Use of skin stretchers to elongate a peninsular thoracodorsal axial pattern flap for antebrachial wound closure in a dog

Objective: To describe preoperative use of skin stretchers to elongate a peninsular thoracodorsal axial pattern flap to close a large antebrachial wound on a dog. Study Design: Case report. Animals: A 21 kg, 7‐year‐old, male intact mixed breed dog. Methods: Two skin stretchers were applied to the site of the thoracodorsal axial pattern flap 4 days before surgery. The elastic cables connecting the adhesive pads were tightened daily to increase the skin available for a peninsular thoracodorsal axial pattern flap, which was created and rotated 180° to cover an antebrachial defect to a level 2 cm proximal to the carpus. Results: The entire flap survived; there was a small amount of incisional separation at the distal margin of the flap that healed without further treatment. Conclusion: Preoperative skin stretching provided additional skin for the axial pattern flap used.     

Sequential opportunistic infections in two German Shepherd dogs

Two German Shepherd dogs with sequential opportunistic infections are described. The first was a 2-year-old male with cryptococcal rhinitis that spread to involve the optic nerves and brain. It was successfully treated with combination therapy utilising amphotericin B administered for 2 years, but the dog developed a disseminated Aspergillus deflectus infection 5 years later and was euthanased. The second case was a 4-year-old male that presented for a severe, deep-seated infection of the right antebrachium, with gradual extension to contiguous tissues. Neosartorya fischeri (anamorph; Aspergillus fischerianus) was isolated in pure culture and detected in histological sections. The infection was refractory to itraconazole, but resolved after amputation of the affected limb. Five months later, the dog developed a localised cutaneous lesion on the proximal pelvic limb, from which Pythium insidiosum was isolated and then visualised in tissue sections, together with a structure thought to be grass seed. This lesion was treated by wide surgical resection, although it was reported that the dog died of disseminated disease some months later. These cases provide further circumstantial evidence that young adult German Shepherd dogs have a predilection to developing invasive infections with fungi and other saprophytic pathogens.     

Ulnar interlocking intramedullary nail stabilization of a proximal radio-ulnar fracture in a dog

Objective: To report use of an ulnar interlocking intramedullary nail for repair of an open highly comminuted fracture of the proximal third of the antebrachium in a dog, caused by gunshot. Study Design: Case report. Animals: 1.5‐year old, 60 kg, neutered male Mastiff. Methods: An ulnar interlocking intramedullary nail was used to stabilize an open comminuted proximal antebrachial fracture and a cast applied for 4 weeks. Results: Union by secondary bone healing occurred in 8 weeks. At 16 weeks, there was advanced remodeling of the radial and ulnar bony callus and fracture lines were no longer evident. Limb use was normal with normal pain free range of motion of the right elbow. Conclusion: Ulnar interlocking nail is a viable alternative treatment for highly comminuted fracture of the proximal third of the antebrachium in dogs.     

Synovial sarcoma of the tendon and tendon sheath in a dog

A 19.5-year-old male mongrel dog developed a progressive lameness and swelling around the right carpus. A tumor (6 x 3 x 3 cm) was found in the caudal of distal antebrachium of the right forelimb, including tendons of the superficial digital flexor muscle and deep digital flexor muscle. No joint destruction was observed. The tumor consisted of round and spindle cells arranged in a compact sheet. There were occasional slit-like spaces or lumina, and areas rich in collagen fibers giving an appearance of tendon tissues. Neoplastic cells gave a positive immunoreaction to vimentin, but negative reactions to antibodies against S-100 protein, cytokeratin and myoglobin. Based on these findings, this tumor was diagnosed as a synovial sarcoma generating from the tendon and tendon sheath, which is very uncommon in dogs.     

Transfer of Free Vascular Cutaneous Flaps by Microvascular Anastomosis Results in Six Dogs

Skin defects on the distal extremities of six dogs were reconstructed with free vascular cutaneous transfers by microvascular anastomosis. The donor flaps were based on the superficial cervical artery and vein. In five of the dogs, bone was exposed and skin was lost from half of the circumference of the limb. Two had infected fractures with sequestra and three had acute shearing injuries. The sixth dog had sensory denervation of the left antebrachium and a carpal acral lick granuloma. Before surgery, the patency of potential recipient vessels was confirmed with arteriography in five dogs and an ultrasonic doppler in one dog. Microvascular technique was used to reestablish circulation to the flaps after they were transferred to the recipient site. Total ischemic time of the flaps averaged 100 minutes. All flaps survived. Successful reconstruction of the cutaneous defects was achieved in these six cases.     

Cutaneous and gastrointestinal pythiosis in a dog in Brazil

The oomycete Pythium insidiosum is the pathogenic cause of pythiosis, a life-threatening disease that affects several animal species. Canines are the second most affected species, and the disease is characterized by the development of cutaneous and gastrointestinal lesions. While concomitant cutaneous and gastrointestinal lesions are rarely found in the same animal, this report documents a case of concurrent cutaneous and gastrointestinal pythiosis in an 18-month-old female Labrador. This dog had an ulcerative cutaneous lesion on the right thoracic region for 12 months that was unresponsive to itraconazole and terbinafine therapy. Two months prior to death and concurrent with the cutaneous lesion, the dog became anorexic with frequent vomiting and bloody stools. At necropsy, a cutaneous lesion that extended subcutaneously into the intercostal muscles was observed. Additionally, the large intestine contained two lesions that caused luminal narrowing. Organs were collected, routinely processed and stained using hematoxylin and eosin and Gomori methenamine silver. Histological examination of the lesions in the large intestine and on the skin revealed areas of necrosis surrounded by a pyogranulomatous infiltrate. Occasionally, black, septate, branching hyphae were detected following staining with Gomori methenamine silver. The diagnosis of pythiosis was confirmed using immunohistochemical methods. This report describes the occurrence of concomitant gastrointestinal and cutaneous lesions in a dog and highlights the therapeutic difficulties encountered with this disease.     

The Isolated Perfused Equine Skin Flap Preparation and Metabolic Parameters

A model for the study of equine cutaneous physiology, pharmacology, and toxicology was developed. Four 4 x 12 cm and twenty-one 6 x 12 cm single-pedicle axial pattern skin flaps based on the caudal superficial epigastric artery, and eight 6 x 12 cm flaps based on the saphenous artery and medial saphenous vein, were raised and sutured in a tubed configuration. On day 2, each flap was removed, the artery was cannulated, and the flap was perfused with a modified Krebs-Ringer's albumin-based medium for at least 6 hours. Flap viability was assessed by glucose use, lactate production, and histologic examination at the end of the perfusion period. The 4 x 12 cm flaps had evidence of skin necrosis, but the 6 x 12 cm flaps remained histologically viable. Results were compared to those previously reported from perfusion of porcine skin flaps based on the caudal superficial epigastric artery. While the ratios of glucose use to lactate production were similar, equine flaps used less glucose and produced less lactate per gram of tissue than similar pig flaps. Equine skin flaps perfused by saphenous vessels used more glucose and produced more lactate than flaps perfused by caudal superficial epigastric vessels. These results indicate that conclusions drawn from cutaneous physiology studies should not be extrapolated across species lines and that site-specific skin should be used for cutaneous physiology, pharmacology, and toxicology studies. The identified skin flaps may have applications in equine reconstructive surgery.     

Use of radiographic measures and three-dimensional computed tomographic imaging in surgical correction of an antebrachial deformity in a dog

CASE DESCRIPTION: A 1-year-old 7.4-kg (16.3-lb) castrated male mixed-breed dog was evaluated because of intermittent lameness and an antebrachial angular limb deformity. CLINICAL FINDINGS: The left forelimb had gross antebrachial external rotation (approx 90 degrees ) and marked procurvatum. Radiography revealed a severe partially compensated biapical antebrachial angular limb deformity. Measurements of medial proximal radial angle (MPRA) and lateral distal radial angle (LDRA) were obtained from orthogonal radiographs of the proximal and distal segments of the radius, respectively. Elbow joint-to-carpus translation was quantified. Deformities were localized and quantified by the center of rotation of angulation (CORA) method. Computed tomographic 3-dimensional image reconstructions of the antebrachium and carpus were completed to create 3 life-size stereolithographic models. TREATMENT AND OUTCOME: 2 closing wedge radial osteotomies were performed at the level of the CORAs and stabilized with bone plates and screws. RESULTS: Frontal and sagittal plane alignments were corrected to 8 degrees and 15 degrees , respectively (reference limits, 0 degrees to 8 degrees and 8 degrees to 35 degrees , respectively). The MPRA was corrected from 55 degrees to 68 degrees , and LDRA was corrected from 32 degrees to 76 degrees (values considered normal are approx 85 degrees and 87 degrees , respectively). Elbow joint-to-carpus translation was improved by 42.5%. After 8 weeks, radiography revealed bone union. Owners considered the outcome acceptable, on the basis of limb appearance and lack of lameness at 1 year after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: A segmental radiographic planning technique combined with the CORA method, computed tomography, and stereolithography may be useful in the characterization of and planning corrective surgery for forelimb deformities in dogs.     

Sow shoulder lesions: risk factors and treatment effects on an Ontario farm

The objectives of this study were to identify risk factors for the development of shoulder lesions in lactating sows and to determine if an effective, economical, and practical treatment could be designed. The study was conducted at a 300-sow farrow-to-finish swine farm in Ontario between July and December 2004. Sow data were recorded on either the day of or 1 d after entering the farrowing crate and before farrowing had occurred. The right and left shoulders of the sows were assigned a score between 0 (normal) and 4 (lesion > 2.3 cm in diam.) on d 1 of the study and weekly thereafter throughout lactation. If a lesion developed, sows were randomly placed into 1 of 3 treatment groups. Groups consisted of a control group that received no treatment, a group that had a 0.2-cm thick, 60 x 60-cm, stainless steel plate attached to the bottom of the farrowing crate, and a group that had a 3.8-cm thick, 60 x 60-cm rubber mat attached to the bottom of the farrowing crate. Of the 310 sows involved in the study, 107 (34%) developed a lesion with a score of 3 or 4. Multivariate regression analysis identified body condition at weaning, flank-to-flank measurements at weaning, breed, parity, farrowing room section, and weaning weight of the litter as significantly associated with development of a shoulder lesion of score 3 or 4. The average number of days for the lesions to be completely resolved was 25 for sows receiving rubber mats, 32 for the controls, and 39 for the sows receiving stainless steel plates. Rubber mats attached to the bottom of the farrowing crates decreased the time required to heal the lesions when compared with controls. The low cost per mat (less than 0.90 dollars factoring in repeated use) makes it an economical and effective treatment.     

Supraspinatus tendinosis associated with biceps brachii tendon displacement in a dog

A 4-year-old spayed female Australian Cattle Dog (Blue Heeler) was evaluated because of right forelimb lameness of 5 months' duration. Orthopedic evaluation revealed signs of pain localized to the cranial aspects of both shoulder joints. Via magnetic resonance imaging, the mass of the supraspinatus tendon insertion in both shoulder joints was increased, compared with findings in cadavers of clinically normal dogs; additional imaging procedures revealed that, compared with clinically normal tendons, the tendon had increased signal intensity that was consistent with increased fluid content. The increased supraspinatus tendon mass in each shoulder joint was associated with medial displacement of the biceps brachii tendon, which was more severe in the right limb. Arthroscopic evaluations of both shoulder joints revealed no abnormalities. The dog underwent surgery, and the abnormal parts of the tendons were resected. The most prominent finding on histologic examination of excised tissues was severe myxomatous degeneration. The lameness resolved, and at 22 months after surgery, the dog was reported to have had no recurrence of lameness. The clinical signs and histologic appearance of the tendons in this dog strongly resemble findings associated with tendinosis in humans. Decompression of the biceps brachii tendon may have contributed to the successful outcome after surgery in this dog. Supraspinatus tendinosis should be considered among the differential diagnoses in dogs with uni- or bilateral forelimb lameness.     

Hinged Ilizarov External Fixation for Correction of Antebrachial Deformities

Objective —To evaluate hinged circular external fixation for correction of antebrachial deformities in dogs.
Study Design —Uncontrolled clinical trial.
Animal Population —Seven client-owned dogs.
Methods —Six dogs had one radius corrected and one dog had both radii corrected. Preoperative planning included measurement of the craniocaudal and mediolateral angular deformities, rotational deformity, length deficit, origin of deformity, graphical or mathematical determination of the amplitude and direction of the actual limb deformity, and frame assembly.
Results —Preoperatively, function and cosmesis were assessed to be fair to poor in all dogs. Deformity correction started 48 to 60 hours postoperatively and ranged from 0.46 mm to 1.36 mm twice daily. Hospitalization time ranged from 4 to 6 days. Corrections were mostly made by the owners, at home. Lengthening and angular correction ranged from 3 to 38 mm and 18° to 48°. Mean residual deformities were 2.7% of radial length and 2.7°. The time duration with the circular external fixators in place ranged from 29 to 71 days. Two additional surgeries were necessary in one dog because of wire breakage. Mean follow-up was 40 months. Long-term function and cosmesis were good to excellent in all dogs.
Conclusion—Although complications were present in six of seven dogs, the outcome of hinged Ilizarov external fixation was successful in all dogs treated for deformities of the antebrachium.
Clinical Relevance —Despite complex preoperative planning, the placement of hinged circular external fixators is straightforward, and allows precise correction of complex antebrachial deformities with minimal tissue trauma.     

Anatomical variations in the cephalic and omobrachial veins in the dog

In the dog, the blood from the antebrachial part of the cephalic vein is typically drained by three vessels: the axillobrachial, the omobrachial and the proximal segment of the cephalic vein. In this work, two anatomical variations affecting the omobrachial and the proximal part of the cephalic vein in dogs are reported. The bilateral absence of the omobrachial vein was observed in two adult mongrel dogs and the lack of the proximal segment of the cephalic vein in one dog. These differences suggest that a certain degree of variation is normal in the layout of the superficial veins of the thoracic limb in the dog and implies that the blood egress from the cephalic vein in the dog, as in other species, is sometimes accomplished by only two veins.     

Idiopathic telangiectasia in a Golden Retriever

A case report of a 12-year-old spayed female Golden Retriever with a 4-month history of persistent diffuse erythema involving the right and left antebrachia is presented. Cutaneous biopsies revealed superficial dermal vascular dilation and proliferation with moderate epidermal acanthosis. Diagnostic tests failed to reveal an underlying aetiology. Telangiectasia is defined as a permanent dilation of pre-existing blood vessels creating small focal lesions. Generalized essential telangiectasia of humans is common in women of middle-age and can involve entire segments of the body. Lesions predominantly affect the extremities and can persist for years without any systemic effects. The cutaneous lesions in this case have remained static for 3 years with no manifestation of systemic signs. A diagnosis of idiopathic telangiectasia was made based on the clinical and histological findings in the dog of this report. The lesions described in this dog resemble generalized essential telangiectasia of humans.     

Immunotherapy for treatment of multicentric cutaneous pythiosis in a dog

A 4-year-old Labrador Retriever was referred for evaluation of 2 ulcerative nodular cutaneous lesions. One lesion was located on the medial aspect of the right carpus; the other was located on the medial aspect of the left tarsus. The dog had spent its entire life in the southeastern part of the United States and approximately half of its time outdoors with free access to a nearby lake. Histologic examination of full-thickness wedge biopsy specimens from both lesions revealed severe, multifocal, puruloeosinophilic to pyogranulomatous deep dermatitis with intralesional filamentous structures, fibroplasia, and neovascularization. Examination of sections stained with Gomori methenamine silver stain revealed a moderate number of wide, bulbous, irregularly septate, branching hyphae. Results of an immunodiffusion test and an ELISA for anti-Pythium insidiosum antibodies were positive. Amputation was eliminated as a treatment option because lesions involved 2 limbs. Long-term systemic antifungal treatment was also rejected because of the cost, lack of therapeutic effect in many cases, and potential for adverse effects. The dog was treated with 2 doses of an anti-P insidiosum vaccine administered 2 weeks apart. One month later, the lesions were nearly completely healed, and values obtained via the immunodiffusion test and ELISA had decreased. Results of the immunodiffusion test and ELISA were negative 1 year later, and the dog had not had any recurrences.     

Panniculitis associated with pancreatitis in a cocker spaniel

A 13-year-old, male cocker spaniel presented with a history of inappetence, depression and reluctance to stand. The dog had multiple, ulcerated skin lesions which were diagnosed as panniculitis by histopathology. A diagnosis of pancreatitis was made on the basis of markedly elevated serum lipase concentrations, abdominal ultrasonography which showed an abnormal lobulated area of hypoechoic tissue in the body and right lobe of the pancreas, and a fine needle biopsy from this area which revealed large numbers of degenerate neutrophils. After treatment with antibiotics and prednisolone, the dog made a full clinical recovery and was free of clinical signs for four months. The dog was euthanased five months later and postmortem examination revealed chronic, active pancreatitis and a pancreatic adenoma. This is the first report of antemortem diagnosis of pancreatitis and panniculitis in a dog.     

EXTRA-ABDOMINAL CHONDROLIPOMA IN A DOG

A 10-year-old male maltise dog was presented for evaluation of a gradual abdominal enlargement, which had developed over 2 years. (On the radiograph of the abdomen, a significant distention of the abdomen with a large accumulation of fat could be seen.) The mass effect was noticeable because of the rightward displacement of the viscera. There was multifocal amorphous mineralization, mostly in the right abdomen. Computed tomography (CT) identified a 13 x 13 x 10 cm mass, most likely an intra-abdominal lipoma, by which the digestive tract had been displaced in the abdomen. It was only during surgery, however, that the mass was found to be located between the peritoneum and transversus abdominis muscles and the rectus abdominus muscle. It was completely resected. Histopathological examination revealed that the mass was chondrolipoma. The amorphous radiopaque lesion on the images corresponded to cartilaginous tissues with calcification. There has been no recurrence for 10 months. This is the first report of an extra-abdominal chondrolipoma in dogs. Cartilaginous metaplasia of lipoma, located in the abdominal area, should be included in the differential diagnosis for multifocal amorphous mineralization.     

EFFECT OF DEPENDENCY VERSUS NONDEPENDENCY ON LUNG LESION VISUALIZATION

Paraffin blocks and mineral oil were used as a model to determine the effect of dependency versus nondependency on radiographic visualization of lung lesions in lateral thoracic radiographs. It was concluded that the increased opacity of the material surrounding the lesion, not contact between the heart and the lesion, was responsible for the inability to detect lung disease in the dependent lung. The results were tested in dogs with pneumonia in the right middle lung lobe. When the dog was in right lateral recumbency, the dependent right lung was increased in opacity and decreased in volume and the pulmonary lesion was difficult to detect. When the dog was in left lateral recumbency, the nondependent right lung was increased in volume and decreased in opacity and the pulmonary disease was clearly visible. A single recumbent lateral radiograph must not be used to assess a dog with suspected lung disease because lesions in the dependent lung lobes may not be detected.     

Premature closure of the proximal physis of the humerus in a dog as a result of harvesting a cancellous bone graft

A 5-month-old castrated male mixed-breed dog was evaluated because of lameness of the right forelimb. Physical examination revealed pain on manipulation of the right elbow joint, and radiography revealed premature closure of the distal physis of the radius with subluxation of the right elbow joint. Corrective osteotomy of the radius was performed to increase the length of the radius and establish congruity of the elbow joint. Cancellous bone was obtained from the proximal portion of the humerus and used as a graft at the osteotomy site. The dog did well after surgery. Four months after surgery, the dog again was lame on the right forelimb. Physical examination revealed instability of the right shoulder, and manipulation of that area elicited signs of pain. Radiography revealed caudomedial subluxation of the right shoulder as well as deformity of the humeral head and hypoplasia of the greater tubercle. It was presumed that these changes were associated with collection of the cancellous bone graft during the initial surgery, which resulted in premature closure of the proximal physis of the humerus. To our knowledge, this is the first report of premature closure of the proximal physis of the humerus as a result of procurement of a bone graft.     

Hematogenous metastasis of embryonal rhabdomyosarcoma originating from skeletal muscle in a young dog.

An 8-month-old, intact male Golden Retriever with a history of left forelimb lameness for 2 months was presented to the Veterinary Medical Teaching Hospital of Konkuk University (Seoul, Korea). Results of a physical examination revealed a mass in the left axillary region. A thoracic radiography showed an osteolytic lesion in the scapula and the presence of a soft tissue density from the thoracic wall to the scapula. A computerized tomography revealed a mass invading into the scapula, and small nodules in the lung that suggested metastasis. At necropsy, a pale-yellow, irregular, firm, 8 x 10 x 5 cm mass extended from axillary region and destroyed the scapular. In addition, small nodules were noted in the lung. On microscopic examination, the mass consisted of round-to-oval cells, with eccentrically located hyperchromatic nuclei and eosinophilic cytoplasm in fibromyxoid stroma. Tumor cells were observed in blood vessels in the primary mass. Tumor cells strongly expressed vimentin, desmin, and myoglobin. In phosphotungstic acid-hematoxylin staining, cross-striations were detected in rhabdomyoblasts. In periodic acid-Schiff reaction, only a few cells were detected. The diagnosis was primary rhabdomyosarcoma of the appendicular muscle of a young dog. The tumor presumably originated in the skeletal muscle of the limb, invaded into the adjacent scapular bone, and metastasized to the lung.     

Resolution of skin lesions and long-term survival in a dog with superficial necrolytic dermatitis and liver cirrhosis

A nine-year-old, neutered female Shetland sheepdog was presented with crusted, ulcerative skin lesions affecting the footpads, commissures of the lips and the lateral canthi of the eyes. Histopathological examination of skin biopsies revealed changes consistent with superficial necrolytic dermatitis and biochemical analysis demonstrated elevated liver enzymes. Abdominal radiography revealed a small liver which, on ultrasonography, appeared diffusely mottled and showed changes suggestive of periportal fibrosis. On exploratory laparotomy, the pancreas appeared normal, but the liver was small and had multiple nodules throughout the parenchyma. This appearance was confirmed as cirrhosis on histopathological examination. The dog was placed on a hepatic support diet and treated with colchicine, essential fatty acid supplementation and raw egg yolks. After four weeks, the skin lesions had resolved and the dog remained free of clinical signs over a 22-month follow-up period.