Evaluation of postoperative complication rates in cats undergoing perineal urethrostomy performed in dorsal recumbency.

CASE SERIES SUMMARY: Medical records were reviewed for cats that underwent a perineal urethrostomy performed in dorsal recumbency for the treatment of urethral obstruction. Information, including signalment, reason for presentation, number of previous obstructions, surgery time, and perioperative and postoperative complications, were collected through a review of medical records and owner follow-up. The objective was to evaluate short- and long-term complications in cats that underwent perineal urethrostomy performed in dorsal recumbency for treatment of urethral obstruction. RELEVANCE AND NOVEL INFORMATION: No major or life-threatening complications, such as urethral stricture, re-obstruction, euthanasia due to lower urinary signs or chronic urinary tract infection, were reported. Short-term complications were limited to dysuria in 2/12 (16.7%) cats. Long-term follow-up was available for nine cats. The most common long-term complication seen in this population of cats was a single recurrence of urinary tract infection in 3/9 (33.3%) cats that resolved after a short course of empirical antibiotic therapy. Performing perineal urethrostomy in dorsal recumbency is safe and may have advantages to ventral recumbency due to improved visualization, allowing for more efficient dissection and improved accuracy in tissue apposition during closure. We believe this has been a major contributor to our reported reduced major postoperative complication rate.

Effect of peritoneal lavage on bacterial isolates in 40 dogs with confirmed septic peritonitis.

OBJECTIVE: To evaluate bacterial isolates, antimicrobial drug susceptibility, and change in resistance among pre- and post-lavage culture samples in dogs with septic peritonitis. DESIGN: Prospective observational study. SETTING: Private practice referral hospital. ANIMALS: Forty client-owned dogs with confirmed septic peritonitis requiring surgical intervention. INTERVENTIONS: All dogs had perioperative abdominal lavage following source control with 200 to 300 mL/kg 0.9% sterile saline. Pre- and post-lavage aerobic and anaerobic culture samples were evaluated. MEASUREMENTS AND MAIN RESULTS: Thirty-five of 40 dogs (87.5%) survived to hospital discharge. The likelihood of an aerobic organism to have multidrug resistance (resistance to 3 or more antimicrobial classes) post-lavage was a third of that pre-lavage (odds ratio [OR] 0.34, 95% CI [0.17-0.68], P = 0.01). Thirty-nine of 40 dogs (97.5%) received appropriate empiric antimicrobial therapy based on pre- and post-lavage culture results, of which 5 (12.8%) did not survive to discharge. The single dog with inappropriate antimicrobial therapy survived to discharge. The most frequent isolates detected included Escherichia coli, Clostridium perfringens, and Enterococcus faecalis. The same organism based on species was isolated in pre- and post-lavage cultures in 32 dogs, accounting for 59 anaerobic and aerobic isolates. There was a new bacterial isolate detected in 20 dogs, accounting for 46 isolates and an overall total decrease of 14 isolates between pre- and post-lavage culture (P = 0.09). CONCLUSIONS: This study suggests that there is a significant decrease in the likelihood of isolating a multidrug resistant organism following peritoneal lavage, and aerobic and anaerobic culture results have the potential to change following peritoneal lavage, although this cannot be confirmed without further studies. Overall survival rates were higher than previously reported in the literature for septic peritonitis.

Triceps brachii muscle reconstruction with a latissimus dorsi muscle flap in a dog.

CASE DESCRIPTION: A 6-year-old spayed female Border Collie was examined for a severe deformity of the right forelimb. Three months prior to examination, the patient awkwardly fell off the couch and became acutely lame in the right forelimb, progressing to non-weight bearing over the following 72 hours. CLINICAL FINDINGS: On physical examination, the dog carried the limb caudally against the thoracic wall, with the shoulder flexed and elbow in extension. The right triceps brachii muscle was atrophied and contracted, resulting in a resistant tension band effect that precluded manipulation of the right elbow joint. The physical changes in the triceps muscle were considered the primary cause of the patient's loss of limb function. TREATMENT AND OUTCOME: Surgical treatment by means of elevation and transposition of the ipsilateral latissimus dorsi muscle was performed. The exposed triceps brachii muscles were transected 3 cm proximal to the tendons of insertion. Via a separate incision, the right latissimus dorsi muscle was elevated and tunneled subcutaneously beneath the interposing skin between the 2 surgical incisions. The muscle was then positioned and sutured to the proximal and distal borders of the divided triceps muscle group. Two weeks later, physical therapy was initiated. After 2 months, the patient regularly walked on the limb most of the time (9/10 steps). CLINICAL RELEVANCE: The surgical procedure for elevation and transposition of the latissimus dorsi muscle was relatively simple to perform. Physical therapy was an essential component to achieving the successful functional outcome in this case. This technique may be considered for treatment of similar patients in which the triceps muscle group is severely compromised.

Treatment of avascular necrosis of the femoral head in small dogs with micro total hip replacement.

OBJECTIVES: To evaluate clinical outcome of small dogs with avascular necrosis (AVN) of the femoral head treated with Micro total hip replacement (THR). STUDY DESIGN: Nonrandomized, retrospective efficacy case series. ANIMALS: Dogs (n = 7; 7 hips) that had Micro THR. METHODS: Medical records (December 2005-March 2009) of dogs affected with AVN treated with Micro THR were reviewed. Data analysis included age, sex, breed, body weight, and body condition. All dogs were evaluated at least 6 months after Micro THR was performed on the affected AVN limb. Physical, orthopedic, and radiographic examination, owner questionnaire, thigh girth, and ground reaction force were evaluated. RESULTS: Seven dogs (7 Micro THR) met the inclusion criteria. Mean age at time of onset of clinical signs was 7.7 months and mean age at time of Micro THR was 9.6 months. Mean body weight was 4.2 kg. Median body condition score was 5.0 (range, 4-6). Mean cumulative functional scores from client questionnaires before (19.5; range, 11-25) and after Micro THR (8.2; range, 7-14) were significantly different (P = .004). There was no significant difference between thigh girths of the Micro THR (17.8 ± 2.6 cm; range, 14.5-21.5 cm) limbs when compared with contralateral (17.5 ± 2.9 cm; range, 14.5-22.0 cm) limbs (P = .38). Peak vertical force (P = .20), vertical impulse (P = .81), peak braking force (P = .91), braking impulse (P = .19), peak propulsion force (P = .32), and propulsion impulse (P = .19) were not significantly different in Micro THR limbs compared with contralateral limbs. CONCLUSION: There was no relationship between age, sex, and breed for development of AVN in this study. Dogs that received Micro THR for the treatment of AVN had no significant differences in thigh girth and ground reaction forces when Micro THR limb was compared with the contralateral limb.

Total hip replacement as a treatment option for capital physeal fractures in dogs and cats.

OBJECTIVES: To evaluate outcome of capital physeal fractures (CPFs) treated by total hip replacement (THR) in dogs and cats. STUDY DESIGN: Retrospective phase II nonrandomized efficacy study. ANIMALS: Dogs (n = 21), cats (n = 4). METHODS: Medical records (1991-2009) and radiographs of dogs and cats with CPF treated by THR were reviewed. Physical examination findings, radiographs, thigh circumference (TC), force plate gait analysis, and an owner questionnaire were reviewed. RESULTS: Signalment and median interval between CPF and THR of all 25 animals had no clinical correlation with post-THR outcome. Force plate gait analysis and TC were available for 12 dogs. No significant difference in TC or force plate analyses between the THR limb and the normal contralateral limb was identified. Owner questionnaires (13 dogs) revealed improvement after THR with minimal (n = 2) or no lameness (n = 11). CONCLUSION: Animals with CPF treated by THR did not have statistically significant differences in any subjective (21 dogs, 4 cats) or objective (12 dogs) variable when compared with the normal contralateral limb.