Evaluation of a stented laryngoplasty for correction of cranial glottic stenosis in four dogs

After laryngeal surgery, cranial glottic stenosis secondary to laryngeal web formation was diagnosed as the cause of upper airway obstruction in 4 dogs. Initial treatment of 3 dogs by peroral laryngeal web excision resulted in rapid recurrence of clinical signs. Subsequently, these 3 and the fourth dog were treated by scar excision, mucosal flap coverage, and placement of a silicone intraluminal laryngeal stent for 14 days. By 5 months (average) after surgery, on the basis of clinical evaluation of exercise intolerance, respiratory distress, and stridor, all dogs had alleviation of upper airway obstruction.     

Bilateral thyroarytenoid cartilage lateralization and vocal fold excision with mucosoplasty for treatment of idiopathic laryngeal paralysis: 67 dogs (1998-2005)

Objective— To evaluate combined bilateral thyroarytenoid cartilage lateralization, vocal fold excision, and mucosoplasty technique (BTAL) through ventral median laryngotomy for treatment of laryngeal paralysis in dogs.
Design— Retrospective study.
Animals— Dogs (n=67) with laryngeal paralysis.
Methods— Medical records were reviewed for dogs with idiopathic laryngeal paralysis that had BTAL between January 1998 and March 2005. Retrieved data included signalment, history, physical and laryngoscopic examination findings, clinicopathologic tests, and results of recheck examination findings.
Results— BTAL was performed by a single surgeon. Short-term (<6 months) follow-up information was available for 67 dogs and long-term (>12 months) for 40 dogs. Major postoperative complications were surgical failures (13; 7 short term, 6 long term) and aspiration pneumonia (1). Mean recurrence of clinical signs was at 19 weeks (range, 2–30 weeks). Minor complications occurred in 22 (33%) dogs including occasional coughing or gagging, stridorous breathing during exercise, panting, noisy or heavy breathing, and aspiration pneumonia (3 dogs) that did not require hospitalization. All owners reported an improved quality of life and had no regrets with surgical outcome.
Conclusions— BTAL is seemingly an effective procedure for treatment of laryngeal paralysis.
Clinical Relevance— BTAL is associated with a low incidence of aspiration pneumonia; however, there is substantial risk of recurrence of clinical signs associated with narrowing of the glottis. Consequently, unilateral arytenoid lateralization currently represents the accepted approach to the treatment of laryngeal paralysis.     

A Mucosal Flap Technique for Correction of Laryngeal Webbing Results in Four Dogs

Postoperative laryngeal webbing in four dogs was corrected with a mucosal flap technique using mucosa harvested from the lateral wall of the laryngeal ventricle. Airway obstruction caused by the webbing was relieved in all dogs. Follow-up time was 3 months to 5 years. The technique allowed mucosal apposition without undue tension on the suture line.     

Surgical management of left-divisional intrahepatic portosystemic shunts: outcome after partial ligation of, or ameroid ring constrictor placement on, the left hepatic vein in twenty-eight dogs (1995-2005)

OBJECTIVES: To evaluate outcome in dogs with left divisional intrahepatic portosystemic shunts (PSS) treated by partial ligation (PL) or ameroid ring constrictor (ARC) placement on the left hepatic vein. DESIGN: Retrospective study. ANIMALS: Dogs (n=28) with left divisional intrahepatic PSS. METHODS: Retrieved data from medical records of dogs with left divisional intrahepatic PSS that had PL (n=17) or ARC (n=11) were signalment, history, clinical signs, preoperative blood work, portal pressure measurements, ARC size, complications and postoperative technetium scintigraphy. Outcome assessed by owner interview 6 months-10 years after surgery was classified as excellent, good or poor. Differences were tested by exact chi2 test. RESULTS: Major complications occurred in 3 dogs: coagulopathy (1 PL dog died), ascites (1 PL dog survived) and seizures (1 ARC dog died). Eight PL dogs had technetium portal scintigraphy; 1 dog was negative and 7 dogs positive for persistent shunting. Seven ARC dogs had scintigraphy; 4 dogs were negative and 3 positive for persistent shunting. In PL dogs, long-term clinical outcome was excellent (92%) or good (8%) whereas, in ARC dogs it was excellent (20%), good (50%) or poor (30%). This outcome difference between treatment groups was significant (P=.0012). CONCLUSION: Dogs treated by PL had significantly better long-term outcome compared with ARC treated dogs. CLINICAL RELEVANCE: Based on these data, ARC placement on the left hepatic vein in dogs with left-divisional intrahepatic PSS cannot be recommended.     

Treatment of chronic pleural effusion with pleuroperitoneal shunts in dogs: 14 cases (1985-1999).

OBJECTIVE: To describe complications and outcome associated with chronic nonseptic pleural effusion treated with pleuroperitoneal shunts in dogs. DESIGN: Retrospective study. ANIMALS: 14 dogs. PROCEDURE: Medical records at 4 veterinary schools were examined to identify dogs with chronic nonseptic pleural effusion that were treated by use of a pleuroperitoneal shunt between 1985 and 1999. Signalment, history, physical examination and laboratory findings, cause and type of pleural effusion, medical and surgical treatments, complications, and outcome were reviewed. RESULTS: 10 of 14 dogs had idiopathic chylothorax, and 4 had an identified disease. All but 1 dog with idiopathic chylothorax and 1 dog with chylothorax from a heart base tumor had unsuccessful thoracic duct ligation prior to pump placement. No intraoperative complications developed during shunt placement. Short-term complications developed in 7 of 13 dogs, necessitating shunt removal in 2 dogs and euthanasia in 1. Eight of 11 dogs with long-term follow-up developed complications; the overall mean survival time and the interval in which dogs remained free of clinical signs of pleural effusion were 27 months (range, 1 to 108 months) and 20 months (range, 0.5 to 108 months), respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Pleuroperitoneal shunts can effectively palliate clinical signs associated with intractable pleural effusion in dogs. Numerous short- and long-term complications related to the shunt should be expected. Most complications can be successfully managed, but even when shunts are functional some treatments fail because of severe abdominal distension or massive pleural fluid production that overwhelms the functional capacity of the shunt.     

Evaluation of ameroid ring constrictors for treatment for single extrahepatic portosystemic shunts in dogs: 168 cases (1995-2001)

OBJECTIVES: To evaluate use of an ameroid ring constrictor (ARC) for treatment for single extrahepatic portosystemic shunts (PSSs) and identify factors associated with postoperative death, continued portosystemic shunting, and long-term outcome in dogs. DESIGN: Retrospective study. ANIMALS: 168 dogs with a single extrahepatic PSS. PROCEDURE: Medical records of dogs that had a single extrahepatic PSS and were treated with an ARC were reviewed. Signalment, history, clinical signs, results of preoperative blood analyses and portal pressure measurements, PSS location, ARC size, postoperative complications, and postoperative scintigraphy results were recorded. Owners were interviewed 6 months to 6 years after surgery. Results-Postoperative complications developed in 10% of dogs. Postoperative mortality rate was 7.1%. Predictive factors for postoperative death included high preoperative WBC count and postoperative complications. Twenty-one percent of dogs in which portal scintigraphy was performed 6 to 10 weeks after surgery had continued shunting. Predictive factors for persistent shunting included low preoperative plasma albumin concentration, high portal pressure after complete occlusion, and high portal pressure difference (postocclusion minus baseline). Clinical outcome in 108 dogs was classified as excellent (80%), good (14%), or poor (6%). Predictive factors for excellent long-term clinical outcome included high preoperative plasma albumin concentration, low preoperative leukocytosis, low portal pressure after complete occlusion, absence of postoperative seizures, and absence of continued shunting. CONCLUSIONS AND CLINICAL RELEVANCE: Use of an ARC for treatment for a single extrahepatic PSS resulted in low morbidity and mortality rates. Certain preoperative factors were associated with increased risk of postoperative death, continued portosystemic shunting, and long-term outcome.     

Tolerance of cutaneous or mucosal flaps placed into a radiation therapy field in dogs

OBJECTIVE: To determine the clinical outcome and factors affecting cutaneous or mucosal flaps in dogs treated with radiation therapy (RT). STUDY DESIGN: Longitudinal clinical study. ANIMALS: Twenty-six client-owned dogs. METHODS: Dogs entered in the study had a flapping procedure and RT as part of their treatment. The sequence of flapping and RT included: (1) planned preoperative RT, (2) postoperative RT, and (3) flapping as a salvage procedure for management of complications or local tumor recurrence after RT. Flap complications were defined as necrosis, local infection, dehiscence, and ulceration. The risk and severity of flap complication were analyzed independently. RESULTS: Twenty (77%) dogs had a complication; 6 dogs required an additional flapping procedure; and 4 dogs had an unresolved complication. Flapping procedures performed to correct a complication, or failure of RT, had a significantly greater risk for complication; however, postoperative RT decreased the severity of complication. A dose per fraction of 4 Gy compared with 3 Gy was prognostic for increased severity of complications, whereas the head and neck location was prognostic for decreased severity of complication. CONCLUSIONS: Although morbidity was substantial, cutaneous or mucosal flaps were used successfully in an RT field in 85% of the dogs. Flaps that were part of the planned therapy as opposed to those used to correct a complication or failure of RT had a better clinical outcome. CLINICAL RELEVANCE: Cutaneous or mucosal flaps can be part of the treatment of dogs with tumor when adjuvant or neoadjuvant RT is to be used.     

Surgical management of intrathoracic tracheal avulsion in cats: long-term results in 9 consecutive cases

OBJECTIVE: To evaluate the outcomes and complications in a consecutive series of cats undergoing surgical repair of intrathoracic tracheal avulsion injuries. STUDY DESIGN: Retrospective clinical study. ANIMALS: Nine client-owned cats. METHODS: The medical records of all cats undergoing surgical repair of intrathoracic tracheal avulsion injuries from 1994 to 1997 were reviewed. The results of physical examination, laboratory evaluations, radiography, tracheoscopy, surgery, and patient follow-up were reviewed. Complications that arose and long-term outcome were noted. RESULTS: Long-term resolution of clinical signs was achieved in all cats after resection of the damaged trachea and its repair by end-to-end anastomosis. Follow-up periods ranged from 12 months to 2.9 years. One cat developed unilateral left-sided laryngeal paralysis 2 to 3 months after surgery; however, this was transient and resolved without intervention within 6 months of surgery. CONCLUSIONS: Surgical management of intrathoracic tracheal avulsion injuries in cats can be accomplished via a right lateral thoracotomy. Careful anesthetic technique is an integral part of the surgical procedure if a successful outcome is to be achieved. The incidence of both short-term and long-term complications was low. Care should be exercised to visualize and protect the left recurrent laryngeal nerve if postoperative iatrogenic unilateral left-sided laryngeal paralysis is to be prevented. CLINICAL RELEVANCE: This retrospective study documents the successful surgical correction of a series of clinical cases of intrathoracic tracheal avulsion in cats.     

Evaluation of a modified castellated laryngofissure for alleviation of upper airway obstruction in dogs with laryngeal paralysis

A modified castellated laryngofissure procedure (castellated laryngofissure, vocal fold resection, and bilateral arytenoid lateralization) was performed on 12 dogs with bilateral laryngeal paralysis. Clinical signs of airway obstruction were assessed and a pulmonary function test (tidal breathing flow volume loop) was used to evaluate the severity of obstruction. The dogs were evaluated before surgery and at various periods from 4 days to 15 months after surgery. One dog died immediately after surgery and 3 dogs died due to nonrelated or unknown causes 1, 9, and 11 months after surgery. Clinical signs of upper airway obstruction disappeared or decreased in severity in the 11 dogs that recovered from surgery. Tidal breathing flow volume loop values were normal in 7 of 10 dogs evaluated within 5 to 189 days after surgery. The modified castellated laryngofissure procedure provided successful long-term relief of upper airway obstruction associated with bilateral laryngeal paralysis.     

Results of pacemaker implantation in 104 dogs

OBJECTIVES: To document the outcome, survival and complications involved in pacemaker implantation in dogs in a retrospective study. METHODS: Case records for all dogs in which pacemaker implantation was performed were reviewed. RESULTS: A total of 104 dogs underwent pacemaker implantation. Dogs were presented with atrioventricular (AV) block (71), sick sinus syndrome (25) or vasovagal syncope (eight). Age at presentation varied from six months to 13 years with a median age of seven years and two months. The Labrador was the most commonly represented breed (17 cases). All but one dog survived pacemaker implantation, with 93 showing resolution of their clinical signs while 10 dogs showed intermittent residual signs. One-, three- and five-year survival estimates were 86, 65 and 39 per cent, respectively. Major complications after implantation were documented in 15 dogs and three of these led to fatalities. Minor complications were noted in 23 dogs. Sudden death occurred in six dogs three to 55 months following successful pacemaker implantation. CLINICAL SIGNIFICANCE: Transvenous pacemaker implantation was successful in reducing or eliminating clinical signs in over 90 per cent of dogs with third-degree atrioventricular (AV) block or sick sinus syndrome. In dogs with vasovagal syncope, six of eight dogs had greatly reduced frequency of collapse and two became asymptomatic. Although the procedure was associated with complications, these were rarely life threatening and good survival was documented in the majority of cases.     

Laryngeal collapse in seven brachycephalic puppies

OBJECTIVES: To document the histories, clinical findings, and management of seven puppies with laryngeal collapse occurring secondarily to brachycephalic airway syndrome. METHODS: Seven brachycephalic puppies aged between 4.5 and six months underwent surgery for management of brachycephalic airway syndrome following presentation for exercise intolerance and increased respiratory noise and effort. RESULTS: Stenotic nares of varying severity and an elongated soft palate were common to all dogs. All dogs had tracheal hypoplasia and this was severe in four dogs. Laryngeal collapse was present in all dogs. Two dogs had stage I, four dogs stage II, and one dog stage III laryngeal collapse. The dog with stage III laryngeal collapse and one dog with stage II laryngeal collapse died. There was no apparent association between the changes evident on thoracic radiographs or the degree of tracheal hypoplasia and postoperative outcome. CLINICAL SIGNIFICANCE: The development of severe secondary laryngeal changes in dogs aged six months or less supports the suggestion that immature brachycephalic dogs should undergo assessment and, if indicated, surgery as soon as any clinical signs of BAS are apparent.     

Surgical treatment of lumbosacral foraminal stenosis using a lateral approach in twenty dogs with degenerative lumbosacral stenosis

Objectives— To describe clinical signs, magnetic resonance imaging (MRI) and surgical findings using a lateral approach to the lumbosacral intervertebral foramen and to evaluate clinical outcomes in dogs with or without concurrent dorsal decompression and annulectomy.
Study Design— Retrospective study.
Animals— Dogs (n=20) with degenerative lumbosacral stenosis (DLSS).
Methods— Medical records (2002–2006) of dogs that had lumbosacral lateral foraminotomy alone or in combination with dorsal decompression were reviewed. Degree of dysfunction was assessed separately for each pelvic limb; dogs with unilateral signs were included in group A, those with bilateral signs in group B. Retrieved data were: signalment, history, neurologic status on admission, 3 days, 6 weeks, and 6 months postoperatively, duration of clinical signs, results of MRI, surgical site(s), intraoperative findings, and outcome.
Results— Based on the clinical and MRI findings unilateral foraminotomy was performed in 8 dogs, bilateral foraminotomy in 1 dog, unilateral foraminotomy with concurrent dorsal decompression in 7 dogs, and bilateral foraminotomy with concomitant dorsal decompression in 4 dogs. Surgery confirmed the presence of foraminal stenosis in all dogs, with osteophyte formation and soft tissue proliferations being the most common lesions. Outcome was good to excellent in 19 dogs and poor in 1 dog. Mean follow-up was 15.2 months (range, 6–42 months).
Conclusion— Lateral foraminotomy addresses compressive lesions within exit and middle zones of the lumbosacral foramen.
Clinical Relevance— Successful surgical management of DLSS is dependent on recognition and correction of each of the compressive lesions within the lumbosacral junction.     

Surgical correction of brachycephalic syndrome in dogs: 62 cases (1991-2004)

OBJECTIVE: To assess results of surgical correction of brachycephalic syndrome (including stenotic nares, elongated soft palate, and everted laryngeal saccules) in dogs and determine whether dogs with hypoplastic trachea have a less favorable long-term outcome. DESIGN: Retrospective case series. ANIMALS: 62 dogs with brachycephalic syndrome. PROCEDURES: Medical records from 1991 to 2004 were reviewed for information regarding signalment, clinical signs, diagnosis, surgery, and long-term outcome. Surgical outcome was rated by owners as excellent, good, fair, or poor. Common abnormalities, treatments, and long-term outcomes among the 62 dogs were assessed. RESULTS: Predominantly affected breeds included English Bulldog, Pug, and Boston Terrier. Elongated soft palate was the most common abnormality (54/62 [87.1%] dogs); the most common combination of abnormalities was elongated soft palate, stenotic nares, and everted saccules (16/62 [25.8%] dogs). The English Bulldog was the most common breed for all abnormalities, including elongated soft palate (27/54 [50%] dogs), stenotic nares (14/36 [38.9%] dogs), everted saccules (20/36 [55.6%] dogs), hypoplastic trachea (7/13 [53.9%] dogs), and laryngeal collapse (2/5 [40%]). No dogs had everted saccules alone. Outcome did not differ between dogs under-going staphylectomy by use of laser or scissor resection. Follow-up information was obtained for 34 dogs; 16 (47.1%) had an excellent outcome, and 16 (47.1%) had a good outcome. Overall treatment success rate was 94.2%, and overall mortality rate was 3.2%. CONCLUSIONS AND CLINICAL RELEVANCE: Surgical treatment of brachycephalic syndrome in dogs appeared to be associated with a favorable long-term outcome, regardless of age, breed, specific diagnoses, or number and combinations of diagnoses.     

Outcome of and complications associated with prophylactic percutaneous laser disk ablation in dogs with thoracolumbar disk disease: 277 cases (1992-2001)

OBJECTIVE: To determine outcome of and complications associated with prophylactic percutaneous laser disk ablation in dogs with thoracolumbar disk disease. DESIGN: Retrospective study. ANIMALS: 277 dogs. PROCEDURE: Medical records of dogs with a history of thoracolumbar disk disease in which the 7 intervertebral disks from T10-11 through L3-4 were ablated with a holmium-yttrium-aluminum-garnet laser inserted through percutaneously placed needles were reviewed. Complications and episodes of a recurrence of neurologic signs (eg, paresis or paralysis) were recorded. Owners were contacted by telephone for follow-up information. RESULTS: Nine of 262 (3.4%) dogs for which follow-up information was available had a recurrence of paresis or paralysis. Follow-up time ranged from 1 to 85 months (mean, 15 months); signs recurred between 3 and 52 months (mean, 15.1 months) after laser disk ablation. Acute complications occurred in 5 dogs and included mild pneumothorax in 1 dog, an abscess at a needle insertion site in 1 dog, and proprioceptive deficits in 3 dogs, 1 of which required hemilaminectomy within 1 week because of progression and severity of neurologic signs. One dog developed diskospondylitis. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that prophylactic percutaneous laser disk ablation is associated with few complications and may reduce the risk of recurrence of signs of intervertebral disk disease in dogs.     

Complications and Long-term Results after Partial Laryngectomy for the Treatment of Idiopathic Laryngeal Paralysis in 45 Dogs

Forty-five dogs with severe respiratory signs caused by idiopathic, acquired laryngeal paralysis were treated by partial laryngectomy. The predominant postoperative complications were coughing in 28 dogs and pneumonia in 15 dogs. Eight dogs required a second operation to alleviate persistent or recurrent upper airway obstruction. Results of surgery were considered excellent in 11 dogs (25%), good in 18 dogs (40%), fair in 6 dogs (13%), and poor in 10 dogs (22%). Poorer results were obtained by surgical residents than by more experienced surgeons. Death in the immediate postoperative period was related to pneumonia (8 dogs) and laryngeal collapse (1 dog). Nine dogs died later of respiratory disease. Although partial laryngectomy is effective for the treatment of laryngeal paralysis, it is not recommended because of the high incidence of postoperative complications.     

Retained surgical swabs in 13 dogs

To report the signalment, history, clinical signs, diagnostic and surgical findings and outcome in dogs and cats with retained swabs, medical records of dogs and cats that were referred to four referral centres were reviewed. Cases in which a retained surgical swab was identified during surgery at the referral hospital were selected for further study. The signalment, history, clinical signs, diagnostic and surgical findings and outcome in these cases were reviewed. Thirteen dogs with retained surgical swabs were included in the study. Bodyweight ranged from 9 to 45 kg. The initial surgery was a 'non-routine' abdominal procedure in seven dogs, ovariohysterectomy in five dogs and perineal hernia repair in one dog. Time from initial surgery to presentation at the referral centre ranged from four days to seven years. Treatment involved major surgery in eight of the 13 dogs. Outcome was excellent in 12 of 13 cases, one dog was euthanased.     

Surgery alone or in combination with radiation therapy for treatment of intracranial meningiomas in dogs: 31 cases (1989-2002)

OBJECTIVE: To compare, for dogs with intracranial meningiomas, survival times for dogs treated with surgical resection followed by radiation therapy with survival times for dogs treated with surgery alone. DESIGN: Retrospective study. ANIMALS: 31 dogs with intracranial meningiomas. PROCEDURE: Medical records of dogs with histologic confirmation of an intracranial meningioma were reviewed. For each dog, signalment, clinical signs, tumor location, treatment protocol, and survival time were obtained from the medical record and through follow-up telephone interviews. RESULTS: Dogs that underwent tumor resection alone and survived > 1 week after surgery had a median survival time of 7 months (range, 0.5 to 22 months). Dogs that underwent tumor resection followed by radiation therapy had a median survival time of 16.5 months (range, 3 to 58 months). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in dogs with intracranial meningiomas, use of radiation therapy as a supplement to tumor resection can significantly extend life expectancy.     

Massive hepatocellular carcinoma in dogs: 48 cases (1992-2002)

OBJECTIVE: To determine clinical signs, diagnostic findings, outcome, and prognostic factors in dogs treated surgically for massive hepatocellular carcinoma (HCC) and compare survival times of surgically and conservatively treated dogs. DESIGN: Retrospective study. ANIMALS: 48 dogs. PROCEDURE: Medical records were examined for clinical signs, diagnostic and surgical findings, and postoperative outcome. Dogs were allocated into surgery and nonsurgery groups depending on whether curative-intent liver lobectomy was performed. Data from the surgical and nonsurgical groups were analyzed to identify prognostic factors and determine and compare rates of tumor control and survival time. RESULTS: 42 dogs were treated surgically, and 6 were managed conservatively. In the surgery group, intraoperative mortality rate was 4.8% with no local recurrence, metastatic rate was 4.8%, and median survival time was > 1,460 days (range, 1 to 1,460 days). High alanine aminotransferase and aspartate aminotransferase activities were associated with poor prognosis. Median survival time for the nonsurgery group was 270 days (range, 0 to 415 days), which was significantly less than that of surgically treated dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Liver lobectomy is recommended for dogs with massive HCC because tumor-related mortality rate was 15.4 times higher in dogs in the nonsurgery group, compared with the surgery group. Tumor control was excellent after surgical resection with no local recurrence and a low metastatic rate. Prognostic factors were identified, but their clinical relevance was uncertain because only 9.5% of dogs in the surgery group died as a result of their disease.     

Outcome of surgical versus medical treatment of dogs with beta cell neoplasia: 39 cases (1990-1997).

OBJECTIVE: To compare outcome of surgical versus medical treatment of dogs with beta cell neoplasia. DESIGN: Retrospective study. ANIMALS: 39 dogs with clinical signs of hypoglycemia and serum glucose and insulin concentrations consistent with a diagnosis of beta cell neoplasia. PROCEDURE: Information on signalment; clinical history; physical examination findings; results of CBC, serum biochemical analyses, and urinalysis; serum glucose and insulin concentrations; results of thoracic radiography and abdominal ultrasonography; treatment and treatment complications; survival time; and cause of death were obtained from medical records. RESULTS: 26 dogs underwent exploratory celiotomy and partial pancreatectomy; 13 dogs were treated medically (i.e., dietary change and prednisone). Median survival time was significantly longer for dogs treated surgically than for dogs treated medically. Significant differences were not found in mean age, body weight, duration of clinical signs prior to diagnosis, serum glucose and insulin concentration, or results of other serum biochemical tests between dogs treated surgically and dogs treated medically; also, there was no significant correlation between any of these parameters and survival time for either group of dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that exploratory celiotomy and partial pancreatectomy are indicated once a tentative diagnosis of beta cell neoplasia is established in dogs.     

Intercalary bone grafts for joint and limb preservation in 17 dogs with high-grade malignant tumors of the diaphysis

OBJECTIVE: To evaluate postoperative complications, limb function, and tumor control after intercalary resection and reconstruction for preservation of limb and joint function in dogs with high-grade malignant tumors of diaphyseal bone. STUDY DESIGN: Retrospective study. ANIMALS: Seventeen client-owned dogs. METHODS: The bone tumor database and medical records were reviewed (1986-2002) for dogs with diaphyseal tumors treated with intercalary resection and reconstruction with either an allograft or irradiated autograft. Clinical presentation, diagnostic findings, surgical management, and outcome were determined from medical records and telephone interviews with veterinarians and owners. Statistical analyses included chi2 to test associations between intra- and postoperative variables with complications, and Kaplan-Meier survival analysis for disease-free interval, metastasis-free interval (MFI), and median survival time. RESULTS: Intercalary limb-sparing surgery was performed in 17 dogs with diaphyseal tumors: osteosarcoma (OSA) (15), histiocytic sarcoma (1), and solitary metastasis from a pulmonary adenocarcinoma (1). One dog was excluded from further analysis when the spared limb was amputated 4 days postoperatively because of incomplete tumor resection. In 16 dogs, limb function was good to excellent. Complications occurred in 5 dogs (31.3%) and included superficial infection in 2 dogs (12.5%) and implant failure in 4 dogs (25%). All implant failures occurred in the ulna and there was a significant association between implant failure and non-cemented allografts (P=.042). Non-union of 1 or both osteotomies was diagnosed in 10 dogs (83.3%) and, despite lack of clinical signs in all cases, was significantly associated with the use of intracavitary locally released cisplatin (P=.046) and cemented intercalary grafts (P=.046). Local tumor recurrence was diagnosed in 1 dog (6.3%) and metastatic disease in 12 dogs (75.0%), including 10 dogs with OSA. The median MFI was 137 days. The local disease-free and overall limb-salvage rate was 94% and 100%, respectively. Overall median survival time was 393 days and the median survival time for dogs with OSA was 449 days. CONCLUSION: Intercalary limb-sparing surgery results in better postoperative limb function with fewer and less severe complications than historical reports of dogs treated with non-intercalary limb-sparing surgery. CLINICAL RELEVANCE: In dogs with diaphyseal tumors, intercalary limb-sparing surgery preserves normal joint function and results in good to excellent limb use with few complications and good local tumor control.