Vascularized ulnar bone grafts for limb-sparing surgery for the treatment of distal radial osteosarcoma.

The objective of this retrospective study was to compare vascularized free or roll-in ulnar bone grafts for limb-sparing surgery in dogs with radial osteosarcoma with the cortical allograft, metal endoprosthesis, or distraction osteogenesis techniques. Overall, the ulnar graft techniques used in this study demonstrated excellent healing properties. Complications included recurrence of the tumor in 25% (2/8) of the dogs, metastasis in 50% (4/8) of the dogs, implant loosening in 37.5% (3/8) of the dogs, implant failure in 12.5% (1/8) of the dogs, and infection in 62.5% (5/8) of the dogs. Mean survival time was 29.3 mo (range, 9 to 61 mo). The mean metastasis-free interval was 33.67 mo (range, 8 to 54 mo). Tumors recurred locally in two dogs at 10 mo and 20 mo postoperatively. This study yielded similar long-term complications as other limb-sparing options (such as cortical allografts and metal endoprostheses) and allowed dogs to bear weight on the operated limb with acceptable limb function. More research is needed regarding specific healing times for ulnar vascularized grafts, time until implant removal, and the extent of radial bone that could ultimately be replaced by the ulna.

Diagnosis of prostatic inflammation: efficacy of needle biopsies versus tissue blocks.

OBJECTIVES: To assess the variation of inflammation found on single needle biopsies, we compared our results using multiple needle biopsies and surgical samples taken from predetermined areas of prostates removed from patients with prostate cancer. METHODS: Biopsies and tissue blocks were taken from 25 prostates that had been removed at prostate cancer surgery. These samples were taken from the contralateral side from the cancer whenever possible. The biopsies were taken from the apex, middle, and base, and blocks were taken from the peripheral and transition zones of the middle region. The biopsies were evaluated for density of inflammatory cells and their histologic location (glandular vs. periglandular vs. stromal). RESULTS: Inflammation was generally periglandular, with multifocal and diffuse patterns. The severity of the inflammation was quite variable. The overall inflammatory cell counts did not differ among the regions except for lower levels at the base. Correlation coefficients demonstrated significant correlations of the middle region biopsies with the peripheral zone and transition zone blocks (P = 0.02 and P = 0.016); the apical biopsies also correlated with the transition zone blocks. CONCLUSIONS: Our results suggest that individual, transrectal needle biopsies taken consistently from the peripheral zone or transition zone of the apex or middle region of prostates from patients with incidental prostatitis may serve as well as multiple biopsies for evaluating the degree of inflammation.

Evaluation of primary critical ischemia time for the deep circumflex iliac cutaneous flap in cats.

OBJECTIVE: To evaluate the primary critical ischemia time for the deep circumflex iliac (DCI) cutaneous flap in cats. STUDY DESIGN: In vivo model. ANIMALS: Thirteen young adult female cats. METHODS: An island skin flap was created on the right side of each cat based on the angiosome of the ventral branches of the DCI vessels. The cats were randomly assigned to a flap ischemia time ranging from 1 to 3 hours in 10-minute intervals. Microvascular clamps were used to occlude the artery and vein for the designated time. Flaps were sutured into position after the ischemic period. On day 3, fluorescein dye was administered and the flaps were evaluated under ultraviolet light to assess percent area of perfusion. On days 7 and 14, the percent area of survival was determined for each flap based on cutaneous morphometry. RESULTS: All flaps had 100 percent area of survival throughout the study. On day 3, all flaps fluoresced uniformly compared with the surrounding skin. On days 7 and 14, all flaps were uniformly viable as confirmed by skin color, consistency, bleeding, and hair re-growth. CONCLUSION: The DCI cutaneous flap in cats can withstand up to 3 hours of ischemia with predictable survival. CLINICAL RELEVANCE: In a clinical setting, high success rates can be expected with microvascular transfer of the DCI cutaneous flap in cats when the ischemia time is <3 hours and precise surgical technique is used.

Comparison of the effects of the CO2 surgical laser and conventional surgical techniques on healing and wound tensile strength of skin flaps in the dog.

OBJECTIVE: To determine if CO(2) laser was superior to conventional surgical techniques (CST) for creation of skin flaps in dogs as determined by hemostasis, wound healing, and wound tensile strength. STUDY DESIGN: In-vivo model ANIMALS: Six large, mixed-breed dogs. METHODS: On each dog's trunk, 3 pairs of identical, dorsally based, pedicled skin flaps were created and sutured back into position. Based on a Latin Square design, flaps on one side were created with a CO(2) laser and on the other side by CST. Intraoperative hemorrhage was measured by weighing sponges used to absorb blood. On days 7, 10, and 14, specimens from the flap-skin junction and the central portion of each pair of flaps were collected. Specimens were subjected to tensile strength testing and histologic examination to evaluate wound healing. RESULTS: Mean (+/- standard error of mean [SEM]) hemorrhage was significantly less (P =.02) with CO(2) laser (4.70 +/- 1.37 g) than CST (10.82 +/- 1.37 g). Wound tensile strength (N/m(2)) after CST (0.49 +/- 0.049) was significantly greater (P =.01) than with CO(2) laser (0.17 +/- 0.049). Laser incisions had partial necrosis of the wound edges and a more extensive inflammatory response; however, healing of the wound beds were similar regardless of technique. CONCLUSIONS: The CO(2) laser provided better intraoperative hemostasis than CST. However, overall healing and increase in tensile strength of the skin-flap junction of the flaps created by the laser may be delayed during the first few weeks of wound healing. CLINICAL RELEVANCE: Skin flaps used to repair large skin defects in dogs can be created and elevated with a CO(2) laser. In areas of increased skin mobility or tension, skin flaps created with CO(2) laser may be more susceptible to complications such as dehiscence, and care should be taken to minimize these complications.