Evaluation of a genicular axial pattern flap to repair large cutaneous tibial defects in two dogs.

BACKGROUND: Clinical outcome after cutaneous reconstruction using genicular artery flaps has not been reported. Major cutaneous defects of the pelvic limb between the stifle and hock are frequent in dogs and closure is difficult due to lack of available skin from immediately adjacent areas. CASE PRESENTATION: Here we report the first two clinical cases successfully managed by genicular axial pattern flap closure. A 2-year-old 38 kg (83.77-lb) intact male Labrador Retriever and a 14-year-old 42 kg (92.59-lb) spayed mixed breed female dog were admitted for the management of large skin defects in the lateral tibiotarsal joint. One defect was the result of a fibrosarcoma removal in the Labrador dog and the other defect was a chronic large wound caused by a car accident in the mixed breed female dog. Both defects were reconstructed by using genicular flaps. The bed of the wound in mixed breed dog was surgically debrided and underwent open wound management until a proper granulation tissue bed was formed before reconstruction. The skin defect in the Labrador dog was covered immediately after tumor removal. After surgery both dogs were bearing weight on the limbs normally. Small area of dehiscence occurred in both dogs 2 weeks after surgery. At follow-up examination one month after surgery, the surgical wound of the Labrador retriever still had a small area of dehiscence. Two months after surgery, the wound of the mixed breed dog was completely healed, covered with hair and no lameness was observed. CONCLUSION: Findings suggested that genicular axial pattern flap is a good option for reconstruction of large cutaneous defects of the lateral aspects of the tibia in dogs.

Pelvic modelling and the comparison between plate position for double pelvic osteotomy using artificial cancellous bone and finite element analysis.

BACKGROUND: Finite element analysis was used to compare fixation methods for double pelvic osteotomy (DPO). Using 3D scanning a stereolithography (stl) image was produced of a canine pelvis and this was subsequently refined in computer aided design (CAD). Using the CAD files, the images were imported in MSC Marc software to produce a working finite element (FE) model with 3 dimensional tetrahedral elements with linear shaped functions. The dimensions of a precontoured pelvic osteotomy plate with eight screws and a twisted seven screw straight plate were used to build the 2 fixations implants for the FE models. An equivalent load of 300 N was applied progressively on all FE models in order to facilitate its convergence. The load was applied in a distributed manner on the femur-hip joint contact area in order to simulate the actual behavior of the joint. The aim of the present study was to analyze the difference in stiffness and behavior under loading between a lateral vs ventral plate fixation, with unlocked screws and different gap scenarios, for stabilization of a pelvic osteotomy using finite element analysis. RESULTS: From both configurations the maximum displacement of the ventral plate with 7 screws without gap had a value of 1.988 mm, while in the DPO plate had a maximum displacement of 2.191 mm. The load applied for each of the different configurations studied when a gap of 1° was considered and also when a condition of no gap was considered. The ventral plate was stiffer than the lateral plate when a gap was not present. When the gap was closed in the ventral plate, the stiffness increased until a point that remained constant. CONCLUSIONS: Ventral plate fixation can be as or more stiff as lateral plate fixation and provides flexible fixation. This behavior should reduce screw loosening. Using ventral plate fixation is recommended to reduce screw loosening or failure.

Accurate Preoperative Localization of Thoracolumbar Disc Extrusion in Dogs: A Prospective Controlled Study.

Intervertebral disc disease (IVDD) is a very common cause of spinal cord compression in dogs. The errors of human surgeons operating on the wrong level or wrong side is a recognized problem and has been largely analyzed. To date, little information is available regarding these errors in dogs. The objective of this study was to assess the accuracy of disc localization prior to possible surgery for IVDD to ensure the surgeon begins their incision directly over the extruded disc. Eighty-five chondrodystrophic or brachycephalic dogs that presented with IVDD confirmed by CT or MRI scan were included in the study. Two small Backhaus clamps were placed cranial and caudal to the lesion site and a control clamp placed at the wing of the ilium. The main interest was whether the surgeon was able to preoperatively pinpoint the correct site for the surgery. Dorsoventral radiographs were taken to verify by another person if the clamps had been placed in the correct position. If the result was incorrect, the surgeon was asked to try again without knowing that the clamps were incorrect, and another radiograph was taken. This was repeated until the position was correct. The results were recorded as correct or incorrect and the number of attempts were registered. The results suggested no significant trend over time for any of the outcomes examined. There were some slight improvements over time, but none of the results was close to statistical significance. The findings of the study showed that in the thoracolumbar region the surgeon has a higher chance of incorrectly marking the exact site for surgery.

Case report: Total hip replacement using Innoplant system in a dog with chronic hip luxation and contralateral pelvic limb amputation.

A 6-year-old female neutered Border Collie presented with an inability to walk. The patient had undergone pelvic limb amputation over a year prior. Orthopedic examination revealed discomfort during hip manipulation, and radiographic examination revealed chronic hip luxation. Total hip replacement was performed using the InnoPlant system, which includes modular screw-in cementless pieces to improve implant stability. Cage rest was for the first four postoperative weeks. Subsequently, assistance was provided while standing until the patient could stand unassisted at 10 postoperative weeks. The clinical and radiological outcomes were excellent 3 months postoperatively. Since it is a new system, there are no data regarding the use of the components of the Innoplant system in dogs with a contralateral amputated pelvic limb. This is the first report describing the use of the Innoplant system for total hip replacement in a dog with a contralateral amputated pelvic limb. Based on the clinical outcomes of this case, the use of an Innoplant prosthesis can be an effective treatment option for dogs with contralateral amputated limbs.

Lateral Approach and Plate Rod Sliding Humeral Osteotomy in Dogs-A Short Case Series.

Five dogs of different breeds and ages were diagnosed with medial compartment disease of the elbow (MCDE). To resolve the condition, a modified technique using a lateral approach and plate/rod sliding humeral osteotomy (SHO) was considered. All dogs recovered uneventfully after surgery. There were no major complications, and all dogs were significantly improved compared to pre-operative condition. This novel technique of adding a pin, based on the alteration of the original technique, optimized resistance to fixation failure. An additional benefit was that the lateral approach was surgically familiar and easily allowed bone grafting. All five dogs treated with the novel approach had improved scores for pain and lameness. This study showed that SHO was more stable and less technically demanding with the addition of an intramedullary pin. This is the first report of a lateral approach and plate rod sliding humeral osteotomy to treat MCDE in dogs.

Modified Tibial Tuberosity Advancement Rapid in a Dog with One Contralateral Amputated Limb.

Cranial cruciate ligament disease (CCLD) is one of the most frequent causes of hindlimb lameness in dogs. Tibial tuberosity advancement (TTA) is a common surgery performed for CCLD. A modified, simplified technique (TTA Rapid) is also reported to have very good clinical outcomes. In this paper, we report a modified TTA Rapid technique to treat a CCLD in a dog with an amputated contralateral hindlimb. A 5-year-old mixed breed dog presented with amputated right hindlimb and difficulty walking. Pain and positive drawer sign were present at manipulation of left stifle joint. Radiographic findings of the stifle joint confirmed the presence of moderate osteoarthritis associated with CCLD, and modified TTA Rapid procedure was performed. Recovery from surgery was uneventful, and the dog was able to stand by his own by the second day postoperative. At three months follow-up evaluation, the dog was free of lameness and the osteotomy site was completely healed. This paper describes the first modified TTA rapid osteotomy technique performed in a dog with a contralateral amputated hindlimb.

A rare case of a double vagina in a young American Staffordshire Terrier bitch (Canis lupus familiaris). A case report.

The presence of congenital urogenital malformations is relatively common in bitches. However, cases of double vagina in the literature are scarce, and the ones reported usually accompany other urogenital defects. The vaginal anomaly was an incidental finding in the present case during a routine spay and was not accompanied by any other malformations. A detailed presentation of the diagnosis and surgical management of the double vagina is presented in the current paper. A 1-year-old nulliparous American Staffordshire Terrier bitch was presented for dysuria in the past 24 h. After inspection and palpation, a distended abdomen was noticed. Biochemistry, hematology, and urinalysis were performed. No other laboratory findings were noted besides mild hypocalcemia, hypoproteinemia, hypobilirubinemia, and increased lipase. During the ultrasonographic examination, a hypoechoic fluid accumulation was observed caudal to the urinary bladder in what seemed to be hydrocolpos. Exploratory laparotomy was recommended. Ovariohysterovaginectomy was performed, and the gross and histological findings were highly suggestive of a double vagina. The dog recovered from surgery uneventfully, and it was free of clinical signs six months after the surgery. To the extent of our knowledge, this is the first case of double vagina, without any other congenital defects, ultrasonography documented and surgically corrected, in a young bitch.

The Use of Sixty Degree Rotation of the Acetabulum for Treatment of Dogs With Canine Hip Dysplasia. A Short Case Series.

Triple pelvic osteotomy (TPO) is a prophylactic surgical procedure performed on dogs with canine hip dysplasia. The procedure is indicated in skeletally immature dogs without secondary osteoarthritis (OA). It has been suggested that 60° of rotation is excessive and is associated with poor outcome. The objective of the study was to assess the medium term outcome in dogs having undergone triple pelvic osteotomy (TPO) using 60° dedicated plates. Nine TPOs were performed in seven dogs with hip dysplasia. Eight of nine hips had 72-100% osseous union at the time of revisit. The mean time to final radiographic recheck was 200 days (range, 185-229 days). The mean time to follow-up was 11.5 months (range 11-12 months). All 7 dogs had regained full function and did not require supplemental analgesia. Pelvic canal narrowing was noted in the two dogs with bilateral surgeries, but no clinical consequences were noted according to owner's statement.If more than 40 degrees reduction angles at Ortolani test, 60° of rotation of the acetabulum can be used successfully in dogs with hip dysplasia. At the time of mid-term follow-up, all dogs in this case series had full function.

Suturing Achilles tendon and mesh simultaneously in augmented repair resists gap formation foremost: an experimental study.

BACKGROUND: The common calcanean tendon (Achilles tendon) is the strongest and largest tendon and is one of the most commonly affected by spontaneous rupture. Different suture techniques are used to repair the tendon rupture. We compare the biomechanical properties of three different modalities of suture pattern in a mechanical experiment in rabbits with the purpose of evaluating the use of polypropylene mesh augmentation for Achilles tendon repair to find out the best surgical option. METHODS: The study tests single cycle to failure tensile strength characteristics of three different combinations of the 3-loop pulley (3-LP) suture technique with polypropylene mesh, and statistically compares the biomechanical properties as the maximum load at failure for all 3-LP repair. RESULTS: The normal Achilles tendon-control group-failed at a mean load of 25.5 + 13.6; the experimental groups failed at a significantly lower load (p < 0.001), with the group of 3-LP suture with polypropylene mesh included in the suture being the more similar to controls, but all the groups exhibited statistically significant differences with regard to normal tendons (p < 0.001). The distance at which each group failed was also significant between control and experimental groups (p < 0.001) with the exception of the suture-only group and the group with the mesh over the suture (p = 0.15). CONCLUSION: Results from this study suggest that incorporating the mesh within the suture provides benefit to the Achilles tendon repair by improving strength and resistance to pull through. However, further in vivo studies will be necessary to confirm these results and incorporate this technique to the routine human and veterinary surgery.

Comparison of tension band wiring and other tibial tuberosity advancement techniques for cranial cruciate ligament repair: an experimental study.

BACKGROUND: Cranial cruciate ligament (CCL) rupture is one of the most common causes of limb lameness in dogs. Surgical techniques based on tibial osteotomies such as tibial plateau leveling osteotomy and tibial tuberosity advancement are used to eliminate dynamic thrust. Tibial tuberosity advancement (TTA) uses an osteotomy fixated by cage, plates, forks and screws to change the relationship of the patellar tendon and tibial plateau angle. Tension band wiring technique is one of the most common surgical methods used to treat a tension fracture and remains the gold standard for the treatment of tibial tuberosity fractures. In this study, we compared experimentally the biomechanical effect of application of tension band wiring compared to other techniques for the fixation of the TTA osteotomy. The techniques compared to are standard commercially available systems for TTA fixation. RESULTS: Tension band wiring (TBW) presented the higher resistance to failure compared to all the other surgical procedures, with the highest values found in the TBW group with 1.47 ± 0.07 N and the lowest in the TTA cage (0.82 ± 0.08) and TTA-2 (0.85 ± 0.06) groups with statistically significant differences in all cases (P < 0.001). TTA rapid and TTA plate groups exhibited a similar strength, and same happened between TTA-2 and TTA cage groups. All the other comparisons by pair were significantly different with P < 0.001. CONCLUSIONS: Results suggest that fixating the osteotomy with tension band wiring increases the strength of the fixation and decrease the risk of implant failure. Further clinical studies are needed to demonstrate in vivo reliability and to test different variables such as size and weight of dogs. These results could have important clinical implications in the treatment of CCL ruptures.

Utility of Deep Inspiration Breath Hold for Left-Sided Breast Radiation Therapy in Preventing Early Cardiac Perfusion Defects: A Prospective Study.

PURPOSE: To evaluate early cardiac single photon computed tomography (SPECT) findings after left breast/chest wall postoperative radiation therapy (RT) in the setting of deep inspiration breath hold (DIBH). METHODS AND MATERIALS: We performed a prospective single-institution single-arm study of patients who were planned for tangential RT with DIBH to the left breast/chest wall (± internal mammary nodes). The DIBH was done by use of a controlled surface monitoring technique (AlignRT, Vision RT Ltd, London, UK). The RT was given with tangential fields and a heart block. Radiation-induced cardiac perfusion and wall motion changes were assessed by pre-RT and 6-month post-RT SPECT scans. A cumulative SPECT summed-rest score was used to quantify perfusion in predefined left ventricle segments. The incidence of wall motion abnormalities was assessed in each of these same segments. RESULTS: A total of 20 patients with normal pre-RT scans were studied; their median age was 56 years (range, 39-72 years). Seven (35%) patients also received irradiation to the left internal mammary chain, and 5 (25%) received an additional RT field to supraclavicular nodes. The median heart dose was 94 cGy (range, 56-200 cGy), and the median V25Gy was zero (range, 0-0.1). None of the patients had post-RT perfusion or wall motion abnormalities. CONCLUSIONS: Our results suggest that DIBH and conformal cardiac blocking for patients receiving tangential RT for left-sided breast cancer is an effective means to avoid early RT-associated cardiac perfusion defects.

18F-FDG PET/CT Imaging of Extranodal Rosai-Dorfman Disease with Hepatopancreatic Involvement - A Pictorial and Literature Review.

We share our experience with serial PET/CT imaging on a patient with extranodal Rosai-Dorfman disease (RDD) with hepatopancreatic involvement. RDD is a benign proliferative disorder of histiocytes mainly involving the lymph nodes. It typically presents with fever and painless cervical lymphadenopathy in young adults and less than half of RDS cases demonstrate extranodal involvement. RDD involvement of the liver and pancreas is extremely rare, and this case highlights the role of PET/CT in its management.

Gallbladder function before and after fundoplication.

No study has reported an association between gastroesophageal reflux disease (GERD) or its therapies and gallbladder function. We compared pre- and postoperative gallbladder function in patients undergoing fundoplication to determine the following: (1) whether patients with chronic GERD have preexisting gallbladder motor dysfunction; (2) whether medical or surgical therapy alters gallbladder function; and (3) whether division of the hepatic branch of the anterior vagus nerve is detrimental to gallbladder motility. Nineteen patients with documented GERD consented to a preoperative cholecystokinin-stimulated technetium hepatobiliary (CCK-HIDA) scan to quantify the gallbladder ejection fraction (GBEF). All patients underwent laparoscopic Nissen fundoplication. One month after fundoplication, 12 patients completed a repeat CCK-HIDA scan for determination of GBEF, with comparison to the preoperative GBEF. Among patients with preoperative GERD, 11 (58%) of 19 met the scintigraphic criteria for gallbladder dysfunction (GBEF <35%), which is a ratio comparable to that in patients undergoing a CCK-HIDA scan for presumed biliary dyskinesia during the same time period (31 [60%] of 53; P = NS, chi-square test) and exceeds the rate of abnormal GBEF reported in healthy volunteers (3%). Six of seven patients with a low preoperative GBEF who underwent repeat evaluation postoperatively had normalization of the GBEF (P < 0.05, paired t-test). In the 12 patients who underwent postoperative CCK-HIDA scanning, there was no association between preservation or division of the hepatic branch of the anterior vagus nerve and postoperative gallbladder dysfunction (P = NS, chi-square test). Unexpectedly, 58% of patients with GERD demonstrated gallbladder motor dysfunction prior to fundoplication, with improvement to normal occurring in most of those studied postoperatively. These data support controlled trials to determine the effect of chronic GERD and antisecretory therapy on gallbladder and global gastrointestinal smooth muscle function. Preservation of the hepatic branch of the anterior vagus nerve during fundoplication offered no clear benefit with regard to early postoperative gallbladder function.

Value of 2-[18F]-fluoro-2-deoxy-D-glucose imaging with dual-head gamma camera in coincidence mode: comparison with computed tomography/magnetic resonance imaging in patients with suspected recurrent head and neck cancers.

OBJECTIVE: The aim of the present study was to assess the value of dual-head gamma-camera (DHGC) imaging in the coincidence mode using 2-[18F]-fluoro-2-deoxy-D-glucose in differentiating recurrent tumor from posttreatment changes in previously treated head and neck cancer. METHODS: This was a single-center prospective study performed with the approval of our Institutional Review Board. Twenty-nine patients with suspected recurrent head and neck cancers were prospectively enrolled in this study. Dual-head gamma-camera imaging in the coincidence mode followed computed tomography (CT; n = 24)/magnetic resonance imaging (MRI; n = 5) within a period of 1 week (mean = 3.5 days) in all patients. Thirteen patients had definite pathologic confirmation of recurrence by undergoing a biopsy. Sixteen patients, however, did not have a definite pathologic confirmation and were followed clinically. The mean duration of follow-up for the subgroup of patients who were followed clinically was 22.8 months (range: 4-48 months). Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for CT/MRI and DHGC imaging in the coincidence mode were calculated. RESULTS: The sensitivity, specificity, PPV, NPV, and accuracy of CT/MRI in the detection of recurrent cancer were 76.5%, 58.3%, 72.2%, 63.6%, and 69%, respectively. In contrast, the sensitivity (100%), NPV (100%), and accuracy (82.8%) of DHGC imaging in the coincidence mode were superior to that of CT/MRI. Dual-head gamma-camera imaging in the coincidence mode had a specificity (58.3%) and PPV (77.3%) comparable to those of CT/MRI. CONCLUSION: Our data suggest that modified positron emission tomography with DHGC imaging in the coincidence mode is a useful tool in the assessment of recurrent head and neck cancer.