Effects of Cold Compression, Bandaging, and Microcurrent Electrical Therapy after Cranial Cruciate Ligament Repair in Dogs

Objective— To compare 4 therapeutic techniques to reduce soft tissue swelling after cranial cruciate ligament repair in the dog.
Study Design— Prospective study.
Animals— Twenty-four dogs with cranial cruciate ligament rupture (CCLR).
Methods— Dogs with naturally occurring CCLR, were surgically repaired by an extracapsular technique and randomly divided into 4 treatment groups (cold compression [CC], modified Robert Jones bandage [B], cold compression and bandage [CCB], and microcurrent electrical therapy and bandage [METB]) each with 6 dogs. Data were collected at 2 time points, the morning after surgery before the 1st treatment and 72 hours later after the last treatment. Limb girth was measured at 3 anatomic locations to assess soft tissue swelling and all affected limbs were evaluated for presence (or absence) of pitting edema and bruising. Analysis of covariance was used to determine effect of treatment on the percent change in circumference. Duncan's multiple-range test was used to determine differences in treatment groups circumferential percent change over 72 hours. Statistical significance was set at P <.05.
Results— Use of a Robert Jones bandage had the least effect on reducing postoperative soft tissue swelling with CC, METB, and CCB being equally effective in reducing swelling by 72 hours after surgery.
Conclusion— Use of cold compresses alone or with a bandage, or using microcurrent electrical therapy in combination with a bandage decreases soft tissue swelling over 72 hours more than a bandaging alone after extracapsular repair of CCLR.
Clinical Relevance— CC, METB, and CCB should be considered as viable options to limit soft tissue swelling after extracapsular repair of CCLR in dogs.     

Complications of external skeletal fixation.

Complications associated with ESF can deleteriously affect soft tissue and bone healing. Adherence to proper surgical techniques and guidelines will minimize development of ESF-related complications. The most common problems associated with ESF are pin tract infections, fixator problems, and soft tissue impalement. These complications can be avoided by using proper pin insertion techniques that reduce skin tension; pin-bone, pin-skin motion; and soft tissue trauma. In addition, proper selection of pins (size, threaded or smooth), fixator configuration, ancillary implants, and a cancellous bone graft further reduce the risk of complications and inadequate healing.     

Rehabilitation of companion animals following orthopaedic surgery

ABSTRACT

Physical therapy and rehabilitation following orthopaedic surgery in companion animals have become more common and new advancements in this field have been made in recent years. Surgery alone may not return the animal to its previous physical activity or work-related tasks, whether due to concurrent soft tissue trauma, arthrogenic muscle inhibition or osteoarthritis. Rehabilitation therapies following surgery can restore function as well as strength, coordination and balance. Many simple techniques such as cryotherapy and passive range of motion exercises have been shown to improve outcomes following musculoskeletal procedures and may help restore function as well as reduce pain and facilitate healing. Some techniques are more useful during different stages in order to achieve optimum tissue healing and recovery of function. During the first 72 hours, rehabilitation should focus on reduction of inflammation and pain, maintaining joint nutrition and range of motion, and stimulating vascularisation and healing; and may include cryotherapy, passive range of motion exercises, massage and therapeutic exercises. Following the initial recovery period, the goals of rehabilitation also include restoring strength, balance and normal gait patterns, as well as recovery of function. During this period the focus of therapy may shift toward therapeutic exercises, aquatic therapy and increasing activity in the animal. Therapeutic modalities such as neuromuscular electrical stimulation, photobiomodulation (laser therapy), therapeutic ultrasound and extracorporeal shock wave therapy have been reported to reduce pain and inflammation, enhance healing and reduce recovery time in the early and late stages following orthopaedic surgery.     

RADIOTHERAPY AND SURGERY FOR FELINE SOFT TISSUE SARCOMA

Medical records for 79 cats with soft tissue sarcomas treated with preoperative or postoperative curative intent radiation therapy between August 1994 and February 2004 were reviewed. The purpose was to assess the effectiveness of preoperative and postoperative radiation therapy, and to determine the association of patient and radiation treatment variables with survival. Gender, age, weight, anatomic tumor site, packed cell volume (PCV), computerized vs. manual treatment planning, radiation field length, preoperative vs. postoperative irradiation, total radiation dose, and biologically effective dose (BED) were assessed as prognostic factors for survival. Fifty-six of 79 (71%) of cats were anemic within 2 weeks before or during radiation treatment. The median survival was 520 days for all cats, with a 1-year survival rate of 61.6%, and a 2-year survival rate of 41.6%. Only timing of radiation therapy relative to surgery and presence of a moderate or severe anemia were significantly related to survival. The median survival was 310 days for cats treated with preoperative radiation therapy, and 705 days for cats treated with postoperative radiation therapy ( P =0.03). The median survival was 308 days for cats with a PCV<25%, and 760 days for cats with a PCV≥25% ( P =0.017). Radiation therapy in combination with surgery results in relatively long-term survival in cats with soft tissue sarcomas. Anemia is common in cats undergoing radiation therapy for soft tissue sarcomas, and is associated with decreased survival.     

COMPUTED TOMOGRAPHY AND POSITIVE CONTRAST COMPUTED TOMOGRAPHIC ARTHROGRAPHY OF THE CANINE SHOULDER: NORMAL ANATOMY AND EFFECTS OF LIMB POSITION ON VISIBILITY OF SOFT TISSUE STRUCTURES

Soft tissue injuries of the shoulder are an important cause of forelimb lameness in dogs. The objectives of this canine cadaver study were to describe normal anatomy of shoulder soft tissue structures using computed tomography (CT) and computed tomographic arthrography (CTA) and to determine the effects of positioning on visualization of shoulder soft tissue structures. Thirteen forelimbs were removed from eight canine cadavers. Two forelimbs were used for contrast dose optimization. For the remaining 11 forelimbs, shoulder CT and CTA were performed using three defined joint angles (140°, 90°, and 70°). For three forelimbs, CT and CTA images were compared with frozen anatomic sections to describe normal anatomy. Ten forelimbs were used for analysis of positioning effects. Soft tissue structures evaluated were the joint capsule, cartilage, ligaments, tendons, and muscles. A visual assessment score was assigned to each structure using a consensus of two observers. The range and mode of scores were calculated and compared for each modality and limb position. The shoulder joint capsule and medial and lateral glenohumeral ligaments were completely visible with CTA. All tendons and muscles were visualized in all the examinations except for the teres minor muscle tendon and the coracobrachialis muscle, which were not visible on all scans. Positioning the limb in an extended position significantly improved visualization of most soft tissue shoulder structures. Shoulder cartilage was best seen with CTA and with neutral or flexed positioning of the shoulder. Findings indicated that both CT and CTA are feasible imaging techniques for visualization of soft tissue structures of the canine shoulder.     

Use of local and axial pattern flaps for reconstruction of the hard and soft palate

There are numerous conditions that may result in defects of the hard and soft palate. Reconstruction of these defects may be difficult due to anatomical limitations and limited tissue availability. The majority of palate defects, even when large, may be closed using local and/or axial pattern flaps, while other more advanced techniques such as free tissue transfer and prosthetic implants are required in a smaller number of cases. This article describes the use of local and axial pattern flaps in the reconstruction of the hard and soft palate.     

Comparison of isolation and expansion techniques for equine osteogenic progenitor cells from periosteal tissue

Stem cell therapy and cell-based therapies using other progenitor cells are becoming the treatment of choice for many equine orthopedic lesions. Important criteria for obtaining autogenous equine progenitor cells in vitro for use in clinical cell-based therapy include the ability to isolate and expand cells repeatedly to high numbers (millions) required for therapy, in a clinically relevant time frame. Cells must also maintain their ability to differentiate into the tissue type of choice. The objective of this study was to compare isolation and expansion techniques for preparation of periosteal-derived osteogenic progenitor cells for use in commercial autogenous cell-based therapy. Cells were allowed to migrate spontaneously from periosteal tissue or were enzymatically released. Isolated cells were expanded using enzymatic detachment of cells and subsequent monolayer or dynamic culture techniques. Viable osteogenic progenitor cells from each group were counted at 2 weeks, and osteogenic potential determined. Cells isolated or expanded using the explant or bioreactor technique yielded cells at a much lower number per gram of tissue compared with that of enzyme digestion and monolayer expansion, but all cells were able to differentiate into the ostoblast phenotype. Osteogenic progenitor cells isolated by enzymatic release and expanded using monolayer culture reached the highest number of viable cells per gram of donor periosteal tissue while maintaining the ability to differentiate into bone forming cells in vitro. This technique would be an easy, consistent method of preparation of equine osteogenic cells for clinical cell based therapy for orthopedic conditions.     

Surgical Excision of Soft Tissue Fibrosarcomas in Cats

Objective — The purpose of this study was to determine the tumor-free interval and survival times of cats who had one (group 1) or more (group 2) surgeries, or surgery and radiation therapy (RTH) (group 3) for treatment of soft tissue fibrosarcomas (FSA).
Study Design — Retrospective study.
Animals or Sample Population — 45 client-owned cats.
Methods — Medical records of cats with soft tissue FSA were examined. Vaccination and feline leukemia virus (FeLV) status, age, sex, breed, tumor location, number of surgeries, completeness of excision, and histopathological grade were evaluated to correlate with tumor-free interval and survival periods.
Results — Overall median tumor-free interval and survival times were 10 and 11.5 (range, 1 to 40) months. Median tumor-free interval and survival times were more than 16 months each in group 1, more than 5 and 13 months in group 2, and 4.5 and 9 months in group 3. Age, sex, breed, vaccination or FeLV status, tumor location, or histopathological grade did not affect median tumor-free interval or survival times ( P <.05). Cats with complete excisions had significantly longer median tumor-free interval (>16 versus 4 months) and survival time (>16 versus 9 months) than those with incomplete excisions ( P =.008). Radiation therapy did not seem to extend tumor-free interval and survival times ( P =.013). However, most group 3 cats had incomplete surgical excisions, resulting in recurrent or progressive disease.
Conclusions — Complete surgical excision of FSA in cats is possible and can be curative.
Clinical Relevance — Aggressive surgical excision with wide margins appears to contribute to extended tumor-free interval and survival times in cats with soft tissue FSA. Controlled prospective studies are needed to determine the efficacy of RTH in treatment.     

Free tissue transfer of the rectus abdominis myoperitoneal flap for oral reconstruction in a dog

A five-month-old intact/male Boxer dog was presented 5-days following bite wound trauma to the maxillary region resulting in an oronasal fistula extending from the maxillary canine teeth to the soft palate. Multiple surgical procedures using local, buccal mucosal flaps failed to repair the oronasal fistula. Free tissue transfer of the rectus abdominis myoperitoneal flap using microvascular surgical techniques was successful in providing soft tissue reconstruction of the hard palate area. Complications of these surgical techniques included muscle contraction and subsequent muzzle distortion. Small, refractory oronasal fistulae at the perimeter of the myoperitoneal flap were repaired by primary wound closure.     

Cauda equina syndrome in the dog: Radiographic evaluation

Dogs with clinical signs typical of cauda equina syndrome require careful evaluation to determine the cause of the disease as this strongly influences choice of treatment. Possible aetiologies include congenital or developmental, inflammatory, traumatic, neoplastic, and degenerative lesions that may involve vertebrae, vertebral joints, intervertebral discs, spinal cord, spinal nerves, or meninges. It must be determined whether clinical signs are due to musculoskeletal or neurological disease before performing special radiographic procedures. Non-contrast radiography permits false-positive diagnosis of obvious degenerative changes involving the L-S disc that may be without clinical signs or permits a false-negative diagnosis due to the failure to appreciate soft tissue lesions not seen radiographically. Special radiographic techniques are recommended and include: (1) stress radiography, (2) discography, and (3) epidural myelography. Evaluation of the results of these studies assists in determining the cause of the cauda equina syndrome and the type of therapy required.     

Evaluation of primary re-excision after recent inadequate resection of soft tissue sarcomas in dogs: 41 cases (1999-2004)

OBJECTIVE: To determine the efficacy of primary re-excision alone for treatment of soft tissue sarcomas after recent incomplete resection, the frequency and clinical importance of detecting residual tumor in resected scars, and prognostic factors associated with the procedure. DESIGN: Retrospective case series. ANIMALS: 41 dogs. PROCEDURES: Medical records of dogs that had undergone recent incomplete excision of a soft tissue sarcoma at a referring veterinary practice and subsequent re-excision of the scar at the Colorado State University Veterinary Medical Center were reviewed. Owners and referring veterinarians were contacted for follow-up information. Slides from re-excised specimens were reviewed. Dogs that underwent radiation therapy after the re-excision procedure were excluded. RESULTS: 41 dogs met the inclusion criteria, and long-term follow-up information was available for 39 dogs. Median follow-up time was 816 days. Local recurrence of tumor developed in 6 of 39 (15%) dogs, and distant metastasis occurred in 4 of 39 (10%) dogs. Healthy tissue margins of 0.5 to 3.5 cm were achieved at re-excision. Residual tumor was identified in 9 of 41 (22%) resected scars. No tumor-, patient-, or treatment-related variables were associated with local recurrence except for the presence of liposarcoma or fibrosarcoma or whether fine-needle aspiration had been performed prior to surgery. CONCLUSIONS AND CLINICAL RELEVANCE: After incomplete resection of soft tissue sarcomas, resection of local tissue should be performed, even if excisable tissue margins appear narrow. A long-term favorable prognosis is achievable without radiation therapy or amputation. The presence of residual tumor in resected scar tissue should not be used to predict local recurrence.     

Advances in Reptile Clinical Therapeutics

The standard of today's reptile practice calls on clinicians to use an ever-increasing array of diagnostic tools to gather information and obtain a definitive diagnosis. Few, if any, pathognomonic signs exist for reptile diseases, and for most clinical syndromes there is a lack of information regarding pathophysiology for one to define standard therapeutic protocols based solely on clinical signs without objective diagnostic information. For example, in the relatively distant past, clinicians treating reptile patients would routinely administer parenteral calcium to green iguanas (Iguana iguana) with the primary presenting clinical sign of muscle tremors. Today, veterinarians who treat reptiles recognize that the risk of soft tissue mineralization and permanent damage to arteries, renal tubules, and other tissues usually outweighs the potential short-term benefit of calcium therapy. Before calcium therapy is initiated, it is best to know the patient's ionized calcium concentration to reduce the risk of potential adverse therapeutic side effects. A problem-oriented diagnostic approach directed toward minimizing risk and maximizing therapeutic benefit is now the standard of reptile practice.     

SCINTIGRAPHIC DETECTION OF SUBCUTANEOUS METASTASIS IN A DOG WITH APPENDICULAR OSTEOSARCOMA

This report describes the detection of subclinical soft tissue metastasis of an appendicular osteosarcoma in a dog using bone scintigraphy. A 7-year-old spayed female Rottweiler was presented with a biopsy confirmed diagnosis of osteosarcoma. Initial radiographs revealed an aggressive bone lesion of the left distal radius. At presentation, there was no clinical or radiographic evidence of metastasis; however, a nuclear bone scan showed the primary bone lesion of the distal left radius and numerous soft tissue lesions consistent with diffuse soft tissue metastases. A left foreleg amputation was performed and cisplatin chemotherapy was given post-operatively. A second bone scan performed one month following initial presentation showed progression in size and number of soft tissue masses. Many of the lesions had become apparent on physical exam and survey radiographs. Excisional biopsy was performed on one of the soft tissue masses and a diagnosis of metastatic osteosarcoma was made. The dog was euthanized 2 months after initial presentation at the owners request due to deterioration of the animals physical condition.     

Arthrodesis tarsocrural or tarsometatarsal in 2 dogs using circular external skeletal fixator

An external fixation technique, using a circular fixator, to obtain arthrodesis was evaluated in 2 dogs with infected open lesions and soft tissue damage. In both cases, articular cartilage was curetted, and devitalized bone and necrotic soft tissue were removed. No bone graft was used. The wounds were maintained open and the dogs received postoperative antibiotic therapy. The arthrodesis site was compressed progressively as needed. Infection was eradicated and bony union was obtained in both dogs. It was concluded that the use of a circular fixator is an effective method to achieve arthrodesis.     

Chalastospora gossypii in a Maine Coon cat: case report and literature review

A 15-y-old castrated male Maine Coon cat was evaluated for an ulcerated soft tissue mass on the right hindlimb that had been observed for 4 mo and had grown rapidly. A 3 × 3 cm soft, raised, amorphous, and ulcerated subcutaneous mass was observed on the lateral right metatarsus. In-house cytology via fine-needle aspiration was nondiagnostic. Incisional biopsy of the mass and further staging was declined, and amputation was elected. The amputated limb was submitted for histopathology, which revealed severe chronic nodular granulomatous dermatitis and multifocal granulomatous popliteal lymphadenitis with large numbers of intralesional fungal hyphae. Fungal PCR and sequencing on formalin-fixed, paraffin-embedded tissue identified Chalastospora gossypii. No adjunctive therapy was elected at the time. The patient has done well clinically 1 y post-operatively. C. gossypii is a rare microfungus found worldwide and is considered a minor pathogen of several plants. To our knowledge, infection by this fungus has not been reported previously in veterinary species. Features in our case are comparable to other mycotic infections. Nodular granulomatous mycotic dermatitis and cellulitis, although uncommon, should be a differential for soft tissue masses in veterinary species; C. gossypii is a novel isolate.     

Synovial Hemangioma in a Dog

Objective— To report arthroscopic diagnosis and treatment of synovial hemangioma in a dog.
Study Design— Case report.
Animal— Standard Poodle (8-year-old neutered male).
Methods— A soft tissue density mass observed radiographically in the left stifle joint of a dog with a 2-month history of recurrent lameness, hemarthrosis, and a slight cranial drawer sign, was located by diagnostic arthroscopy and surgically excised via arthrotomy.
Results— Histologic evaluation revealed tissue composed of variably sized cavernous vascular spaces filled with erythrocytes that were considered compatible with synovial hemangioma.
Conclusions— In this dog, synovial hemangioma evident as a soft tissue mass on radiographs was associated with chronic lameness and hemarthrosis, and resolved with surgical excision.
Clinical Relevance— Synovial hemangioma, although seemingly rare in dogs, should be considered in the differential diagnosis for nontraumatic, recurrent lameness, and unresponsive to anti-inflammatory therapy when there is a circumscribed intracapsular soft tissue mass evident radiographically together with hemarthrosis.     

Extraskeletal osteosarcoma associated with retained surgical sponge in a dog.

Retained surgical sponges are usually discovered in the abdominal cavity, sometimes years after the surgical procedure, and the typical reaction is formation of a foreign-body granuloma, often called gossypiboma or textiloma. In this instance, an extraskeletal osteosarcoma, associated with the granulomatous reaction to a retained surgical sponge adjacent to the stifle, was diagnosed in an 11-year-old Labrador Retriever 9 years after repair of a ruptured cranial cruciate ligament. Radiographic detection of linear foreign material in the soft tissue mass was the basis for a diagnosis of gossypiboma. The mass was surgically excised. Histologically, fibers consistent with those of cotton gauze were associated with the granulomatous inflammation and the osteosarcoma. Amputation or radiation therapy was declined; the dog was treated conservatively with doxycycline and deracoxib. Three months after surgical excision, the dog was euthanized because of local recurrence of the mass along with lameness and decreased appetite.     

Surgical endodontics in dogs: a review

Surgical endodontic therapy (apical surgery) is a treatment alternative aimed at removing periapical inflammatory tissue followed by apical resection and retro-filling of the root canal. These procedures are performed through a trans-osseous approach. Terminology pertinent to this article include: apical (periapical) curettage--a surgical procedure to remove diseased tissue from the alveolar bone in the apical region of a pulpless tooth; apical cyst--a cyst in bone at the apex of a pulpless tooth. It is believed that such cysts arise after the death of the pulp from noxious physical, chemical, or bacterial stimulation of epithelial rests of Malassez; apicoectomy (apical resection) amputation of the apical portion of the root and removal of soft tissue in the bone; epithelial rests of Malassez--cords, strands, or clusters of ectodermal cells in the periodontal ligament (or sometimes alveolar bone) derived from remnants of Hertwigs epithelial root sheath. These cells frequently begin proliferating when inflammation occurs in the periodontal ligament and are believed to be responsible for the genesis of the epithelial lining of apical cysts.     

Soft palate hypoplasia in a horse

Several imaging techniques were used to diagnose hypoplasia of the soft palate in a horse. The absence of the caudal soft palate, hypertrophied lymphoid tissue and the formation of a pseudouvula were observed endoscopically. Plain and contrast radiography were used to demonstrate a soft palate remnant and to identify structures rostral to the epiglottis. Retrograde endoscopy of the pharynx via a tracheotomy incision is described.