Comparison of complications and outcome following unilateral, staged bilateral, and single-stage bilateral ventral bulla osteotomy in cats.

OBJECTIVE: To compare complications and outcome following unilateral, staged bilateral, and single-stage bilateral ventral bulla osteotomy (VBO) in cats. ANIMALS: 282 client-owned cats treated by VBO at 25 veterinary referral and academic hospitals from 2005 through 2016. PROCEDURES: Medical records of cats were reviewed to collect information on signalment, clinical signs, diagnostic test results, surgical and postoperative management details, complications (anesthetic, surgical, and postoperative), and outcome. Associations were evaluated among selected variables. RESULTS: Unilateral, staged bilateral, and single-stage bilateral VBO was performed in 211, 7, and 64 cats, respectively, representing 289 separate procedures. Eighteen (9%), 2 (29%), and 30 (47%) of these cats, respectively, had postoperative respiratory complications. Cats treated with single-stage bilateral VBO were significantly more likely to have severe respiratory complications and surgery-related death than cats treated with other VBO procedures. Overall, 68.2% (n = 197) of the 289 procedures were associated with Horner syndrome (19.4% permanently), 30.1% (87) with head tilt (22.1% permanently), 13.5% (39) with facial nerve paralysis (8.0% permanently), and 6.2% (18) with local disease recurrence. Cats with (vs without) Horner syndrome, head tilt, and facial nerve paralysis before VBO had 2.6, 3.3, and 5.6 times the odds, respectively, of having these conditions permanently. CONCLUSIONS AND CLINICAL RELEVANCE: Findings suggested that staged bilateral VBO should be recommended over single-stage bilateral VBO for cats with bilateral middle ear disease. Cats with Horner syndrome, head tilt, and facial nerve paralysis before surgery were more likely to have these conditions permanently following surgery than were cats without these conditions.

Carotid artery bursting pressure and seal time after multiple uses of a vessel sealing device.

OBJECTIVE: To determine any loss of function of a single-use bipolar vessel sealing device after repeated sterilization and use on canine carotid arteries. STUDY DESIGN: Ex vivo; randomized block design (dog). SAMPLE POPULATION: Carotid artery segments (n = 90) from 15 canine cadavers. METHODS: Six 10-mm LigaSure Atlas 20 cm devices (Covidien Inc, Minneapolis, Minnesota) were used to seal canine carotid artery segments in one cadaver, then resterilized using ethylene oxide and reused in a second cadaver, and so on, for a total of 15 uses/15 cadavers per LigaSure. Sealing times and bursting pressures of each carotid artery segment after each use were recorded. Charring and sticking at each seal location was qualitatively assessed. RESULTS: Mean (SD) sealing time for all segments was 5.3 (1.4) seconds, ranging from 2.7 to 9.5 seconds. There was no significant change in sealing time for successive uses (P = .117). The mean (SD) bursting pressure for all segments was 1041.3 (316.7) mm Hg, ranging from 355 to 1555 mm Hg. There was no change in bursting pressure across uses (P = .57). Moderate sticking and charring occurred at each time point but was not subjectively different throughout the study. CONCLUSION: The LigaSure Atlas vessel sealing device can be used and resterilized with ethylene oxide up to 15 times with no change in sealing time or bursting pressure of the seal.

Intertarsal Joint Stabilization in a Bateleur Eagle (Terathopius ecaudatus) Using a Novel Application of a Braided Suture and Titanium Button System.

A 32-year-old adult captive male bateleur eagle (Terathopius ecaudatus) with a history of laxity, degenerative joint disease, and varus deviation of the distal left hindlimb for several years was presented for evaluation of left hindlimb lameness and was diagnosed with chronic subluxation of the left intertarsal joint. After failing to improve with conservative management and pain medication, surgical stabilization of the joint was performed using a novel application of a braided suture and titanium button system. Unsatisfactory clinical improvement and postsurgical reevaluation indicated that the initial surgical stabilization was unsuccessful. The surgery was repeated, and the animal showed postsurgical improvement in intertarsal joint stability, weight-bearing, and lameness for a period of several years with use and adjustment of chronic pain medications. The novel surgical technique described in this case report represents an additional treatment option for management of avian intertarsal joint subluxations. Presurgical planning should consider the unique anatomic features and variability of the avian tarsometatarsus to avoid surgical complications.

Assessment of an implant-skin interface scoring system for external skeletal fixation of dogs.

OBJECTIVE To assess intraobserver repeatability and interobserver and in vivo versus photographic agreement of a scoring system for the implant-skin interface (ISI) of external skeletal fixation (ESF). SAMPLE 42 photographs of ISIs from 18 dogs for interobserver agreement and intraobserver repeatability and 27 photographs of ISIs from 6 dogs for in vivo versus photograph agreement. PROCEDURES An ISI inflammation scoring system was developed. It included scales for 6 metrics (erythema, drainage amount, drainage type, swelling, hair loss or lack of hair regrowth, and granulation tissue). Photographs of the ISI of ESF were obtained by use of a standard protocol and evaluated to determine intraobserver repeatability and interobserver agreement (Cronbach α; 4 raters) of the ISI score. Agreement between in vivo and photographic ISI scores (2 raters) and correlation between median scores across metrics were evaluated. RESULTS 42 photographs met the inclusion criteria. Overall intraclass correlation coefficients ranged from 0.922 to 0.975. Interobserver overall Cronbach α ranged from 0.835 to 0.943. For in vivo versus photographic assessment, 27 ISIs in 6 dogs and their photographs were evaluated. The Cronbach α for both raters ranged from 0.614 to 0.938. Overall, the Cronbach α ranged from 0.725 to 0.932. Mean photographic scores were greater than mean in vivo scores for each metric. Pearson correlation coefficients ranged from 0.221 to 0.923. Erythema, swelling, and granulation were correlated with all other metrics. CONCLUSIONS AND CLINICAL RELEVANCE In this study, an ISI scoring system used in this study had high repeatability and agreement and may therefore be considered for use in clinical situations. Photographic scores were not equivalent to in vivo scores and should not be used interchangeably.

Biomechanical evaluation of the influence of an intramedullary pin on the stability of a feline ilial fracture model stabilized with a bone plate.

OBJECTIVE: To compare the mechanical properties of feline ilial fractures stabilized with either a plate (P), or a plate and IM pin (P + P). STUDY DESIGN: Mechanical study. SAMPLE POPULATION: Cadaveric cat pelvii (n = 10). METHODS: Feline ilial fractures (n = 20) stabilized with either P or P + P were subjected to 100 nondestructive load cycles, then loaded to failure. Deformation after cycling, yield load and displacement, stiffness and load at 2 mm of displacement were compared between groups. RESULTS: There were no significant differences between groups for any of the parameters. Variability of data was much larger for the P + P group. CONCLUSIONS: No biomechanical advantage was demonstrated. The P + P constructs were not significantly stronger than plates alone in this acutely loaded cadaveric model.

Evaluation of a midhumeral block of the radial, ulnar, musculocutaneous and median (RUMM block) nerves for analgesia of the distal aspect of the thoracic limb in dogs.

OBJECTIVE: To evaluate a technique for midhumeral peripheral nerve blockade in the dog. STUDY DESIGN: Cadaveric technique development; in vivo placebo-controlled, prospective crossover study. ANIMALS: Canine cadavers (n=38) and 8 clinically healthy, adult hound dogs. METHODS: A technique for peripheral block of the radial, ulnar, musculocutaneous, and median nerves (RUMM block) was evaluated using cadaver limbs. Eight purpose-bred, research dogs were anesthetized; a RUMM block was performed on each thoracic limb. One limb from each dog randomly received 0.5% bupivacaine and the opposite limb was assigned to receive sterile saline solution as a control. After recovery from anesthesia, skin sensation at selected dermatomes was evaluated for 24 hours using a mechanical stimulus. Weight-bearing, conscious proprioception, and withdrawal reflex were also evaluated. One month after initial testing, each dog was reanesthetized and each limb received the opposite treatment. RESULTS: Sensory thresholds were significantly increased over baseline measurements when compared with control limbs for all nerves. Complete sensory block was achieved in radial (15/16), ulnar (3/16), musculocutaneous (8/16), and median (11/16) nerves, using a mechanical stimulus of analgesia. Complete simultaneous block of all nerves was only obtained in 1 of 16 limbs. CONCLUSION: RUMM block resulted in desensitization of the skin in the associated dermatomes for 4-10 hours. Complete sensory block of the dermatomes supplied by the radial nerve was most consistent. CLINICAL RELEVANCE: RUMM block may be an effective technique to provide adjunctive analgesia for dogs undergoing surgery of the distal aspect of the thoracic limb.

Surgical correction of severe strabismus and enophthalmos secondary to zygomatic arch fracture in a dog.

A grossly displaced segmental zygomatic arch fracture with marked ventro-lateral deviation of the left globe was diagnosed in a 3-month-old male German Shepherd dog following a bite injury. The fracture was approached via a modified lateral orbitotomy and a fragment of the lacrimal bone removed. The rostral portion of the fracture was stabilized with a 5-hole 2.0 dynamic compression plate bone plate. The surgical correction achieved sufficient skeletal fixation for proper anatomical reduction of the globe and excellent cosmetic and functional outcomes.

Parotid duct sialolithiasis in a dog.

Computed tomography was used to evaluate a 7-year-old English bulldog with a history of facial swelling and to aid in the diagnosis of parotid duct sialolithiasis. Removal of the sialolith with repair of the duct was not possible because of ductal fibrosis. Histological evaluation revealed glandular atrophy and fibrosis with lymphoplasmacytic inflammation. The parotid duct was ulcerated and fibrotic, with a mixed inflammatory infiltrate. Surgical excision of the parotid duct and salivary gland was curative.

The effects of patient positioning and slice selection on canine acetabular angle assessment with computed tomography.

Acetabular angles (AAs) and dorsal acetabular rim angles acquired by computed tomographic (CT) imaging have been used to assess patient response to juvenile pubic symphysiodesis surgery. The purpose of this study was to evaluate the effects of patient positioning and slice selection on these angles, and an attempt was made to devise a repeatable method of measuring these angles that would eliminate positioning effects. We found significant variation in AAs with small differences in pelvic tilt and slice selection. Dorsal acetabular rim angles were not affected. As a result of positioning differences from one CT study to the next, every attempt should be made to standardize pelvic tilt, or eliminate its effect on AAs by standardizing gantry angle in relation to an anatomic landmark that will not change over time. The floor of the sacral vertebral canal may be a reasonable landmark for this purpose and deserves further study.

Radiographic anatomy of the canine coxofemoral joint using the dorsal acetabular rim (DAR) view.

A radiographic study of the anatomy of the canine acetabulum was performed. The relationship between the area of dorsal acetabular rim that is subject to early damage in dogs with coxofemoral joint laxity, and the "DAR point" identified on dorsal acetabular rim (DAR) radiographic views was examined. Radiographs and digital photographs were made of the pelvis harvested from each of six skeletally mature dogs. Through analysis of these images, it was determined that in the standing animal, the DAR point is located 4-6 mm (or approximately 37 degrees) caudal to the dorsal acetabular rim area that is prone to early damage in dogs with coxofemoral joint laxity. This study suggests that the DAR radiographic view may under-represent changes to the dorsal acetabular rim in dogs with coxofemoral laxity.