Characteristics and long-term outcomes of dogs with gastroesophageal intussusception.

OBJECTIVE: To determine long-term outcomes and factors associated with those outcomes in dogs with gastroesophageal intussusception (GEI). ANIMALS: 36 dogs with GEI evaluated at 16 veterinary hospitals from January 2000 through January 2018. PROCEDURES: Medical records of included dogs were reviewed to collect information regarding signalment, clinical signs, physical examination findings, blood work and diagnostic imaging results, surgical findings, and outcome. Factors were evaluated for associations with various outcomes. RESULTS: Median age of dogs with GEI was 13.2 months, and males (72% [26/36]) and German Shepherd Dogs (33% [12/36]) were most common. Vomiting (67% [24/36]) and regurgitation (33% [12/36]) were the most common clinical signs. Ten of 36 (28%) dogs were euthanized without treatment, and 26 (72%) underwent treatment (25 surgically and 1 endoscopically). Twenty-three of the 26 (88%) treated dogs survived to discharge; median survival time was 995 days. At last follow-up, 15 of the 23 (65%) surviving dogs remained alive and 8 (35%) had died for reasons related to persistent regurgitation (n = 6) or reasons unrelated to GEI (2). Of the 10 dogs for which owners were contacted, 7 had persistent regurgitation, the severity of which was reduced through managed feedings. Dogs with acute (≤ 7 days) clinical signs or a previous diagnosis of megaesophagus were more likely to have persistent regurgitation than were dogs without these factors. CONCLUSIONS AND CLINICAL RELEVANCE: Treatment should be considered for dogs with GEI given the high rate of survival to discharge and median survival time. Although persistent regurgitation was common after treatment, a satisfactory outcome was possible with medical management, including managed feedings and medications.

Comparison of tensile strength among simple interrupted, cruciate, intradermal, and subdermal suture patterns for incision closure in ex vivo canine skin specimens.

OBJECTIVE To compare suture placement time, tension at skin separation and suture line failure, and mode of failure among 4 suture patterns. DESIGN Randomized trial. SAMPLE 60 skin specimens from the pelvic limbs of 30 purpose-bred Beagles. PROCEDURES Skin specimens were harvested within 2 hours after euthanasia and tested within 6 hours after harvest. An 8-cm incision was made in each specimen and sutured with 1 of 4 randomly assigned suture patterns (simple interrupted, cruciate, intradermal, or subdermal). Suture placement time and percentage of skin apposition were evaluated. Specimens were mounted in a calibrated material testing machine and distracted until suture line failure. Tensile strength at skin-edge separation and suture-line failure and mode of failure were compared among the 4 patterns. RESULTS Mean suture placement time for the cruciate pattern was significantly less than that for other patterns. Percentage of skin apposition did not differ among the 4 patterns. Mean tensile strength at skin-edge separation and suture-line failure for the simple interrupted and cruciate patterns were significantly higher than those for the intradermal and subdermal patterns. Mean tensile strength at skin-edge separation and suture-line failure did not differ significantly between the intradermal and subdermal patterns or the simple interrupted and cruciate patterns. The primary mode of failure for the simple interrupted pattern was suture breakage, whereas that for the cruciate, intradermal, and subdermal patterns was tissue failure. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested external skin sutures may be preferred for closure of incisions under tension to reduce risk of dehiscence.

Ex vivo biomechanical comparison of V-LOC 180® absorbable wound closure device and standard polyglyconate suture for diaphragmatic herniorrhaphy in a canine model.

OBJECTIVE: To compare 2-0 polyglyconate barbed suture (V-LOC™ 180 Absorbable Wound Closure Device, Covidien, Mansfield, MA) to standard 2-0 monofilament absorbable polyglyconate suture (Maxon™, Covidien) for maximum load to failure and failure mode when used to appose standardized defects in canine diaphragm muscle. STUDY DESIGN: Randomized, cadaveric ex vivo mechanical testing. SAMPLE POPULATION: Canine cadaveric hemi-diaphragmatic specimens (n = 32 pairs). METHODS: Thirty-two cadaveric diaphragm specimens were collected and divided to obtain 64 muscle specimens (9 cm × 4 cm). Paired specimens were bisected in the midpoint of their 9 cm length in the direction of the muscle fibers and apposed using either 2-0 polyglyconate or 2-0 barbed polyglyconate (V-LOC™ 180 Absorbable Wound Closure Device) in a simple continuous pattern. Increasing tension was applied perpendicular to the suture line until specimen failure. Failure mode and maximum load to failure were recorded for each specimen. RESULTS: Mean ± SD failure load of simulated herniorrhaphies performed with barbed polyglyconate suture (54.5 ± 10.27 N) was not significantly different than repair with polyglyconate (56.9 ± 10.87 N). Failure mode for both construct types was suture tear out rather than suture failure. CONCLUSIONS: Clinical application of 2-0 barbed polyglyconate suture can be considered as an alternative to the use of 2-0 polyglyconate for diaphragmatic herniorrhaphy.

Brachycephalic airway syndrome: management.

Brachycephalic airway syndrome (BAS) is a group of primary and secondary abnormalities that result in upper airway obstruction. Several of these abnormalities can be addressed medically and/or surgically to improve quality of life. This article reviews potential complications, anesthetic considerations, recovery strategies, and outcomes associated with medical and surgical management of BAS.

Brachycephalic airway syndrome: pathophysiology and diagnosis.

Brachycephalic airway syndrome (BAS) is a group of abnormalities that result in upper airway obstruction. Primary malformations include stenotic nares, elongated soft palate, and hypoplastic trachea, which cause an increase in negative pressure within the upper airways that can eventually lead to secondary abnormalities such as everted laryngeal saccules, everted tonsils, and laryngeal and tracheal collapse. Abnormal nasopharyngeal turbinates are also encountered, but have not been classified as primary or secondary. BAS is readily diagnosed, and quality of life is improved with appropriate medical and/or surgical management.

Effects of carprofen on the integrity and barrier function of canine colonic mucosa.

OBJECTIVE: To measure effects of carprofen on conductance and permeability to mannitol and histologic appearance in canine colonic mucosa. SAMPLE POPULATION: Colonic mucosa from 13 mature mixed-breed dogs. Procedures-Sections of mucosa from the transverse colon and proximal and distal portions of the descending colon were obtained immediately after dogs were euthanized. Sections were mounted in Ussing chambers. Carprofen (400 microg/mL) was added to the bathing solution for treated sections. Conductance was calculated at 15-minute intervals for 240 minutes. Flux of mannitol was calculated for three 1-hour periods. Histologic examination of sections was performed after experiments concluded. Conductance was graphed against time for each chamber, and area under each curve was calculated. Conductance X time, flux of mannitol, and frequency distribution of histologic findings were analyzed for an effect of region and carprofen. RESULTS: Carprofen significantly increased mean conductance X time, compared with values for control (untreated) sections for all regions of colon. Carprofen significantly increased mean flux of mannitol from period 1 to period 2 and from period 2 to period 3 for all regions of colon. Carprofen caused a significant proportion of sections to have severe sloughing of cells and erosions involving >or= 10% of the epithelium, compared with control sections. CONCLUSIONS AND CLINICAL RELEVANCE: Carprofen increased in vitro conductance and permeability to mannitol in canine colonic mucosa. Carprofen resulted in sloughing of cells and erosion of the colonic mucosa. These findings suggested that carprofen can compromise the integrity and barrier function of the colonic mucosa of dogs.

Tracheal resection and anastomosis in a mallard duck (Anas platyrhynchos) with traumatic segmental tracheal collapse.

A male mallard duck (Anas platyrhynchos) presented for examination for acute respiratory distress and lethargy. The duck had experienced recurrent episodes of respiratory distress since being attacked by a raccoon the previous year, resulting in neck lacerations. Diagnostic tests, including a complete blood count, plasma biochemical analysis, radiography, and tracheoscopy, revealed a collapsed trachea. Surgical correction of the collapsed tracheal segment resulted in resection of 9% of the total tracheal length and subsequent anastomosis. Tracheoscopy performed 2 and 3 months after surgery revealed a healthy mucosa, minimal reduction of the tracheal lumen in the area of anastomosis, and minimal suture granuloma formation.

Large trunk wounds.

Management of large trunk wounds begins with good wound management and bandaging. When a healthy wound bed exists and adequate tissue is present, the wound is closed. Fortunately, there is an abundance of loose trunk skin in most animals, and wound closure can be accomplished by simple reconstructive techniques, such as undermining and tension or "walking sutures." Nevertheless, some wounds and areas of the torso may require more advanced tension-relieving techniques, skin stretching, and tissue implants or flaps to achieve tension-free closure and successful wound healing. Use of these techniques allows wound closure and good cosmetic results for even those wounds that initially may seem foreboding.

In vitro evaluation of the 18 and 36 kg Securos Cranial Cruciate Ligament Repair System.

OBJECTIVE: To evaluate the mechanical properties of the 18 and 36 kg Securos Cranial Cruciate Ligament Repair System. STUDY DESIGN: In vitro mechanical evaluation. SAMPLE POPULATION: Loop constructs of 18, 27, and 36 kilogram test (kgt) nylon leader line (NLL) secured with Securos crimp-clamps (SCC, n=40 per NLL test weight) or by a clamped square knot (CSK; n=40/NLL test weight). METHODS: The 36 kg SCC were used for the 27 and 36 kgt NLL, and 18 kg SCC were used for the 18 kgt NLL. Loop constructs were mounted on a material testing machine, and distracted at 500 mm/min for static tests, and for cyclic tests at 500 mm/min to a distraction limit of 6 mm (18 kgt) or 7.5 mm (27 and 36 kgt) for 49 cycles, until failure. Constructs were tested at 20 degrees C except for 1 group of 27 kgt CSK loops tested at 40 degrees C. Load at failure, elongation, and stiffness was recorded and compared between groups under static or cyclic testing conditions. RESULTS: All 27 and 36 kgt loops failed by disruption of NLL contained within the knot or crimp-clamp, whereas 18 kgt SCC loops failed by the NLL pulling through the crimp-clamp. The 18 kg SCC loops had considerable variability in ultimate load and elongation (coefficient of variation 29.6% and 18.3%, respectively). There was no significant difference in elongation between 27.3 kgt CSK loops tested at 20 degrees C and 40 degrees C. Generally, in both static and cyclic testing, SCC constructs formed with 27.3 or 36.4 kgt NLL performed as well or better than CSK constructs, resulting in loops that were strong, underwent minimal elongation, and had high stiffness. CONCLUSION: The results support use of the 36 kg Securos system but not the 18 kg Securos system (with the clamp and crimping device used). The significantly lower load required for failure, slippage through the clamp, and substantial variability suggested that the crimp tube diameter or the crimping device tested may be inappropriate for use with 18 kgt NLL. CLINICAL RELEVANCE: Surgeons should be aware that crimp-clamp design is important in controlling suture slippage or breakage within the clamp, and that novel systems should undergo mechanical testing with the size suture material they are intended to secure before clinical use.

Gastric and intestinal surgery.

Gastric surgery is commonly performed to remove foreign bodies and correct gastric dilatation-volvulus and is less commonly performed to treat gastric ulceration or erosion, neoplasia, and benign gastric outflow obstruction. Intestinal surgery, although commonly performed by veterinarians, should never be considered routine. The most common procedures of the small intestinal tract performed in dogs and cats include enterotomy and resection/anastomosis. Surgery of the large intestine is indicated for lesions causing obstruction, perforations, colonic inertia, or chronic inflammation.

Postoperative integrity of veterinary surgical gloves.

A multicenter, prospective study was performed to document the incidence of defective gloves postoperatively in veterinary surgery and to correlate defects with a variety of influencing factors. Gloves were collected after surgical procedures performed by the small animal clinical services at two veterinary teaching hospitals and one institution's student surgery laboratories. Gloves were evaluated for defects using electrical resistance testing. The overall incidence of glove defects was 23.3%. Significantly more defects occurred in gloves used for nonsoft-tissue procedures and in gloves worn on the nondominant hand. Eighty-four percent of all defects occurred in procedures lasting >60 minutes. No differences were detected in the brands of gloves used nor among surgeons of different experience levels. The individuals performing the surgery were not able to accurately predict the presence of a defect in their gloves. Surgeons should remain alert for possible glove defects and consider measures such as changing gloves every 60 minutes or double-gloving to minimize potential complications.

Surgical education: attitudes toward animal use in teaching surgery at Louisiana State University.

Concerns over the use of animals in teaching have lead to a reduction in the number of live animal laboratories. A survey of 275 students and faculty was conducted to characterize their attitude toward the use of animals in teaching surgery. Respondents favored live animal use. They believed that model laboratories were helpful in learning aseptic technique and suturing skills but less helpful in learning tissue handling, dissection, hemostasis, or anesthesia.