Evaluation of various carbon dioxide laser settings on the time and number of laser beam passes required to make a full-thickness skin incision and amount of laser-induced tissue artifact.

OBJECTIVE: To evaluate the time and number of laser beam passes required to make full-thickness skin incisions and extent of laser-induced tissue artifacts following use of a CO2 laser at various settings. SAMPLE: 24 skin specimens from six 5-month-old porcine carcasses. PROCEDURES: 4 full-thickness skin specimens were harvested from the flank regions of each carcass within 30 minutes after euthanasia and randomly assigned to 4 treatment groups. Three 5-cm-long incisions were made in each specimen with a CO2 laser (beam diameter, 0.4 mm) set to deliver a continuous wave of energy alone (groups 1 and 2) or in superpulse mode (groups 3 and 4) at 10 (groups 1 and 3) or 20 (groups 2 and 4) W of power. The time and number of passes required to achieve a full-thickness incision were recorded, and extent of laser-induced tissue artifact (as determined by histologic evaluation) was compared among the 4 groups. RESULTS: Mean time required to make a full-thickness skin incision for groups 2 and 4 (power, 20 W) was significantly less than that for groups 1 and 3 (power, 10 W). Mean number of passes was lowest for group 2 (continuous wave at 20 W). Extent of laser-induced tissue artifact was greatest for group 4 (superpulse mode at 20 W). CONCLUSIONS AND CLINICAL RELEVANCE: Results provided preliminary information regarding use of CO2 lasers to make skin incisions in veterinary patients. In vivo studies are necessary to evaluate the effect of various CO2 laser settings on tissue healing and patient outcome.

Clinical and histologic tissue responses of skin incisions closed with glycomer 631 and lactomer 9-1 using a subcuticular technique in pigs.

BACKGROUND: Glycomer 631 and lactomer 9-1 are absorbable suture materials indicated for soft tissue approximation in non-infected wounds. Pigs are often used as surgical models in translational research; however, reports of tissue reactions to both suture materials in pigs are limited. The aim of this study was to assess clinical and histologic responses of skin incisions closed with a subcuticular technique using glycomer 631 and lactomer 9-1 in pigs. RESULTS: Skin incisions on 17 pigs were closed with glycomer 631 and lactomer 9-1, and a clinical reactive score (CRS) including erythema, swelling, discharge and dehiscence was calculated on postoperative days 7 and 14. Subcuticular tissue reaction was assessed histologically on postoperative day 14 (the presence of extravascular neutrophils, macrophages, multinucleated giant cells, lymphocytes, fibroblasts, bacterial colonies and the overall severity of the inflammatory response to the suture material), and the cumulative score of the variables was calculated as an aggregate tissue irritation score (ATIS). Tissue samples were examined for suture extrusion and evaluated microbiologically. The clinical reactive score did not differ between the suture materials. Only one ATIS variable, namely the overall severity of the inflammatory response, was lower (p = 0.029) when glycomer 631 was used. Suture extrusion was found in 10/17 of the incisions closed by glycomer 631 and in 7/13 of the incisions closed by lactomer 9-1. Trueperella pyogenes was isolated from the skin and from the area of tissue reaction in six pigs. CONCLUSIONS: No difference in CRS between the suture materials was observed, and thus both materials may be used for the subcuticular technique in pigs. Glycomer 631 induced less tissue reaction only in terms of the overall severity of the inflammatory response. Suture extrusion was observed in more than 50% of incisions regardless of the suture material, possibly due to a large amount of suture material in the wound. Trueperella pyogenes was the only pathogen isolated from the tissue surrounding the suture material.

Ex vivo comparison of intradermal closures with conventional monofilament suture vs unidirectional barbed suture in dogs.

OBJECTIVE: To evaluate the mechanical properties, strength, and quality of seal provided by continuous intradermal suture lines closed with barbed suture vs monofilament suture. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Forty-eight full-thickness wounds in canine cadavers. METHODS: Four-centimeter-long parasagittal cutaneous wounds were created in canine cadavers. Each intradermal closure was closed with smooth monofilament suture and terminated with a 2 + 1 Aberdeen knot (n = 24) or a unidirectional barbed suture terminated with a single end pass (n = 24). Wounds (n = 12/group) were harvested, and a servohydraulic machine applied tensile load perpendicular to the long axis of the suture line. A load-displacement curve was generated; maximum load, displacement, stiffness, and mode of construct failure were recorded. Harvested wounds were placed in a watertight construct to measure the volume of fluid leaking over 3 minutes at 1.0 ± 0.1 psi. RESULTS: Stiffness did not differ between constructs (P > .05). Incisions closed with monofilament sutures sustained higher maximum load (311.21 N ± 87.40) and displacement at failure (21.19 mm ± 4.51) compared with those with barbed sutures (116.38 N ± 42.82 and 15.03 mm ± 2.32, respectively, P < .05). Closures with monofilament sutures leaked more (4.38 mL ± 7.90) compared with those with barbed sutures (0.15 mL ± 0.43, P < .05). CONCLUSION: Monofilament sutures resulted in stronger constructs, whereas barbed suture constructs provided a better watertight seal. CLINICAL SIGNIFICANCE: While unidirectional barbed sutures may improve watertight skin closure, surgeons should consider using conventional monofilament sutures when mechanical strength of the closure is of primary concern.

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.

Surgical Management of a Chronic Neck Abscess in a U.S. Navy Bottlenose Dolphin.

Surgical intervention on cetaceans is rarely performed due to challenges including general anesthesia and post-operative wound healing. This report describes the evaluation and treatment of an adult female bottlenose dolphin (Tursiops truncatus) with the US Navy Marine Mammal Program, with a chronic ventral cervical abscess caused by Candida glabrata. Despite aspiration and lavage along with multiple antifungal drugs, the patient developed inspiratory stridor with decreased performance level and surgical treatment was pursued. Under general anesthesia with the dolphin in dorsal recumbency position a 12-cm longitudinal ventral midline neck incision was used for exploration. Intraoperative ultrasound aided the identification of surgical landmarks and the abscess cavity. After adequate drainage and curettage, a closed-suction drain was placed in the surgical site. Retention sutures were used to close the incision and the external drain bulb was secured to a pectoral fin strap. One-year post-op, the dolphin was clinically normal and follow-up imaging showed no significant recurrence of the abscess. This case demonstrates a novel surgical approach of managing abscesses in dolphins, including placement and management of a negative suction drain in a submerged patient. The successful collaboration between veterinary anesthesiology, veterinary medicine, radiology, and general surgery allowed the patient to continue her normal activities as a full-duty service member.

Proof of concept of a new autologous skin substitute for the treatment of deep wounds in dogs.

Autologous skin grafts are effective for the repair of large skin wounds, but the availability of large amounts of skin is often limited. Through bioengineering, several autologous skin substitutes have been developed for use in human clinical practice. However, few skin substitutes are available for use in animals. The aim of this study was to develop and assess an engineered autologous skin substitute for the treatment of deep wounds in veterinary medicine. Canine keratinocytes and fibroblasts were isolated after double enzyme digestion from 8mm punch biopsies from four healthy Beagle dogs. Skin substitutes were constructed on a fibrin-based matrix and grafting capacity was assessed by xenografting in six athymic mice. Bioengineered autologous skin was assessed clinically in two dogs with large deep skin wounds. The canine skin construct was ready for use within 12-14days after the initial biopsy specimens were obtained. Grafting capacity in this model was confirmed by successful grafting of the construct in athymic mice. In both dogs, grafts were established and permanent epithelialisation occurred. Histological studies confirmed successful grafting. This full thickness skin substitute developed for the management of large skin defects in dogs appears to be a safe and useful tool for clinical veterinary practice. Further studies are needed to validate its efficacy for the treatment of deep wounds.

Use of a non-invasive surgical skin closure device in dogs following dorsolateral hemilaminectomy.

The ZipLine 16 surgical skin closure device (ZipLine 16; Zipline Medical, Campbell, California, USA) provides noninvasive surgical wound closure. This prospective study investigated its use in dogs undergoing a dorsolateral hemilaminectomy. Although the device produced normal appositional healing compared with controls, unacceptable traumatic dermatitis that is likely related to the device adhesive was noted after removal.

Utilisation d'un dispositif chirurgical non invasif pour la fermeture de la peau chez les chiens après une hémilaminectomie dorsolatérale. Le dispositif chirurgical de fermeture de la peau ZipLine 16 (ZipLine 16; Zipline Medical, Campbell, Californie, États-Unis) permet de fermer une plaie chirurgicale de manière non invasive. Cette étude prospective a réalisé une enquête sur son utilisation chez les chiens subissant une hémilaminectomie dorsolatérale. Même si le dispositif a produit une guérison apositionnelle normale comparativement aux témoins, une dermatite traumatique inacceptable, qui est probablement associée à l'adhésif du dispositif, a été observée après l'enlèvement.(Traduit par Isabelle Vallières).

Biomechanical Testing and Histologic Examination of Intradermal Skin Closure in Dogs Using Barbed Suture Device and Non-Barbed Monofilament Suture.

OBJECTIVE: To compare the biomechanical strength and histologic features of 3-0 Glycomer™ 631 barbed suture (V-LOC™ 90 Absorbable Wound Closure Device, Covidien, Mansfield, MA) to non-barbed 3-0 Glycomer™ 631 suture (Biosyn™, Covidien) for intradermal skin wound closure in the dog. STUDY DESIGN: Randomized, factorial, in vivo. ANIMALS: Eighteen purpose-bred, mature male, and female hound dogs. METHODS: Eighteen adult hound dogs were randomly assigned to 1 of 3 groups designated by postoperative day of assessment. Six skin incisions were made along the dorsum in the thoracolumbar region of each dog with an equal number (n=3) randomly assigned to closure with barbed or non-barbed suture. Six dogs were euthanatized on postoperative days 3, 10, and 14, respectively. Two additional incisions were made on each dog after euthanasia for baseline data (Day 0). The skin incision specimens were harvested for biomechanical testing and histologic evaluation. RESULTS: Non-barbed closure had significantly higher maximum load at failure (P<.001) and stiffness (P<.001) than barbed closure regardless of day. The average tissue reaction score was significantly higher for barbed closure (P=.008), regardless of day. Suturing time for barbed closures was significantly shorter. There was no significant difference in frequency of complications between closures. CONCLUSION: Barbed Glycomer™ 631 closures had a significantly lower maximum load at failure and stiffness, and higher average tissue reaction scores, but showed no difference in short term outcome for intradermal closure of dorsally located skin incisions in dogs.

Security and biomechanical strength of three end-pass configurations for the terminal end of intradermal closures performed with unidirectional barbed suture material in dogs.

OBJECTIVE To compare security of continuous intradermal suture lines closed by use of barbed suture with 3 end-pass configurations or without an end-pass configuration. SAMPLE 40 full-thickness, 4-cm-long, parasagittal wounds in canine cadavers. PROCEDURES Each continuous intradermal closure was terminated with 1 of 3 end-pass techniques or without an end-pass configuration (control group). A servohydraulic machine applied tensile load perpendicular to the long axis of the suture line. A load-displacement curve was generated for each sample; maximum load, displacement, stiffness, mode of construct failure, and load at first suture slippage at termination (ie, terminal end of the suture line) were recorded. RESULTS Values for maximum load, displacement, and stiffness did not differ significantly among the 3 end-pass techniques, and load at first suture slippage at termination was not significantly different among the 4 groups. A 1-pass technique slipped in 5 of 9 samples; 3 of these 5 slips caused failure of wound closure. A 2-pass technique slipped in 3 of 9 samples, none of which caused failure of wound closure. Another 2-pass technique slipped in 4 of 10 samples; 2 of these 4 slips caused failure of wound closure. The control group had slippage in 10 of 10 samples; 9 of 10 slips caused failure of wound closure CONCLUSIONS AND CLINICAL RELEVANCE An end-pass anchor was necessary to terminate a continuous intradermal suture line, and all 3 end-pass anchor techniques were suitable to prevent wound disruption. The 2-pass technique for which none of the suture slippages caused wound closure failure provided the most reliable configuration.

Regeneration of dermal patterns from the remaining pigments after surgery in Eublepharis macularius (a case report).

BACKGROUND: Dermal injury of the Eublepharis macularius (leopard gecko) often results in a loss of the spotted patterns. The scar is usually well recovered, but the spots and the tubercles may be lost depending on the size and part of the lesion. This report presents a surgical attempting, in which the pigments in the edge of the remaining skin flap are partially preserved to maximally restore the natural pigmentation patterns during the course of dermal regeneration. CASE PRESENTATION: A four-year-old female lizard E. macularius was evaluated due to a subcutaneous tumor in the occipito-pterional portion behind its right eye. A solid tumor beneath the skin was surgically enucleated under general anesthesia. Then, the ulcerated skin was dissected away together with the tumor. The necrotic edge of the remaining skin flap was carefully trimmed to leave as much of the pigmented portions as possible on the outskirt of the skin flap. The scar was covered with the remaining skin flap, and the uncovered lesion was protected with Vaseline containing gentamicin. The lesion was rapidly covered with regenerated dermis within a week, and the epidermis with round and well-oriented pigmented spots were almost completely restored in four months. CONCLUSION: The surgical suture of the skin flap after removal of the ulcerated margins resulted in the scar-free regeneration of the scales and the pigmented spots. And the pigmented spots of the remaining skin close to the lesion site might be a source of the regenerated spots.

Medical and Surgical Emergencies in Ferrets.

In the last few years, significant improvement in diagnosis and treatment of ferret emergencies has occurred. Scientific advances demonstrated the need of specific practices when dealing with emergencies in ferrets. The risk of overdiagnosis of hypoglycemia with human portable blood glucose meters is a clear example. The purpose of this article is to describe the current approach to common medical and surgical emergencies in ferrets.

The Effect of Specimen Preparation on Post-Excision and Post-Fixation Dimensions, Translation, and Distortion of Canine Cadaver Skin-Muscle-Fascia Specimens.

OBJECTIVE: To assess the effect of various tissue apposition techniques on specimens after formalin fixation, and to assess canine cadaveric composite skin-muscle-fascia specimen changes after excision without and with addition of a tumor model. STUDY DESIGN: Canine cadaveric study; unbalanced paired design. ANIMALS: Fresh canine cadavers (n = 30) METHODS: Experiment 1: Paired 7 cm diameter, circular skin-muscle-fascia specimens were harvested bilaterally from three sites (thorax, abdomen, and thigh) on 10 cadavers. For each pair, the skin-to-fascia was sutured with a circumferential continuous pattern in one specimen and left unsutured in the other during excision. Specimen length and width were measured post-excision and post-fixation. Specimen rotation, translation, and distortion was measured post-fixation. Experiment 2: A subcutaneous tumor model was implanted at 2 sites (neck, thorax) on 20 cadavers and specimens were then excised with 2 cm lateral margins and a deep fascial plane. Three suturing techniques of the skin-to-fascia at both sites were performed during excision: unsutured versus circumferential continuous suture (10 pairs) or circumferential versus 4 interrupted quadrant sutures (10 pairs). Lateral margins were compared post-excision and post-fixation. RESULTS: Experiment 1: There was significant reduction in the length and width of the fascia and skin post-excision, but no further reduction after fixation. The circumferential suture decreased rotation and translation of the tissue layers but did not significantly affect specimen shrinkage or distortion compared with the unsutured specimen. Experiment 2: All 4 lateral margins decreased significantly post-excision and post-fixation compared with the planned pre-excision margins. No difference was found between any of the 4 lateral margins for any skin-to-fascia suture technique. CONCLUSION: Canine skin-muscle-fascia specimens significantly decrease in size from gross pre-excision dimensions after removal. Suturing the specimen during surgery before excision will significantly improve alignment of tissue planes without creating distortion of the sample, but may alter the length, width, and lateral margins of the specimen.

Surgery in Amphibians.

Amphibian surgery has been especially described in research. Since the last decade, interest for captive amphibians has increased, so have the indications for surgical intervention. Clinicians should not hesitate to advocate such manipulations. Amphibian surgeries have no overwhelming obstacles. These patients heal well and tolerate blood loss more than higher vertebrates. Most procedures described in reptiles (mostly lizards) can be undertaken in most amphibians if equipment can be matched to the patients' size. In general, the most difficult aspect would be the provision of adequate anesthesia.

Reptile Soft Tissue Surgery.

The surgical approach to reptiles can be challenging. Reptiles have unique physiologic, anatomic, and pathologic differences. This may result in frustrating surgical experiences. However, recent investigations provided novel, less invasive, surgical techniques. The purpose of this review was to describe the technical aspects behind soft tissue surgical techniques that have been used in reptiles, so as to provide a general guideline for veterinarians working with reptiles.

Avian Soft Tissue Surgery.

Basic surgical instrumentation for avian soft tissue surgery includes soft tissue retractors, microsurgical instrumentation, surgical loupes, and head-mounted lights. Hemostasis is fundamental during the surgical procedures. The indications, approach, and complications associated with soft tissue surgeries of the integumentary (digit constriction repair, feather cyst excision, cranial wound repair, sternal wound repair, uropygial gland excision), gastrointestinal (ingluviotomy, crop biopsy, crop burn repair, celiotomy, coelomic hernia and pseudohernia repair, proventriculotomy, ventriculotomy, enterotomy, intestinal resection and anastomosis, cloacoplasty, cloacopexy), respiratory (rhinolith removal, sinusotomy, tracheotomy, tracheal resection and anastomosis, tracheostomy, pneumonectomy) and reproductive (ovocentesis, ovariectomy, salpingohysterectomy, cesarean section, orchidectomy, vasectomy, phallectomy) systems are reviewed.

Small Mammals: Common Surgical Procedures of Rodents, Ferrets, Hedgehogs, and Sugar Gliders.

Small mammal surgical procedures are a part of clinical veterinary practice and are performed with regularity. Anesthetic and analgesic techniques are important components of any successful small mammal surgical procedure. Many basic surgical principles used in dogs and cats can be directly applied to small mammals, but tissues tend to be smaller and thinner, and hemostasis is critical with small patients due to risk of death with minimal blood loss. Common surgical procedures in small mammals include integumentary mass and abscess excision, reproductive procedures, gastrointestinal foreign body removal, urolith removal, prolapsed tissues associated with the gastrointestinal tract, intra-abdominal mass excision, and hepatic surgery.

Surgically planned versus histologically measured lateral tumor margins for resection of cutaneous and subcutaneous mast cell tumors in dogs: 46 cases (2010-2013).

OBJECTIVE: To compare preplanned lateral surgical margins and measured lateral histologic margins for cutaneous and subcutaneous mast cell tumor (MCT) resections in dogs. DESIGN: Retrospective case series. SAMPLE: 51 biopsy specimens from dogs (n = 46) with MCTs. PROCEDURES: All canine patients that underwent curative-intent surgical resection of cutaneous or subcutaneous MCTs from January 1, 2010, through June 30, 2013, with complete medical records including signalment, body condition score (BCS), surgery report (with measured surgical margins), and histopathology report were included. The surgically measured tumor margins in each quadrant were grouped and compared with the corresponding histologic margins. Specimens from dogs with truncal MCTs and a BCS of 7 to 9 on a scale from 1 to 9 (ie, high) were compared with those of dogs with a BCS of 4 to 6 to evaluate effect of BCS on tissue margins. RESULTS: 51 specimens were included. Surgically mapped lateral margins differed significantly from histologically reported margins in all 4 quadrants. The mean histologic margins were 35% to 42% smaller than the surgical margins for the combined 51 specimens. A higher BCS did not significantly influence the magnitude of the decrease in lateral margins measured histologically. No significant difference was found for the magnitude of the differences between any of the 4 lateral margins. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study suggested that surgical and histologic margins may differ significantly for canine cutaneous and subcutaneous MCTs. This may be a result of tissue shrinkage following excision and fixation, extension of the MCT beyond palpable margins, or both. Histologic measurements may significantly underestimate the tumor-free margins in dogs with cutaneous and subcutaneous MCTs.

Effects of sample site and size, skin tension lines, surgeon, and formalin fixation on shrinkage of skin samples excised from canine cadavers.

OBJECTIVE: To assess the effects of sample size and location, skin tension lines, surgeon, and formalin fixation on the extent of shrinkage that occurs in excised canine skin samples. ANIMALS: Cadavers of 4 adult purpose-bred mixed-breed hound dogs with grossly normal skin. PROCEDURES: 54 circular areas of skin (2-, 4-, and 6-cm-diameter samples from each of 9 body regions on each side) were excised by 1 of 2 surgeons from each cadaver. The diameter of each sample was measured in 4 orientations (parallel to previously reported tension lines, perpendicular to tension lines, in a dorsoventral orientation, and in a craniocaudal [or rostrocaudal] orientation) at 3 time points (before and immediately after excision and after 24 hours of formalin fixation). RESULTS: 216 samples were measured in all 4 orientations at all 3 time points. For all samples, mean ± SE decrease in diameter after fixation, compared with pre-excision findings, was 6.2 ± 0.7 mm. No significant correlations were found between percentage of skin shrinkage and surgeon, body side or region, or measurement orientation in relation to skin tension lines. The mean sample diameter immediately after excision differed significantly from that before excision (mean diameter decrease, 5.5 ± 0.7 mm). Overall, sample diameter immediately after excision and after formalin fixation did not differ. CONCLUSIONS AND CLINICAL RELEVANCE: The extent of shrinkage of skin samples from hound cadavers that occurred immediately after excision was notable. A better understanding of the effectors of excised skin sample shrinkage is needed, especially when histopathologic findings provide guidelines for surgical margins.

Mandibular degloving injury in an Arabian filly.

A 6-month-old Arabian filly escaped its handler while being led and slipped on pavement. The referring veterinarian recognized severe, soft tissue damage to the filly's lower jaw and referred the filly to the Veterinary Teaching Hospital for surgical management.

Blessure de dégantage mandibulaire chez une pouliche arabe. Une pouliche arabe âgée de 6 ans s'est échappée de son préposé pendant qu'il la menait et a glissé sur la chaussée. Le vétérinaire traitant a reconnu des dommages graves aux tissus mous de la mâchoire inférieure de la pouliche et a recommandé la pouliche à l'hôpital d'enseignement vétérinaire pour une gestion chirurgicale.(Traduit par Isabelle Vallières).

Percutaneous approach for sialolith removal in a donkey.

Salivary duct lithiasis is a condition characterized by the partial or total obstruction ofa salivary gland or its excretory duct due to the formation of sialoliths. A 9-year-old female donkey, belonging to the unique and endangered indigenous breed of donkey in Portugal, was diagnosed with a sialolith in the rostral portion of the right parotid duct based on clinical, oral, dental, and radiographic examination results. Surgical removal of the sialolith was done through a percutaneous approach.