Surgical excision of P3 fragments in 86 declawed cats: case series (2013-2023).

CASE SERIES SUMMARY: This case series describes the clinical findings and surgical intervention of 86 declawed cats; 52 from a shelter or rescue and 34 owned cats. Historical reports from owners and shelter staff included house-soiling, biting behavior, repelling behavior, barbering, lameness, chronic digit infection and nail regrowth. All the cats had fragments of the third phalanx (P3) of varying sizes diagnosed on radiographs. Pathology visible on examination included digital subcutaneous swelling, ecchymosis, malaligned digital pads, ulcerations, exudate, tendon contracture, nail regrowth and callusing. Surgery was pursued in these cases to remove the P3 fragments, relieve tendon contracture and reposition the digital pads with an anchoring suture. Gross findings intraoperatively included fragmented growth of cornified and non-cornified nail tissue, osteophytes on the surface of the second phalanx, deep digital flexor tendon calcification, and both bacterial and sterile exudate. The most common complication 14 days postoperatively was mild (14%) to moderate (1%) lameness. All historical parameters recorded improved in both populations of cats (house-soiling, biting behavior, repelling behavior, barbering, lameness, tendon contracture and chronic digit infection). Postoperatively, 1/47 cats exhibited continued malalignment of two digital pads and there were no reports of long-term postoperative lameness. RELEVANCE AND NOVEL INFORMATION: Two methods of declawing cats are detailed in the veterinary literature, including partial amputation of P3 and disarticulation of the entire P3 bone. The novel information in this report includes historical and clinical signs of declawed cats with P3 fragments, intraoperative gross pathology, surgical intervention and the postoperative follow-up results.

Lesions found at foot trimming of dairy goats: Baseline data for comparing lesions and locomotion scoring.

Data on the foot lesions of housed dairy goats, especially those that are not lame, is sparse. In this study, visits were made to four farms for whole herd locomotion scoring after milking and to observe routine foot trimming. During trimming, the amount of trimming required for each hoof was recorded, alongside the presence of lesions. The process was repeated at the next routine foot trim on three of the four farms (on Farm 1 whole herd locomotion scoring after milking was not feasible). Across both visits, 3445 locomotion scores were recorded, alongside 3850 trimming and lesion records. There were large differences between farms and visits in the proportion of lame goats (6.7 to 25.5%) and in the proportion of goats which needed a substantial trim of all four feet (15.1-33.1%). Hoof lesions were observed in 65.5% of trimmed goats. We defined lesions by their site and presence of separation and/or granuloma, with white line separation being the most commonly recorded lesion (41.5% of goats). On all visits on the three farms which were locomotion scored, the number of goats recorded as lame was lower than the number observed with white line lesions, but the relative proportion ranged from 17% to 95.4%. Separations were much more common than granulomas, as granulomas were usually accompanied by separation. Toe lesions were much more likely to be associated with granulomas than white line lesions, with 91.5% of toe separations having granulomas but only 10.6% of white line separations. This study provides useful baseline data for comparing lesions and locomotion scoring between goat herds but also identifies areas where we need more data and more consensus.

Other Clinical Problems of the Equine Foot.

Many disorders affect the equine foot, and many hoof problems have multiple predisposing causes. Surgery may be necessary after conservative management has failed. Diseases of the hoof capsule may seem simple, but their effect on performance can be long-lasting and healing is often prolonged. Diagnosis of problems within the hoof capsule is enhanced with the use of computed tomography and MRI. The prognosis of fractures has improved with strategic placement of lag screws across fracture planes using aiming devices and advanced intraoperative imaging techniques. Collaboration between the clinician and a skilled farrier is important for successful management of hoof disorders.

Platelet-rich Plasma Combined With a Sterile 3D Polylactic Acid Scaffold for Postoperative Management of Complete Hoof Wall Resection for Keratoma in Four Horses.

Keratoma is a nonmalignant horse tumor that grows in the space between the horn of the hoof and the distal phalanx. Keratoma causes lameness in the horse, and surgical excision is the treatment of choice. Four horses underwent removal of a keratoma by complete hoof wall resection. The remaining wound was treated with platelet-rich plasma (PRP) combined with a sterile three-dimensional polylactic acid scaffold. The PRP was applied at 3, 6, 9, 12, 15, and 18 days postoperatively. The surgical site was cleaned with gauzes and swabs soaked in Ringer's lactate solution before applying PRP and the foot bandage. Healthy granulation tissue developed at 6-21 days postoperatively. The hoof wall defect was completely filled with new hoof wall within 6-8 months after surgery. All horses returned to their previous exercise level, and no recurrence of lameness was reported by the owner.

Combination effect of allyl isothiocyanate and hoof trimming on bovine digital dermatitis.

Digital Dermatitis is a localized infectious dermatitis caused by Treponema-like spirochetes. Antibiotics, such as lincomycin, are currently used for treatment, but their use imposes a withdrawal period. This study investigated the therapeutic effect of topical application of the natural component allyl isothiocyanate, in combination with maintenance hoof trimming, on bovine Digital Dermatitis. Study cows were divided into two groups, the Trimming Group and Non-Trimming Group. The day when allyl isothiocyanate was applied, along with hoof trimming, was set as Day 0. Lesion scores, pain, and the presence of Treponema-like spirochetes on the surface of hooves and in biopsy samples of the tissues were evaluated until Day 6. Both groups showed improvement of lesion scores and improved elimination of Treponema-like spirochetes from within the tissues. The presence of Treponema-like spirochetes on the surface of lesions was significantly higher in the Non-Trimming Group by Day 6. These results suggest that allyl isothiocyanate has therapeutic effects on Digital Dermatitis, when combined with hoof trimming, and may prevent a relapse of dermatitis and a re-infection of Treponema-like spirochetes.

Modified abaxial approach for resection of the distal sesamoid bone and distal interphalangeal joint while preserving the digital flexor tendons of three Angus bulls with septic arthritis.

CASE DESCRIPTION 3 Angus bulls, aged 2 to 3 years, with severe lameness of 2 to 4 weeks' duration and swelling proximal to the coronary band of the affected limb were evaluated after failing to respond to antimicrobial treatment. CLINICAL FINDINGS Septic arthritis of a distal interphalangeal joint (DIPJ) was diagnosed in all 3 bulls on the basis of results of a physical examination, radiographic and ultrasonographic evaluations of the affected foot, and cytologic evaluation of synovial fluid from the affected DIPJ. TREATMENT AND OUTCOME A novel modified abaxial approach was used to resect the infected distal sesamoid bone (navicular bone) and DIPJ of all 3 bulls. A window was created in the abaxial hoof wall that was lateral to and of sufficient size to extract the navicular bone. Following removal of the navicular bone, the DIPJ was debrided and resected and an orthopedic block was applied to the contralateral claw to minimize weight bearing on the infected digit. Two bulls also had a fiberglass cast applied to the affected limb to help immobilize the DIPJ. All 3 bulls recovered without complications, and 2 bulls were no longer lame, whereas the remaining bull was only mildly lame, at 4 to 5 weeks after surgery. CLINICAL RELEVANCE The modified abaxial approach described for surgical resection of the DIPJ allowed extraction of the infected navicular bone without damage to the digital flexor tendons, something that cannot be achieved with other abaxial approaches. This approach is best used for patients without septic tenosynovitis.

Pain and adverse behavior in declawed cats.

Objectives The aim of this study was to assess the impact of onychectomy (declawing) upon subsequent development of back pain and unwanted behavior in cohorts of treated and control cats housed in two different locations. Methods This was a retrospective cohort study. In total, there was 137 declawed and 137 non-declawed cats, of which 176 were owned cats (88 declawed, 88 non-declawed) and 98 were shelter cats (49 declawed and 49 non-declawed). All cats were physically examined for signs of pain and barbering. The previous 2 years of medical history were reviewed for documented unwanted behavior such as inappropriate elimination and biting with minimal provocation and aggression. All declawed cats were radiographed for distal limb abnormalities, including P3 (third phalanx) bone fragments. The associations of declaw surgery with the outcomes of interest were examined using χ2 analysis, two sample t-tests and manual, backwards, stepwise logistic regression. Results Significant increases in the odds of back pain (odds ratio [OR] 2.9), periuria/perichezia (OR 7.2), biting (OR 4.5) and barbering (OR 3.06) occurred in declawed compared with control cats. Of the 137 declawed cats, 86 (63%) showed radiographic evidence of residual P3 fragments. The odds of back pain (OR 2.66), periuria/perichezia (OR 2.52) and aggression (OR 8.9) were significantly increased in declawed cats with retained P3 fragments compared with those declawed cats without. Optimal surgical technique, with removal of P3 in its entirety, was associated with fewer adverse outcomes and lower odds of these outcomes, but operated animals remained at increased odds of biting (OR 3.0) and undesirable habits of elimination (OR 4.0) compared with non-surgical controls. Conclusions and relevance Declawing cats increases the risk of unwanted behaviors and may increase risk for developing back pain. Evidence of inadequate surgical technique was common in the study population. Among declawed cats, retained P3 fragments further increased the risk of developing back pain and adverse behaviors. The use of optimal surgical technique does not eliminate the risk of adverse behavior subsequent to onychectomy.

Pilot evaluation of a novel unilateral onychectomy model and efficacy of an extended release buprenorphine product.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs), transdermal fentanyl patches, and transmucosal buprenorphine are probably the most commonly used options for providing post-operative analgesia in the early at-home period. However, these require daily administration or are associated with abuse concerns. One of the significant unmet needs in veterinary surgery and pain management is for longer acting opioids for cats to effectively bridge the gap between the in-hospital and at-home recovery periods. A proof of concept study of an extended release formulation of buprenorphine HCL (ER-Bup) was conducted using objective kinetic measures and a unilateral onychectomy model. Using a blinded, randomized, two period crossover design, four cats were allocated to control (saline) or ER-Bup (0.6 mg/kg, subcutaneously [SC]) treatment groups. All animals underwent a unilateral forelimb onychectomy per period with a washout/recovery period in between. Observational pain scores and kinetic data (using a pressure sensitive walkway [PSW]) were collected prior to (baseline) and at intervals for 72 h following surgery. Symmetry indices were derived for kinetic variables (peak vertical force [PVF]; vertical impulse [VI]) of each forelimb for landing following a jump and for walking. A rescue analgesic protocol was in place. Effect of surgery and treatment were evaluated using a mixed model statistical approach. RESULTS: No cats required rescue analgesics based on subjective pain score. ER-Bup had a positive influence on subjective pain scores during the 72 h postsurgery (p = 0.0473). PVF and VI of the operated limb were significantly decreased for both landing (p < 0.0001 and p < 0.0001) and walking (p < 0.0001 and p < 0.0001 respectively) compared to control. ER-Bup resulted in significantly decreased asymmetry in limb use during landing (PVF, p < 0.0001; VI, p < 0.0001) and walking (PVF, p = 0.0002, VI, p < 0.0001). The novel use of data collected following a jump from an elevated platform appeared to provide all desired information and was easier to collect than walking data. CONCLUSION: This study demonstrates that SC administration of ER-Bup may be an effective analgesic for a 72 h period postoperatively. Furthermore, landing onto a PSW from an elevated perch may be a useful and efficient way to assess analgesics in cats using a unilateral model of limb pain.

Flightless I Expression Enhances Murine Claw Regeneration Following Digit Amputation.

The mammalian digit tip is capable of both reparative and regenerative wound healing dependent on the level of amputation injury. Removal of the distal third of the terminal phalange results in successful regeneration, whereas a more severe, proximal, amputation heals by tissue repair. Flightless I (Flii) is involved in both tissue repair and regeneration. It negatively regulates wound repair but elicits a positive effect in hair follicle regeneration, with Flii overexpression resulting in significantly longer hair fibers. Using a model of digit amputation in Flii overexpressing (FIT) mice, we investigated Flii in digit regeneration. Both wild-type and FIT digits regenerated after distal amputation with newly regenerated FIT claws being significantly longer than intact controls. No regeneration was observed in wild-type mice after severe proximal amputation; however, FIT mice showed significant regeneration of the missing digit. Using a three-dimensional model of nail formation, connective tissue fibroblasts isolated from the mesenchymal tissue surrounding the wild-type and FIT digit tips and cocultured with skin keratinocytes demonstrated aggregate structures resembling rudimentary nail buds only when Flii was overexpressed. Moreover, ß-catenin and cyclin D1 expression was maintained in the FIT regenerating germinal matrix suggesting a potential interaction of Flii with Wnt signaling during regeneration.

Effect of Cortical Screw Diameter on Reduction and Stabilization of Type III Distal Phalanx Fractures: An Equine Cadaveric Study.

OBJECTIVE: To compare reduction of type III distal phalangeal fractures using 4.5 and 5.5 mm cortical screws placed in lag fashion and an intact hoof capsule model. STUDY DESIGN: Cadaveric experimental study. SAMPLE POPULATION: Hooves from 12 adult horses (n=24). METHODS: Sagittal fractures were created in pairs of distal phalanges after distal interphalangeal joint disarticulation and were reduced with either 4.5 or 5.5 mm cortical screws placed in lag fashion. Contralateral phalanges served as non-reduced controls. Fracture reduction following screw placement was assessed by comparing pre-reduction and post-reduction fracture gap measurements from radiographs using paired t-tests. Effects of incremental loading (0, 135, 270, 540, 800, 1070, and 1335 kg) on fracture gaps in 6 phalanges reduced with 4.5 mm screws and 5 phalanges reduced with 5.5 mm screws were measured from fluoroscopic images and assessed by 2-way ANOVA. Significance was set at P<.05. RESULTS: Type III distal phalanx fractures were reliably created. Only 5.5 mm cortical screws, not 4.5 mm screws, significantly reduced fracture gaps and constrained fracture gap expansion 3 cm distal to the articular surface. Compressive loading closed the fracture gaps at the articular surface in both non-reduced control groups and those reduced with either 5.5 or 4.5 mm screws. CONCLUSION: The 5.5 mm cortical screws were more effective than 4.5 mm screws in reducing type III distal phalanx fractures and restricting distal fracture gap expansion under load.

Feline onychectomy: Current practices and perceptions of veterinarians in Ontario, Canada.

The objective of the study was to determine the proportion of practitioners from Ontario, Canada who perform onychectomy, identify the techniques utilized, and obtain practitioners views on the procedure. An anonymous survey was distributed to Ontario Veterinary Medical Association members. Mann-Whitney U-tests were used to compare responses of opinion questions related to declawing between respondents who indicated they perform declawing procedures and those who do not. Of 500 respondents, 75.8% reported performing onychectomy, with 60.1% of those reporting performing the procedure less than monthly and 73.3% only performing the procedure after recommending alternatives. Statistically significant differences were found between those who do and those who do not perform onychectomy for perception of procedural pain, concept of mutilation, perception of procedural necessity for behavior modification or prevention of euthanasia, and support of province-wide procedural bans.

Onychectomie féline : pratiques et perceptions actuelles des vétérinaires en Ontario, Canada. L'objectif de l'étude consistait à déterminer la proportion de praticiens en Ontario, au Canada, qui réalisent l'onychectomie, d'identifier les techniques utilisées et d'obtenir le point de vue des praticiens sur l'intervention. Un sondage anonyme a été distribué aux membres de l'Ontario Veterinary Medical Association. Des tests U de Mann-Whitney ont été utilisés pour comparer les réponses aux questions d'opinion portant sur le dégriffage entre les répondants qui avaient indiqué qu'ils réalisaient des interventions de dégriffage et ceux qui n'en effectuaient pas. Parmi les 500 répondants, 75,8 % ont déclaré qu'ils réalisaient l'onychectomie : 60,1 % ont déclaré la réaliser moins d'une fois par mois et 73,3 % ont dit l'effectuer après avoir recommandé des solutions de remplacement. Des différences statistiquement significatives ont été constatées entre ceux qui réalisaient l'onychectomie et ceux qui ne la réalisaient pas, au niveau de la perception de la douleur associée à l'intervention, du concept de mutilation, de la nécessité de l'intervention pour la modification du comportement ou la prévention de l'euthanasie et de l'appui d'une interdiction à l'échelle de province.(Traduit par Isabelle Vallières).

Survey of practices and perceptions regarding feline onychectomy among private practitioners.

OBJECTIVE To estimate the proportion of veterinarians working with feline patients in private practices who do or do not perform onychectomy and assess attitudes regarding and practices related to onychectomy in a large population of veterinary practitioners. DESIGN Anonymous online survey. SAMPLE 3,441 veterinarians. PROCEDURES An online survey was provided to members of the Veterinary Information Network from June 18, 2014, through July 9, 2014. Descriptive statistics and frequency distributions for applicable response types were calculated, and Mann-Whitney U tests were conducted to compare responses to onychectomy-related opinion questions between respondents who indicated they did or did not perform the procedure. Not all respondents answered every question. RESULTS 2,503 of 3,441 (72.7%) survey respondents reported performing onychectomy, and 827 (24.0%) indicated they did not; 1,534 of 2,498 (61.4%) performing the procedure reported a frequency of < 1 onychectomy/month. Most (2,256/3,023 [74.6%]) respondents who performed onychectomy indicated that they recommended nonsurgical alternatives. Surgical techniques and approaches to analgesia varied, with use of a scalpel only (1,046/1,722 [60.7%]) and perioperative administration of injectable opioids (1,933/2,482 [77.9%]) most commonly reported. Responses to opinion questions in regard to the degree of pain associated with onychectomy and recovery; whether declawing is a form of mutilation, is necessary in some cats for behavioral reasons, or is a necessary alternative to euthanasia in some cats; and whether state organizations should support a legislative ban on onychectomy differed significantly between respondents who did and did not perform the procedure. CONCLUSIONS AND CLINICAL RELEVANCE Onychectomy is a controversial topic, and this was reflected in survey results. In this sample, most veterinarians performing the procedure reported that they did so infrequently, and most offered nonsurgical alternatives to the procedure.

Complete ostectomy of middle phalanx and partial ostectomy of proximal phalanx in a Brown Swiss calf for treatment of purulent arthritis of the proximal interphalangeal joint and adjacent severe osteomyelitis.

A five month old Brown Swiss heifer calf (212 kg body mass) with severe left hind limb lameness, caused by a wound of the lateral digit was referred to the veterinary teaching hospital. The calf showed a score 4 of 5 lameness on the left hind limb. A scarified skin lesion with a fistula formation and purulent exudate was observed at the level of the proximal interphalangeal joint (PIJ) of the lateral digit of the left hind. The PIJ region and the lateral digit were severely swollen and painful. Ultrasonography showed a moderate anechoic effusion of the lateral digital flexor tendon sheet (DFTS) and a severe heterogeneous hypoechoic effusion with some small hyperechoic areas of the plantar and dorsal pouch of the PIJ. In addition, a highly irregular contour of the dorsal and abaxial surface of the phalanx media (P2) and the distal aspect of the proximal phalanx (P1) were imaged. Based on physical examination and ultrasonographic findings, the diagnosis was chronic purulent arthritis of the PIJ, osteitis of P2 and the distal end of P1 with suspected adjacent osteomyelitis. Complete ostectomy of P2 and ostectomy of the distal part of the P1 of the lateral digit was performed with an oscillating saw through the extended debrided wound. The lameness improved subsequently and 21 days post-surgery the calf was discharged from the clinic without lameness, and with a wooden block attached to the healthy claw. A year later the heifer was pregnant and still in the herd, during this period it did not exhibit lameness. The described surgical technique resulted in an excellent long-term outcome and may be considered in cases of severe purulent joint infection of the PIJ with osteolytic processes in adjacent bones, as a digit salvage procedure especially for young cattle.

Surgical Management of Orthopedic and Musculoskeletal Diseases of Feedlot Calves.

Injuries, infections, and disorders of the musculoskeletal system are common in feedlot calves. These conditions often are amenable to surgical treatment with return of the calf to productivity. Weight gain and carcass quality are expected to be significantly adversely affected by pain and debilitation. The goal of surgical management of disorders of the joints, muscles, and feet should be resolution of the inciting cause, mitigation of pain, and restoration of form and function. If these are achieved, calves should return to acceptable, if not normal, feed intake, rate of gain, and carcass quality.

Prospective Randomized Study of the Effect of Music on the Efficiency of Surgical Closures.

BACKGROUND: Music is commonly played in operating theaters. Some surgeons believe music reduces stress and operative time, while others think music is a distraction and should be avoided. There is limited published evidence evaluating the effects of music on surgical performance. OBJECTIVE: The goal of this study is to evaluate the effect of music on simple wound closure. METHODS: Plastic surgery residents were asked to perform layered closures on pigs' feet with and without their preferred music playing. Simple randomization was used to assign residents to the music playing first or music playing second group. The time to complete the repair was measured and repairs were graded by blinded faculty. Results were analyzed to determine significant differences in time to complete the task and quality of repair. Participants were retested in a second session with music played in the opposite order to evaluate consistency. RESULTS: Listening to preferred music decreased repair time by 8% for all plastic surgery residents (p = 0.009). Subgroup analysis demonstrated even more significant improvement in speed for senior residents (PGY 4-6), resulting in a 10% decrease in repair time (p = 0.006). The quality of repair was also better in the music group, at 3.3 versus 3.1 (p = 0.047). Retesting revealed results remained significant whether music was played first or second. CONCLUSIONS: Playing preferred music made plastic surgery residents faster in completing wound closure with a 10% improvement in senior residents. Music also improved quality of repair as judged by blinded faculty. Our study showed that music improves efficiency of wound closure, which may translate to healthcare cost savings.

Effect of Presurgical Iodine-Based Disinfection on Bacterial Colonization of the Equine Peripodal Region.

OBJECTIVE: To compare bacterial colonization after diluted iodine tincture or povidone iodine solution for presurgical disinfection of the equine peripodal region. STUDY DESIGN: Complete block design. ANIMALS: Five horses. METHODS: Disinfection protocols using iodine tincture or povidone iodine solutions were tested on 5 pairs (n = 10) equine front feet. Iodine tincture was applied to the left feet and povidone iodine to the right feet. Fixed surfaces of the sole, frog, hoof wall, and peripodal skin were swabbed pre-preparation (T0), after a standard pre-disinfection step (T1), after short disinfection with a 4-minute application of 0.5% iodine tincture or povidone iodine (T2), and after long disinfection with 12-hour soaking in 0.25% iodine tincture or povidone iodine (T3). Quantitative bacteriology was performed on each swab. RESULTS: The frog and sole were the most contaminated sites compared to hoof wall and skin at T0. Bacterial counts were significantly decreased at T2 for both solutions. Bacterial counts did not change significantly with iodine tincture at T3 but increased with povidone iodine compared to T2. Skin abrasions were detected on almost all feet but were subjectively more severe on iodine tincture-treated feet. CONCLUSION: Soaking for 12 hours with either iodine tincture or povidone iodine is not recommended as these solutions damaged the skin and bacterial recolonization was noted with povidone iodine. Four-minute disinfection using either iodine tincture or povidone iodine (0.5% available iodine) is appropriate for presurgical preparation of the equine peripodal region.

Solar keratoma: An atypical case.

This case report shows that keratomas can occur in both hind feet of equine patients and should be considered as a diagnosis for long-standing, intermittent lameness localised to the hooves. A Thoroughbred racehorse presented with long-standing abscessation of the right hind hoof. Owing to the long-standing nature, the abscess draining tract was surgically explored. A focal mass was found within the solar horn. Histopathology revealed the mass to be a keratoma. A similar mass was removed from the left hind hoof a few months later after similar presenting signs. This case shows that keratomas can occur in more than one hoof within a short period and should be considered a differential diagnosis for long-standing lameness localised to the hoof.