Successful closed suction drain management of a canine elbow hygroma.

A 1-year-old castrated male St. Bernard dog presented to Angell Animal Medical Center with bilateral elbow hygromas which had been present for several weeks. The largest hygroma involving the left elbow was managed with a closed suction (active) drain system to continuously collapse the hygroma pocket over a 3-week period. Soft bedding was used to protect the elbows from further impact trauma to the olecranon areas. Following drain removal, there was no evidence of hygroma recurrence based on periodic examinations over an 18-month period. The smaller non-operated right elbow hygroma had slightly enlarged during this period. Closed suction drain management of the hygroma proved to be a simple and economical method of collapsing the left elbow hygroma. This closed drainage system eliminated the need for the postoperative bandage care required with the use of the Penrose (passive) drain method of managing elbow hygromas. The external drain tube should be adequately secured in order to minimise the risk of its inadvertent displacement.

Triple A syndrome: genotype-phenotype assessment.

The triple A or Allgrove syndrome is an autosomal-recessive disease (MIM*231550) characterized by the triad of achalasia, alacrima and adrenocorticotropic hormone (ACTH)-resistant adrenal insufficiency. Associated features of the syndrome are neurological and dermatological abnormalities. Until the discovery of the AAAS gene as the responsible gene in triple A syndrome, the diagnosis was based on characteristic clinical features. Here we present the clinical and molecular genetic data which demonstrated the marked phenotypic variability in three unrelated patients with triple A syndrome. The final diagnosis of triple A syndrome was confirmed by molecular analysis. In one patient with isolated achalasia, the diagnosis of triple A syndrome could only be made on the basis of the molecular genetic analysis of the AAAS gene. We therefore suggest that the diagnosis of triple A syndrome should be considered in patients who exhibit only one or two of the main symptoms (i.e. alacrima, achalasia or adrenal insufficiency). These patients require careful neurological investigation, and mutation analysis of the AAAS gene should be performed.

Use of an external skin-stretching device for wound closure in dogs and cats.

Use of an externally applied, noninvasive skin-stretching device in 24 dogs and cats is described. The device uses adhesive-coated pads that are applied to the skin of an animal; pads are positioned on opposite sides of a surgical site and are connected by means of adjustable elastic cables. The cables maintain continuous tension, and cable tension is adjusted and progressively increased at intervals of 6 to 8 hours to promote skin recruitment (stretching), using the cutaneous viscoelastic properties of mechanical creep and stress relaxation. Consequently, skin adjacent and distant to the surgical site can be recruited to facilitate wound closure, typically within 72 to 96 hours after application of the device. The skin-stretching device has been used effectively in dogs and cats to stretch skin prior to elective surgical procedures, stretch skin during management of open wounds prior to suturing, and alleviate incisional tension after surgery.

Reconstruction of a facial defect using the ear pinna as a composite flap.

A four-month-old, female pit bull was evaluated for multiple, resolving, second- and third-degree burn wounds. The convex surface of the left pinna was severely burned and distorted. Contraction of a large (6 cm by 4 cm), facial cutaneous defect had resulted in contracture of surrounding normal skin and dorsal displacement of both upper eyelids. Decreased ability to blink predisposed the puppy to exposure keratitis. The cutaneous facial defect was repaired using the left pinna as a composite skin flap. Surgery resulted in a successful repair of the defect and immediate return of normal eyelid function.

Use of a caudal auricular axial pattern flap in cats.

A caudal auricular axial pattern flap was used in 3 cats to successfully reconstruct large cutaneous defects of the head that were a result of trauma or surgical excision of neoplasms. The technique was a convenient, practical, one-stage procedure for closure of the defects, and flaps up to 7.0 x 12.0 cm were developed. All flaps healed without complications. Anatomic landmarks and surgical guidelines for developing the flap were determined through anatomic dissections and angiographic studies of the cutaneous vasculature of the head and neck in feline cadavers. This report confirms findings of a previous study describing a platysma myocutaneous flap.

Partial scapulectomy for management of sarcomas in three dogs and two cats.

Three dogs and 2 cats were treated by partial scapulectomy for management of sarcomas of the proximal aspect of the scapula. Surgical margins were considered complete in all cases. In 3 animals, limb function was excellent for 8, 18, and 24 months, respectively, after surgery. Poor limb function persisted in 1 dog that developed local metastatic disease to the affected forelimb. One dog had good limb function for 3 months after surgery and underwent force-plate analysis, which determined a reduction in peak vertical force, decelerating force, and stride time for the affected limb, compared with that for the forelimb that was not subjected to surgery. Tumor recurrence associated with fibrosarcomas was detected in 2 animals. In selected cases, partial scapulectomy can preserve limb function and may be considered a viable alternative to limb amputation.

Comparative viability of peninsular and island axial pattern flaps incorporating the cranial superficial epigastric artery in dogs.

Experimental island and peninsular axial pattern flaps that incorporated the cranial superficial epigastric artery and vein were developed in 6 Beagles. Mean percentage of flap area that survived, for both flaps, was 87%, and percentage of surviving flap area was not significantly different for island versus peninsular flaps. In 1 dog, ligation of an aberrant, perforating branch of the cranial epigastric artery resulted in necrosis of 53% of the flap area. The cranial superficial epigastric axial pattern flaps have potential application for closure of skin defects within their arc of rotation and may be particularly useful for closure of large defects on the ventral aspect of the thorax. A peninsular flap was used to close a defect of the ventral portion of the thoracic wall in a clinical case.

Stapling instrumentation.

A number of surgical stapling instruments are on the market. The variety of instruments, stapling cartridges, and their potential veterinary uses are discussed. The basic principles of application and operation of these devices are emphasized.

Stapling in esophageal surgery.

Indications for esophageal surgery include the closure of tears from foreign bodies and incisions for their removal, esophageal anastomosis after removal of diseased or nonfunctional segments, esophagogastric anastomosis after major gastric resection, removal of esophageal diverticula, resection of fistulas, and esophageal reconstructive surgical techniques. The potential use and application of surgical stapling instruments for these esophageal disorders in the veterinary patient are discussed.

Controlled tissue expansion in the distal extremities of dogs.

Controlled tissue expansion using a 100 cc rectangular silicone elastomer expander was performed in the mid-antebrachium and mid-crus of eight adult mixed-breed dogs. Two expander inflation schedules were followed. Group 1 dogs (n = 4) underwent expander inflation using 10 cc sterile saline every other day, and group 2 dogs (n = 4) underwent expander inflation using 15 cc sterile saline every other day until the nominal volume (100 cc) was attained. Significant mean postexpansion increases in skin surface area of 94.1 cm2 (35.9%) and 108.9 cm2 (37.3%) were measured in the antebrachium and crus, respectively (p < .05). In a second procedure, the expanders were removed and skin flaps were developed from the redundant tissue generated during the expansion process. Single pedicle advancement flaps and transposition flaps were used to cover surgically created defects measuring 5 x 10 cm in the antebrachium and crus. Single pedicle advancement flaps consistently measured 10 x 10 cm and could be advanced to cover defects involving one third of the mid-antebrachial or mid-crural circumference. Transposition flaps were rotated up to 170 degrees and the donor site defects were easily closed under minimal or no tension. Complications included an abscess in one dog and seroma formation in four dogs. Differences in success or complication rates between group 1 dogs and group 2 dogs were not observed; an accelerated inflation schedule using 15 cc sterile saline every other day was recommended.

Subtotal colectomy with surgical stapling instruments via a trans-cecal approach for treatment of acquired megacolon in cats.

Surgical stapling equipment was used to perform an end-to-end colonic anastomosis in 15 cats for the treatment of acquired megacolon. An end-to-end stapling device was passed to the anastomotic site by a trans-cecal approach. Subsequent closure of the cecal incision was accomplished with a thoracoabdominal stapling device. Two cats had hemorrhagic episodes immediately after surgery that required blood transfusions. All 15 cats have had good to excellent health after subtotal colectomy and colocolostomy performed using this stapling technique. Results of this study have demonstrated that "single surgical field" placement of the end-to-end stapling device has the primary advantage of simplicity and a lower chance of contamination compared with (dual field) rectal passage of similar devices. Closure of the cecal access incision is easily performed without reducing the diameter of the large intestinal lumen. The stapling technique provided an efficient and consistent method for anastomosis of the large bowel in cats.

Chronic vaginal prolapse during pregnancy in a bitch.

A 4-year-old bitch was referred with chronic vaginal prolapse. It was first noticed during estrus, about 58 days prior to referral. Artificial insemination (AI) was performed twice after reducing the prolapse manually. Abdominal radiography (53 to 55 days after AI) was performed by the attending veterinarian and the bitch was determined to be not pregnant. Serum progesterone and estradiol concentrations were 1.38 ng/ml and 1.79 pg/ml, respectively. With the bitch under general anesthesia, the vaginal prolapse was partially reduced and a hysteropexy was performed. Six days after surgery, the bitch delivered a live male pup. It is recommended that bitches so affected should not be bred, and that those not required for breeding should be ovariectomized.

Use of human chorionic gonadotropin stimulation test to detect a retained testis in a cat.

A 4-year-old male cat was referred because of aggressive behavior and spraying urine. When the cat was 6 months old, only 1 testis was found in the scrotum. When the cat was 1 year old, the scrotal right testis was surgically removed and the left testis was not found, either within the scrotum or within the abdomen. The cat developed male behavior and another laparotomy was performed 1 year later, at which time the left testis could not be located. The cat continued to show male behavior. On referral, the penis was well developed and had spines. Human chorionic gonadotropin (HCG), 500 IU, was administered IV. At baseline, 30, and 120 minutes after HCG administration, serum testosterone activity (ng/ml) was 0.68, 5.0, and 10.5, respectively. Laparotomy was performed with the cat under general anesthesia. The left testis was found in the facial plane lateral to the symphysis pubis. Six weeks after the surgery, the HCG stimulation test was repeated and testosterone was not detected in any serum sample. The most practical solution to locate the undescended testis would have been to follow the intact ductus deferens to the testis adjacent to the pubic symphysis.

Abdominal wall reconstruction with a vascular external abdominal oblique myofascial flap.

A myofascial island flap for abdominal wall reconstruction was based on the lumbar component of the external abdominal oblique muscle and supplied by a major neurovascular pedicle consisting of branches of the cranial abdominal artery, cranial hypogastric nerve, and a satellite vein. The flap was elevated and sutured into a 10 cm x 10 cm body wall defect in five dogs. The dogs were observed for 26 to 28 days. Abdominal wall contour and function were preserved. All dogs developed seromas, two of which became infected. One dog developed a hernia at the dorsal margin of the flap, which was repaired. At necropsy, there was no evidence of dehiscence in any of the dogs. Loose adhesions of omentum to the inner surface of the flap occurred in four dogs. Results of histologic examination confirmed the clinical impression of flap viability. The myofascial island flap has a wide range of mobility over the ventral and caudal areas of the abdomen and lateral thoracic wall. It has potential clinical use for reconstruction of defects within its arc of rotation.

Open intestinal anastomosis with surgical stapling equipment in 24 dogs and cats.

Surgical stapling equipment was used to perform open antiperistaltic side-to-side ("functional end-to-end") entero-anastomoses in 20 dogs and 4 cats. Twenty-one anastomoses healed uneventfully. Seven animals with severe bacterial peritonitis required open peritoneal drainage and delayed abdominal closure. There was postoperative leakage at the anastomotic site in two dogs and a localized abscess at the staple line in one cat. No long-term complications occurred in follow-up periods of 3 to 29 months.

Anatomy and circulation of the canine skin.

The skin of the dog has several anatomic differences from human skin. Skin thickness, hair growth, and circulation vary regionally in the dog and between breeds to some degree. Direct cutaneous arteries supply the canine skin. The deep or subdermal layer is closely associated with the panniculus muscle (where present) and should be elevated with the overlying skin during routine flap elevation or undermining procedures. Flaps in the dog elevated without inclusion of a direct cutaneous artery and vein have been termed subdermal plexus flaps to avoid confusing them with random flaps in the human based on musculocutaneous vessels. Axial pattern flaps developed for veterinary clinical use are discussed, several of which have potential for free flap transfer in cutaneous reconstructive surgery.