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

Evaluation of Two Protocols for Analgesia during Total Unilateral Mastectomy in Bitches

Background: Proper evaluation of pain is essential to select effective anesthetic protocols in surgical procedures in animals. Pain assessment can be accomplished during the perioperative period by measuring several physiological parameters, such as heart and respiratory rates. Measuring serum levels of cortisol and glucose is one of the most commonly used methods to assess the effectiveness of protocols for pain control. The aim of this study was to compare two analgesic protocols in dogs undergoing unilateral total mastectomy, a surgery that can cause moderate-to-severe pain in dogs. Materials, Methods & Results: Eighteen female dogs seen at the Veterinary Hospital of the University of Southern Santa Catarina, Brazil, were recruited for this study, without stratification by breed and age, except for brachycephalic breeds. The animals were divided into two groups: 1) FLK group, in which the animals received preoperative ketamine (5 mg/ kg, IM) and midazolam (0.3 mg/kg, IM), an IV bolus of fentanyl (0.004 mg/kg), lidocaine (2 mg/kg) and ketamine (0.5 mg/kg), and then a combination of fentanyl (0.008 mg/kg/h), ketamine (0.6 mg/kg/h) and lidocaine (2 mg/kg/h) diluted in normal saline solution were infused at a rate of 10 mL/kg/h until the end of the surgical procedure; 2) AM group, in which the animals received preoperative morphine (0.5 mg/kg, IM) and acepromazine (0.05 mg/kg, IM). In both groups, anesthesia was induced by using propofol (6 mg/kg, IV) and maintained with isoflurane. Blood samples were collected by jugular venipuncture (4 mL) in the preoperative and postoperative periods to evaluate serum levels of cortisol and glucose. Statistical analysis was carried out using the two-way analysis of variance (ANOVA) for repeated measures, followed by the Tukey test (P < 0.05). Cortisol levels showed no significant difference between pre- and postoperative periods. Glucose levels showed a significant difference between pre- and postoperative periods in the AM group (P = 0.001). The respiratory rate showed a significant difference between groups at 10 (T10) min after induction (P < 0.001). Discussion: In this study, 67% of the experimental animals were mixed-breed dogs. The average weight was 16.9 ± 10.1 kg. The most frequent age group seen at the Veterinary Hospital was 8-10 years, which is in accordance with other published studies on female dogs with mean age of 10 years. The significant difference in the respiratory rate at T10 can be explained by the respiratory depression caused by a bolus administration of fentanyl in the FLK group. Both protocols were similar in this study; however, higher values of cortisol and glucose, even above the physiological reference values, were observed in the AM group as compared to the FLK group. These higher values must be taken into consideration due to their clinical importance, given that consequences of stress include several deleterious effects, such as immunosuppression, delayed wound healing, and acceleration of disease processes. Findings from this study indicate that the use of a multimodal analgesia protocol, such as the one used in the FLK group, is probably the best alternative for patients submitted to unilateral total mastectomy

Uveíte associada à infecção por Trypanosoma evansi em cães no município de Uruguaiana, RS, Brasil Uveíte associated to the infection by Trypanosoma evansi in dogs from Uruguaiana, RS, Brazil

Descrevem-se, neste trabalho, as alterações oculares de dois cães naturalmente infectados por Trypanosoma evansi. Os animais apresentaram, ao exame oftalmológico, teste lacrimal de Schirmer I normal, teste de fluoresceína negativo, quemose, hiperemia conjuntival, secreção mucopurulenta, miose, edema de córnea, pressão intraocular diminuída e efeito Tyndall positivo. No esfregaço sanguíneo, foram identificadas formas tripomastigotas, classificadas como pertencentes à espécie T. evansi. Pelos resultados aqui apresentados, concluímos quanto à necessidade de realização de avaliação oftalmológica completa em cães apresentando uveíte, incluindo exames parasitológicos específicos para hemoparasitas.This paper describes the ocular alterations of two dogs naturally infected by Trypanosoma evansi. The animals presented to an ophthalmologic examination, normal Schirmer tear test , negative fluorescein test, chemosis, conjunctival hyperemia, mucopurulent discharge, miosis, corneal edema, intraocular pressure decreased and positive Tyndall effect. In blood smears, trypomastigotes were identified, classified as belonging to the species T. evansi. By the results presented here, it was concluded that there is a necessity of performing a complete ophthalmological examination in dogs with uveitis, including parasitological examination specific to hemoparasites

Mixed Epigastric Axial Pattern Flap Following Cutaneous Hemangiosarcoma Excision in a Male Dog

Background: Axial pattern flaps use direct cutaneous arteries to enable closure of a skin defect using a large skin segment. Caudal epigastric axial pattern flaps are highly versatile owing to their wide arc of rotation, which includes the preputial area. The presence of abundant loose and elastic skin allows wider flaps. Hemangiosarcoma (HSA) is a malignant neoplasm of endothelial cells with aggressive local behavior and high metastatic rate; the lungs are the most common site of metastasis. This case report aims to describe the use of a caudal epigastric artery-based flap, with preservation of some cranial epigastric artery branches for penis sparing, following resection of a hemangiosarcoma in the right inguinal region of a male dog.Case: An eight-year-old male Pitt Bull dog was referred with a 15 cm, ulcerated hemangiosarcoma in the right inguinal region, near the prepuce. A similar tumor had been removed from the same location two years before. Previous treatment with oral prednisone did not provide satisfactory results. The patient was suffering from intense chronic blood loss andbacterial infection of the tumor tissue. Thoracic radiographs revealed multiple metastatic nodules. Only mild regenerative anemia was found in blood tests. Considerable reductions in tumor size and in the ulcerated surface, decrease in bleeding, and recovery of appetite were observed after 7 days of administration of piroxicam and cephalexin. Surgical resectionof the tumor was performed as a palliative treatment with a minimal safety margin of 2 cm, which spared the penis. An epigastric skin flap incorporating the second mammary gland was performed preserving branches of cranial epigastric arteries, and was rotated 160° to cover the defect created in the right inguinal region and on the body of the penis. A small suture dehiscence, necrosis of the distal border of the flap, seroma, and multidrug-resistant Escherichia coli infection were observed in the postoperative period. Administration of penicillin V and topical collagenase, placement of a passive drain, and a second surgical procedure to correct the dehiscence were necessary to solve postoperative complications. Piroxicam based metronomic chemotherapy was maintained continuously, as the patient would exhibit worsening of overall condition upon discontinuation of medication. One hundred days after the initial presentation, the animal was euthanized owing to the presence of an osteolytic lesion on the vertebral bodies of L3-L4 and L5-L6, which were suggestive of discosponlylitis or axial bone metastasis.Discussion: Since lung metastases were present, penectomy and uretrostomy were not considered an option, and a pallia tive surgical treatment was performed. In this case report, cranial and caudal epigastric flap presented few complications. Caudal epigastric blood vessels are robust and abundant. Distal necrosis was considered a minor complication and was in accordance with others reports. The multidrug resistant infection was considered a nosocomial infection that arised from a long hospital stay. By inhibiting cyclooxygenase, piroxicam decreases angiogenesis, increases apoptosis, and prolongs disease-free intervals with mild toxicity. An excellent response to preoperative administration of piroxicam was crucial when choosing the postoperative protocol. A signifcant tumor size reduction and a decrease in chronic bleeding associated to improvement in general health were observed with the piroxicam-based treatment. To our knowledge, this is the frst report of a mixed (cranial and caudal) epigastric artery skin flap. This type of flap was considered a good option for correction of large defects in the inguinal region and for preservation of the prepuce and penis.Keywords: hemangiosarcoma, cranial, caudal, penis, sparing

Pub. 45 Síndrome de Haw em Gatos Haw&apos;s Syndrome in Cats

ABSTRACT Background: Haw&apos;s syndrome is an uncommon but underdiagnosed disease that affects cats. It occurs due to changes in the innervation of the third eyelid causing protrusion. These changes may occur due to some change in sympathetic innervation efferent to the eye and its annexes The diagnosis is based on the instillation of sympathomimetic agents. The palliative treatment is based on the instillation of sympathomimetic agents only if the protrusion is preventing eyesight. The aim of this study is to report the clinical management of three cats with this syndrome, emphasizing its clinical, diagnostic and treatment demonstration. Case: Three cats were referred to the Department of Ophthalmology Veterinary of the Catholic University of Rio Grande do Sul (PUCRS), two with undefi ned breeds (male and female) and a Siamese (male), aged between 2 and 4 years, with bilateral protrusion of the third eyelid. The owners reported that the animals ate well, were active and did not observe any other problems concomitantly, with the exception of diarrhea In one of the animals a week ago, but that had passed. The animals underwent a complete ophthalmologic examination where they were evaluated since the symmetry orbits until intraocular pressure, Schirmer tear test, fl uorescein test and lissamine green, without any obvious change, with values within the normal range for the species, except for the bilateral protrusion of the third eyelid was the only clinical sign present. In the fundoscopic exam no apparent changes were observed, with the optic nerve head and retinal vasculature normal for the species. All patients received instillation of 10% phenylephrine in the left eye, with total regression of the third eyelid to its anatomical position. As it was an isolated problem, without visual or systemic repercussions, no medication was prescribed, although the animals kept coming for revisions weekly for 60 days. After 47 days, on average, the third eyelid returned to its anatomical position. Discussion: Haw&apos;s syndrome is an uncommon and with little expression in the ophthalmic medical clinic eye disease, a fact which may explain the limited literature available on the subject. However, this disease deserves attention, given the need to obtain the differential diagnosis of other ocular and systemic diseases that can cause protrusion of the third eyelid, as Horner&apos;s syndrome, ocular atrophy, lymphoma, retrobulbar tumors, among others. Furthermore, for the defi nitive diagnosis of the syndrome, it is interesting that the veterinary ophthalmologist is familiar with the physiology of the sympathetic innervation via the eye and its attachments, making the necessary tests to confi rm the diagnosis and avoid hasty conclusions. In this case, as stressed in the literature, if the third eyelid returns within 20 min to its anatomical position, it means that the likely cause is in the third neuron postganglionic order, as observed in the three cats after instilling phenylephrine 10% . This occurs as a result of hypersensitivity to sympathetic stimulation generated exclusively in post-ganglionic lesions. If there is no pupillary dilation within 20 min the lesion is preganglionic. The cat that had diarrhea also was thought in viral involvement, but it has not been proved. In the treated cases, the authors found that there was no loss of vision without the need for treatment, but they consider essential the diagnostic condition to reassure the owners, informing them of the favorable prognosis and pathogenesis of the syndrome

Mandibular osteosynthesis in a Boa constrictor snake

Tem-se observado um aumento do achado de determinados animais selvagens em áreas urbanas, em função das alterações ambientais provocadas pelo desmatamento e uso econômico de áreas naturais. Isso causa o desaparecimento das presas usuais e força esses animais, inclusive serpentes, a migrar para áreas urbanizadas, tornando-os vulneráveis aos traumatismos provocados por agressões, atropelamentos e acidentes de captura. As fraturas de mandíbula e maxila são comuns em diversas espécies animais, representando cerca de 3 a 6% de todas as fraturas ósseas em cães e gatos. O trauma mandibular ocorre geralmente em consequência de lutas, acidentes veiculares e manejo e/ou contenção inadequados. A mandíbula é um osso chato com diferenças em relação aos ossos longos que devem ser levadas em consideração para o sucesso do tratamento, e a necessidade de manutenção da oclusão e a cobertura muscular mínima são fatores que influenciam a definição do melhor método de redução. Entre os métodos de estabilização se destacam a utilização de fio metálico, pino intramedular, fixador esquelético externo, placa de compressão dinâmica e resina acrílica. A utilização de placas ósseas convencionais é eficiente, mas está relacionada a diversas complicações, tais como a necessidade de elevação da musculatura para sua aplicação e alto risco de lesão às estruturas mandibulares. Este artigo descreve os resultados satisfatórios da aplicação de placa de compressão dinâmica e parafusos na redução de fratura mandibular em uma serpente jibóia (Boa constrictor) do sexo feminino, com peso de 8,0 kg e comprimento de 1,80 m, atendida na Fundação RIOZOO (Rio de Janeiro, RJ, Brasil).Nowadays are observed an increase in the finding of certain wild animals in urban areas, due to environmental changes caused by deforestation and economic use of natural areas. It causes disappearance of usual prey and forces these animals, including snakes, to migrate to urban areas, becoming vulnerable to injuries caused by aggressions, car accidents and capture. Mandibular and maxillar fractures are common in many animal species, representing about 3-6% of all bone fractures in dogs and cats. Mandibular trauma usually occurs as a result of fights, car accidents and improper handling and/or restraint, and fractures can be closed or open, clean or contaminated. The jaw is a flat bone with differences from the long bones that should be taken into consideration for successful treatment, being minimal muscle coverage and need to maintain occlusion factors that influence the definition of the best ostheosynthesis method. The methods of stabilization include using intramedullary pins, wires, external skeletal fixation, bone plate, and acrylic resin. Conventional bone plates are efficient but related to some complications, such as the necessity of muscular elevation and high risk of injuries to mandibular structures. This article describes the successful results of the application of plate and screws in the ostheosynthesis of a mandibular fracture in a female Boa constrictor snake with weight of 8.0 kg and length of 1.80 m, at the RIOZOO Foundation (Rio de Janeiro, RJ, Brazil)

Síndrome da dilatação volvo gástrica em cães Gastric volvulus dilatation syndrome in dogs

A síndrome da dilatação volvo gástrica (DVG) é uma condição grave, de caráter agudo, que confere alto índice de óbito em pequenos animais. A etiologia não está completamente estabelecida e, em contrapartida, diversas possibilidades de tratamento são descritas. A DVG causa grave redução na perfusão tecidual, afetando vários órgãos, incluindo os sistemas respiratório e cardiovascular. Este estudo tem como objetivo realizar uma revisão de literatura sobre a patogenia desta síndrome e seu tratamento.<br>The syndrome of gastric dilatation volvulus (GDV) is a severe condition of acute character, which gives a high rate of death in small animals. The etiology is not fully established, however, several treatment options have been described. The DVG causes severe reduction in tissue perfusion, affecting many organs, including the respiratory and cardiovascular systems. This study aims to conduct a comprehensive literature review of the pathogenesis of this syndrome as well as its treatment