Reconstructive Surgical Repair of a Forth Degree Iatrogenic Burn in a Dog

Background: Burns are uncommon in small animal surgery routine and represents a real therapeutic challenge. Skin can be affect in different degrees of deepness as superfcial, partial thickness, full thickness and full thickness affecting underlying tissues. Each degree has individual features. Progression through degrees can occur in the frst 24 h or if treatment is inadequate. This paper aims to describe therapeutic approach and surgical technique to treat a huge dorsal iatrogenic thermal burn injury. Case: A 4-year-old female German Shepard was referred to veterinary hospital after 11 days of elective ovariosalpingohisterectomy. The patient presented a severe skin injury with crusts, eschars, purulent discharge and myiasis on dorsal cervical, thoracic and lumbar region. Beside severity of the wound, animal present good general status and normal vital signs. Complete blood count and biochemical analysis were within normal ranges. Histopathologic analysis of a wound tissue sample revealed the presence of coagulation necrosis and inflammatory response. The absence of traumatic events, histopathologic result and wound features increased suspicious of an iatrogenic burn injury from a poorly regulated thermal mattress used during surgical intervention. “Rule of Nines” was estimated as 25% of total body surface area. Systemic antibiotics and topical treatment with 0.05% chlorhexidine digluconate and 2.5% silver sulfadiazine ointment followed by wet-wet bandage was performed after initial surgical debridement. Muscle and vertebral bone explosion were evident. Topical treatment with Silver Sulfadiazine and chlorhexidine persisted twice daily until granulation tissue formation. Pain killers and sedation were often necessary during bandage changes. At 65th day proceeded to en bloc excision of scar tissue and surgical reconstruction with skin advancement and recruitment technique. Tie-over dressing was applied to cover the fnal wound. After 14 days animal received hospital discharge, and was assessed bi-weekly for 60 days. Discussion: Besides great extension of the burn injury, patient’s age, absence of systemic involvement and fluid therapy or critical care the prognosis was good. Modifed “rule of nine” are used to estimate wound size in dogs. The wound was classifed as forth degree or full thickness injury due to exposed muscular layer and bone. Early debridement, standard topical and systemic treatment protocol applied granted good recovery of wound bed. Due to be uncommon in small animal routine, main diagnosis and therapeutic recommendations for veterinary patients are based on human data. Systemic antimicrobial drugs are usually not recommended due to low concentration in burned tissues, however, prophylactic use was necessary due to highly infected tissues and possible bacterial absorption from devitalized tissues. Delayed primary closure technique was necessary due to highly infection site and extension, which turns surgical approach hard to perform. After formation of a granulation tissue bed for wound reconstruction, surgical treatment was performed. Surgical reconstruction is indicated in large full thickness defects and for better cosmetic appearance. The correct use and regulation of thermal mattress can avoid burns that can be life threatening. This case report rises the important concept that even low contact temperatures when persistent for long time can cause burn injuries. Keywords: thermal, mattress, injury, dogs, plastic

Intermuscular Lipoma in Dogs

Background: Lipoma is a benign tumor composed of mature adipose tissue commonly found in subcutaneous tissues. However, eventually, lipomas may be located between the muscle fasciae being classifed as intermuscular lipomas. Complete surgical resection of the tumor mass is indicated as a treatment of affected patients.This report describes fve cases of intermuscular lipoma in dogs, due to the scarcity of data in the literature and lipoma relative importance in the clinical and surgical routine.Case: Five dogs were presented with a history of a large volume in the limbs with progressive growth, suggesting the presence of neoplasia. The frst step was to conduct anamnesis, when the owner reported slow growth, absence of pain, limping and licking of site. No other change was observed upon physical examination. Complete blood count (CBC) as well as liver assessment (FA) and renal (creatinine) were performed in all patients, and the results showed no changes. Fine needle aspiration cytology (FNAC) was performed and showed cells from adipose tissue, followed by histopathological examination of the lesions. Histopathological examination after incisional biopsy of the tumors showed malignancy-freetissue, composed of adipocytes without atypia, interspersed with fbrovascular stroma, confrming the lipoma diagnosis.Intermuscular lipomas were diagnosed in fve dogs with a history of a large volume in the limbs with progressive growth; all of them underwent bloc resection of the tumors. In all cases, the intermuscular lipomatous tumors were well-circumscribed and easily isolated from the tissues.Discussion: Although lipomas are relatively common in older dogs, especially in the subcutaneous tissue, intermuscular subtype is rare in veterinary medicine, which justifes the report of these cases. Intermuscular lipomas account for only 0.3% of the occurrences in human medicine. Morphologically described as tumors of slow and progressive evolution, typically reaching sizes up to 2 cm in humans, the particular cases of tumor masses greater than 5 cm are called giant lipomas. Theslow development of intermuscular lipomas has also been described in domestic animals by, thus corroborating the clini cal history in this work. The intermuscular septum is considered as the origin of intermuscular lipoma, with subsequent development of the adipose tissue between adjacent muscle bundles, thus, resulting usually in well-circumscribed mass of easy surgical divulsion. The morphological characteristics of the resected lipomas, as well as the simple surgical technique corroborate descriptions in the literature. Intermuscular lipomas consist of a challenging diagnosis despite attracting little attention from surgeons. The possibility of the mass being malignant, such as liposarcoma, should also be consideredsince the clinical symptoms consist of swelling of the deep soft tissues. The diagnosis for all these patients was obtained by histopathological examination, since the simple observation of the clinical fndings alone does not support the tumor diagnosis. Lipoma and liposarcoma should be differentiated by cytological and histopathological evaluations of the neoplasia, whereas infltrative lipomas can be diagnosed based on diagnostic imaging methods or even on the fndings during surgery. In this report, specifcally, the fndings during surgery contributed to the differentiation between infltrative and intermuscular lipoma, while for malignancy rating all patients underwent cytological and histopathological evaluations asindicated in the literature. In conclusion, this study demonstrated that complete resection of intermuscular lipoma proved to be an effective treatment to cure the patients.Keywords: benign neoplasm, surgery, resection of intermuscular, canine

Right Laparoscopic Adrenalectomy in a Bitch

Background: The medical procedure of Laparoscopic adrenalectomy is common in human medicine; however, this is not true in veterinary medicine, where it isperformed rarely. The current treatment of choice for adrenal neoplasms is total adrenalectomy, unless there is a pre-operativediagnosis of metastasis that precludes surgery. The laparoscopic approach option becomes an interesting alternative because, through this technique,it has shown good results. In this report, we demonstrate the experience of a case in which we performed unilateral laparoscopic right adrenalectomy, without caudalvena cava invasion, in a dogsuffering from hyperadrenocorticism caused by adrenocortical carcinoma.Case: A 9-year-old beagle bitch, 12 kg in weight, showedpolyphagia, polydipsia, polyuria, pendular abdomen, thin and dark skin, lumbar alopecic areas and lethargy. The team carried out Complete Blood Count (CBC), blood chemistry (liver and renal functions) and urine sampling by cystocentesis for urinalysis and bacterial culture. All exams had normal results, except for ALP, which reached levels higher than 150 UIL-1. On abdominal radiographic examination, we noted mild adrenal enlargement, and by ultrasonography, it was possible to identify adrenal asymmetry and right adrenal enlargement (2.8x2x2.15 cm) in relation to the left gland (2x1x1.5 cm). As a treatment for adrenal neoplasm-dependent HAC,we recommended the execution of total right adrenalectomy execution. The videosurgery used four accesses arranged in the right hypogastric region; the diameters were 10 (two), 5, and 3mm. The adrenal gland was carefully dissected with the aid of laparoscopic forceps; during the intraoperative period, there was a small laceration of the abdominal phrenic vein that resulted in bleeding, which was overcome with two titanium clips. The dog had an excellent recovery, and the teamdischarged it 48 h after the procedure. The signs of hyperadrenocorticism disappeared about two weeks after surgery. One year after having the procedure, the animal remainswell and has no signs of tumor recurrence or Cushing’s syndrome.Discussion: The choice laparoscopic approach provided less invasiveness in surgical access, reduced animal convalescence, and provided image magnifcation for the more accurate dissection of the adrenal gland. Some reports that middle-aged to older bitches were the most predisposed to present adrenal neoplasm-dependent HAC, and generally, in unilateral form, characteristics which are presented in this report. Among the clinical signs and observed in this report, are polydipsia, polyphagia, tachypnea, alopecia, and skin hyperpigmentation. That recommended the low-dose dexamethasone suppression test to diagnose Cushing’s syndrome and the endogenous ACTH test to distinguish hypophysary from adrenocorticotrophic HAC. The same tests were performed in the case reported here, as these are also important to establish the fnal diagnosisand refer the total adrenalectomy realization. In the current case report, access to the right hypogastric region using four videosurgery portals provided good surgical access. Towards the hospital convalescence time, the animal was discharged early, just 48 h post-operatively; remission of HAC clinical signs occurredwithin three weeks, and the survival alreadyreached 12 months.To the best of the authors’ knowledge, this is the frst successful case of total right adrenalectomy without caudal vena cava invasion via the laparoscopic route as treatment for adrenocortical carcinoma in the national literature.Keywords: adrenal gland, neoplasm, videosurgery, dogs

Eficacia y seguridad de morfina y metadona como analgésicos en un protocolo anestésico balanceado en conejos

The efficacy of preventive analgesia and the cardiopulmonary effects of morphine or methadone in rabbits undergoing experimental skin surgery were evaluated and compared. Thirty-six rabbits were randomly assigned to three experimental groups: Control, Morphine, and Methadone. The rabbits received midazolam 1 mg/kg IM associated with: placebo (NaCl 0.9%) 0.05 ml/kg, methadone 0.5 mg/kg or morphine 0.5 mg/kg, depending on the experimental group. Anaesthesia was induced and maintained with isoflurane. Heart (HR) and respiratory (fR) rates, peripheral oxygen saturation (SpO2), mean arterial pressure (MAP), and body temperature were assessed every 10 minutes. Electrocardiographic examination was performed after sedation, in the trans and immediate postoperative period. After procedure, the control group received tramadol 5 mg/kg IV. Postoperative analgesia was assessed using the visual analogue scale (VAS) and Von-Frey filament stimulation responses. All variables were compared between groups by ANOVA or Friedman. Methadone and morphine caused an increase in MAP (p=0.0112) and a decrease in HR (p=0.0001). fR and SpO2 were reduced in the methadone group (p=0.0100). The response to Von-Frey filaments (p=0.6824) and VAS (p=0.7661) were similar between treatments, however, the control group presented a higher proportion of analgesic rescue (33%) compared to morphine (19%) and methadone (12%). Electrocardiographic variables were similar between treatments (p>0.05). In conclusion, preventive treatment with morphine or methadone was effective in controlling trans and postoperative pain in rabbits, and its cardiovascular effects were limited; however, methadone caused marked respiratory depression.Se evaluó y comparó la eficacia de la analgesia preventiva y los efectos cardiopulmonares de morfina o metadona en conejos sometidos a cirugía cutánea experimental. Treinta y seis conejos fueron asignados al azar a tres grupos experimentales: Control, Morfina y Metadona. Los conejos recibieron midazolam 1 mg/kg vía IM asociado a: placebo (NaCl 0.9%) 0.05 ml/kg, metadona 0.5 mg/kg o morfina 0.5 mg/kg, según el grupo experimental. La anestesia fue inducida y mantenida con isoflurano. La frecuencia cardíaca (FC) y respiratoria (fR), la saturación periférica de oxígeno (SpO2), la presión arterial media (PAM) y la temperatura corporal se evaluaron cada 10 minutos. Se realizó examen electrocardiográfico después de la sedación, en el trans y posoperatorio inmediato. Después del procedimiento, el grupo control recibió tramadol 5 mg/kg vía IV. La analgesia posoperatoria fue evaluada mediante la escala analógica visual (VAS) y la respuesta a estímulos con filamentos de Von-Frey. Todas las variables se compararon entre los grupos mediante ANOVA o Friedman. Metadona y morfina causaron aumento de PAM (p=0.0112) y reducción de la fR (p=0.0001). La fR y la SpO2 se redujeron en el grupo de metadona (p=0.0100). La respuesta a los filamentos de Von-Frey (p=0.6824) y la VAS (p=0.7661) fueron similares entre tratamientos, sin embargo, el grupo control presentó una mayor proporción de rescate analgésico (33%) en comparación con la morfina (19%) y la metadona (12%). Las variables electrocardiográficas fueron similares entre tratamientos (p>0.05). En conclusión, el tratamiento preventivo con morfina o metadona resultó eficaz para controlar el dolor trans y posoperatorio en conejos y sus efectos cardiovasculares fueron limitados; sin embargo, la metadona ocasionó depresión respiratoria marcada

Concentração de proteínas de fase aguda e vitamina D em cães com linfoma multicêntrico

Objetivou-se caracterizar a concentração sérica da vitamina D e das PFAs (Proteínas de Fase Aguda) (alfa-1 glicoproteína ácida, haptoglobina, transferrina, ceruloplasmina, albumina, IgA, IgG e alfa-1 – antitripsina) em cães com linfoma multicêntrico, submetidos ao tratamento quimioterápico com protocolo CHOP (Ciclofosfamida, Doxorrubicina, Vincristina e Prednisona), determinando o valor prognóstico desses marcadores para a doença. Foram avaliadas as concentrações séricas das PFAs, através do método da eletroforese e as concentrações da vitamina D, através da quimioluminescência em dois grupos experimentais, um grupo de 13 cães com linfoma multicêntrico classificados como alto grau pela citologia (GL) durante as semanas T0, T5 e T10 do tratamento com protocolo quimioterápico antineoplásico e em um grupo de 10 animais saudáveis para compor o grupo controle (GC), em coleta única. Para isso, foi realizado o diagnóstico, estadiamento e avaliação de resposta terapêutica dos 13 pacientes com linfoma multicêntrico através de técnicas de citopatologia, histopatologia, imuno-histoquímica do linfonodo periférico acometido. Foi observado que 9 pacientes tiveram resposta completa e 4 pacientes tiveram resposta parcial ao tratamento. Os dados foram analisados através do software R. Os resultados indicam que as diferenças entre as variáveis IgA, haptoglobina e α1-glicoproteína ácida foram significativas entre os grupos, e entre os diferentes momentos da quimioterapia (p< 0,05), indicando que podem ser marcadores sensíveis ao linfoma em cães. A α1-glicoproteína ácida apresentou valor prognóstico para o linfoma, com 63% de especificidade. Porém a vitamina D não apresentou valor prognóstico para o linfoma multicêntrico em cães. Palavras-chave: linfossarcoma; prognóstico; reação de fase aguda; resposta terapêutica; neoplasia hematopoiética

Fechamento de defeitos em padrão de figura geométrica associado ao emprego de anestesia por tumescência com lidocaína em coelhos (Oryctolagus cuniculus)

O uso da anestesia por tumescência com lidocaína pode proporcionar melhor analgesia transoperatória e pós-operatória, o que seria um benefício em cirurgias reconstrutivas extensas. Entretanto, a lidocaína pode interferir na cicatrização. Diante disso, delineou-se um estudo a fim de avaliar a interferência local da cicatrização de defeitos cutâneos induzidos e fechados em padrão de figura geométrica, associado ao emprego de anestesia por tumescência com lidocaína em coelhos. Ademais, avaliar sua influência em parâmetros cardiorrespiratórios e na analgesia pós-operatória. Foi realizado um estudo com 27 coelhos, separados em três grupos, compreendidos em GC (sem o emprego de tumescência), GS (emprego de tumescência com solução NaCl 0.9%) e GL (emprego de anestesia por tumescência com lidocaína). Não houve diferença estatística em nenhuma etapa do processo cicatricial da ferida entre os grupos, tampouco nas avaliações macroscópicas, e no processo de angiogênese, ou ainda no processo de colagenização e deposição de fibroblastos. Houve diferença significativa na frequência cardíaca (menor no GL) e na respiratória (maior no GC), na pressão arterial média (maior no GL) e na concentração expirada de isoflurano (menor no GL). Não houve diferença significativa entre os grupos no teste de filamentos de von Frey e na Escala Visual Analógica, utilizados para avaliar a analgesia pós-operatória. Conclui-se que anestesia por tumescência com lidocaína não prejudica a regeneração tecidual após a cirurgia. O seu uso oferece benefícios como a diminuição do volume de anestésico inalatório, manutenção do plano anestésico, estabilidade das frequências cardíaca e respiratória, além de menor hipotensão durante o procedimento cirúrgico. Palavras-chave: Anestésico local; Cirurgia reconstrutiva; Dor; Reparação tecidua

Emprego de plasma rico em plaquetas associado à esponja cirúrgica em enxertos cutâneos em coelhos (Oryctolagus cuniculus)

RESUMO. Pazzini J.M., Serafim E.L., Uscategui R.R.A., de Almeida V.T., Oliva C.A.C., Gartner F., de Carvalho M.F.F., Reis N. de P., Ferreira M.G.P.A., Moraes P.C., de Oliveira J.A. & De Nardi A.B. [Rich plasma platelets employed with surgical sponge in skin grafts in rabbits (Oryctolagus cuniculus).] Emprego de plasma rico em plaquetas associado à esponja cirúrgica em enxertos cutâneos em coelhos (Oryctolagus cuniculus). Revista Brasileira de Medicina Veterinária, 38(4):397-405, 2016. Programa de Pós-Graduação em Cirurgia Veterinária, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista, Campus Jaboticabal, Via de Acesso Paulo Donatto Castellane s/n, Jaboticabal, SP 14884-900, Brazil. E-mail: [email protected] Objetivou-se com este estudo avaliar a eficácia do uso do gel de PRP associado as esponjas cirúrgicas favorecerem a integração do enxerto em malha ao leito receptor. Foi realizado, um estudo com 16 coelhos, Nova Zelândia branco, fêmeas, com 60 dias de idade, separados em dois grupos, com oito animais, que foram todos submetidos à técnica de cirurgia reconstrutiva para confecção de enxerto em malha. Os grupos foram compreendidos em Gprpme receberam gel de PRP e Gcme que receberam solução fisiológica 0,9% ambos associando esponja cirúrgica como forma de curativo. As amostras de sangue do grupo Gprpme no qual se realizou o PRP, a contagem média de plaquetas após a centrifugação foi de 1.288.750 plaquetas/µL, sendo os resultados obtidos na amostra final de PRP quando comparada com a inicial foram significativamente maior. Assim, o protocolo de centrifugação dupla para obtenção do PRP que foi realizado neste ensaio foi adequado, visto que a concentração de plaquetas após centrifugação dupla aumentou três vezes quando comparado com a contagem inicial da amostra de sangue, e foi possível alcançar bons resultados terapêuticos. Nas avaliações macroscópicas do 3º dia, edema, rubor, coloração e aspecto cosmético não foram significativas entre os grupos. Porém, exsudato apresentou diferenças significativas no Gprpme quando comparado com Gcme. Nas avaliações do 7º e do 14º dia edema, rubor, coloração, exsudato e aspecto cosmético não foram significativas entre os grupos. As avaliações histológicas qualitativas utilizando as colorações HE e Tricromio de Massom observou-se que a intensidade de polimorfonucleares, proliferação fibroblástica, reepitelização e colagenização não houve diferença significativa. Entretanto, a proliferação vascular foi significativamente maior no Gprpme quando comparado com o Gcme. Já presença de células mononucleares e hemorragia foram significativamente maior no Gcme quando comparado com Gprpme. Portanto, a utilização do plasma rico em plaquetas na forma de gel em enxertos cutâneos em malha é capaz de estimular a angiogênese na ferida favorecendo a integração do enxerto ao leito receptor, sem presença prévia de tecido de granulação. E associação da esponja cirúrgica como curativo compressivo favorece a cicatrização do enxerto por reduzir complicações como seu deslocamento no leito receptor e presença de edema, sendo viável e aconselhável seu emprego

Plasma rico em plaquetas empregado na cirurgia reconstrutiva em coelhos (Oryctolagus cuniculus): avaliação da exequibilidade da técnica, achados macroscópicos e histopatológicos

Wounds of large tracts with loss of tissue viability and delayed healing by secondary intention are cases where it is necessary the use of reconstructive surgical techniques. The platelet rich plasma (PRP) is a product with a higher platelet concentration, adjuvant in the healing process of reconstructive surgeries, assisting in the processes of hemostasis and stimulation of angiogenesis. Thus, a study was devised to assess the efficacy of the gel produced from the platelet rich plasma (PRP) in the forward axial flaps thoracodorsal pattern in rabbits to evaluate the ability to promote the integration of the flap the recipient bed. We used 30 white rabbits New Zealand, separated into two groups of 15 animals, comprising the platelet rich plasma groups (GPRP), in which we used the gel before the synthesis of the surgical wound , and control (CG), in which only saline was used. To obtain the PRP, the blood was collected from the animals, was determined and the platelet count before preparation of the gel. At the beginning and end of the experiment the animals were weighed for analysis of average weight gain. After surgery began macroscopic in the 3rd, 7th and 14th day reviews, and we assessed the presence or absence of exudate, skin integrity, edema, redness and necrosis. After this step, yielded the material for the manufacture of surgical wound, followed by microscopic histological slides. We evaluated vascular proliferation, presence of polymorphonuclear and mononuclear cells, fibroblast proliferation, collagen deposition, reepithelialization and hemorrhage. The data were subjected to statistical analysis (Student t test, t paired, and Kruskal Wallis test, and p<0.05). The average weight gain was not significant between the groups; platelet concentration in the final sample of PRP was significantly higher when compared with the original; exudate and necrosis were significantly higher in the ...Feridas de grandes extensões, com perda da viabilidade tecidual e retardo na cicatrização por segunda intenção são casos que se faz necessário o emprego de técnicas cirúrgicas reconstrutivas. O plasma rico em plaquetas (PRP) é um produto com maior concentração plaquetária, adjuvante no processo cicatricial de cirurgias reconstrutivas, auxiliando nos processos de hemostasia e estimulação da angiogênese. Dessa forma, delineou-se um estudo a fim de avaliar a eficácia do uso do gel produzido a partir do plasma rico em plaquetas (PRP) em flapes de avanço de padrão axial toracodorsal em coelhos, para avaliar a possibilidade de favorecer a integração do retalho no leito receptor. Utilizaram-se 30 coelhos da raça Nova Zelândia branco, separados em dois grupos de 15 animais, compreendendo os grupos plasma rico em plaquetas (GPRP), na qual empregou-se o gel antes da síntese da ferida cirúrgica, e controle (GC), na qual utilizou-se apenas solução fisiológica. Para obtenção do PRP, coletou-se sangue dos animais, e determinou-se a contagem plaquetária antes da preparação do gel. No início e término do experimento os animais foram pesados para posterior análise de ganho peso médio. Após o procedimento cirúrgico iniciou-se as avaliações macroscópicas no 3º, 7º e 14º dia, e avaliou-se presença ou ausência de exsudato, integridade da pele, edema, rubor e necrose. Após esta etapa, coletou-se o material da ferida cirúrgica para confecção das lâminas histológicas e posterior avaliação microscópica. Avaliou-se a proliferação vascular, presença de células mononucleares e polimorfonucleares, proliferação fibroblástica, colagenização, reepitelização e hemorragia. Os dados obtidos foram submetidos à análise estatística (Teste t Student, t emparalhado, e Kruskall Walis, sendo p<0,05). O ganho de peso médio não foi significativo entre os grupos ..