 h in BG (0.31 ± 0.04, 0.80 ± 0.05) and CG (0.34 ± 0.03, 0.72 ± 0.06), respectively. Similarly, 15 days post-surgery the same structures did not differ between BG (0.26 ± 0.02, 0.74 ± 0.08) and CG (0.26 ± 0.03, 0.64 ± 0.05) (p > 0.05). In one bitch from each group, a mild seroma was observed on one side of the surgical wound 48 h after surgery (p = 1.00). The procedures in which barbed sutures were used had an average additional cost of R$ 200.00 ± 11.66 (p < 0.0001). Conclusions Barbed suture has proven to be efficient and safe for abdominal and subcutaneous closure. However, considering its current high cost in addition thatthe surgical time of bitches with pyometra undergone OH was not reduced, no advantages were observed with theuse of barbed sutures for this type of surgery.

Evaluation of biomechanical traction of incisional gastropexy and scarification gastropexy techniques in dogs

Background: Gastropexy is used to correct gastric dilatation volvulus, a disease that usually affects large and giant dogsand leads to death in 23.4 - 43% of patients. This study aimed to evaluate the biomechanical traction of 2 gastropexytechniques, incisional gastropexy and scarified gastropexy, in 10 dog cadavers. Incisional gastropexy comprises a singleincision in the abdominal wall and another incision in the stomach wall in the pyloric region followed by simple continuous sutures. The scarification technique creates scarification along the stomach borders of the pexy. Thereby, knowing thatboth techniques are successful, the biomechanical traction of each technique was compared.Materials, Methods & Results: A total of 10 animals without defined breed weighing from 6.4 - 43.0 kg were allocatedinto 2 equal groups (GE [scarified gastropexy] and GI [incisional gastropexy]). Incisional gastropexy was performed witha simple continuous suture pattern in the GI group and scarified gastropexy with an interrupted simple suture pattern wasperformed in the GE group. Absorbable 2-0 monofilament yarn (polygllecaprone 25) was used for sutures in both groups.Rectangular segments of the gastric antrum were collected from the right abdominal wall and from the bottom of thestomach at the left abdominal wall, which were subjected to a traction test. The scarification technique was easier, faster,and used less surgical sutures than the incisional technique. Both techniques were effective regardless of the site applied,with no significant differences. There was a difference in stretching depending on location.Discussion: The pathogenesis of gastric dilatation volvulus (GDV) is unknown. However, gas accumulation inside thegastric chamber may lead to organ dilation and consequently cause torsion of the cardia region and pyloric antrum, resulting in strangulation of blood vessels and nerves. This torsion could cause stomach ischemia followed by organ necrosis if...

Evaluation of biomechanical traction of incisional gastropexy and scarification gastropexy techniques in dogs

Background: Gastropexy is used to correct gastric dilatation volvulus, a disease that usually affects large and giant dogsand leads to death in 23.4 - 43% of patients. This study aimed to evaluate the biomechanical traction of 2 gastropexytechniques, incisional gastropexy and scarified gastropexy, in 10 dog cadavers. Incisional gastropexy comprises a singleincision in the abdominal wall and another incision in the stomach wall in the pyloric region followed by simple continuous sutures. The scarification technique creates scarification along the stomach borders of the pexy. Thereby, knowing thatboth techniques are successful, the biomechanical traction of each technique was compared.Materials, Methods & Results: A total of 10 animals without defined breed weighing from 6.4 - 43.0 kg were allocatedinto 2 equal groups (GE [scarified gastropexy] and GI [incisional gastropexy]). Incisional gastropexy was performed witha simple continuous suture pattern in the GI group and scarified gastropexy with an interrupted simple suture pattern wasperformed in the GE group. Absorbable 2-0 monofilament yarn (polygllecaprone 25) was used for sutures in both groups.Rectangular segments of the gastric antrum were collected from the right abdominal wall and from the bottom of thestomach at the left abdominal wall, which were subjected to a traction test. The scarification technique was easier, faster,and used less surgical sutures than the incisional technique. Both techniques were effective regardless of the site applied,with no significant differences. There was a difference in stretching depending on location.Discussion: The pathogenesis of gastric dilatation volvulus (GDV) is unknown. However, gas accumulation inside thegastric chamber may lead to organ dilation and consequently cause torsion of the cardia region and pyloric antrum, resulting in strangulation of blood vessels and nerves. This torsion could cause stomach ischemia followed by organ necrosis if...(AU)

Cloacoplasty in a 40-day-old monk parakeet with cloacal prolapse

Background: The monk parakeet (Myiopsitta monachus) is also known as the quaker parrot and belongs to the order Psittaciformes in the family Psittacidae. The cloaca is a posterior orifice common to reproductive, digestive and urinary systems and the cloacal prolapse is the displacement or inversion of its anatomic position. Nowadays, the non-conventional pet market in Brazil is rapidly growing, which demands more skills and competences from an avian veterinarian. This study case has as its main objective to present a 40-day-old monk parakeet (Myiopsitta monachus) with cloacal prolapse, treated using the cloacoplasty technique. It is important to mention that the occurrence of cloacal prolapse in this species and in such an early age is uncommon. Case: The patient presented 1 day before the physical examination an increased volume in the cloacal region and hematochezia, and diagnosed as cloacal prolapse. For the treatment, wounds were washed using physiological saline solution, ice and sugar were applied in order to reduce the edema, and mineral oil was used for repositioning the cloacal mucosa. Finally, local anesthesia was applied and 2 isolated contralateral sutures were done with the objective of reducing the sphincter's diameter, without compromising the flow of urine and feces. The monk parakeet was treated with antibiotic Avitrin® [oxytetracycline hydrochloride - 8.1 mg/mL] and a vermifuge [mebendazole 50 mg/mL]. A sample of feces was also obtained and sent to the Laboratory of Avian Pathology Diagnosis. The patient was discharged after 7 days of the treatment, obtaining a favorable result with no further complications. Discussion: The results of the coproparasitological examination were negative for the samples analyzed; nevertheless, the possibility of a false negative result cannot be totally dismissed. Cloacal prolapse may be related to cases of hypersexual disorder or overexertion to defecate due to intestinal parasites, posture, polyps, enteritis, neoplasm or cloacal hyperplasia. Besides that, endoparasitism is common in captive birds. For the correct treatment, proceed with a cloacoplasty, in which 1 or 2 simple sutures are made separated laterally in both sides, promoting the narrowing of the orifice. The surgeries such as the cloacoplasty are currently being defended, but in most cases as an adjuvant therapy. Cloacal prolapse in birds is a disease considered as an intestinal emergency. The techniques presented in this work demand sedation or anesthesia for the patient, which were not authorized by the tutor due to the high risk involved. However, due to the characteristic of domestication and docile behavior of the bird, it was possible to perform the 2 sutures with a local anesthetic block only. Cloacal prolapse is relatively common in adult psittacine birds, but uncommon in monk parakeets and young birds. The treatment performed was effective for the monk-parakeet presented in this study case. The authors, however, would like to strongly reinforce the need to identify the cause of cloacal prolapse in order to properly treat it. The importance of correctly identifying the anatomy of a psittacine bird as well as applying precisely the suture techniques are the most important conclusions obtained, making both the identification of the problem and its solution through surgical intervention a simpler and successful process.

Submerged vascular anastomosis. A technique for vascular suturing in experimental microsurgery

ABSTRACT Purpose: To evaluate the impact of submersion of the microsurgical anastomosis suture area using saline (0.9% NaCl) in an experimental laboratory during the training of medical students and resident physicians. Methods: Wistar rats (n = 10) were selected to have the two femoral arteries sectioned and anastomosed end-to-end under optical magnification. They were randomly divided, so that on one side suturing was performed under submersion with saline, and the contralateral side was kept dry during the procedure. The surgical times, as well as the patency within 30 min and 72 h of the procedure, were evaluated. Results: Six male Wistar rats survived the surgical anesthetic procedure, with the average initial weight of 243.3 g and the average artery diameter of 0.86 mm, with average time of 15.67 min for the submerged technique and 20.50 min for the dry technique (p = 0.03). The failure rates were 17 and 50% for the submerged group and the dry one, respectively (p = 0.62). Conclusions: Submerged microvascular suture does not compromise the patency of the vessel or increase the time of anastomosis. Therefore, it is a strategy that can be applied by the surgeon according to his/her technical preferences.

Modified eye evisceration in a tropical screech owl (Megascops choliba)

Background: An adult owl was presented with an injury to the right eye that rendered it blind in that eye. The left eye was normal. Removal of the right eye was recommended and a modified eye evisceration was performed. No complications were observed during or after surgery. The objective of this paper is to describe the modified eye evisceration technique that was successfully used in a tropical screech owl (Megascops choliba). Case: An adult owl was presented with an injury to the right eye that rendered it blind in that eye. Two previous surgical treatments have been carried out but have not been successful. Using a portable slit-lamp (Kowa SL-15®), both eyes were examined. The left eye was normal. Upon ophthalmic examination of the right eye, the owl demonstrated blepharospasm and large central corneal ulcer. Removal of the right eye was recommended. The bird received midazolam hydrochloride [Dormire® - 1 mg/kg, IM] and ketamine hydrochloride [Ketamina® - 5 mg/kg IM] as pre-anesthetic medications. Subsequently, the bird was anesthetized with isoflurane (Isoforine®) by facemask for induction, and then maintained with isoflurane vaporized in 100% oxygen through an endotracheal tube. With the aid of a surgical microscope and microsurgery materials, a modified eye evisceration was performed. Post-operatively, the owl received meloxicam [Maxicam® - 0.5 mg/kg, IM] and tramadol hydrochloride [Cronidor® - 15 mg/kg, orally for 4 days]. The day after surgery, the owl was comfortable and its usual appetite was regained. The patient remained hospitalized for 3 weeks and was evaluated daily. The skin sutures were removed 10 days after the surgical procedure and the surgical wound had healed normally. The patient was reintroduced into the wild after 2 months. During the 6 months post-release, the bird was evaluated once a month, and no complications were observed. Discussion: Severe eye trauma and complicated corneal ulcers are common causes of eyeball removal in birds. In birds, there is a high risk of complications during enucleation. The fragility of the orbital bones makes them susceptible to trauma during the surgery. Evisceration involves the removal of the inner contents of the eye while leaving the cornea and the sclera intact. In the current case, evisceration was chosen because the eye was blind, and maintaining a blind eye would be a source of pain and infection. In the modified evisceration technique, the risk of complications is minimal compared to enucleation, mainly because surgical manipulation is minimal. In our case, the total surgery time was 20 min. Another complication reported after enucleation in birds is the possibility of disfiguring the bird because the removal of the globe disturbs the natural head balance. To avoid these complications, the use of an intraocular prosthesis after evisceration in birds has been performed. However, owls have a tubular-shaped globe with scleral ossicles. These factors could hinder or even prevent the accommodation of a cylindrical silicone prosthesis. In the present case, an intraocular prosthesis implant was never considered due to the unavailability of the prosthesis and to avoid the risk of postoperative complications that have been reported from the literature in dogs. In this case, the owl recovered well from anesthesia without complications, and no postoperative hemorrhage was observed. No signs of pain were observed during the postoperative period and the owl had already shown an appetite and fed on the first postoperative day. The previously published reports using the modified evisceration technique also demonstrated an absence of pain signs during the postoperative period.(AU)

Clinical, surgical, and radiographic aspects in a white-eared opossum (Didelphis albiventris) with traumatic diaphragmatic hernia / Aspectos clínicos, cirúrgicos e radiográficos em um Gambá-de-orelha-branca (Didelphis albiventris) com hérnia diafragmática traumática

This is the case of a specimen of Didelphis albiventris with signs of respiratory difficulty after a dog attack. Thoracic radiographic examination revealed pneumothorax, pulmonary contusion, and rib fracture, but no alteration compatible with diaphragmatic hernia was observed. Pneumothorax was reduced and the other alterations were treated. However, clinical manifestations persisted, and thus a contrast-gastrointestinal radiographic study was performed, showing abdominal organs in the thoracic cavity and loss of diaphragmatic line. The surgical approach was instituted, with access to the diaphragm through median laparotomy. Through the diaphragmatic rupture, present in the left antimere, there were herniated liver and gastric portions, intestinal segments, and omentum. After inspection and repositioning of the abdominal organs, the diaphragm raffia was performed with single sutures interrupted with 3-0 Nylon thread. The patient’s complete recovery occurred 14 days after the surgical procedure, with remission of clinical manifestations and normality of thoracic images in radiographic studies.

Esse é o caso de um espécime de Didelphis albiventris com sinais de dificuldade respiratória após ataque por cão. O exame radiográfico torácico revelou pneumotórax, contusão pulmonar e fratura de costelas, porém nenhuma alteração com-patível com hérnia diafragmática foi observada. O pneumotórax foi reduzido e as demais alterações tratadas. Contudo; houve a persistência das manifestações clínicas, e dessa forma um estudo radiográfico gastrointestinal contrastado foi realizado, sendo evidenciados órgãos abdominais na cavidade torácica e perda da linha diafragmática. A abordagem cirúrgica foi instituída, com acesso ao diafragma por meio de laparotomia mediana. Através da ruptura diafragmática, presente no antímero esquerdo, estavam herniadas porções hepáticas e gástricas, segmentos intestinais e omento. Após inspeção e reposicionamento dos órgãos abdominais, a rafia do diafragma foi realizada com suturas simples interrompidas com fio Nylon 3-0. A recuperação completa do paciente ocorreu 14 dias após o procedimento cirúrgico, com remissão das manifestações clínicas e normalidade das ima-gens torácicas nos estudos radiográficos.

Clinical, surgical, and radiographic aspects in a white-eared opossum (Didelphis albiventris) with traumatic diaphragmatic hernia / Aspectos clínicos, cirúrgicos e radiográficos em um Gambá-de-orelha-branca (Didelphis albiventris) com hérnia diafragmática traumática

This is the case of a specimen of Didelphis albiventris with signs of respiratory difficulty after a dog attack. Thoracic radiographic examination revealed pneumothorax, pulmonary contusion, and rib fracture, but no alteration compatible with diaphragmatic hernia was observed. Pneumothorax was reduced and the other alterations were treated. However, clinical manifestations persisted, and thus a contrast-gastrointestinal radiographic study was performed, showing abdominal organs in the thoracic cavity and loss of diaphragmatic line. The surgical approach was instituted, with access to the diaphragm through median laparotomy. Through the diaphragmatic rupture, present in the left antimere, there were herniated liver and gastric portions, intestinal segments, and omentum. After inspection and repositioning of the abdominal organs, the diaphragm raffia was performed with single sutures interrupted with 3-0 Nylon thread. The patients complete recovery occurred 14 days after the surgical procedure, with remission of clinical manifestations and normality of thoracic images in radiographic studies.(AU)

Esse é o caso de um espécime de Didelphis albiventris com sinais de dificuldade respiratória após ataque por cão. O exame radiográfico torácico revelou pneumotórax, contusão pulmonar e fratura de costelas, porém nenhuma alteração com-patível com hérnia diafragmática foi observada. O pneumotórax foi reduzido e as demais alterações tratadas. Contudo; houve a persistência das manifestações clínicas, e dessa forma um estudo radiográfico gastrointestinal contrastado foi realizado, sendo evidenciados órgãos abdominais na cavidade torácica e perda da linha diafragmática. A abordagem cirúrgica foi instituída, com acesso ao diafragma por meio de laparotomia mediana. Através da ruptura diafragmática, presente no antímero esquerdo, estavam herniadas porções hepáticas e gástricas, segmentos intestinais e omento. Após inspeção e reposicionamento dos órgãos abdominais, a rafia do diafragma foi realizada com suturas simples interrompidas com fio Nylon 3-0. A recuperação completa do paciente ocorreu 14 dias após o procedimento cirúrgico, com remissão das manifestações clínicas e normalidade das ima-gens torácicas nos estudos radiográficos.(AU)

Hernioplastia com aplicação de tela por laparoscopia em equino com hérnia incisional / Hernioplasty with laparoscopy mesh application in equine with incisional hernia

Background: Incisional hernia in the midline can be a consequence of abdominal surgeries, which incidence is around5.7-18%. Surgical indication occurs in cases of large hernias, and the most common techniques used involve the closingof the musculature in a primary way, with sutures, and the implantation of a mesh on the abdominal wall. Laparoscopichernioplasty emerged as a less invasive option, showing superiority when compared with open surgical techniques in human medicine, however there are few reports describing this technique in equines. So, the aim of this paper is to report acase of hernioplasty, using laparoscopic mesh, in a horse with midline incisional hernia.Case: A 13-year-old castrated male Brasileiro de Hipismo horse, weighing 415 kg, practitioner of classic equestrian, presented an incisional hernia after 14 days from an exploratory laparotomy surgery realized to treat colic syndrome. After 6months, the patient was referred to a Veterinary Medicine Teaching Hospital for the correction of the defect in the abdominal wall. During palpation, the animal did not present local pain or other sign of inflammation, and the hernia measuredapproximately 20 cm in diameter. The animal was submitted to general anesthesia and placed in dorsal decubitus for thehernioplasty surgical procedure. An incision was made in cranial region of the midline, close to the xiphoid to introduce asingle port; the abdomen was inflated with CO2 gas (12 mmHg) and the operating table was tilted in order to displace theorgans cranially, facilitating the laparoscopic procedure. The abdomen was inspected and the presence of a single adherence could be observed, which was disrupted with endoscopic forceps. The mesh was introduced through the single port...

Hernioplastia com aplicação de tela por laparoscopia em equino com hérnia incisional / Hernioplasty with laparoscopy mesh application in equine with incisional hernia

Background: Incisional hernia in the midline can be a consequence of abdominal surgeries, which incidence is around5.7-18%. Surgical indication occurs in cases of large hernias, and the most common techniques used involve the closingof the musculature in a primary way, with sutures, and the implantation of a mesh on the abdominal wall. Laparoscopichernioplasty emerged as a less invasive option, showing superiority when compared with open surgical techniques in human medicine, however there are few reports describing this technique in equines. So, the aim of this paper is to report acase of hernioplasty, using laparoscopic mesh, in a horse with midline incisional hernia.Case: A 13-year-old castrated male Brasileiro de Hipismo horse, weighing 415 kg, practitioner of classic equestrian, presented an incisional hernia after 14 days from an exploratory laparotomy surgery realized to treat colic syndrome. After 6months, the patient was referred to a Veterinary Medicine Teaching Hospital for the correction of the defect in the abdominal wall. During palpation, the animal did not present local pain or other sign of inflammation, and the hernia measuredapproximately 20 cm in diameter. The animal was submitted to general anesthesia and placed in dorsal decubitus for thehernioplasty surgical procedure. An incision was made in cranial region of the midline, close to the xiphoid to introduce asingle port; the abdomen was inflated with CO2 gas (12 mmHg) and the operating table was tilted in order to displace theorgans cranially, facilitating the laparoscopic procedure. The abdomen was inspected and the presence of a single adherence could be observed, which was disrupted with endoscopic forceps. The mesh was introduced through the single port...(AU)

Cicatrização da musculatura reto-abdominal em coelhos submetidos à laparorrafia com fios de sutura à base de quitosana, categute cromado e poliglactina 910 / [Healing of the rectus abdominis muscle in rabbits submitted to laparorrhaphy with suture-based chitosan, chromic catgut and polyglactin 910]

Objetivou-se, com este estudo, avaliar o processo de cicatrização da musculatura reto-abdominal em coelhos submetidos à laparorrafia, utilizando-se o fio de sutura à base de quitosana, comparando-o aos fios de categute cromado e poliglactina 910. Foram utilizados 24 coelhos adultos, divididos aleatoriamente em quatro grupos: quitosana e categute 15 dias (QC-15dias), quitosana e categute 30 dias (QC-30 dias), quitosana e poliglactina 910 15 dias (QP-15 dias) e quitosana e poliglactina 910 30 dias (QP-30 dias). Cada grupo foi composto por seis coelhos, nos quais foram realizadas duas incisões, uma do lado direito e outra do lado esquerdo e, posteriormente, a laparorrafia, com o fio de quitosana de um lado e o categute cromado ou poliglactina 910 do outro. Realizou-se análise clínico-cirúrgica, histológica e avaliação de achados de necropsia, além de testes de citotoxicidade e de mecânica no fio de quitosana. Ele apresentou baixa resistência mecânica e citotóxica. O fio de quitosana não proporcionou uma cicatrização satisfatória em coelhos, pois desencadeou uma resposta inflamatória acentuada.(AU)

The objective of this study was to evaluate the healing process of the recto-abdominal muscles in rabbits submitted to laparorrhaphy using chitosan-based suture yarn, comparing it to chrome catgut and polyglactin 910 yarns. Twenty-four adult rabbits were divided in to four random groups: chitosan and polyglactin 910 15 days (QP-15 days) and chitosan and polyglactin 910 30 days (QC-30 days), chitosan and polyglactin 910 15 days (QP-15 days) QP-30 days). Each group consisted of six rabbits, in which two incisions were made, one on the right side and one on the left side, and later the laparorraphy with the chitosan yarn on one side and chromed catgut or polyglactin 910 on the other. Clinical-surgical, histological and necropsy findings were evaluated, as well as cytotoxicity and mechanical tests on the chitosan wire. It presented low mechanical and cytotoxic resistance. Chitosan thread did not provide satisfactory healing in rabbits, as it triggered a marked inflammatory response.(AU)

Iliofemoral technique modification using an anchor screw as treatment of canine traumatic hip luxation - case report / [Modificação da técnica de sutura iliofemoral com uso de parafuso âncora no tratamento da luxação coxofemoral traumática em cães - relato de caso]

Twelve dogs with traumatic hip luxation were selected for surgical intervention with a modified iliofemoral suture technique using an anchor screw to substitute the passage of suture material through a perforated tunnel in the ilium. Six procedures were performed with non-absorbable suture and other six with absorbable suture materials. These cases were evaluated at 15, 30, 60, and 90 days after surgery by performing an ambulation analysis and palpation of the joint. In all cases, there was a return of partial and total limb support in an average of 3 and 19 postoperative, respectively. The fixation strategy of the suture material in the ilium using an anchor screw proved to be efficient with a smaller surgical approach and lesser surgical difficulty, maintaining joint congruence in acute as chronic luxation cases. The use of absorbable and non-absorbable sutures had excellent clinical results, but there was a subjective superiority of the first ones, once 4 dogs of the non-absorbable group presented some discomfort during the postoperative palpation of the joint, 90 days after surgery.(AU)

Doze cães com luxação coxofemoral traumática foram submetidos à intervenção cirúrgica de sutura iliofemoral modificada com uso de parafuso âncora substituindo a passagem de fio através de túnel perfurado no ílio. Seis procedimentos foram realizados com fio não absorvível, e outros seis com fio absorvível. Os casos foram avaliados aos 15, 30, 60 e 90 dias após a cirurgia, por meio de análise de deambulação e palpação articular. Em todos os casos, houve retorno de suporte parcial e total do peso no membro operado, em média, aos três e 19 dias de pós-operatório, respectivamente. A estratégia de fixação do fio de sutura no ílio com parafuso âncora se mostrou eficaz, permitindo uma abordagem cirúrgica menos invasiva, com menor dificuldade na execução, garantindo manutenção da congruência articular tanto em quadros de luxação aguda como crônica. O uso de fio absorvível e não absorvível teve bons resultados clínicos, porém houve uma superioridade subjetiva do primeiro, uma vez que quatro pacientes do grupo fio inabsorvível mostraram desconforto à palpação da articulação aos 90 dias após a cirurgia.(AU)

The effect of fibrin glue in preventing staple-line leak after sleeve gastrectomy. An experimental study in rats

Abstract Purpose To evaluate the effect of fibrin glue on staple-line leak after sleeve gastrectomy. Methods Fourteen adult wistar rats 300 gr were randomized into two groups: Control group (n=7) and study group (n=7). All the rats underwent sleeve gastrectomy using lineer stapler. In the study group, fibrin glue was used to reinforce the staple-line. The rats were sacrificed 7 days after surgery. The stomach was resected, submerged in saline and exposed to excess pressure to obtain a burst pressure value. The gastric staple line was evaluated histopathologically according to the Ehrlich Hunt scale. The results of the two groups were compared. Results The mean Ehrlich-Hunt scores for inflammation, fibroblastic activity and neo-angiogenesis were similar between the groups (p>0.05). Collagen deposition was significantly higher in study group (3.42±0.53) when compared with control group (2.57±0.78) (p=0.035). The mean burst pressure was 137.8±8.5 mmHg for control group and 135.0±8.1 mmHg for study group (p=0.536). Conclusion Reinforcement of the staple-line with fibrin glue has no effect on the burst pressure after sleeve gastrectomy. More studies are needed to evaluate the precautions against leak after sleeve gastrectomy.(AU)

The alternative model of silicone for experimental simulation of suture of living tissue in the teaching of surgical technique

Purpose: To develop a silicone alternative model of tissue suture simulation to be used in the teaching of surgical technique. Methods: Twelve alternative models of silicone for tissue suture simulation were manufactured and implemented as a tool for suture pattern training of undergraduate medical students of Universidade Federal do Amazonas. Forty-eight students participated in the research. The evaluation of the proposed model was done through a questionnaire using the Likert scale, in order to verify the student satisfaction index of the alternative resource and its performance as opposed to the model historically used in the discipline, which is to suture in cloths. Results: The alternative model showed satisfactory results, especially with respect to the structural aspect, such as, better perception of anatomical planes, handling and transport. About 89.58% of positive concordant responses demonstrating expressive approval for incorporation of a complementary form of the alternative methodological proposal of the discipline of surgical technique. Conclusions: The model developed for experimental simulation of tissue sutures has proved to be a fully feasible alternative method for the training of this surgical skill. It is a simple, reproducible and low-cost model.(AU)

Absorbable suture. Best aesthetic outcome in cesarian scar

Purpose:To compare two suture threads, poliglecaprone 25 and nylon, used as intradermal suture for skin closure in women undergoing their first cesarean section.Methods:This is a randomized clinical trial. A total of 60 women undergoing their first cesarean section were enrolled and prospectively assessed. They were randomly allocated to group I (n=30), which received an intradermal suture with nylon 4.0 or to group II (n=30), which had an intradermal suture with poliglecaprone 25, 4.0. The main author took standardized photographs of the scar 6 months after the operation. Four independent raters, two senior obstetricians and two senior plastic surgeons (a male and a female physician from each specialty) assessed the photographs.The panelists rated the scar according to Trimbos scale, composed by the subscales hypertrophy, color and width of the scar.Results:At baseline, patients in both groups were similar regarding age and body mass index. Five patients withdraw the study, four from group and one from group II. Scars of patients from group II were significantly less hypertrophic (p=0.001), thinner (p=0.019) and had more acceptable color (p=0.019).Conclusion:The intradermal suture with poliglecaprone 25 for skin closure after cesarean incision provides better aesthetic result.(AU)

Evaluation of ventral laparoscopic abomasopexy using surgical staples associated with suture material in dairy cattle

Background: Displaced Abomasum is known for being on of the main illnesses that affect milking cows. Increase in diagnosis of this illness is due to advancement in diagnosis techniques. Increase in incidence of this illness can be explained by genetic selection of animals with high production, breed systems and changes to the diet with a higher level of protein. For laparoscopic treatment, several surgical changes were performed to optimize the procedure and thus achieve better results. The main purpose of this study was to evaluate applicability of the ventral laparoscopic abomasopexy technique, using surgical clamps attached to the suture thread, to milking cows.Materials, Methods & Results: Six adult cows were placed under anesthesia with isoflurane and placed in dorsal decubitus. Animals were kept with no water for 24 h and no food for 48 h. Four laparoscopic accesses were performed. The first one was created with the intention of inspecting the abdominal cavity and the remaining three for access of surgical instruments. Serous membrane of the abomasum was cauterized, combined with suture threads and placed at the greater abomasal curvature. The free part of suture threads was kept out of the abdominal cavity and after traction of the abomasum against the abdominal wall was tied to the skin. Ultrasound exam was performed for abdominal evaluation after abomasopexy. Anesthesia time and surgery time were recorded and analyzes through average and standard deviation (SD). The average anesthesia time recorded was 94 min (SD 14.63 min) and average surgery time was 51 min (SD 14.71 min). The fasting period was considered adequate, however all animals had to undergo intubation with orogastric tube to drain liquids and gas during the procedure. Four of the six animals had lineal adhesion. Three of the four animals that had adhesion did not keep the abomasum at the retroperitoneal area, however viscera movement was stopped in the abdominal cavity.[...]