Owner-assisted recovery and early discharge after surgical treatment in dogs with brachycephalic obstructive airway syndrome.

OBJECTIVES: This study aims to describe a perioperative protocol for dogs recovered from anaesthesia with the owners and discharged from the hospital on the same day after surgical management of brachycephalic obstructive airway syndrome and to determine whether implementation of this protocol was associated with reduced incidence of complications compared with standard anaesthesia recovery and 24 hours hospitalisation. MATERIALS AND METHODS: Medical records of dogs that underwent brachycephalic obstructive airway surgery over two consecutive years (June 2017 to May 2019) were reviewed retrospectively. Signalment, clinical signs, diagnostic findings, surgical procedures and postoperative respiratory complications were recorded. Data were compared using the chi-squared or Fisher's exact tests. RESULTS: Sixty-three dogs met the inclusion criteria for the study. Forty-two dogs underwent owner-assisted recovery and 21 dogs standard recovery. No statistical difference was found between groups in age, breed, gender, severity of respiratory or gastrointestinal clinical signs and surgical techniques employed. The incidence of postoperative complications was higher in dogs that received standard recovery (28%) compared to dogs recovered with the owners (2%). None of the dogs recovered with the owners and discharged the same day required veterinary assistance after discharge from the hospital. CLINICAL SIGNIFICANCE: Corrective surgery for brachycephalic obstructive airway syndrome was associated with lower postoperative respiratory complications when dogs were discharged on the same day after recovery with the owners. Owner-assisted recovery and early discharge are possible and safe and may decrease the incidence of postoperative complications. However, other unmeasured factors may have contributed to the lower complication rate in dogs recovered with the owners during the course of this study.

The indications, complications and outcomes of dogs undergoing partial penile amputation: 10 cases (2014-2021).

OBJECTIVES: To report the signalment, indications for surgery, postoperative complications and medium-/long-term outcomes in dogs undergoing partial penile amputation. MATERIALS AND METHODS: Retrospective case series. The electronic medical records of a single small animal referral hospital were searched between January 2014 and January 2021 for dogs that underwent a partial penile amputation. Data collected included signalment, presenting clinical signs, indication for partial penile amputation, surgical technique, postoperative complications and outcome. RESULTS: Ten dogs were included in the study. Indications for surgery were treatment of preputial neoplasia (n=5), penile neoplasia (n=1), idiopathic paraphimosis (n=3) and chronic urethritis (n=1). Five of five preputial tumours were cutaneous mast cell tumours, and the penile tumour was a squamous cell carcinoma. All dogs recovered uneventfully from surgery with a median postoperative hospitalisation time of 28.8 hours. Two of the three dogs treated for paraphimosis had major postoperative complications requiring further resection of the tip of the penis at 2 weeks and 24 months. Four dogs had minor complications managed without surgical intervention. The outcome was good to excellent in nine of nine dogs for which medium- or long-term follow-up data were available. CLINICAL SIGNIFICANCE: In this group of dogs, partial penile amputation, performed with or without concurrent resection of the prepuce, was a well-tolerated surgical procedure with low intraoperative and postoperative complication rates and good functional outcomes. Partial penile amputation should be considered for conditions affecting the distal penis and prepuce.

Titanium mesh osteosynthesis for the treatment of severely comminuted maxillofacial fractures in four dogs.

INTRODUCTION: Major goals in maxillofacial fracture treatment include to restore the dental occlusion, stabilise the major skeletal supports, restore the contour of the face and achieve proper function and appearance of the face. Titanium is considered an optimal material for maxillofacial reconstruction due to its biocompatibility, high strength, minimal inflammatory reaction and minimal imaging artefact. OBJECTIVES: To describe the clinical details, surgical technique, pre- and postoperative imaging and short- and long-term follow-up of severely comminuted maxillofacial fractures treated with titanium mesh and titanium screws in dogs. MATERIALS AND METHODS: Retrospective short case series included four client-owned dogs with maxillofacial fractures. After appropriate medical stabilisation, preoperative CT examination of the head was obtained in all patients for evaluation of fracture configuration and surgical planning. The maxillofacial fractures were stabilised by titanium mesh osteosynthesis. Short- and long-term clinical and radiographic follow-ups were available for all dogs. RESULTS: Proper dental occlusion and reconstruction of the anatomic buttresses was achieved in all cases. All dogs recovered uneventfully from the surgery and no complications were recorded on the long-term follow-up up to 43 months. Occlusion was maintained in all dogs, as well as excellent cosmesis of the midface. CLINICAL SIGNIFICANCE: Titanium mesh osteosynthesis can achieve sufficient rigidity and lead to uncomplicated healing of severely comminuted maxillofacial fractures. This internal fixation method can be considered a valuable option to treat maxillofacial fractures in particular in cases of large bone defect and midface reconstruction.

The use of methylene blue to assist with parotid sialadenectomy in dogs.

INTRODUCTION: There is an important morbidity associated with parotidectomy. The most commonly reported permanent complication is facial nerve injury. Methylene blue staining has been used as an intra-operative tool to improve tissue visualisation and preserve facial nerve integrity. OBJECTIVES: To describe the functionality and feasibility of the use of methylene blue for parotidectomy in dogs. MATERIALS AND METHODS: Retrospective study included seven client-owned dogs that underwent parotidectomy after injection of methylene blue from 2016 to 2019 in a referral centre. Cross-sectional imaging was used to confirm parotid gland surgical disease and for staging purposes. All dogs underwent parotid resection and removal of the parotid duct after injection of methylene blue. Methylene blue was either administered via cannulation of the parotid duct or directly injected into the abnormal gland. RESULTS: In all cases, the gland stained dark blue within seconds without any evident leakage. Complete parotid gland resection and removal of the parotid duct was achieved successfully in all dogs with a mean surgical time of 97 minutes. Subjectively, the staining was useful to identify innervation outside the coloured gland and facilitated dissection. No complications, including facial nerve injury, were recorded. CLINICAL SIGNIFICANCE: Methylene blue staining for complete parotidectomy was feasible, rapid and easy in these dogs. It can be used as an indirect facial nerve identification technique, and can therefore facilitate dissection and possibly reduce the incidence of post-operative facial nerve paralysis.

Feasibility of the single-incision subxiphoid approach for video-assisted thoracoscopic surgery in dogs.

OBJECTIVES: To report early results of uniportal video-assisted thoracoscopic surgery in dogs using a single-incision subxiphoid approach. MATERIALS AND METHODS: Retrospective study of 10 client-owned dogs with: pyothorax (n=5), pericardial effusion (n=2), bilateral pneumothorax (n=1), retained surgical swab (n=1), cranial mediastinal mass (n=1). With the dog in dorsal recumbency a 3-4 cm incision was made over the xiphoid process. After resection of the xiphoid process, a tunnel was created towards the pleura and open access maintained with an Alexis™ wound retractor. The pleural cavity was explored with a 10 mm 30° or 5 mm 0° telescope and straight laparoscopic instruments. RESULTS: Median surgical time was 75 minutes. The SISA technique was performed successfully in five of 10 cases and allowed easy and adequate inspection of the intra-thoracic structures. One case was converted to lateral thoracotomy after laceration of the vena cava and one converted to median sternotomy because of adhesions. An additional port was placed in three cases to facilitate triangulation and surgical manipulation. No other intra-operative complications were encountered. CLINICAL SIGNIFICANCE: In this initial report of uniportal thoracic approach in dogs, this technique allowed excellent access and treatment of mediastinal structures. Further cases are required to assess its suitability for pulmonary surgery.

A modified temporary tracheostomy in dogs: outcome and complications in 21 dogs (2012 to 2017).

OBJECTIVES: To describe a modified temporary tracheostomy that included placing a Penrose drain sling dorsal to the trachea. To report outcomes and complications in brachycephalic versus non-brachycephalic breeds. MATERIALS AND METHODS: Retrospective review of signalment, diagnosis, outcome, complications and management of dogs that underwent modified temporary tracheostomy. RESULTS: Twenty-one dogs were included. Tracheostomy tubes were maintained for periods ranging from 1 to 21 days (median 4 days). There were no intraoperative complications or complications related to the placement of the Penrose drain. Postoperative complications occurred in eight dogs, including dislodgement of the tracheostomy tube (n=6), obstruction of the tracheostomy tube (n=1), subcutaneous emphysema and pneumomediastinum (n=1). Twenty dogs survived until discharge; one was euthanised due to persistence of primary disease. The complication rate in brachycephalic breeds and non-brachycephalic was 37∙5 and 40%, respectively. Tube dwell duration of 4 days or longer was associated with a higher complication rate. CLINICAL SIGNIFICANCE: The modified temporary tracheostomy appears to simplify tracheostomy care, improve tracheostomy outcome and reduce tube-associated mortality compared with standard tracheostomy. In this study, brachycephalic dogs did not have a higher complication rate than non-brachycephalic dogs.

The incidence of surgical site dehiscence following full-thickness gastrointestinal biopsy in dogs and cats and associated risk factors.

OBJECTIVES: The objectives of this study were to: (1) document the incidence of surgical site dehiscence after full-thickness gastrointestinal biopsy in dogs and cats and (2) identify potential risk factors. METHODS: Data relating to dogs and cats undergoing full-thickness gastrointestinal biopsy were reviewed retrospectively following submission of a completed questionnaire by 12 referral institutions. Outcome measures were definite dehiscence, possible dehiscence (clinical records suggestive of dehiscence but not confirmed), suspected dehiscence (definite and possible combined) and death within 14 days. Logistic regression was planned for analysis of association of dehiscence with low preoperative serum albumin, biopsy through neoplastic tissue, biopsy alongside another major abdominal surgical procedure and biopsy of the colon. RESULTS: Of 172 cats, two (1·2%) had definite dehiscence, and four (2·3%) had possible dehiscence. Low preoperative serum albumin was significantly associated with definite dehiscence in univariable analysis and with suspected dehiscence and death within 14 days in univariable analysis, but all odds ratios had wide 95% confidence intervals. A histopathological diagnosis of neoplasia was significantly associated with death within 14 days in univariable analysis. Of 195 dogs, two (1·0%) had definite dehiscence, and three (1·5%) had possible dehiscence. In dogs, there was no association between any outcome measure and the putative risk factors. CLINICAL SIGNIFICANCE: Incidence of dehiscence following full-thickness gastrointestinal biopsy was low in this study. When determining the appropriateness of biopsy in individual cases, this information should be balanced against the potentially life-threatening consequences of dehiscence.

Effects of mechanical load on flow, volume and pressure delivered by high-frequency percussive ventilation.

High-frequency percussive ventilation (HFPV) has proved its unique efficacy in the treatment of acute respiratory distress, when conventional mechanical ventilation (CMV) has demonstrated a limited response. We analysed flow (V(dot)), volume (V) and airway pressure (Paw) during ventilation of a single-compartment mechanical lung simulator, in which resistance (R) and elastance (E) values were modified, while maintaining the selected ventilatory settings of the HFPV device. These signals reveal the physical effect of the imposed loads on the output of the ventilatory device, secondary to constant (millisecond by millisecond) alterations in pulmonary dynamics. V(dot), V and Paw values depended fundamentally on the value of R, but their shapes were modified by R and E. Although peak Paw increased 70.3% in relation to control value, mean Paw augmented solely 36.5% under the same circumstances (maximum of 9.4 cm H2O). Finally, a mechanism for washing gas out of the lung was suggested.

High frequency percussive ventilation (HFPV). Principles and technique.

In recent years, the usefulness of high frequency ventilation (HFV) has been clinically reassessed as an alternative to conventional mechanical ventilation (CMV). HFV has often been combined with or in some cases even completely replaced CMV in the attempt to reduce iatrogenic injury. High frequency percussive ventilation (HFPV) is a specific mode of HFV that has been successfully applied in the treatment of acute respiratory failure after smoke inhalation; it has also been more widely used in pediatric than in adult patients. This article gives an introduction to and a description of the basic principles of HFPV, a mode of ventilation which we found particularly versatile and reliable in our preliminary clinical experience with the maneuver.

Positive behavioral support of adults with developmental disabilities: assessment of long-term adjustment and habilitation following restrictive treatment histories.

The long-term maintenance of behavioral treatment effects is an important measure of clinical significance but is not reported with regularity in the published literature. The present report concerned therapeutic maintenance by evaluating five adults with developmental disabilities who had been exposed to multiple, restrictive procedures (food deprivation, mechanical restraint, electric shock) in a prior residential treatment facility and were transitioned to a new habilitation setting where these procedures were terminated in favor of alternative methods of behavior support. As revealed through a 24-month follow-up period, all of the participants were able to maintain clinically acceptable levels of challenging behaviors following the removal of the restrictive treatment procedures. Quality of life measures also revealed that the participants experienced greater independence, reduced supervision, and increased diversity in their living and work environments. These findings add to the limited studies on extended maintenance outcomes from behavioral intervention for serious clinical disorders in adults with developmental disabilities by demonstrating that positive adjustment can be sustained in the long-term without the continuation of restrictive treatment procedures.