Microvascular Free Tissue Transfer: Results in 57 Consecutive Cases     

J. DAVID FOWLER DVM  MVSC  Diplomate ACVS    DANIEL A. DEGNER DVM  Diplomate ACVS    RICHARD WALSHAW BVMS  Diplomate ACVS  DAVID WALKER DVM 《Veterinary surgery : VS》1998,27(5):406-412

Objective —To evaluate the outcomes and complications in a consecutive series of animals undergoing microvascular reconstructive procedures at two veterinary institutions. Study Design—Retrospective study. Animals or Sample Population—A total of 44 client-owned dogs and one red-necked wallaby. Methods —The medical records of all animals undergoing reconstructive microsurgical procedures at the Western College of Veterinary Medicine and Michigan State University were reviewed. Microvascular flap survival and related complications were described. Statistical analysis was performed to determine the significance of relationships between operative factors and outcome. Results —A total of 57 microvascular procedures were performed on 55 animals. Reconstruction was required after trauma in 42 animals, after ablative cancer surgery in 11 animals and for correction of congenital tissue aplasia in 1 animal. Donor tissues included the superficial cervical cutaneous, medial saphenous fasciocutaneous or musculofasciocutaneous, caudal superficial epigastric cutaneous, trapezius muscle or musculocutaneous, caudal sartorius muscle, latissimus dorsi muscle or musculocutaneous, cranial abdominal myoperitoneal, carpal footpad, digital footpad, and vascularized ulnar bone flaps. A total of 53 of 57 flaps (93%) survived. There was a significant relationship between flap failure and level of assistant surgeon experience (P < .05). Latissimus dorsi flaps were significantly more likely to fail when compared with pooled data from all other flap types (P < .01). Conclusions —The success of microvascular tissue transfer in this case series compares favorably with those reported in human reconstructive microsurgery. Both the primary and assistant surgeon should be practiced in microsurgical technique. Failure of latissimus dorsi flaps was not likely caused by an inherently deficient flap design, but was more likely attributed to the location and severity of trauma at the recipient site, the difficulty in isolating suitable recipient vessels for anastomosis or the absence of a trained assistant surgeon during these procedures. Clinical Relevance —This retrospective study documents the successful application of microvascular technique in a series of clinical cases requiring tissue reconstruction.  相似文献   

Biomechanical Comparison of the Trocar Tip Point and the Hollow Ground Tip Point for Smooth External Skeletal Fixation Pins     

JUAN M. MARTI LV  Cert SAO  MVM  MRCVS  SIMON C. ROE BVSc  MS  PhD  Diplomate ACVS 《Veterinary surgery : VS》1998,27(5):423-428

Objective —To compare the insertional characteristics of external fixator pins with hollow ground (HG), modified HG, and trocar (T) points.
Study Design —An acute, in vitro biomechanical evaluation.
Sample Population—Thirteen radii from canine cadavers.
Methods —A total of 16 T-tipped and 16 HG-tipped pins were inserted into 8 canine radii. Ten pins of each modification of the HG tip (length of the cutting edge reduced by 0.127 mm and 0.254 mm, respectively) were inserted into another five radii. All pins were inserted with low-speed power drilling and 80 N drilling load. Differences between peak tip temperature, drilling energy, and pullout force were determined for each pin type at both diaphyseal and metaphyseal locations.
Results —HG-tipped pins showed a 40% lower tip temperature in diaphyseal bone, a 25% reduction in drilling energy in diaphyseal bone, and a reduction of pullout force in both diaphyseal (65%) and metaphyseal (50%) bone compared with T-tipped pins. HG 0.254-mm pins generated higher tip temperatures and had greater pullout than HG pins in diaphyseal bone.
Conclusions —The HG tip was a more efficient design; however, the reduction in pullout force suggests that, because a better hole was drilled, radial preload is reduced. Reduction of the cutting edge by 0.254 mm increased the pullout force but also increased the temperatures.
Clinical Relevance —Thermal and microstructural damage are reduced by the HG tip, but pin-bone interface stability is also compromised. The use of a tip with 0.254 mm reduction in the cutting edge may optimize the biological and mechanical factors at the pin-bone interface.  相似文献   

Repair of Complete Dorsal Fracture of the Proximal Phalanx in Two Horses     

JULIE E. DECHANT DVM    DAVID G. MACDONALD DVM  MVSC  Diplomate ACVS  WILLIAM H. CRAWFORD DVM  MVSC  Diplomate ACVS 《Veterinary surgery : VS》1998,27(5):445-449

Simple complete dorsal fractures of the proximal phalanx were repaired in 2 mature pleasure horses with cortical bone screws placed in lag fashion. Healing occurred within 12 weeks and both horses returned to their previous performance level of light pleasure riding within 6 months of injury.  相似文献   

Plasma Concentrations and Cardiovascular Influence of Lidocaine Infusions During Isoflurane Anesthesia in Healthy Dogs and Dogs With Subaortic Stenosis     

AURY NUNES DE MORAES DVM  DVSC    DORIS H. DYSON DVM  DVSC  Diplomate ACVA    MICHAEL R. O'GRADY DVM  Diplomate ACVIM    WAYNE N. McDONELL DVM  PhD  Diplomate ACVA  DAVID L. HOLMBERG DVM  MVSC  Diplomate ACVS 《Veterinary surgery : VS》1998,27(5):486-497

Objective—To determine the plasma concentrations and cardiovascular changes that occur in healthy dogs and dogs with aortic stenosis that are given an infusion of lidocaine during isoflurane anesthesia. Study Design—Phase 1, controlled randomized cross-over trial; Phase 2, before and after trial Animals—Phase 1, 6 healthy dogs (4 female, 2 male) weighing 23.8 ± 7.4 kg; Phase 2, 7 dogs (4 female, 3 male) with moderate to severe subaortic stenosis (confirmed by Doppler echocardiography) weighing 31.1 ± 14.5 kg. Methods—After mask induction, intubation, and institution of positive pressure ventilation, instrumentation was performed to measure hemodynamic variables. After baseline, measurement at an end-tidal isoflurane concentration of 1.9% (phase 1) or 1.85% (phase 2), a loading dose infusion of lidocaine at 400 μg/kg/min was given. Phase 1: Maintenance doses of lidocaine were administered consecutively (40, 120, and 200 μg/kg/min) after the loading dose (given for 10, 10, and 5 minutes, respectively) in advance of each maintenance concentrations. Measurements were taken at the end of each loading dose and at 25 and 35 minutes during each maintenance level. The same animals on a different day were given dextrose 5% and acted as the control. Phase 2: Dogs were studied on a single occasion during an infusion of lidocaine at 120 μg/kg/ min given after the loading dose (10 minutes). Measurements occurred after the loading dose and at 25 and 35 minutes. A blood sample for lidocaine concentration was taken at 70 minutes. Data were compared using a one-way ANOVA for phase 1, and between phase 1 and 2. Statistical analysis for phase 2 was performed using a paired r-test with a Bonferroni correction. A P value ± .05 was considered significant. Results—Phase 1: Plasma lidocaine concentrations achieved with 40, 120, and 200 μg of lidocaine/kg/min were 2.70, 5.27, and 7.17 μg/mL, respectively. A significant increase in heart rate (HR) (all concentrations), central venous pressure (CVP), mean pulmonary areterial pressure (PAP), and a decrease in stroke index (SI) (200 μg/kg/min) were observed. An increase in systemic vascular resistance (SVR) and mean PAP, and a decrease in SI also followed the loading dose given before the 200 μg/kg/min infusion. No other significant differences from the control measurements, during dextrose 5% infusion alone, were detected. Phase 2: Plasma lidocaine concentrations achieved were 5.35, 4.23, 4.23, and 5.60 μg/mL at 10, 25, 35, and 70 minutes, respectively. They were not significantly different from concentrations found in our healthy dogs at the same infusions. A significant but small increase in CVP compared with baseline was noted after the loading dose. There were no significant differences from baseline shown in all other cardiovascular data. There were no statistically significant differences in any measurements taken during the lidocaine infusion between the dogs in phase 1 and phase 2. Dogs with aortic stenosis tended to have a lower cardiac index than healthy dogs at baseline (88 v 121 mL/kg/min) and during lidocaine infusion (81 v 111 mL/kg/min). A small, statistically significant difference in systolic PAP was present at baseline. Conclusions—There does not appear to be any detrimental cardiovascular effects related to an infusion of lidocaine at 120 μg/kg/min during isoflurane anesthesia in healthy dogs or dogs with aortic stenosis. The technique used in this study resulted in therapeutic plasma concentrations of lidocaine. Clinical Relevance—Methods shown in the study can be used in clinical cases to achieve therapeutic lidocaine levels without significant cardiovascular depression during isoflurane anesthesia.  相似文献   

Biomechanical Comparison of the Herbert and AO Cortical Bone Screws for Compression of an Equine Third Carpal Bone Dorsal Plane Slab Osteotomy     

RACHEL C. MURRAY vetMB MS  Diplomate ACVS  Diplomate ECVS    EARL M. GAUGHAN DVM  Diplomate ACVS    RICHARD M. DEBOWES DVM  MS  Diplomate ACVS  JAMES J. HOSKINSON DVM  Diplomate ACVR 《Veterinary surgery : VS》1998,27(1):49-55

Objective—To assess feasibility of insertion of 4.5-mm Herbert cannulated bone screws (HS) using fluoroscopic guidance and compare the mechanical shear strength of these HS and 4.5-mm AO cortical bone screws (AO) for fixation of dorsal plane slab osteotomies in equine cadaver third carpal bones (C3).
Animals or Sample Population—Eight equine cadavers.
Methods—Bone mineral composition and density of contralateral C3 were confirmed to be equivalent using dual-energy x-ray absorptiometry. A standard 10-mm C3 slab osteotomy was reduced using HS or AO instrumentation under fluoroscopic guidance. Specimens were loaded in shear until failure, using a materials testing apparatus.
Results—HS and AO instrumentation allowed accurate reconstruction of the osteotomy, but there was difficulty encountered seating the HS proximal self-tapping threads. There was no significant difference in maximal load to failure, stiffness, or mode of failure of constructs created with the HS and AO screws.
Conclusions —Use of 4.5-mm HS for repair of C3 radial facet, dorsal plane slab fractures may result in a mechanically comparable fixation to a repair using a 4.5-mm AO. Equine dorsal C3 may be too dense, however, to allow placement of the proximal self-tapping threads of the HS without potentially excessive application of torque to the screw itself.
Clinical Relevance —Dorsal plane, radial facet slab fractures of the equine C3 are a significant clinical problem. Accurate reconstruction and stabilization are necessary for return to athletic function.  相似文献   

Effect of Omentectomy on Adhesion Formation in Horses     

K. LEANN KUEBELBECK DVM    DONNIE E. SLONE DVM  MS  Diplomate ACVS  KIM A. MAY DVM 《Veterinary surgery : VS》1998,27(2):132-137

Objective —To determine if omentectomy would decrease the frequency of postoperative intraabdominal adhesions. Study Design —Retrospective study. Animals or Sample Population—44 horses that had either two ventral median celiotomies or a ventral median celiotomy and a necropsy more than 4 days later; 19 of these horses had their omentum removed at the initial surgery. Methods —Data retrieved from the records included location and type of intraabdominal adhesions; location of the surgical lesion; relationship of adhesions to the surgical lesion; surgical procedures; duration of initial surgery; time interval between procedures; age, gender, and breed of the horse; and clinical outcome. Fisher's exact test was used to evaluate the association between categorical explanatory and outcome variables. The effect of potential risk factors on the incidence rate of adhesion formation was estimated using a proportional hazards regression model. Results —Of 25 horses in the nonomentectomy group, 15 (60%) had postoperative adhesions that resulted in the need for a second surgical intervention, whereas of 19 horses that had omentectomy initially, only 4 (21%) had postoperative adhesions that required a second procedure. Rate of adhesion formation was higher in horses that did not have omentectomy initially (incidence ratio rate [IRR], 0.46; 90% confidence interval [CI], 0.18 to 1.19). At initial surgery, 24 horses had a small intestinal lesion, and 20 horses had a large intestinal lesion. Fifteen horses (63%) with small intestinal lesions subsequently developed adhesions compared with four horses (20%) with an initial large intestinal lesion (P= .006). At the second procedure, small intestine lesions were identified in 32 horses and large intestine lesions in 12 horses (1 horse had both small and large intestine lesions), and 1 horse had a gastric lesion. Adhesions were identified as the cause of colic signs in 19 (61%) horses with small intestinal lesions and in none of the horses with large intestine lesions. The frequency of adhesion development leading to colic associated with only the small intestine at the second surgery or necropsy was significantly greater (P= .001) than the frequency only in the large intestine. Conclusions —Omentectomy reduced the rate of postoperative adhesion formation. Adhesions are more likely to occur after small intestinal surgery and if they do occur likely involve the small intestine. Clinical Relevance —Omentectomy is a safe procedure and should be considered prophylactically for reduction of adhesion formation after abdominal surgery in horses.  相似文献   

Comparison of Plasma Fentanyl Concentrations by Using Three Transdermal Fentanyl Patch Sizes in Dogs     

CHRISTINE M. EGGER DVM  MVSC    TANYA DUKE BVetMed  DVA  Diplomate ACVA    JOY ARCHER DVM  PhD  Diplomate ACVP  PETER H. CRIBB BSc  MRCVS  Diplomate ACVA 《Veterinary surgery : VS》1998,27(2):159-166

Objective—To compare plasma fentanyl concentrations attained after the application of three transdermal fentanyl patch sizes (50, 75, and 100 μg/hour) in dogs. Design—Repeated Latin square controlled study. Animals—Six intact, mixed-breed adult dogs (2 males, 4 females) weighing 19.9 ± 3.4 kg. Methods—Each dog was randomly assigned to receive each of three treatments: 50 (P50), 75 (P75), or 100 (P100) μg/hour transdermal patches. Patches were left in place for 72 hours. Jugular venous blood was collected at 1,2, 4, 8, 12, 24, 36, 48, 60, and 72 hours after patch application and for 1, 2, 4, 8, and 12 hours after patch removal. Plasma fentanyl concentrations were measured using a radioimmunoassay technique. After a 96-hour washout period, each dog was moved to another treatment group and received a different patch size. Results—The following results were obtained (mean ± SD): average plasma fentanyl concentration from 24 to 72 hours, 0.7 ± 0.2 ng/mL (P50), 1.4 ± 0.5 ng/mL (P75), 1.2 ± 0.5 ng/mL (P100); the total area under the concentration versus time curve (0 hours to infinity), 46 ± 12.2 ng/h/mL (P50), 101.2 ± 41.4 ng/h/mL (P75), 80.4 ± 38.3 ng/h/mL (P100); and the apparent elimination half-life, 3.6 ± 1.2 hours (P50), 3.4 ± 2.7 hours (P75), and 2.5 ± 2.0 hours (P100). There was a high degree of variability in plasma fentanyl concentrations achieved. Plasma fentanyl concentrations declined rapidly after patch removal. Conclusions—The attainment of steady-state plasma concentrations takes up to 24 hours, and there is a great deal of variability in the final concentrations reached in different individuals. In this study, the 100 μg/hour patches did not provide statistically increased plasma concentrations when compared with the 50 μg/hour patches. Clinical Relevance—Because of the interindividual and intraindividual variation in plasma fentanyl concentrations, patches should be applied 24 hours before the anticipated time that analgesia will be required. Adequacy of analgesia and potentially deleterious side effects, such as sedation and respiratory depression, should be monitored while the patches are in place. Skin reactions may occur, and the patches should be removed if such skin irritation is seen. After the patch is removed, it is expected that analgesia will wane rapidly because of the brief elimination half-life.  相似文献   

Surgical Treatment of Male Dogs With Urinary Incontinence Due to Urethral Sphincter Mechanism Incompetence     

U.Th. WEBER DrMedVet  Diplomate ECVS    S. ARNOLD DrMedVet    M. HUBLER DMV  J.R. KUPPER DrMedVet 《Veterinary surgery : VS》1997,26(1):51-56

A modified technique for fixation of the deferent ducts to the abdominal wall as a therapy for urinary incontinence caused by urethral sphincter mechanism incompetence (USMI) in male dogs is described, and the results in seven dogs are reported. The goal of this treatment was to achieve an effect similar to colposuspension in female dogs with USMI. An increase in urethral length of an average of 28 mm was obtained (range, 5 to 50 mm, measured radiographically). Preoperatively, the neck of the bladder was located intrapelvically in five of seven dogs. Postoperatively, the neck of the bladder was located intra-abdominally, near the caudo-ventral abdominal wall, in all dogs. After a follow-up period of 12 to 49 months, the response to surgery, based on lack of or decrease of incontinence, was excellent in three dogs, good in another three, and poor in one dog.  相似文献   

Bacterial Isolates From Plaque and From Blood During and After Routine Dental Procedures in Dogs     

MARY ANN NIEVES DVM  MS    PATRICIA HARTWIG DVM    JOANN M. KINYON BS  MS  DEAN H. RIEDESEL DVM  PhD  Diplomate ACVA 《Veterinary surgery : VS》1997,26(1):26-32

Objective — This study evaluates the association between dental procedures and bacteremia in dogs, including a comparison of bacteria isolated from plaque and blood, severity of the bacteremia versus the severity of dental disease, and the longevity of bacteremia.
Study Design — Bacteria cultured from the blood over time were compared with those isolated from the plaque and crevicular fluid and in relation to severity of dental disease.
Animals or Sample Population — Twenty adult greyhounds.
Methods — Blood samples were collected for culture before induction of general anesthesia, immediately after intubation, 20 minutes after initiation of the dental procedure, and at 10-minute intervals until 10 minutes after the dental procedure was completed. Samples of plaque were taken for microbiological culture.
Results — Sixty to ninety percent of the bacterial genera isolated from the plaque were present in the blood. Dogs classified according to severity of dental disease showed no difference in the total number of different species or number of different Gram-negative, Gram-positive, or anaerobic bacteria isolated from plaque or blood (P <.05). Bacteremia was present in all of the dogs studied, within 40 minutes from the initiation of the dental procedure, regardless of the severity of oral disease.
Conclusions — Gram-negative, Gram-positive, and anaerobic bacteria are present in blood during dental procedures; the bacteremia can persist beyond the dental procedure, and is not associated with the severity of dental disease.
Clinical Relevance — The nature and extent of bacteremia occuring during routine dental procedures is important in understanding a potential risk to dogs.  相似文献   

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Jeryl C. Jones DVM  PhD  Dipl. ACVR 《Veterinary radiology & ultrasound》2015,56(1):1-2

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