Distal femoral lateral closing wedge osteotomy as a component of comprehensive treatment of medial patellar luxation and distal femoral varus in dogs.

OBJECTIVE: To describe a cohort of dogs with medial patellar luxation managed with a distal femoral lateral closing wedge ostectomy (DFO) as a component of comprehensive treatment, and to report radiographic and long-term clinical outcome of this technique. METHODS: Medical records of dogs that had a lateral closing wedge DFO as part of management of medial patellar luxation at three veterinary teaching hospitals were reviewed. Surgical reports as well as the preoperative, postoperative, and follow-up radiographs were reviewed. The anatomical lateral distal femoral angle (aLDFA) was determined. Long-term clinical outcome was assessed by telephone interview with the owner. RESULTS: A lateral closing wedge DFO was performed on 66 limbs. The mean pre- and postoperative aLDFA was 107.6° ± 5.8° and 94.1° ± 4.2°, respectively. Cranial cruciate ligament disease was identified in 28/66 affected limbs. Tibial angular deformity, torsional deformity, or both was identified in nine of the 66 limbs. Ostectomy healing was confirmed radiographically in 51/66 limbs. The mean time to union was 73 ± 37 days. All patellae were in the normal position and stable. Complications included infection (2/51), fixation failure (1/51), delayed healing (2/51), and persistent lameness (1/51). CLINICAL SIGNIFICANCE: In this cohort of cases, DFO was a highly successful and repeatable component of surgical treatment for dogs with medial patellar luxation associated with femoral varus. This study also provides more evidence of the high rate of concurrent cranial cruciate ligament disease in cases of medial patellar luxation complicated by femoral varus, and supports an association between stifle instability and medial patellar luxation.

Microcirculatory effects of a hyperviscous hemoglobin-based solution administered intravenously in dogs with experimentally induced hemorrhagic shock.

OBJECTIVE: To determine whether increasing the viscosity of a standard hemoglobin-based oxygen-carrying solution (HBOC) would offset its associated vasoconstrictive effects and result in improved microvascular perfusion in healthy splenectomized dogs with experimentally induced hemorrhagic shock. ANIMALS: 12 male American Foxhounds. PROCEDURES: Each dog underwent anesthesia and splenectomy. Shock was induced by controlled hemorrhage until a mean arterial blood pressure of 40 mm Hg was achieved and maintained for 60 minutes. Dogs were then randomly assigned to receive either a standard or hyperviscous HBOC (6 dogs/group). Sidestream dark-field microscopy was used to assess the effects of shock and HBOC administration on the microcirculation of the buccal mucosa and the jejunal serosa. Video recordings of the microcirculation were collected before shock was induced (baseline) and at intervals up to 180 minutes following HBOC administration. Vascular analysis software was used to compute microcirculatory variables. RESULTS: Compared with baseline findings, hemorrhagic shock resulted in decreases in all microvascular variables in the buccal mucosa and the jejunal serosa. At all time points following HBOC administration, microvascular variables were similar to initial values and no significant differences between treatment groups were detected. At all time points following HBOC administration, blood and plasma viscosities in dogs treated with the hyperviscous solution were significantly higher than values in dogs receiving the standard solution. CONCLUSIONS AND CLINICAL RELEVANCE: In splenectomized dogs with experimentally induced hemorrhagic shock, administration of a hyperviscous HBOC did not significantly affect microvascular variables, compared with effects of a standard HBOC. Microcirculatory flow returned to baseline values in both treatment groups, suggesting that marked HBOC-associated vasoconstriction did not occur.

Assessment of microcirculatory changes by use of sidestream dark field microscopy during hemorrhagic shock in dogs.

OBJECTIVE: To directly assess microcirculatory changes associated with induced hemorrhagic shock by use of sidestream dark field microscopy (SDM) and correlate those values with concurrently measured macrovascular and blood gas variables in healthy anesthetized dogs. ANIMALS: 12 adult dogs. PROCEDURES: Dogs were anesthetized and splenectomized. Instrumentation and catheterization were performed for determination of macrohemodynamic and blood gas variables. Hemorrhagic shock was induced via controlled hemorrhage to a mean arterial blood pressure (MAP) of 40 mm Hg. Dogs were maintained in the shock state (MAP, 35 to 45 mm Hg) for 60 minutes. An SDM device was used to image microcirculation of buccal mucosa, and vascular analysis software was used to determine microcirculatory variables. These values were compared with other cardiovascular and blood gas variables to determine correlations. RESULTS: Following hemorrhage, there was a significant decrease in microvascular variables (mean ± SD), including proportion of perfused vessels (82.77 ± 8.32% vs 57.21 ± 28.83%), perfused vessel density (14.86 ± 2.64 mm/m(2) vs 6.66 ± 4.75 mm/m(2)), and microvascular flow index (2.54 ± 0.52 vs 1.59 ± 0.85). Perfused vessel density individually correlated well with macrovascular variables, with heart rate (zero order, partial correlation, and part correlation coefficients = -0.762, -0.884, and -0.793, respectively) and oxygen extraction ratio (-0.734, -0.832, and -0.746, respectively) being the most important predictors. CONCLUSIONS AND CLINICAL RELEVANCE: SDM allowed real-time imaging of the microvasculature and has potential as an effective tool in experimental and clinical applications for monitoring microcirculatory changes associated with hemorrhagic shock and resuscitation in dogs.