The use of absorbable staples for skin closure after tibial plateau leveling osteotomy.

OBJECTIVE: To compare the use of stainless steel staples with absorbable staples for closure of skin incisions in dogs undergoing tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: Prospective study. SAMPLE POPULATION: Client-owned dogs (n = 80). METHODS: With client consent, dogs were randomly assigned a staple type (stainless steel or absorbable) immediately prior to closure of a TPLO skin incision. Incisions were compared for length, staple type and number, and an inflammation-infection score 2 weeks after surgery. RESULTS: Overall, 18.8% of incisions were diagnosed with inflammation or infection. No difference was found between inflammation-infection scores, incision length, number of staples used, or general anesthetic time between the 2 staple groups. However, wound closure was faster with stainless steel staples (22.50 seconds; range, 11-180) by approximately 30 seconds compared with absorbable staples (56.50 seconds; range, 18-190; P < .001). Time taken to close the incision correlated negatively with the number of occasions that absorbable staples were used (P = .01). CONCLUSION: Absorbable skin staples were successfully used to close skin incisions after TPLO and were not associated with an increased level of inflammation or infection in our clinical setting. CLINICAL SIGNIFICANCE: Absorbable staples may be considered to close surgical wounds when subsequent suture removal would be impractical, without specific concerns over inflammation or infection of the wound.

Multi-centre retrospective study of long-term outcomes following traumatic elbow luxation in 37 dogs.

OBJECTIVES: Limited guidelines exist regarding the optimal treatment of traumatic canine elbow luxation, and there is a lack of information on long-term functional outcome. Here we report reduction and stabilisation techniques for a series of traumatic elbow luxations and describe clinical outcome plus long-term questionnaire-based follow-up. METHODS: Retrospective review of canine traumatic elbow luxations (2006 to 2013) treated at five referral centres. Data recorded included signalment, luxation aetiology, time to reduction, reduction technique, surgical procedure, post-reduction care and complications. Questionnaire follow-up was attempted for all cases with owners completing the Canine Brief Pain Inventory. RESULTS: Thirty-seven dogs were included. The most frequent cause of luxation was road traffic accident (n=22). Twenty cases were treated surgically. Seven dogs suffered major postoperative complications: reluxation (n=6), infection requiring implant removal (n=1). Four of the six reluxations occurred in dogs that had other orthopaedic injuries. Twenty-two owners completed the Canine Brief Pain Inventory questionnaire: there were 13 excellent, 6 very good, 1 good and 2 fair outcomes. Outcome was not associated with the reduction technique. CLINICAL SIGNIFICANCE: Initial closed reduction, followed by surgical stabilisation if unsuccessful, results in good-to-excellent outcomes in the majority of traumatic canine elbow luxations. Reluxation was the most common major complication and there was a higher incidence of reluxation in patients with multiple orthopaedic injuries.

Interactions of the beta carboline abecarnil with the high pressure neurological syndrome in a primate model.

The neurophysiological interactions between the high pressure neurological syndrome (HPNS) and a new beta carboline, abecarnil, were studied in the non-human primate Papio anubis. Abecarnil is a partial agonist at the benzodiazepine site on the GABA/benzodiazepine receptor. Six animals were exposed on two occasions to pressures of 91 ATA in an environment of helium and oxygen. One exposure was pretreated with a total dose of abecarnil 1.0 mg/kg, the other with an equivalent volume of vehicle. Treatment with abecarnil prevented the severe signs of HPNS occurring between 51 and 91 ATA. Onset pressures of the various signs were unaffected. Some signs, e.g. myoclonus, became more frequent when abecarnil was used. A residual protective effect of abecarnil was present 4 weeks after the dose was given, active at pressures less than 71 ATA. Changes with pressure in the EEG were recorded primarily from the frontal cortex, but were also present in the parietal and occipital areas of the left cortex. Amplitude and frequency spectra were calculated and changes with pressure in the four conventional wavebands, plus two others, analysed. The most striking change was the prevention by abecarnil of the pressure-induced 100% increase in alpha wave amplitude in the frontal region. It is concluded that modulation of GABA transmission is important in controlling the expression of HPNS.

Airway injury associated with cervical bite wounds in dogs and cats: 56 cases.

OBJECTIVE: To investigate the frequency of airway injury and damage to other vital structures associated with cervical bite wounds in dogs and cats and the implications for management and outcome. METHODS: A retrospective search of electronic patient records was used to identify dogs and cats suffering cervical bite wounds that were presented to a large multidisciplinary veterinary hospital over a four year period. RESULTS: Complete records were available for 55 animals, with one animal suffering two separate injuries. Fourteen animals (25%) had injuries to vital structures, including airway injury in nine (17%) which was surgically confirmed and treated in six (11%). Airway injuries were associated with either subcutaneous or mediastinal emphysema in all affected animals. Other structures injured included the jugular vein, pharynx, oesophagus and spine. Airway injuries were treated with primary repair in five animals and a fasciomuscular patch in one. Temporary tracheostomy was performed in three animals. Median duration of hospitalisation was one day (0-19) with 53 animals (54 cases) (96%) surviving to discharge. Long-term follow-up (16-114 months) revealed that 43 of 49 animals were alive with six that died due to unrelated reasons. CLINICAL SIGNIFICANCE: Cervical bite wounds are associated with significant injury to vital structures. Up to 17% of animals may have injury to their airway. Identification and treatment of airway injury is vital and was associated with an excellent outcome in six animals.

Management of peristomal tissue necrosis following prepubic urethrostomy in a cat.

This report describes the successful management of peristomal tissue necrosis following prepubic urethrostomy in a cat. The novel technique of temporary urethral ligation was used in combination with temporary tube cystostomy and vacuum assisted closure to allow for wound management prior to performing wound closure by utilization of a flank fold skin flap then definitive prepubic urethrostomy. Eleven month follow-up indicated excellent outcome with the cat having returned to normal behaviour apart from having adapted its posture to urinate.

A review of surgical rehabilitation of the upper limb in quadriplegia.

The options for surgical reconstruction of the quadriplegic upper limb are clarified by a new international classification of each limb independently, based upon the lowest functioning key muscle and residual sensation. Surgical restoration of active elbow extension, of pinch, and of grasp is now an accepted part of rehabilitation. This additional function may be achieved by transfer of a non-essential muscle, by tenodesis, or occasionally by arthrodesis. The techniques available for each group of the new international classification are described.

Surgical rehabilitation of the upper limb in quadriplegia.

Fifteen quadriplegic (tetraplegic) patients from the Spinal Injuries Unit of the Austin Hospital have had surgery to improve function in 17 of their upper limbs. Changes in strength, function, subjective ratings and the influence on 198 activities of daily living are reviewed. The posterior third of the deltoid muscle was transferred into 8 triceps tendons to provide active elbow extension in seven patients. Six patients had transfers of forearm muscles to provide grasp and lateral pinch or active extension of wrist and fingers. Other operations included transfer of the latissimus dorsi to the forearm producing elbow flexion, medial advancement of the anterior deltoid origin improving shoulder control (an operation which has not been described previously), and tenodesis for stabilizing the wrist. The objective results were satisfactory in 12 patients. Eleven patients had either good or excellent subjective results. The maximum force of active elbow extension achieved was 6.8 kg and the peak grip strength reached was 10.5 kg. Six patients achieved subjective results higher than would have been expected from objective assessment. All patients benefited in some way, 13 patients felt that surgery was worthwhile and no patient lost appreciable function. The results of this series indicate that upper limb surgery has a definite place in rehabilitation of the quadriplegic patient. Improved surgical technique may reduce the time required for postoperative rehabilitation and thus make these procedures feasible for a larger number of patients.