Enucleation of Exotic Pets

Enucleation is often the final option when considering ocular treatment for an exotic pet patient. There are many considerations when performing the surgical procedure to remove the eye. It is incumbent on the surgeon to be familiar with the anatomy of the individual species’ globe and orbit to reduce hemorrhage, optic nerve trauma, and postsurgical complications. This review of enucleation procedures will focus on ocular anatomical differences and techniques that should be used to maximize surgical success.     

Local and systemic complications in a cat after poorly performed dental extractions

This case report describes a cat that was presented with infected oral tissues and signs of systemic inflammatory response. Incomplete dental extractions had been performed 10-days earlier During a second dental procedure, 22 tooth root remnants were removed. Diabetic ketoacidosis and possible thromboembolism complicated the cat's recovery period After 13-days of hospitalization, the patient was stable enough to be sent home. Postoperative examinations at 1, 3, 6, 12, 16, 24, and 52-weeks indicated continued improvement with moderate glycemic control and chronic but stable renal failure. The patient died from further complications of diabetic ketoacidosis 20-months following root remnant extractions.     

Pain management and regional anesthesia for the dental patient

Current standards of care in veterinary medicine dictate an adequate level of pain control for our patients. Effective pain control uses a proactive, multimode approach that starts with preoperative medications, includes the anesthetic protocol selected, and continues into the postoperative period. A basic understanding of the physiology of pain assists in selecting those agents and modalities best suited for individual patients. Analgesic drug selection and local anesthesia are both integral parts of pain control when performing surgery in the oral cavity. Local (regional) anesthesia plays an important part in the pain control of oral surgical patients. Regional anesthetic techniques are used for many common oral procedures, including extractions, periodontal flap surgery, treatment of traumatic injuries of the oral cavity, tumor removal, palatal surgery, periodontal therapy, and root canal therapy. This presentation will cover strategies for analgesia and the techniques and materials used in local/regional anesthesia in the oral cavity. Anatomic landmarks and guidelines for effective regional blocks will be covered.     

The acute abdomen: a surgeon's approach to diagnosis and treatment

Clinical approach to a patient with acute abdominal distress involves decision making: whether to take a patient to surgery, or manage the patient medically. A thorough and systematic approach requires the use of diagnostic imaging modalities, including radiology and ultrasonography, performing diagnostic peritoneal lavage or abdominal paracentesis techniques, and bloodwork evaluation, including complete blood count and serum biochemistry profiles. In some cases, the results of diagnostic tests may lead to surgical versus medical management, particularly when a patient fails to respond to medical management alone. In other cases, such as GDV syndrome, penetrating abdominal wounds, pyometra, or uncontrolled abdominal hemorrhage, rapid surgical management is necessary for patient survival. This article describes a systematic approach to a small animal patient with acute abdomen.     

Extraction techniques

Dental extractions are a very common veterinary procedure. As common as they are, they are not a simple undertaking and should be approached with the same depth of preparation as any other surgical procedure. Regardless of size of the tooth, all extractions start with the 9 steps used for simple single-root extractions. These are: obtain consent, expose a dental radiograph, obtain proper lighting and visualization, administer proper pain management, cut the gingival attachment, elevate carefully, remove the tooth, perform alveoplasty, and close. Multi-root teeth require sectioning into single-rooted pieces, which are then treated as single-root extractions. Finally, some extractions (especially canine and carnassial teeth) are better performed after the creation of gingival flaps and removal of bone to ease the extraction process.     

Canine intrapericardial cyst – complicated surgical correction of an unusual cause of right heart failure

Intrapericardial cysts are non-neoplastic structures that can become clinically significant by compressing cardiac chambers. Surgical excision is recommended to resolve clinical signs and this has been reported to be easily achieved by blunt manipulation. The present report describes a case of an intrapericardial cyst in a dog. The singularity of this case lays on the fact that the patient was presented unusually late, at the age of four years, and most importantly that its surgical correction was significantly complicated by the strong adherence of the cyst to both the pericardium and epicardium. This was possibly the result of chronic trauma and continued haemorrhage with subsequent healing and fibrosis. It is therefore important to consider intrapericardial cysts as a possible differential diagnosis in young to middle age patients presented with signs of right-sided heart failure. Surgical excision must be planned carefully as this may not be as straightforward as previously suggested.     

Iatrogenic fractures of ribs and vertebrae during delivery in perinatally dying calves: 235 cases (1978-1988)

To determine the pathogenesis of vertebral fractures in calves during the perinatal period, a retrospective study was done to determine the relationships between clinical factors at dystocia and the findings during necropsy of 235 perinatally dying calves. It was concluded that excessive traction is the most important cause of rib and vertebral fractures in the calf during dystocia. Vertebral fractures in perinatally dying calves may not be simply judged as a sign of asphyxia. The occurrence of vertebral fractures is highly correlated with the type of delivery and the force of traction. The veterinarian as well as the type of calf also are influencing factors. More perinatally dying calves were delivered after hips were locked, when extraction had been forced, or through induction of trauma when the head of the calf had the pelvic canal during the first obstetric examination. Consequently, fetal position at delivery may predispose calves to risky extractions and to the risk of perinatal death secondary to trauma. In light calves, significantly more vertebral fractures occurred during extractions than in other calves. Therefore, the veterinarian should accurately estimate the birth weight of the calf and the force of traction that should be applied.     

A modified ab externo approach for suture fixation of an intraocular lens implant in the dog

The goals of canine cataract and lens instability surgery should be to ensure a small incision, minimal tissue trauma, shortened surgical time, maintenance of the anterior chamber, and restoration of emmetropia through the use of a stable intraocular lens specifically designed for the canine eye. While this is usually the case with routine phacoemulsification and in-the-bag intraocular lens implantation, it is often not the case with lens instability, lens luxation or large posterior capsular ruptures. In such cases the incisions are often larger, surgical time and tissue trauma are excessive, and the patient is often left aphakic. The goal of this paper is to present a modified ab externo technique designed to allow removal of the lens and placement of a ciliary sulcus sutured IOL through a small incision, with minimal trauma and shortened surgical time. Use of this technique may allow more canine patients to be emmetropic postoperatively. In addition, the ease of this procedure may encourage earlier removal of an unstable lens and decrease the risk of secondary glaucoma and retinal detachment that occur in association with lens luxation.     

Success Rates of Unilateral vs. Bilateral Cataract Extraction in Dogs

Postoperative results of 113 unilateral and 77 bilateral extracapsular cataract extractions (EC-CEs) in dogs were evaluated retrospectively. Restoration or improvement of functional vision was achieved in 79.6% of the eyes in dogs with unilateral extraction and 85.7% of the eyes in dogs with bilateral extractions at weeks 4 to 6. Complications occurring 6 weeks to 9 months after lens extraction lessened the surgical success rate in both groups. Twenty-six percent of the dogs in which bilateral lens removal was performed suffered complications resulting in surgical failure in one eye. When using the criterion that one or both treated eyes had functional vision, a short-term success rate of 98.7% was found for bilateral extractions.     

Surgical repair of rib fractures in 14 neonatal foals: case selection, surgical technique and results

Reasons for performing study: Fractured ribs are encountered quite frequently in newborn Thoroughbred foals, often with fatal outcome. Surgical repair of fractures therefore requires consideration as a means of reducing mortality. Objectives: To evaluate the repair of rib fractures using internal fixation techniques in foals at 2 different equine hospitals following similar diagnostics and case selection. Methods: The records of 14 foals that underwent internal fixation of fracture ribs were reviewed. Subject details, clinical presentation, diagnosis, surgical technique, post operative care and complications were recorded. Follow-up information was obtained in 7 foals. Results: The fractured ribs were reduced and stabilised using reconstruction plate(s), self-tapping cortical screws and cerclage wire in 12 cases, Steinmann pins and cerclage wires in 1 case and both techniques in 1 case. Not every rib was reduced on each case. Surgical reduction was performed on an average of 2 ribs, range 1-3 ribs in each foal. At the time of writing, 4 foals had been sold, one age 2 years was in training and 2 others died from unrelated causes. Conclusions: Our data support the use of surgical stabilisation utilising reconstruction plates, self-tapping cortical screws and cerclage wire for selected cases of thoracic trauma in neonatal foals. The use of Steinmann pins may be suboptimal due to cyclic failure, implant migration and the potential for iatrogenic internal thoracic trauma. Potential relevance: Foals with existing extensive internal thoracic trauma resulting from rib fracture(s), or the potential for such trauma, previously considered to have a guarded to poor prognosis for survival, may be successfully managed with internal fixation of selected fracture sites.     

Cystotomy, partial cystectomy, and tube cystostomy

Knowledge of the regional anatomy and healing characteristics of the urinary bladder are crucial to successful surgical intervention in common disorders of the bladder. Innervation and blood supply enter the neck region of the bladder on the dorsal surface. Surgical approach to the bladder is via a ventral midline incision. Cystotomy is most commonly performed on the ventral surface of the bladder and the incision is closed using absorbable suture material in a single-layer, appositional closure. Removal of urinary calculi is the most common indication for cystotomy and should be accompanied by mucosal biopsy and culture. After cystotomy for removal of calculi, a lateral radiograph should be made to confirm removal of all calculi. Partial cystectomy is indicated for bladder trauma, neoplasia, patent urachus, and urachal diverticula. A large percentage of the bladder wall can be excised with gradual return to near normal function when the trigone region is preserved. Complete cystectomy is not recommended because of the patient morbidity and client dissatisfaction with these procedures. Tube cystostomy is performed routinely for temporary or permanent urinary diversion. Temporary diversion may be performed concurrently with surgical repair of urethral trauma or to relieve acute urethral obstructions. Permanent cystostomy may be performed in cases of neurogenic bladder atony or bladder cancer.     

Ferret orthopedics.

Orthopedic conditions requiring surgical intervention and correction frequently occur in the ferret patient. Elbow luxations and long bone fractures are among the most common syndromes affecting the ferret patient, which often presents in an emergency setting. Orthopedic conditions in the ferret, as in other mammalian species, are often the result of trauma. Surgical treatment including reduction and stabilization of the affected bony structure, combined with supervision and the recommended postoperative care, can provide a good prognosis to return to normal function for the ferret.     

Management of complicated wounds.

Most injuries, including those with significant tissue loss, can be successfully managed with proper therapy. With delayed healing, potential causes for the delay, such as sequestra, foreign bodies, and excessive motion,should be determined and treated to permit complete wound resolution.Horses have the innate ability to heal rapidly; however, minor injuries can quickly turn into complicated wounds, given the severity of the inciting trauma and the less than ideal environment in which the horses are housed.Wound management must focus on a combination of timely surgical and medical intervention to ensure the best potential outcome.     

PREOPERATIVE CLINICAL EVALUATION OF THE SURGICAL PATIENT WITH POTENTIAL OR APPARENT INFECTION

Because of the type of patient treated, and the nature of the injury, the veterinarian is often called upon to treat surgical infections. These infections may be primary, or can be sequelae or trauma or elective surgery. Each clinician has his own protocol and priorities in evaluation of the patient with a surgical infection. A careful history and physical examination, together with clinical and microbiological laboratory testing procedures will help identify the pathogenic organism and indicate the severity of the infection in the animal patient. With this preliminary evaluation, the clinician and surgeon may attack the problem appropriately, and with a greater assurance of success.     

Thoracic trauma. Newer concepts

Thoracic trauma induces pulmonary injury by functional as well as by structural damage. Injury at the cellular level causes changes seen 24 to 48 hours after initial trauma. Treatment should be aimed at stabilizing the patient upon initial presentation, and one should be aware of potential problems that may arise as the injury progresses. An animal with tracheobronchial tree injury is usually presented a few days after the initial injury with a client complaint of dyspnea. The only treatment is surgical repair.     

Periodontal surgery equipment

Periodontal surgery requires the operator to have specific knowledge and skills. The use of proper equipment will improve the operator's skill and will decrease surgical time. It will also result in less tissue trauma, thus increasing healing time and reducing postoperative complications and patient discomfort. Various surgical procedures can be enhanced with the usage of equipment that is designed for specific tasks of the procedure. Proper care of equipment is essential for extended instrument life.     

Acute Phase Response to Surgery of Varying Intensity in Horses: A Preliminary Study

Objective— To evaluate the postoperative inflammatory response of horses to elective surgery of varying intensity.
Study Design— Prospective longitudinal study.
Animals— Horses referred to 2 hospitals for either arthroscopic removal of a unilateral osteochondritic lesion in the tibiotarsal joint (minimal surgical trauma, n=11), correction of recurrent laryngeal neuropathy by laryngoplasty and ventriculectomy (intermediate surgical trauma, n=10) or removal of an ovarian tumor by laparotomy (major surgical trauma, n=5).
Methods— Horses had a thorough clinical examination every day. White blood cell (WBC) counts and concentrations of serum amyloid A (SAA), fibrinogen, and iron were assessed in blood samples obtained before, and 1–3, 5, 7, 9, and 11 days after surgery. Differences in levels of the inflammatory markers between the 3 surgical groups were analyzed using repeated measures ANOVA.
Results— Postoperative concentrations of SAA and fibrinogen were significantly higher in horses that had laparotomy and ovariectomy than in horses that had laryngoplasty and ventriculectomy, or arthroscopy. Iron concentrations decreased to lower levels after intermediate and major surgical trauma than after small surgical trauma. WBC count did not differ between the 3 groups.
Conclusions— Levels of SAA, fibrinogen, and iron reflected the intensity of the surgical trauma, whereas WBC count did not.
Clinical Relevance— Postoperative measurements of SAA, fibrinogen, and iron may be useful for comparing surgical trauma associated with new and established surgical techniques. Moreover, knowledge of the normal postoperative acute phase response is essential, if acute phase reactants are to be used for monitoring occurrence of postoperative infections.     

Osteosynthesis today

Modern osteosynthesis has remarkably changed the fracture treatment in small animals with its aim to re-establish full limb function. The scientific basis is elaborated and the different surgical methods are clinically proved. Veterinarians who want to perform operative fracture treatment must have sufficient training in the different techniques, the possibility to perform aseptic surgery and suitable instruments and implants. As this type of surgery means severe stress to the trauma patient, surgery cannot be done before his condition is stabilized.     

Radiographic examination and outcome in consecutive feline trauma patients.

Using univariate analysis, the correlation between signalment, history, outcome and radiographic diagnosis made on whole-body radiographs was investigated in 100 consecutive feline trauma patients of an urban clinic. The radiographic findings included: 53 thoracic injuries, 39 abdominal injuries, 34 pelvic injuries, 28 soft tissue injuries, 26 spinal injuries, and 19 cases with signs of hypovolemia. Only four radiographs were considered normal. Surgical intervention was carried out in 51 cases. Of the 100 cases, 73 survived, 23 were euthanatized, and four died. A significant positive correlation with euthanasia was found when compared to patient age (p=0.0059), abdominal trauma (P=0.0500), spinal fractures (P=0.0468), and soft tissue injuries (P=0.0175). A significant negative correlation with survival was found when compared to patient age (P=0.0358), abdominal trauma (P=0.0439), intraperitoneal free air (P=0.0041), and soft tissue injury (P=0.0288). The results of this study indicate that whole-body radiographs are useful in detecting injury in the thorax, abdomen, spine, pelvis and soft tissues, and are valuable in the diagnostic work-up of feline trauma patients.     

Pathology in Continuous Infusion Studies in Rodents and Non-Rodents and ITO (Infusion Technology Organisation)-Recommended Protocol for Tissue Sampling and Terminology for Procedure-Related Lesions

Many variables may affect the outcome of continuous infusion studies. The results largely depend on the experience of the laboratory performing these studies, the technical equipment used, the choice of blood vessels and hence the surgical technique as well the quality of pathological evaluation. The latter is of major interest due to the fact that the pathologist is not involved until necropsy in most cases, i.e. not dealing with the complicated surgical or in-life procedures of this study type. The technique of tissue sampling during necropsy and the histology processing procedures may influence the tissues presented for evaluation, hence the pathologist may be a source of misinterpretation. Therefore, ITO proposes a tissue sampling procedure and a standard nomenclature for pathological lesions for all sites and tissues in contact with the port-access and/or catheter system.