Limb-Sparing Using Total Hip Arthroplasty in a Dog with Femoral Head Osteosarcoma

Background: Osteosarcoma (OSA) is the most common primary bone tumor of the appendicular skeleton of dogs. It mainly affects the metaphyseal region of long bones in large and giant breed dogs.The markedly aggressive and metastatic character of the disease leads to an invariably poor to unfavorable prognosis.Although amputation is commonly performed, different surgical techniques may be used to preserve the limb. The most common methods of limb preserving surgeries involve the use of endoprosthesis and allogeneic or autologous grafts. This report describes the successful use of total hip replacement to treat a 3-year-old male dog, with OSA in the femoral head and neck.Case: This report describes the successful use of total hip replacement to treat a 3-year-old male dog, with OSA in the femoral head and neck. The OSA stage IA located in the femoral head and neck was resected and treated through the limb-sparing. The bone defect and joint function was reconstructed with total hip arthroplasty technique using a cementless hip prosthesis. The result of the histopathological analysis of the excised bone tissue showed a minimally productive osteoblastic osteosarcoma. To date, the patient shows satisfactory movement rate and motion range, with no pain to palpation and without lameness in that limb. The radiographic follow-up after 24 months showed no local recurrence, metastasis pulmonary or complications related to the implant. Total hip arthroplasty resulted in safe recovery of orthopedic signs associated with osteosarcoma of the femoral head and neck, effectively acting as a limb preserving surgery after 32 months.Discussion: The limb-sparing procedure is an option to control local tumors that has become more popular among owners that do not accept the amputation of the limb. Similarly, it is a good alternative when another condition may interfere with the other limbs or may require amputation of another limb. The size and the potential for weight gain of the dog in this study could compromise its ambulation later, and it was a factor in the decision for the limb-sparing surgery. The allografts can be used to reconstruct the proximal femur, but they were not considered a viable option for this patient because of the reported complications, including graft fracture, non-union with the host bone and collapse of subchondral bone. The hip region does not allow the realization of arthrodesis because this joint is highly mobile, so the use of prosthetics as described is ideal for the preservation of joint biomechanics. Furthermore, the implant provides rapid postoperative recovery and immediate stability. Mean survival times were not significantly different between the limb-sparing and amputation techniques without adequate chemotherapy. In this case, despite the recommendation, the patient was monitored continuously without the association of adjuvant treatments according to the owner’s choice. The complications related with the use of cortical allograft, endoprosthesis, and pasteurized autograft include infection (31-60%), local recurrence (15-28%) or implant failure (11-40%). The implant luxation is the most common non-traumatic acute complication in the short term after limb-sparing surgery of proximal femur in humans and total hip replacement in dogs. To date, no complications have been observed after the procedure was performed. In conclusion, preservation of limbs in cases of osteosarcoma is favorable depending on the degree of involvement, but it requires specific techniques according to the location, to improve the quality of life and animal survival. In this case, the total hip arthroplasty for initial osteosarcoma in the femoral head and neck got an unexpected result, especially given the nature of osteosarcoma, limitations of wide excision with this approach and lack of adjuvant therapy

Recurrent Canine Paraphimosis: Modified Surgical Approach

Background: Paraphimosis is characterized by persistent penile exposure, due to the inability to retract the penis into the prepuce.This persistent exposure of a non-erect penis might result from traumas, infections, neoplasia, anatomic or neurological alterations, or even occur in its idiopathic form. Surgical treatment is indicated when it is not possible to keep the penis covered by the foreskin by trying it manually. The surgical techniques described are efficient in small exposures, however, when these are over 1.5 cm, surgical success might become a challenge. The objective of this study is to report a modified surgical approach to solve a 5 cm recurrent paraphimosis in a dog.Case: A 1-year-old male unneuteredmixed-breed dog, weighing 26 kg, waspresented for examination with a historypersistent paraphimosis background for around 2 months without apparent cause. The animal’s tutor reported that it had been submitted to 2 unsuccessful surgical procedures. When the reproductive system was examined, the animal showed a flaccid penis with 5 cm exposure outside the foreskin. A conservative treatment was used, which was also unsuccessful. The next step was a surgical procedure that used the combination of techniques, namely, phallopexy, preputial advancement and reconstruction preputial opening with suture along with orchiectomy. After 10 days, dehiscence of the ostium stitches occurred, which required debridement and new suture. However, it was not efficient and recurrence of the paraphimosis was observed. After 1 month, a new surgery was performed by adapting the phallopexy technique, which was carried out bilaterally and associated to the reconstruction preputial opening with captonated suture, which presented a successful outcome. After 8 months as of the last procedure, the patient is healthy and has no signs of paraphimosis recurrence.Discussion: No consensus has been achieved regarding the paraphimosis treatment, and the resolution of such disorder remains a challenge. For this reason, some parameters should be considered to minimize failure when choosing the surgical technique and, consequently, the recurrence of such condition. Tissue viability, morphological alterations, time of exposure, previous surgeries, and the length of the penis exposure are some of the criteria that must be taken into consideration when choosing the surgical technique. In this case, the first choice was the association of techniques that included preputial advancement, phallopexy and suture preputial opening due to the fact that the exposure was over 1.5 cm and for the existence of a preputial ostium defect, which justified its suture. Despite these associations, paraphimosis recurrence was observed and some of the probable causes include the inadequate position of the penis inside the foreskin flap during the phallopexy and lack of preputial integrity in its ventral aspect. The preputial advancement performed was not sufficient to prevent the exposure or reduce it in the recurrence of the condition, showing that the shortening of preputial muscles and the skin tension might loosen up with time. The second surgery employed bilateral phallopexy without penis exposure to guarantee its correct position, more caudal within the foreskin at the moment of the fixation. The ostium captonated suture also had a relevant role in the tension distribution up to the full tissue healing. New surgical approaches might be needed to achieve success in the paraphimosis treatment. In this report, the length of the penis exposure and the ostium defect were complicating factors. However, the association of the modified surgical techniques resulted in a successful resolution of the condition.  Keywords: phallopexy, prepuce, penis, preputial advancement.Descritores: falopexia, prepúcio, pênis, avanço prepucial.Título:  Parafimose canina recidivante: abordagem cirúrgica modificada.

Long bone fractures in Cerdocyon thous: macroscopic and microstructural evaluation

The aim of the present study was to perform the macroscopic and microstructural morphological classification of long bone fractures of Cerdocyon thous. Eighteen cadavers of the species were necropsied, and subjected to radiographic and microscopical evaluation when long bone fractures were detected. Among the 18 cadavers, eight (44%) had fractures equally distributed (33.33%) in the femur, humerus, or tibia. More frequently (61.54%), the fractures were simple and affected the diaphysis, and in smaller proportions (23.08%) reached the physeal line. In diaphyseal and metaphyseal fractures, microscopical evaluation revealed cortical bone tissue, with longitudinal osteons that contained longitudinal and intermediate collagen fibres and lamellae with a delamination aspect. On the other hand, in epiphyseal fractures, trabecular bone tissue was more frequently observed, consisting of trabeculae with disorganised collagen fibres and absence of osteons. In both cases low activity, osteocytes, and low coverage of osteoblasts on the bone surface were noted. It was concluded that the frequency of fractures in the long bones of C. thous was 44%, with females being more predisposed. The findings support the hypothesis that fractures in such animals are caused by being run over by automobiles. The present study contributes significantly in alerting clinicians and surgeons to the types of fractures that C. thous is more predisposed to, its places of greatest occurrence, and its microstructure. Thus, there is a need for joint actions aimed at reducing the number of cases of wild animals being run over by automobiles. Keywords: Bone biology. Orthopaedics. Run-over accidents. Trauma

Osteossíntese de Tíbia Associada a Correção de Luxação Medial de Patela em Cão

Background: Locking bone plates are fixation systems that neutralize the compressive loads applied to fractures. They require minimal contact with the bone tissue, and are commonly used for the repair of tibial diaphyseal fractures. Patellar luxation is one of the most common orthopedic conditions in small animals. There are a number of surgical techniques described for correction of this pathology aiming to realign the extensor mechanism of the stifle joint and reestablish the function of the stifle joint. The aim of this study was to report the use of a combination of an osteosynthesis technique with a locking plate for tibial facture repair with tibial tuberosity transposition and imbrication of the lateral retinaculum for correction of patellar luxation. Case: A 5-year-old bitch was presented with left pelvic limb lameness following a traumatic entrapment of the limb. Orthopedic and radiographic examinations showed a comminuted diaphyseal fracture in the left tibia and fibula, and left-sided medial patella dislocation in relation to the trochlear groove. The fracture was repaired by placement of a locking plate on the medial aspect of the tibia. The surgical incision was then extended cranially to allow correction of the patellar luxation by transposition of the tibial tuberosity: an oscillating saw was used to perform an osteotomy of the tibial tuberosity; the tibial crest was laterally translocated and transfixed with Kirschner pins. Medial retinaculum release and imbrication of the lateral retinaculum was also performed. Discussion: There are a wide range of bone fixation methods for correction of comminuted tibial diaphyseal fractures. Selection of the appropriate method should take into account biological factors (age and general condition of the animal, involvement of adjacent soft tissues, and degree of blood supply), mechanical factors (classification and degree of stability of the fracture, size and activity level of the patient, and number of limbs involved), and practical factors (financial limitations and surgeon's preference). In this case a locking plate was selected, a fixation system where stability is provided by the attachment of the screw head to the plate. In this case, at 30 days postoperatively the radiographs showed insufficient bone callus formation. However, bone healing time in adult animals varies from 16 to 30 weeks, so delayed union cannot be diagnosed so early. The occurrence of patellar luxation after the traumatic episode in an adult animal, suggests that it is a traumatic condition. However, animals with patellar luxation may remain asymptomatic until a traumatic soft tissue injury occurs, so classifying this case as strictly traumatic is controversial. Surgical correction of patellar luxation aims to establish alignment of the extensor mechanism of the stifle joint and stabilization of the patella in the femoral trochlea. In order to achieve this objective, a combination of surgical techniques is used, including tibial tuberosity transposition, corrective osteotomies and trochleoplasties, and release or reconstruction of the soft tissues adjacent to the patella. In this case the combination of osteosynthesis techniques with locked plate, tibial tuberosity transposition and lateral retinaculum imbrication for the correction of patellar dislocation was effective in correcting a pre-existing pathology as well as the acute tibial fracture. Keywords: orthopedics, fracture, dislocation, patelar, stifle, canine. Título: Osteossíntese de tíbia associada à correção de luxação medial de patela em uma cadela Descritores: ortopedia, fratura, deslocamento, patelar, joelho, canino.Background: As placas ósseas bloqueadas consistem em um sistema de fixação capaz de neutralizar as forças atuantes em fraturas através de um mínimo contato com o tecido ósseo, sendo seu uso favorável e frequente na correção de fraturas diafisárias tibiais. A luxação patelar medial é uma das afecções ortopédicas mais comuns na clínica de pequenos animais, sendo a correção efetiva desta condição realizada através da combinação de técnicas cirúrgicas envolvendo tecidos moles e tecido ósseo, tendo como objetivo principal realinhar o mecanismo extensor do joelho. Diante disso, o objetivo deste trabalho foi relatar a associação técnicas de osteossíntese utilizando placa bloqueada em ponte para reparação da fratura tibial combinada com a transposição da tuberosidade tibial e imbricação do retináculo lateral para correção da luxação patelar. Case: Foi atendido um canino, fêmea, de 5 anos de idade, da raça Spitz Alemão, pesando 4,3 kg, com o histórico de impotência funcional do membro pélvico esquerdo há 4 dias, após ter o membro preso no portão. Nos exames ortopédico e radiográfico foi evidenciado uma fratura cominutiva diafisária em tíbia e fíbula esquerdas, além de deslocamento medial da patela em relação ao sulco troclear. Para correção cirúrgica da fratura tibial, foi optado pelo método de osteossíntese por placa óssea bloqueada em ponte na face medial da tíbia. Em seguida, a incisão cirurgica foi ampliada cranialmente para permitir a realização da correção da luxação patelar através da técnica de transposição da tuberosidade tibial: com uma serra oscilatória, realizou-se uma osteotomia linear na crista tibial, em seguida, a crista foi translocada lateralmente e fixada com pinos Kirschner. Por fim, também foram realizados a liberação do retináculo medial e imbricação do retináculo lateral. Discussion: A correção cirúrgica de fraturas tibiais cominutivas diafisárias pode ser feita utilizando toda a gama de métodos de fixação óssea existentes, interno e externo. A escolha do método adequado deve levar em consideração fatores biológicos (idade e estado geral do animal, nível de comprometimento de tecidos moles adjacentes e grau de aporte sanguíneo), fatores mecânicos (estabalecer a classificação e grau de estabilidade da fratura, porte e nível de atividade do paciente, além do número de membros acometidos), e fatores práticos (reconhecer limitações financeiras, preferência e capacidade do cirurgião). Nesse sentido, optou-se pelo uso de fixação com placas ósseas bloqueadas, um sistema interno capaz de neutralizar as forças axial, rotacional e de flexão. A estabilidade nestes implantes é conferida pelo encaixe da cabeça do parafuso à placa, permitindo que a estabilização não dependa da compressão entre o implante e o osso. Na evolução do caso, o exame radiográfico 30 dias pós-operatório constou formação de calo ósseo insuficiente, no entanto, é importante ressaltar que esse período ainda é recente para diagnosticar uma união retardada, uma vez que o período de cicatrização óssea para um animal adulto varia de 16 a 30 semanas. Diante dos fatos descritos, é possível concluir que a associação das técnicas de osteossíntese com placa bloqueada, transposição da tuberosidade tibial e imbricação do retináculo lateral mostrou-se efetiva na correção de de uma patologia preexistente em associação com a correção de um problema recente, como é o caso da fratura tibial

Limb-Sparing Using Total Hip Arthroplasty in a Dog with Femoral Head Osteosarcoma

Background: Osteosarcoma (OSA) is the most common primary bone tumor of the appendicular skeleton of dogs. It mainly affects the metaphyseal region of long bones in large and giant breed dogs.The markedly aggressive and metastatic character of the disease leads to an invariably poor to unfavorable prognosis.Although amputation is commonly performed, different surgical techniques may be used to preserve the limb. The most common methods of limb preserving surgeries involve the use of endoprosthesis and allogeneic or autologous grafts. This report describes the successful use of total hip replacement to treat a 3-year-old male dog, with OSA in the femoral head and neck.Case: This report describes the successful use of total hip replacement to treat a 3-year-old male dog, with OSA in the femoral head and neck. The OSA stage IA located in the femoral head and neck was resected and treated through the limb-sparing. The bone defect and joint function was reconstructed with total hip arthroplasty technique using a cementless hip prosthesis. The result of the histopathological analysis of the excised bone tissue showed a minimally productive osteoblastic osteosarcoma. To date, the patient shows satisfactory movement rate and motion range, with no pain to palpation and without lameness in that limb. The radiographic follow-up after 24 months showed no local recurrence, metastasis pulmonary or complications related to the implant. Total hip arthroplasty resulted in safe recovery of orthopedic signs associated with osteosarcoma of the femoral head and neck, effectively acting as a limb preserving surgery after 32 months.Discussion: The limb-sparing procedure is an option to control local tumors that has become more popular among owners that do not accept the amputation of the limb. Similarly, it is a good alternative when another condition may interfere with the other limbs or may require amputation of another limb. The size and the potential for weight gain of the dog in this study could compromise its ambulation later, and it was a factor in the decision for the limb-sparing surgery. The allografts can be used to reconstruct the proximal femur, but they were not considered a viable option for this patient because of the reported complications, including graft fracture, non-union with the host bone and collapse of subchondral bone. The hip region does not allow the realization of arthrodesis because this joint is highly mobile, so the use of prosthetics as described is ideal for the preservation of joint biomechanics. Furthermore, the implant provides rapid postoperative recovery and immediate stability. Mean survival times were not significantly different between the limb-sparing and amputation techniques without adequate chemotherapy. In this case, despite the recommendation, the patient was monitored continuously without the association of adjuvant treatments according to the owner’s choice. The complications related with the use of cortical allograft, endoprosthesis, and pasteurized autograft include infection (31-60%), local recurrence (15-28%) or implant failure (11-40%). The implant luxation is the most common non-traumatic acute complication in the short term after limb-sparing surgery of proximal femur in humans and total hip replacement in dogs. To date, no complications have been observed after the procedure was performed. In conclusion, preservation of limbs in cases of osteosarcoma is favorable depending on the degree of involvement, but it requires specific techniques according to the location, to improve the quality of life and animal survival. In this case, the total hip arthroplasty for initial osteosarcoma in the femoral head and neck got an unexpected result, especially given the nature of osteosarcoma, limitations of wide excision with this approach and lack of adjuvant therapy

Recurrent Canine Paraphimosis: Modified Surgical Approach

Background: Paraphimosis is characterized by persistent penile exposure, due to the inability to retract the penis into the prepuce.This persistent exposure of a non-erect penis might result from traumas, infections, neoplasia, anatomic or neurological alterations, or even occur in its idiopathic form. Surgical treatment is indicated when it is not possible to keep the penis covered by the foreskin by trying it manually. The surgical techniques described are efficient in small exposures, however, when these are over 1.5 cm, surgical success might become a challenge. The objective of this study is to report a modified surgical approach to solve a 5 cm recurrent paraphimosis in a dog.Case: A 1-year-old male unneuteredmixed-breed dog, weighing 26 kg, waspresented for examination with a historypersistent paraphimosis background for around 2 months without apparent cause. The animal’s tutor reported that it had been submitted to 2 unsuccessful surgical procedures. When the reproductive system was examined, the animal showed a flaccid penis with 5 cm exposure outside the foreskin. A conservative treatment was used, which was also unsuccessful. The next step was a surgical procedure that used the combination of techniques, namely, phallopexy, preputial advancement and reconstruction preputial opening with suture along with orchiectomy. After 10 days, dehiscence of the ostium stitches occurred, which required debridement and new suture. However, it was not efficient and recurrence of the paraphimosis was observed. After 1 month, a new surgery was performed by adapting the phallopexy technique, which was carried out bilaterally and associated to the reconstruction preputial opening with captonated suture, which presented a successful outcome. After 8 months as of the last procedure, the patient is healthy and has no signs of paraphimosis recurrence.Discussion: No consensus has been achieved regarding the paraphimosis treatment, and the resolution of such disorder remains a challenge. For this reason, some parameters should be considered to minimize failure when choosing the surgical technique and, consequently, the recurrence of such condition. Tissue viability, morphological alterations, time of exposure, previous surgeries, and the length of the penis exposure are some of the criteria that must be taken into consideration when choosing the surgical technique. In this case, the first choice was the association of techniques that included preputial advancement, phallopexy and suture preputial opening due to the fact that the exposure was over 1.5 cm and for the existence of a preputial ostium defect, which justified its suture. Despite these associations, paraphimosis recurrence was observed and some of the probable causes include the inadequate position of the penis inside the foreskin flap during the phallopexy and lack of preputial integrity in its ventral aspect. The preputial advancement performed was not sufficient to prevent the exposure or reduce it in the recurrence of the condition, showing that the shortening of preputial muscles and the skin tension might loosen up with time. The second surgery employed bilateral phallopexy without penis exposure to guarantee its correct position, more caudal within the foreskin at the moment of the fixation. The ostium captonated suture also had a relevant role in the tension distribution up to the full tissue healing. New surgical approaches might be needed to achieve success in the paraphimosis treatment. In this report, the length of the penis exposure and the ostium defect were complicating factors. However, the association of the modified surgical techniques resulted in a successful resolution of the condition.  Keywords: phallopexy, prepuce, penis, preputial advancement.Descritores: falopexia, prepúcio, pênis, avanço prepucial.Título:  Parafimose canina recidivante: abordagem cirúrgica modificada.

Principais retalhos empregados em cirurgias reconstrutivas na medicina veterinária

O tratamento de feridas de segunda intenção envolve o emprego de enxertos ou retalhos, a fim de diminuir o tempo de cicatrização das lesões e reduzir os riscos de possíveis infecções. A localização anatômica da ferida, qualidade do leito, elasticidade do tecido periférico são alguns entre vários fatores que devem ser levados em consideração para o emprego correto destas técnicas reconstrutivas. O objetivo deste estudo é relatar os principais retalhos cutâneos, com ênfase em retalhos de padrões subdérmicos e axiais. Os principais retalhos subdérmicos são os retalhos de avanço, unipedicular, H-plastia, de rotação e de transposição e os de padrão axial são o auricular caudal, da artéria temporal superficial, axial omocervical, axial toracodorsal, torácico lateral, braquial superficial, epigástrico superficial caudal, epigástrico superficial cranial, ilíaco circunflexo profundo e genicular. Os retalhos são altamente versáteis e úteis na rotina veterinária e podem ser incorporados em ocasiões em que há uma ferida extensa, com grandes áreas de pele exposta. Desta maneira, possibilitam o fechamento facilitado, cobertura estética e resultados favoráveis

Meningioma transicional intracraniano em felino: relato de caso

Os tumores intracranianos primários, tais como os meningiomas, são os mais diagnosticados em felinos. Essas condições podem ser identificadas por meio de técnicas de imagem, como tomografia computadorizada (TC) e ressonância magnética (RM), que desempenham um papel crucial no diagnóstico. O tratamento preferencial para esses casos envolve intervenções cirúrgicas, como craniotomias. Neste estudo, um felino foi admitido no hospital veterinário da Universidade Federal do Espírito Santo com histórico de convulsões. Durante o exame neurológico, não foram observadas anormalidades além das crises focais, nas quais o animal apresentava nistagmo horizontal, perda súbita de equilíbrio e ataxia vestibular. Com o auxílio da TC, foi possível estabelecer um diagnóstico presuntivo de meningioma. O felino foi submetido a uma craniotomia rostrotentorial direita para a remoção do tumor localizado no lobo temporal direito. Durante o procedimento, houve a necessidade de substituição da dura-máter, utilizando um fragmento de fáscia lata do músculo temporal, além da substituição da calota craniana com polimetilmetacrilato. Logo após a cirurgia, o animal demonstrou estado de alerta e foi liberado para internação, recebendo alta no dia seguinte. A calota craniana e o tumor foram encaminhados para análise histopatológica, a qual forneceu o diagnóstico definitivo de meningioma transicional. O objetivo deste estudo foi relatar um caso de meningioma transicional intracraniano em um felino

Reconstrução do ligamento cruzado cranial com ligamento sintético (Evolig®): relato de caso

A ruptura do LCCr resulta em instabilidade e é conhecida como insuficiência ou doença do ligamento cruzado cranial (DLCCr), envolvendo alterações morfofuncionais associadas a essa estrutura anatômica. Uma técnica cirúrgica mais recente para a reconstrução do LCCr é a substituição do ligamento intracapsular por uma prótese ligamentar sintética, conhecida como Evolig® (prótese ligamentar de tereftalato de polietileno tipo 155), desenvolvida pelo Dr. J. P. Laboureau. Sendo assim, este trabalho irá relatar um caso de reconstrução do ligamento cruzado cranial utilizando a prótese ligamentar sintética Evolig® por meio de uma técnica intracapsular em um cão, sem raça definida de 32 kg com ruptura do LCCr direito, utilizando o ligamento de tamanho L2. Durante o acompanhamento pós-operatório de 90 dias, observou-se uma melhora significativa da estabilidade e função do joelho do animal, portanto a utilização da prótese Evolig® apresentou vantagens notáveis, como a possibilidade de carga compartilhada entre a prótese sintética e o tecido biológico, permitindo uma construção de ligamento cruzado cranial eficaz

Topical application of gentamicin or cephalothin in the healing of surgical wounds in dogs

The present study aimed to evaluate the influence of local administration of gentamicin or cephalothin on the healing of surgical wounds in dogs. Thirty healthy dogs were submitted to surgical castration. They were divided into 2 groups of 15 animals. After the surgical procedure, two 0.6 cm circular cutaneous wounds were made in the abdominal region. Group 1 received 0.1 ml of 0.9% saline in one wound and 0.1 ml of gentamicin (40 mg / ml) in the other wound; and group 2 received 0.1 ml of 0.9% saline and 0.1 ml of cephalothin (200 mg / ml); respectively. All wounds were sutured and assessed macroscopically 1, 3 and 10 days after the operation. On day 10, an incisional biopsy was performed for histopathological evaluation. All analyzes of macroscopic variables did not show significant differences between groups (P <0.05). There were no significant differences between groups for microscopic evaluation of collagenization, vascularization, edema and inflammatory cells (P <0.05). Thus, the topical use of the tested antibiotics does not influence skin healing in dogs