Evaluation of the addition of adrenaline in a bilateral maxillary nerve block to reduce hemorrhage in dogs undergoing sharp staphylectomy for brachycephalic obstructive airway syndrome. A prospective, randomized study.

OBJECTIVE: To assess the use of adrenaline (0.00198%) in a bilateral maxillary nerve block to reduce intraoperative hemorrhage in dogs undergoing staphylectomy for the treatment of brachycephalic obstructive airway syndrome (BOAS). STUDY DESIGN: Prospective, randomized, double-blinded controlled study. SAMPLE POPULATION: A total of 32 client owned, clinically affected dogs undergoing a cut and sew sharp staphylectomy for treatment of BOAS. A total of 16 dogs randomly assigned to adrenaline (A) group and 16 to no-adrenaline (NA) group. METHODS: A bilateral maxillary nerve block was performed in all dogs prior to staphylectomy using lidocaine alone (group NA) or a combination of lidocaine and adrenaline (group A). Total hemorrhage was measured by weighing cotton-tipped applicators and swabs used on precision scales. In addition, a semi-quantitative hemorrhage score (1-5) was determined. Dogs were monitored for intraoperative hemodynamic stability during the procedure. RESULTS: Total hemorrhage was significantly (p = .013) lower in group A compared with group NA. The median semi-quantitative hemorrhage score was significantly lower for group A (p = .029) compared with group NA. No significant adverse effects were noted due to adrenaline usage. CONCLUSION: This study demonstrated that the use of adrenaline in a bilateral maxillary nerve block results in significantly lower intraoperative hemorrhage during cut and sew sharp staphylectomy and appeared safe to use. CLINICAL SIGNIFICANCE: Potential clinical advantages include improved visualization, prevention of unnecessary blood loss and reduction in risk of blood aspiration.

Incomplete histological margins following planned narrow excision of canine appendicular soft tissue sarcomas and mast cell tumors, using the residual tumor classification scheme.

OBJECTIVE: To describe the frequency of incomplete histological margins following planned narrow excision (PNE) of mast cell tumors (MCTs) and soft tissue sarcomas (STSs), and to assess the residual tumor classification (R) scheme for reporting histological margins in clinical cases. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: Forty-four client-owned dogs with 47 masses. METHODS: Medical records of dogs undergoing planned narrow excision of STSs and MCTs were reviewed (2016-2019). Histologic specimens were reviewed by a single pathologist and assigned R scoring (histologically incomplete/R1 margins defined as "tumor on ink"). RESULTS: Six out of 23 (26%) MCT PNEs and 10/42 (42%) of STS PNEs resulted in R1 margins. R1 margins were more likely when performing PNE with 6-10 mm lateral measured surgical margins (LMSMs) versus 0-5 mm LMSM for MCTs (1/14 vs 5/9), but not STSs (3/7 vs 7/17) (P = .049). The R scheme resulted in higher retrospective percentage agreement in histological reporting than defining incomplete histological margin as tumor cells within ≤1 mm of the margin (83% vs 68% agreement). Complications occurred in 12/47 surgeries, with none requiring additional surgery. Tumors recurred in 3/18 (17%) STSs and 2/18 (11%) MCTs. CONCLUSION: Fewer R1 margins were obtained when PNE with LMSM of 6-10 mm was performed for mast cell tumors. The use of the R scheme increased agreement in histopathological margin assessment. CLINICAL SIGNIFICANCE: Planned narrow excision is a viable technique for histopathological diagnosis of appendicular soft tissue sarcomas and mast cell tumors for limb salvage.

Comparison of median sternotomy closure-related complication rates using orthopedic wire or suture in dogs: A multi-institutional observational treatment effect analysis.

OBJECTIVE: To determine and compare median sternotomy (MS) closure-related complication rates using orthopedic wire or suture in dogs. STUDY DESIGN: Multi-institutional, retrospective observational study with treatment effect analysis. ANIMALS: 331 client-owned dogs, of which 68 were excluded. METHODS: Medical records of dogs with MS were examined across nine referral centers (2004-2020). Signalment, weight, clinical presentation, surgical details, complications, and outcomes were recorded. Follow-up was performed using patient records and email/telephone contact. Descriptive statistics, treatment effect analysis and logistic regression were performed. RESULTS: Median sternotomy closure was performed with wire in 115 dogs and suture in 148. Thirty-seven dogs experienced closure-related complications (14.1%), 20 in the wire group and 17 in the suture group. Twenty-three were listed as mild, four as moderate and 10 as severe. Treatment effect analysis showed a mean of 2.3% reduction in closure-related complications associated with using suture versus wire (95% CI: -9.1% to +4.5%). In multivariable logistic regression, the only factor associated with increased risk of closure-related complications was dog size (p = .01). This effect was not modified by the type of closure used (interaction term: OR = 0.99 [95% CI: 0.96/1.01]). CONCLUSION: The incidence of closure-related complication after MS was low compared to previous reports. The likelihood of developing a closure-related complication was equivalent between sutures and wires, independent of dog size, despite a higher proportion of complications seen in larger dogs (≥20 kg). CLINICAL SIGNIFICANCE: Use of either orthopedic wire or suture appear to be an appropriate closure method for sternotomy in dogs of any size.

Retrospective assessment of the clinical relevance of surgical biopsies of abdominal lymph nodes in cats: 51 cases (2014-2018).

OBJECTIVES: The aims of this study were to assess surgical biopsy of abdominal lymph nodes (LNs) in cats taken at the time of exploratory laparotomy and to evaluate any additional benefit of histopathology compared with LN cytology. METHODS: We carried out a retrospective study from a single institution of cats that had abdominal ultrasound and LN biopsies as part of an exploratory laparotomy (2014-2018). Clinical records were reviewed for presenting signs, medical investigations, ultrasound, cytology, surgical findings and histopathology. RESULTS: Fifty-one cats were included. In total, 60 LNs were biopsied. Forty-four cats had evident LN enlargement at the time of surgery. Nine of those cases were reported to have normal-sized LNs on ultrasound, including one cat that was subsequently diagnosed with lymphoma. Ultrasound-guided LN aspiration was performed in 19 cases. Five of these cats had a histological diagnosis of neoplasia following biopsy, but only one was correctly identified with cytology. Histopathology results were reactive hyperplasia (n = 41), tumour metastasis (n = 11), lymphadenitis (n = 6), inconclusive (n = 1) and normal (n = 1). The most common final diagnoses were inflammatory bowel disease (n = 17/51) and gastrointestinal lymphoma (n = 10/51). There were 15 cats with neoplastic disease; LN biopsies confirmed metastatic disease in 10 and ruled out nodal involvement in five. CONCLUSIONS AND RELEVANCE: Surgical biopsy of grossly enlarged or normal abdominal LNs provides additional information to LN cytology in cats and in the majority of cases is associated with a positive histological diagnosis. There appears to be the potential to underdiagnose neoplasia with cytology alone.

Postoperative regurgitation in dogs after upper airway surgery to treat brachycephalic obstructive airway syndrome: 258 cases (2013-2017).

OBJECTIVE: To determine the incidence of and risk factors for regurgitation in dogs within 24 hours of surgical management of brachycephalic obstructive airway syndrome (BOAS). STUDY DESIGN: Retrospective single center study of dogs undergoing BOAS surgery over four years (2013-2017). ANIMALS: Two hundred fifty-eight client-owned dogs referred for surgical intervention for BOAS. METHODS: Electronic medical records were searched for dogs that had undergone surgery for BOAS at a UK specialist referral hospital. Data were assessed by using univariable binomial logistic regression; confounding factors were then identified in a multivariable model. RESULTS: There was an increase in the proportion of dogs that regurgitated while hospitalized preoperatively vs during the first 24 hours postoperatively, from 28 (10.9%) to 89 (34.5%), respectively (P < .0001). History of regurgitation (P = .017, odds ratio [OR] 2.539, 95% confidence interval [CI] 1.178-5.469) and age (P = .008, OR 0.712, 95% CI 0.553-0.916) were detected as risk factors for postoperative regurgitation. For every 1-year increase in age, the odds of experiencing postoperative regurgitation were reduced by 28.8%. CONCLUSION: Corrective surgery for BOAS was associated with a marked incidence of postoperative regurgitation. Younger dogs and those with a history of regurgitation were predisposed to postoperative regurgitation. CLINICAL SIGNIFICANCE: The increased frequency of regurgitation after surgical treatment of BOAS, especially in younger dogs, provides justification for counseling owners regarding this postoperative complication.

Complications and outcome of cats with congenital extrahepatic portosystemic shunts treated with thin film: Thirty-four cases (2008-2017).

BACKGROUND: Congenital extrahepatic portosystemic shunts (CEHPSS) are rare in cats. Outcome after attenuation of CEHPSS with thin film has been described in a small number of cases. OBJECTIVES: To describe the clinical presentation, postoperative complications, and outcome of cats treated with thin film to attenuate CEHPSS. ANIMALS: Thirty-four cats with CEHPSS were identified from the database of 3 institutions over 9 years. METHODS: Retrospective study. Medical records were reviewed to identify cats with a diagnosis of a CEHPSS that underwent surgical attenuation. Congenital extrahepatic portosystemic shunts were suspected from clinical signs, clinicopathologic findings, and diagnostic imaging, and confirmed at exploratory laparotomy. Cats treated with thin film band attenuation were included. Postoperative complications and follow-up were recorded. RESULTS: Complications were recorded in 11 of 34 cats. Deaths related to CEHPSS occurred in 6 of 34; 4 cats did not survive to discharge. Persistent seizures were the cause of death in 4 cats. Seizures were recorded in 8 of 34 cats after surgery; all these cats received preoperative antiepileptic drugs. Serum bile acid concentrations normalized in 25 of 28 of the cats for which data was available. Three cats had persistently increased serum bile acid concentrations and underwent a second exploratory laparotomy. One had a patent shunt, the other 2 had multiple acquired portosystemic shunts. Median follow-up was 8 months (0.5-84 months). CONCLUSIONS AND CLINICAL IMPORTANCE: Congenital extrahepatic portosystemic shunts attenuation using thin film in cats carries a good short- and mid-term prognosis if they survive the postoperative period. Seizures were the most common cause of death.

Outcome of two variations of a surgical technique performed for canine unilateral arytenoid lateralisation.

Background The purpose of this study is to compare the rate of aspiration pneumonia and survival time of dogs undergoing two unilateral arytenoid lateralisation (UAL) techniques.Methods Eighty dogs diagnosed with laryngeal paralysis were treated by one of two UAL techniques: (1) a standard technique (ST) and (2) an anatomic preservation technique (APT). Outcome was assessed by in clinic re-examination and an owner follow-up questionnaire.Results Minor complications were reported for 22 per cent of dogs undergoing ST and 26 per cent for APT. Major complications were 7 per cent for ST versus 23 per cent for APT. Postoperative aspiration pneumonia was reported for 7 per cent of cases in ST and 17 per cent in APT. The median survival time for ST was 636 days and was 1067 days for APT. Cause of death was related to the laryngeal paralysis in 22 per cent, neurological deterioration in 16 per cent and for non-associated reasons in 59 per cent of cases. There was no statistically significant difference in the rate of aspiration pneumonia or survival time among the treatment groups. Owners reported that their dogs improved after both surgical procedures, with 90 per cent of the owners satisfied with the surgical outcome. Eighteen per cent of the dogs suffered recurrence of clinical signs.Conclusions In this study, there was no significant difference in risk of aspiration pneumonia or survival time following arytenoid lateralisation by either an ST or an APT.

Fluoroscopically guided wide-bore thoracostomy tube placement: Description of the technique and comparison to blind placement.

OBJECTIVE: To describe and compare fluoroscopic guidance for placement of wide-bore thoracostomy tubes (FGTT) to traditional, blind placement of thoracostomy tubes (BPTT). STUDY DESIGN: Prospective clinical trial. ANIMALS: Twenty client-owned dogs. METHODS: Dogs requiring medical management of pleural effusion received a BPTT, whereas dogs undergoing postoperative management of pneumothorax and/or pleural fluid after lateral thoracotomy received an FGTT. Time of placement, accuracy of positioning, radiation exposure, and complications were compared between groups. RESULTS: Initial placement of BPTT took a mean of 168 seconds (range, 89-197), whereas adequate placement was radiographically confirmed at 20 minutes and 38 seconds (range, 7 minutes and 57 seconds to 39 min). Initial placement of FGTT took a mean time of 108 seconds (range, 50-341, P = .17), and adequate placement was confirmed at 125 seconds (range, 50-341, P < .001). Major errors in placement requiring removal and replacement occurred in 2 dogs for BPTT and in none for FGTT. Procedural complications did not differ between groups, and no postoperative complication occurred within the first 12 hours after placement. Radiation entrance surface dose was lower in the BPTT group (P = .004), but stochastic radiation doses did not differ. CONCLUSION: Fluoroscopic guidance of wide-bore thoracostomy tubes accelerated the time to accurate tube placement and alleviated the requirement for removal and replacement in this population. Although use of fluoroscopy increased radiation entrance surface dose, the dose was not clinically significant. CLINICAL SIGNIFICANCE: Fluoroscopic guidance of wide-bore thoracostomy tubes should be considered as an alternative to traditional, blind placement.

Magnetic resonance imaging evaluation of olfactory bulb angle and soft palate dimensions in brachycephalic and nonbrachycephalic dogs.

OBJECTIVE To determine from MRI measurements whether soft palate length (SPL) and thickness are correlated in dogs, evaluate the association between the olfactory bulb angle (OBA) and degree of brachycephalia, and determine the correlation between soft palate-epiglottis overlap and OBA in dogs. ANIMALS 50 brachycephalic and 50 nonbrachycephalic client-owned dogs without abnormalities of the head. PROCEDURES Medical records and archived midsagittal T2-weighted MRI images of brachycephalic and nonbrachycephalic dogs' heads were reviewed. Group assignment was based on breed. Data collected included weight, SPL and thickness, OBA, and the distance between the caudal extremity of the soft palate and the basihyoid. Soft palate length and thickness were adjusted on the basis of body weight. RESULTS Brachycephalic dogs had significantly thicker soft palates and lower OBAs, compared with findings for nonbrachycephalic dogs. There was a significant negative correlation (r2 = 0.45) between OBA and soft palate thickness. The correlation between SPL and OBA was less profound (r2 = 0.09). The distance between the caudal extremity of the soft palate and the basihyoid was shorter in brachycephalic dogs than in nonbrachycephalic dogs. The percentage of epiglottis-soft palate overlap significantly decreased with increasing OBA (r2 = 0.31). CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that MRI images can be consistently used to assess anatomic landmarks for measurement of SPL and thickness, OBA, and soft palate-to-epiglottis distance in brachycephalic and nonbrachycephalic dogs. The percentage of epiglottis-soft palate overlap was significantly greater in brachycephalic dogs and was correlated to the degree of brachycephalia.

Outcome of full-thickness skin grafts used to close skin defects involving the distal aspects of the limbs in cats and dogs: 52 cases (2005-2012).

OBJECTIVE: To describe the outcome of full-thickness skin grafts used to close skin defects involving the distal aspects of the limbs in cats and dogs and identify factors associated with outcome. DESIGN: Retrospective case series. ANIMALS: 20 cats and 32 dogs with a skin defect involving the distal aspect of a limb that received 58 full-thickness skin grafts between 2005 and 2012. PROCEDURES: Data regarding patient signalment, location and cause of the skin defect, surgical and anesthetic duration, and postoperative bandaging protocol were obtained from the medical records. Graft outcome was assessed by interpreting descriptions in the records; skin viability over ≥ 75% of the graft area between 7 and 14 days after surgery was considered a successful outcome. RESULTS: For 4 of the 58 grafts, graft outcome could not be determined from the medical record. For the remaining grafts, success rate was significantly higher for grafts placed in cats (17/22 [77%]) than in dogs (12/32 [38%]). The overall complication rate was 50%; complications included skin graft failure, donor site dehiscence, and bandage-induced sloughing of skin adjacent to the graft recipient site. In addition to species, anatomic location of the skin defect was identified as a prognostic indicator of graft outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Full-thickness skin grafting had a higher success rate in cats than in dogs. Skin grafts applied to the antebrachium, compared with other locations on the distal aspects of the limbs, were associated with a poorer prognosis.

Comparison of Veterinary Student Ability to Learn 1-Handed and 2-Handed Techniques for Surgical Knot Tying.

OBJECTIVE: To determine which type of surgical hand-tie trainee surgeons learn most readily in a laboratory setting, using a combination of audiovisual demonstration and one-on-one teaching. STUDY DESIGN: Randomized controlled learning trial. SAMPLE POPULATION: Year 4 veterinary students in their 1st year of clinical training (n = 58). METHODS: Veterinary students entering clinical rotations were randomly allocated to 2 learning groups: 1-handed (28 students) or 2-handed (30 students) surgical ties. Knot tying technique was taught followed by three 15-minute practice sessions with student progress recorded by filming each student tying a square knot (2 throws). All 3 knot tying attempts were scored for technique and knot formation. Data on potential confounding factors between groups, including age and gender, were recorded. RESULTS: There were no significant differences between group scores for each attempt (1st attempt P = .5; 2nd P = .2; 3rd P = .19). Initially, scores indicated more rapid learning in the 1-handed group but fewer individuals achieved a perfect technique and knot after 60 minutes of learning (29/30 for 2-handed; 24/28 for 1-handed group). The 1-handed group was the most error-prone (after 45 minutes P < .01; after 60 min P < .01). CONCLUSIONS: Over 95% of students in the 2-handed group performed the technique and knot perfectly after 60 minutes learning time; were significantly less error-prone and fewer students continued to make corrected errors after 60 minutes. This evidence indicates that the 2-handed technique allows students to achieve success in a manageable teaching time.

Hypertrophic osteopathy in a cat with a concurrent injection-site sarcoma.

Case summary An 11-year old neutered female domestic shorthair cat presented for investigation of a large, partially ulcerated skin mass in the area of the left scapula. The cat had been vaccinated 6 weeks previously in the same area. Haematology showed a marked neutrophilia and monocytosis. Tru-cut biopsies were taken and histopathology was consistent with a high-grade soft tissue sarcoma. Thoracic radiographs and abdominal ultrasound revealed no abnormalities. Moderate mixed (palisading, brush border and smooth) periosteal reaction was seen on the diaphysis of long bones at the time of the radiographic examination. Magnetic resonance imaging of the mass showed infiltration within deeper tissues and the owners elected euthanasia. Post-mortem examination confirmed the presence of hypertrophic osteopathy with a concurrent injection-site sarcoma. No evidence of intra-thoracic or intra-abdominal disease was found. Relevance and novel information To our knowledge, this is the first report where hypertrophic osteopathy has been described in a cat with a soft tissue sarcoma, most likely an injection-site sarcoma.

A retrospective analysis of urethral rupture in 63 cats.

The aim of this study was to investigate the short- and long-term morbidity and mortality associated with urethral rupture in cats. Medical records were reviewed from four veterinary hospitals. Diagnosis was made from retrograde urethrography or direct visualisation during surgery. Location of rupture was categorised as pre-, intra- or post-pelvic. Follow-up data were collected from referring veterinarians. Sixty-three cats were included in the study of which, males predominated (88.9%). Trauma was the most common cause (n = 35; 55.6%) with the remainder due to iatrogenic injury. Forty-eight cats (88.9%) were treated surgically and six (11.1%) managed conservatively. Significant differences between cats suffering traumatic versus iatrogenic injury included the presence of musculoskeletal injuries (P <0.001); the location of rupture (P <0.001); the degree of rupture (P <0.001); definitive management (P <0.001) and short-term complications (P = 0.026). Short-term complications were significantly associated with the following: musculoskeletal injuries (P = 0.012); uroabdomen/uroretroperitoneum (P = 0.004); azotaemia (P = 0.021); postoperative urinary diversion (P = 0.036) and >1 surgery performed (P = 0.006). Forty-seven cats (74.6%) survived to discharge. Prognostic factors associated with survival to discharge included the presence of musculoskeletal injuries (P = 0.017); cause of rupture (P = 0.017); location of rupture (P = 0.039) and definitive management (P = 0.020). Twenty-four cats (57.1%) suffered short-term complications and 10 (27.0%) suffered long-term complications. Of those cats surviving to discharge 30 (71.4%) had a good outcome. Median follow-up was 16 months. Outcome was significantly associated with cause of rupture (P = 0.04); short-term complications (P = 0.03) and long-term complications (P <0.001). In conclusion, a significantly greater proportion of cats with iatrogenic injuries survived to discharge and had a good outcome compared with those that suffered trauma.

Reconstruction of a nonhealing lick granuloma in a dog using a phalangeal fillet technique.

A 6.5-year-old, castrated male Dalmatian was presented with a 3-month history of a chronic, nonhealing wound related to a previously excised lick granuloma. Reconstruction of the wound on the lateral metatarsal region was achieved using a phalangeal fillet technique, without digital pad transposition. The skin flap healed successfully with very good cosmetic and functional results.

Pullout strength for three suture patterns used for canine tracheal anastomosis.

OBJECTIVE: To compare pullout strength of 3 suture patterns used for canine tracheal anastomosis. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Cadaveric canine tracheae (n = 20). METHOD: Tracheal segments were anastomosed with 1 of 3 suture patterns: simple continuous, simple interrupted, and simple interrupted reinforced with horizontal mattress, each encircling annular cartilage rings adjacent to the transection site. Horizontal mattress sutures encircled the annular rings proximal and distal to the rings closest to the anastomosis. Each construct was distracted (0.5 mm/s) in a materials testing machine to failure. Load-displacement curves were generated and failure load (pullout strength) determined and mode of failure recorded. RESULTS: Tracheal anastomosis with a simple interrupted pattern was significantly weaker (mean+/-SD pullout strength, 102.55+/-30.14 N) than simple continuous (135.53+/-15.47 N) or simple interrupted plus horizontal mattress (132.39+/-21.46 N), which were not different from each other. Mode of failure was consistently by suture tear out. CONCLUSIONS: Both simple continuous and simple interrupted reinforced with horizontal mattress suture patterns have significant biomechanical advantage over a simple interrupted pattern alone in canine cadaveric tracheal anastomosis. The simple continuous pattern had the least variability in pullout strength. CLINICAL RELEVANCE: A simple continuous technique should be considered when selecting a tension-relieving pattern for canine tracheal anastomosis. It offers the same biomechanical advantage as a simple interrupted pattern reinforced with a horizontal mattress pattern and its strength appears to be reliably maintained when tested in canine cadaver tracheae.

The effect of two modifications of unilateral arytenoid lateralization on rima glottidis area in dogs.

OBJECTIVES: To evaluate the clinical outcome and percentage increase in rima glottidis area achieved using a combined technique of cricoarytenoid and thyroarytenoid cartilage lateralization compared with cricoarytenoid cartilage lateralization alone in live anesthetized dogs clinically affected with bilateral laryngeal paralysis. STUDY DESIGN: Randomized prospective clinical study. ANIMALS: Twenty dogs with bilateral laryngeal paralysis. Methods-Bilateral laryngeal paralysis was diagnosed by direct laryngoscopy. Each dog was allocated randomly to 1 of 2 surgical groups: CAL (cricoarytenoid lateralization) and CTAL (cricoarytenoid and thyroarytenoid lateralization). Photographs were taken of each larynx before and after surgery, the images were digitized, and the preoperative and postoperative areas of each rima glottidis were measured. The percentage increase in rima glottidis area produced by each of the arytenoid lateralization procedures was compared. Follow-up was obtained by telephone survey of owners and referring veterinarians. RESULTS: There was no significant difference in mean (+/- SD) percentage increase in rima glottidis area for the CAL group (241.5 +/- 42.9%) or the CTAL group (236.4 +/- 44.5%). Clinical follow-up (median, 18 months postoperatively) indicated 60% of the dogs were still alive and only 1 dog had died as a result of complications related to surgery. CONCLUSIONS: CTAL for the treatment of canine laryngeal paralysis does not significantly increase rima glottidis area compared with CAL alone. The mean percentage increase in rima glottidis area obtained with both procedures was comparable to previously reported mean increases with CAL in live anesthetized dogs. Both procedures resulted in good long-term clinical outcome. CLINICAL RELEVANCE: CTAL is as effective as CAL in providing an increased rima glottidis for the treatment of bilateral laryngeal paralysis in dogs.