Association between methicillin-resistant Staphylococcus pseudintermedius carriage and the development of surgical site infections following tibial plateau leveling osteotomy in dogs.

OBJECTIVE: To evaluate the association between preoperative carriage of methicillin-resistant Staphylococcus pseudintermedius (MRSP) and the development of surgical site infections (SSIs) following tibial plateau leveling osteotomy (TPLO) in dogs. DESIGN: Prospective multicenter study. ANIMALS: 549 dogs. PROCEDURES: At 7 veterinary hospitals, swab specimens were obtained from the pharynx, nares, rectum, and skin of dogs admitted for TPLO. Specimens were submitted for culture of MRSP. For each dog, information regarding preoperative and postoperative antimicrobial administration, comorbidities, contact with other dogs, and whether the dog developed an SSI was obtained. Univariable and multivariable analyses were performed to identify variables associated with preoperative and postoperative MRSP colonization and the development of an SSI. RESULTS: Of the 549 study dogs, 24 (4.4%) were identified as MRSP carriers before TPLO and 37 (6.7%) developed an SSI after TPLO. Bacteriologic culture was performed on specimens obtained from 32 of the 37 SSIs, and MRSP was isolated from 11 (34%). Carriers of MRSP (OR, 6.72; 95% confidence interval [CI], 2.12 to 21.4) and Bulldogs (OR, 11.1; 95% CI, 2.07 to 59.3) were at risk for development of an SSI after TPLO, whereas postoperative administration of antimicrobials (OR, 0.36; 95% CI, 0.15 to 0.91) appeared to protect against development of an SSI. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that carriage of MRSP were a risk factor for development of an SSI after TPLO and measures to rapidly identify and treat MRSP carriers are warranted. Postoperative administration of antimicrobials protected against development of an SSI after TPLO.

Acute hind limb paralysis secondary to an extradural spinal cord Cryptococcus gattii lesion in a dog.

A 2-year-old, spayed female, German short-haired pointer was presented with a 1-day history of non-ambulatory paraplegia with absent deep pain perception. A computed tomography scan revealed an irregular eighth thoracic vertebral body and an extradural compressive lesion. Decompression was performed and abnormal tissues were submitted for analysis. Findings were consistent with a Cryptococcus gattii infection.

Paralysie aiguë du membre postérieur secondaire à une lésion de la moelle épinière extradurale due àCryptococcus gattiichez un chien. Une chienne Pointer allemand à poil court stérilisée âgée de deux ans a été présentée avec une anamnèse de 1 journée de paraplégie avec l'absence de perception de 1a douleur profonde. Une lecture par tomodensitomètre a révélé un huitième corps vertébral thoracique irrégulier et une lésion compressive extradurale. La décompression a été effectuée et les tissus anormaux ont été soumis aux fins d'analyse. Les résultats étaient conformes à une infection à Cryptococcus gattii.(Traduit par Isabelle Vallières).

Identification of an intra-cranial intra-axial porcupine quill foreign body with computed tomography in a canine patient.

An intra-cranial intra-axial foreign body was diagnosed in a golden retriever dog through the use of computed tomography (CT). Confirmed by necropsy, a porcupine quill had migrated to the patient's left cerebral hemisphere, likely through the oval foramen. This case study demonstrates the efficacy of CT in visualizing a quill in the canine brain.

Suture-related urolithiasis following repair of inadvertent prostatectomy in a dog.

A 10-month-old male chow chow mixed breed dog was presented for anuria secondary to inadvertent prostatectomy performed during unilateral cryptorchidectomy. Surgical repair was successfully performed; however, this resulted in suture-associated urolith formation 3 months later, requiring a second surgical intervention and urethrostomy.

Surgical views: Vacuum-assisted wound closure: clinical applications.

Vacuum-assisted closure (VAC) is a wound management system that exposes a wound bed to local negative pressure to promote healing. Benefits of VAC therapy include removal of fluid from the extravascular space, improved circulation, enhanced granulation tissue formation, and increased bacterial clearance. VAC therapy has been used extensively in human patients to treat a variety of acute and chronic wound conditions. This article reviews the use of VAC therapy in a variety of wound conditions and describes our experiences with using VAC therapy in dogs and cats at the University of Florida.

Descriptive report of antebrachial growth deformity correction in 17 dogs from 1999 to 2007, using hybrid linear-circular external fixator constructs.

The radiographic and clinical results from 17 dogs (18 limbs) in which hybrid linear-circular external fixators (HLCEF) were used for the correction of antebrachial growth deformities (AGD) are described, retrospectively. Wedge ostectomy and the application of a type IA or IB HLCEF were performed in all cases. Pre- and postoperative AGD measurements, complications, time to staged destabilization and/or fixator removal, cosmesis, and limb function were evaluated. Complications included wire and/or pin tract inflammation (11 limbs) and radial fracture (2 limbs). All dogs had improved function and appearance after surgery. Limb function was assessed as excellent in 13 cases and good in 4 cases. Limb appearance was assessed as excellent in 12 cases and good in 5 cases. This case series substantiates the utility of HLCEF for the correction of AGD in dogs.

Long-term efficacy of a percutaneously adjustable hydraulic urethral sphincter for treatment of urinary incontinence in four dogs.

OBJECTIVE: To evaluate the efficacy of a surgically placed, static hydraulic urethral sphincter (SHUS) for treatment of urethral sphincter mechanism incompetency (USMI). STUDY DESIGN: Prospective study. ANIMALS: Spayed female dogs (n=4) with acquired USMI. METHODS: Urinary incontinence was assessed using a subjective continence score before and after implantation of an SHUS on the proximal urethra via ventral median celiotomy. Dogs were assessed for urinary continence, urinary tract infections, and implant-associated complications for 30 months. Residual incontinence was treated with percutaneous inflation of the SHUS with sterile saline solution through a biocompatible subcutaneous administration port. RESULTS: At last follow-up (26-30 months after surgery), continence scores improved from a median preoperative score of 3/10 to a median postoperative score of 10. One dog developed wound drainage over the subcutaneously placed administration port but remained continent after port removal. Three occluders were percutaneously filled with additional saline (median, 0.18 mL; mean, 0.16 mL) to improve continence after surgery. CONCLUSIONS: Application and adjustment of an SHUS provided sustained improvements in continence score in all dogs. CLINICAL RELEVANCE: In this pilot study, 3 of 4 dogs with hydraulic urethral sphincter implantation had successful percutaneous adjustment and maintained improved continence scores for 2 years after surgery. Continence was maintained in the 4th dog even after administration port removal. Based on this pilot study, the SHUS warrants further clinical evaluation for treatment of dogs with USMI unresponsive to medical management.

Surgical views: Vacuum-assisted wound closure: application and mechanism of action.

Vacuum-assisted closure (VAC) is a wound management therapy that creates local negative pressure over a wound bed to promote healing. Benefits of VAC therapy include removal of fluid from the extravascular space, improved circulation, enhanced granulation tissue formation, increased bacterial clearance, and hastening of wound closure. This article describes the mechanism of action of VAC therapy, reviews application techniques, and lists potential complications and contraindications.

Limited open reduction and stabilization of sacroiliac fracture-luxations using fluoroscopically assisted placement of a trans-iliosacral rod in five dogs.

OBJECTIVE: To describe percutaneous fluoroscopically assisted placement of a trans-iliosacral rod to stabilize sacroiliac fracture-luxations after limited open reduction. STUDY DESIGN: Retrospective clinical case series. ANIMALS: Dogs (n=5) with sacroiliac fracture-luxations. METHODS: Medical records and radiographs were reviewed to evaluate implant placement, fracture reduction, pelvic canal diameter ratio, maintenance of reduction, implant stability, assessment of union, and to identify any complications. Owners were contacted to obtain long-term assessment of limb function. RESULTS: Dogs weighed between 6 and 31 kg. Trans-iliosacral rods were placed correctly traversing the sacral body. Mean (+/-SD) percent reduction of the sacroiliac joint was 92.9+/-6.6%. Pelvic canal diameter ratio did not differ significantly between time periods. With the exception of 1 dog, which died in the early postoperative period, all sacroiliac fracture-luxations healed without appreciable complications. Three dogs were sound and 1 dog had a subtle lameness at final physical and radiographic examination (mean+/-SD: 217+/-205 days). Owners assessed their dog's limb function (mean+/-SD: 355+/-205 days) as good or excellent. CONCLUSIONS: Trans-iliosacral rods can be accurately placed using intraoperative fluoroscopy after limited open reduction of sacroiliac fracture-luxations. Trans-iliosacral rods provided bilateral secure fixation, allowed early weight-bearing and dogs consistently had good long-term clinical results. CLINICAL RELEVANCE: Trans-iliosacral rods are suitable implants for the stabilization of sacroiliac fracture-luxations, particularly in dogs with bilateral fracture-luxations and/or concurrent musculoskeletal injuries.

Closed fluoroscopic-assisted spinal arch external skeletal fixation for the stabilization of vertebral column injuries in five dogs.

OBJECTIVE: To evaluate outcome after closed fluoroscopic-assisted application of spinal arch external skeletal fixators in dogs with vertebral column injuries. STUDY DESIGN: Retrospective case series. ANIMALS: Dogs with traumatic vertebral column injuries (n=5). METHODS: Medical records of dogs with vertebral column fractures and/or luxations stabilized with spinal arch external skeletal fixator frames applied using a closed fluoroscopic-assisted technique were reviewed. Owners were contacted to obtain long-term clinical outcomes. RESULTS: Five dogs (age range, 6-72 months; weight, 10-54 kg) had traumatic vertebral column injuries stabilized with spinal arch external skeletal fixators applied in closed fashion. Injuries involved vertebral segments of the thoracolumbar junction, lumbar spine, and lumbosacral junction. Immediately postoperatively, 4 dogs had anatomic alignment of their vertebral fracture/luxation; 1 dog had 1 mm of vertebral canal height compromise. Time to fixator removal ranged from 65 to 282 days (141+/-87 days). All dogs had regained satisfactory neurologic function by 3 months. At long-term follow-up (range, 282-780 days; mean 445+/-190 days) all dogs were judged to have good to excellent return of function by their owners. CONCLUSION: Successful closed fluoroscopic-assisted application of external skeletal fixators using spinal arches provided satisfactory reduction with few complications in 5 dogs. Return to function was judged to be good to excellent in all dogs at long-term evaluation. CLINICAL RELEVANCE: Closed fluoroscopic-assisted application of ESF using spinal arches provided satisfactory reduction and effective stabilization of spinal fractures with few complications and should be considered as a treatment approach.

Outcome associated with use of a percutaneously controlled hydraulic occluder for treatment of dogs with intrahepatic portosystemic shunts.

OBJECTIVE: To evaluate efficacy of a hydraulic occluder (HO) used for treatment of dogs with an intrahepatic portosystemic shunt (IHPSS). DESIGN: Prospective study. ANIMALS: 10 dogs with an IHPSS. PROCEDURES: Serum biochemical and postprandial bile acids (PPBA) analyses and transcolonic scintigraphy were performed before surgery. Laparotomy was performed, and an uninflated HO was placed around the portal vein branch leading to the IHPSS. After surgery, 0.9% NaCl solution was injected into subcutaneous injection ports at 2, 4, 6, and 8 weeks to achieve staged occlusion of the HO. Serum biochemical analyses, PPBA analysis, and scintigraphy were performed 2 weeks after occlusion. Serum biochemical analyses were repeated 1 year after surgery. RESULTS: Implant revision was required in 3 dogs because of rupture of the HO (n = 2) or detachment of the actuating tubing (1). Serum biochemical values and clinical signs improved in all dogs after surgery. Six of 10 dogs had PPBA concentration within reference range 2 weeks after occlusion, and 2 additional dogs had concentrations within reference range at 1 year. Only 5 of 10 dogs had complete resolution of portosystemic shunting 2 weeks after occlusion. Two dogs were lost to follow-up, and 8 dogs remained alive with no recurrence of clinical signs at a median of 22 months after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Use of the HO appeared to be an effective method for surgical treatment for dogs with IHPSS, although problems with implant reliability indicate a need for modifications in design and manufacturing.

Evaluation of manufacturing variability, diffusion of filling solutions, and long-term maintenance of occlusion in silicone hydraulic occluders.

OBJECTIVE: To evaluate manufacturing variability, diffusion of filling solutions, and maintenance of occlusion over time in 3 sizes of silicone hydraulic occluders (HOs). SAMPLE POPULATION: 2-, 5-, and 20-mm HOs (HO2, HO5, and HO20, respectively). PROCEDURES: Manufacturing variability was analyzed by comparing variation in internal luminal areas and filling volumes within each size group. Occluders were filled to 100% occlusion with air (n = 4), saline (0.9% NaCl) solution (4), or sodium hyaluronate (4) and submerged in simulated body fluid. Changes in luminal area and weight were recorded for 133 days to evaluate maintenance of occlusion. RESULTS: Considerable variability in uninflated luminal area and fill volumes was observed among the 3 sizes of HOs. Loss of occlusion developed in the first 12 hours in all air-filled HOs. Fluid-filled occluders were reliable in maintenance of occlusion after 133 days (99.99% for HO20, 99.59% for HO5, and 90.40% for HO2), although diffusion of saline solution and hyaluronate from all HOs was confirmed by detection of significant decreases in weight over time. There was no significant difference in weight loss between HOs filled with saline solution and HOs filled with sodium hyaluronate. CONCLUSIONS AND CLINICAL RELEVANCE: Saline solution or sodium hyaluronate may be used as a filling solution in the HOs tested. Maintenance of occlusion was best in the larger sizes. Saline solution or sodium hyaluronate should be used in future clinical investigations of HOs. Retrograde filling to remove air should be used when filling HOs with fluid.

Use of an ultrasonically activated scalpel for splenectomy in 10 dogs with naturally occurring splenic disease.

OBJECTIVE: To evaluate the safety and efficacy of an ultrasonically activated scalpel for performing splenectomy, with minimal ligation, in dogs. STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs (10) with naturally occurring splenic disease. METHODS: Between October 2003 and February 2004, splenectomy was performed using an ultrasonically activated scalpel and a double seal method, in 10 dogs with naturally occurring splenic disease. Time for splenectomy and number of ligatures required were recorded. Intraoperative hemostasis, device ease of use, postoperative hemorrhage, and short-term survival were evaluated. RESULTS: Mean operative time for splenectomy, exclusive of celiotomy and closure, was 18 minutes (range, 8-25 minutes). The mean number of ligatures needed to perform splenectomy was 1 (range, 0-2 ligatures). One dog hemorrhaged from the splenic vein after ultrasonic scalpel transection of a vessel >5-mm diameter and required a ligature. The ultrasonic scalpel was easy to use, with a minimal learning curve. None of the dogs had postoperative abdominal hemorrhage; 9 dogs were discharged and 1 dog was euthanatized because of septicemia. CONCLUSION: Ultrasonic activated scalpel may be used to achieve efficient and safe hemostasis of the splenic vascular pedicle in dogs with minimal need for vascular ligation. CLINICAL RELEVANCE: Ultrasonic scalpels can be used to perform splenectomy in dogs with naturally occurring splenic disease.

Evaluation of a percutaneously controlled hydraulic occluder in a rat model of gradual venous occlusion.

OBJECTIVE: To evaluate the efficacy of a percutaneously controlled hydraulic occluder (HO) in a rat model of gradual venous occlusion. STUDY DESIGN: Experimental study. ANIMALS: Ten male Sprague-Dawley rats. METHODS: HOs and perivascular transit time ultrasound flow probes were applied to the caudal vena cava (CVC). Occluders in group I rats (n=6) were gradually attenuated over 8 weeks, whereas occluders in group II rats (n=4) were not attenuated. Vena caval blood flow measurements were performed weekly in all rats for 8 weeks. After euthanasia, the CVC was evaluated grossly and by histopathology. RESULTS: Premature occlusion of the vena cava occurred during the 1st week in 3 rats (1 in group I, 2 in group II) because of kinking of the vena cava between the HO and the flow probe. For the remaining rats, mean blood flow in group I decreased significantly from 40.71 mL/min/kg at baseline to 4.68 mL/min/kg at 8 weeks (P=.0094, power=0.91). Group II rats maintained vena caval blood flow at all times during the study. Complete occlusion of the vena cava was confirmed at necropsy in all group I rats. CONCLUSIONS: Gradual occlusion of the CVC of rats was achieved with HOs over 8 weeks. This model is limited by the size of the experimental animals and comparatively large implants. CLINICAL RELEVANCE: HOs may provide a method for gradual occlusion of congenital portosystemic shunts.

Methods of gradual vascular occlusion and their applications in treatment of congenital portosystemic shunts in dogs: a review.

OBJECTIVE: To provide a comprehensive review of the experimental and clinical data related to gradual vascular occlusion of congenital portosystemic shunts (CPS) in dogs. STUDY DESIGN: Literature review. METHODS: PubMed literature search (1966-2004). RESULTS: Surgical intervention and complete vascular occlusion have been recommended for CPS therapy in dogs; however, acute complete ligation of CPS is often associated with life-threatening portal hypertension. Recently, several investigators have attempted to reduce the risk of postoperative portal hypertension by using gradual vascular occlusion. Successful vascular occlusion has been achieved using partial ligation with silk suture, ameroid constrictors, cellophane bands, thrombogenic coils and hydraulic vascular occluders. Objective comparisons of the reliability and rate of vascular occlusion produced by each of these methods have been limited by differences in experimental models and a lack of definitive follow up evaluation in some clinical studies. CONCLUSIONS: Gradual vascular occlusion is widely used in the clinical treatment of CPS in dogs. Objective evaluation of the experimental and clinical data on each of the techniques for gradual vascular occlusion is necessary for informed clinical practice and for the planning of future research into this important area. CLINICAL RELEVANCE: Even from the limited data available, it is clear that the ideal method for gradual vascular occlusion of CPS has yet to be identified.

Concurrent use of a medial saphenous fasciocutaneous free tissue flap and external skeletal fixation for treatment of a distal antebrachial injury in a dog.

OBJECTIVE: To report the surgical management of a traumatic distal antebrachial wound using a medial saphenous fasciocutaneous free tissue flap and a type I external skeletal fixator (ESF). STUDY DESIGN: Case report. ANIMALS: A 7-year-old spayed, female Labrador retriever. RESULT: Wound coverage and pancarpal arthrodesis were accomplished during a single anesthetic episode using a medial saphenous fasciocutaneous free tissue flap and type I ESF. A second surgical procedure was performed to expedite healing of part of the original wound that was initially left to heal by second intention. CONCLUSIONS: Free tissue transfer can be used in combination with an ESF for repair of distal antebrachial wounds, allowing orthopedic repair and soft tissue coverage in a single anesthetic episode. CLINICAL RELEVANCE: Concurrent use of free tissue transfer and carpal arthrodesis with an ESF could be used for repair of complex antebrachial wounds without need for multiple procedures, extended hospitalization, and increased cost.

Iatrogenic proximal urethral obstruction after inadvertent prostatectomy during bilateral perineal herniorrhaphy in a dog.

Proximal urethral obstruction was diagnosed 2 days after bilateral perineal herniorrhaphy in a 12-year-old male Pomeranian-cross dog. The obstruction was caused by ligation of the proximal urethra during resection of a presumed paraprostatic cyst. Surgical repair involved reconstruction of the urethra and bladder wall, but urinary incontinence persisted.