Preputial Reconstruction Combined with Graft in Dogs

Background: Preputial injuries are significant in the clinical routine. Traumas, conditions, and mass excision result in extensive and full-thickness defects that lead to chronic penile exposure and consequential injuries. Severe injuries may require preputial reconstructive surgery to restore function and aesthetics. The objective is to report the use of the preputial reconstruction technique using the caudal superficial epigastric axial standard flap associated with a single-stage, full-thickness oral mucosa graft in 3 dogs where the loss of the prepuce was significant. Cases: Three dogs were admitted to the Veterinary Teaching Hospital of UFMT with preputial lesions of different etiologies. All cases were referred for preventive reconstruction using a flap in the caudal axial epigastric pattern associated with a single-stage oral mucosa graft. In the 3 reported cases, changes that compromised surgical success, such as suture dehiscence, necrosis, or infection, were not observed during hospitalization. Cutaneous stitch dehiscence, however, was observed in all 3 cases. Dog 1. A small point of dehiscence and tissue necrosis was found and treated with chemical debridement and healed by second intention, which proved to be sufficient on the 30th day. Dog 2.  A half-moon rotation flap was performed, which closed the defect. Dog 3.  A new procedure using the reporting theme technique was necessary in order to cover the cranial portion of the foreskin. The dehiscence present in dogs 2 and 3 was significant. Flap retraction was observed in all 3 cases. In dogs 1 and 3, the retraction was slight, and the exposure of a small portion of the penile glans were observed, showing no changes that required intervention. In dog 2, retraction was important, leading to partial stenosis of the preputial ostium. A larger ostium was obtained by suturing the mucosa to the edge of the wedge. Considering the possibility of adhesion formation, “captons” were made in sterile silicone tubes, and sutures were placed in the dorsal and ventral aspects to prevent adherence of the oral mucosa graft located on the inside of the new foreskin. The captons were removed on the tenth post-operative day, revealing a good opening of the preputial orifice and adequate penile exposure. Discussion: The absence of a foreskin caused by trauma or surgical excision leads to chronic penile exposure, dryness, and ulcerations. The simple covering of the skin with an axial-type flap of the caudal superficial epigastric region tends to fail since only the graft edges are sutured into the abdominal skin. In these circumstances, the subcutaneous region on the penis is exposed and comes in direct contact with urine and the penile mucosa, causing the flap skin to grow to exacerbated retraction. The transplantation of a free-lip mucosa graft allows the subcutaneous region of the transposed skin flap to create adhesions in the fenestrated regions of the lip tissue through the formation of granulation tissue buds, which is performed in a single stage. The permanence of the penis protects the lower urinary system from the occurrence of infections relative to what is normally observed in cases where partial or total penile amputation is practiced in combination with adjunctive scrotal urethrostomy. Given the observations of the 3 cases described here, the technique of pre-facial reconstruction with an axial skin flap of the caudal superficial epigastric region, combined with free-labial mucosa graft, was found to be feasible for the single-stage foreskin technique, but that paraphimosis remanagement may be necessary when cutaneous portions of the penile skin caudal to the glans are removed. Keywords: prepuce, reconstruction, oral mucosa. Título: Reconstrução prepucial com uso de enxerto combinado em cães. Descritores: prepúcio, reconstrução, mucosa oral

Pectus Excavatum and Pectus Carinatum in dogs

Background: Deformities of the anterior thoracic wall are called pectus: pectus excavatum and pectus carinatum. Pectus excavatum is characterised by dorsal deviation of the caudal region of the sternum while pectus carinatum consists of protrusion of the sternum and/or adjacent cartilage. Both defects may remain symptom-free, but respiratory and cardiac abnormalities have been reported. Another deformity observed in dogs is the swimming dog syndrome, which consists of the lateral opening of the thoracic and pelvic limbs, associated with the pedalling movement. These disorders are frequently reported in medical practice, are considered rare among canines. This report aims to describe a case of pectus excavatum associated with the swimming dog syndrome (Case 1) and another case of pectus carinatum (Case 2).Case: In Case 1, an approximately 45-day-old male American Pitbull canine had difficulty standing. Physical examination revealed hyperextension of the thoracic and pelvic limb joints and flattening of the thorax. After radiographic examination, pectus excavatum and the swimming dog syndrome were confirmed. The conservative treatment with splinting and hydrotherapy was chosen. At the 3-month follow-up, slight improvement in the limbs and irregular and unsatisfactory growth of the thorax leading to episodes of dyspnoea were observed. In Case 2, a female Pug, approximately 2 months old, had a thorax deformity. Physical examination revealed thorax protrusion, confirmed on radiography as pectus carinatum. Conservative therapy was provided using compressive bandage. One month later, the tutor reported improvement in the condition and absence of respiratory changes.Discussion: Pectus deformities has low incidence, and cases to pectus carinatum, there is a sexual predisposition, that is, males are more predisposed, differing from Case 2, a female dog. In the cases of pectus excavatum, no genetic alteration was directly related to its occurrence, although familial occurrence is reported in humans, as in Case 1, in which the patient was the only one of this litter to present this deformity. Though the possibility is lower, the acquired aetiology has been described in other cases. In pectus carinatum, there is the possibility of an acquired aetiology, which corroborates Case 2, considering that the canine had no history of inbreeding, nor family history. However, it is important consider racial predisposition, where there is an increasing number of cases of pectus carinatum in brachycephalic canines. Respiratory symptoms are frequently reported in cases of pectus excavatum, which the evolution of the condition occurred in Case 1, that can be explained by the displacement of organs or the restriction to ventilation. Humans have shown that pectus excavatum reduces static lung function. Case 2 showed no clinical signs, despite this presented dextrocardia, which in the future may confer cardiac dysfunctions. The diagnosis for pectus is considered simple. Performed only by radiography, it can be complemented by echocardiography. In both cases, conservative treatment was the choice. However, in Case 1 there was no success due to the degree of patient involvement, unlike Case 2, which had a better development of the thoracic wall, ensuring better quality of life for the patient. Thus, it is possible to conclude that some differences were found in these two reported cases when compared to others described in the literature.  The radiographic diagnosis is confirmatory, and the therapy must be adequate to the degree of thoracic wall deformity. In addition, the prognosis is more reserved for pectus excavatum than pectus carinatum

Preputial Reconstruction Combined with Graft in Dogs

Background: Preputial injuries are significant in the clinical routine. Traumas, conditions, and mass excision result in extensive and full-thickness defects that lead to chronic penile exposure and consequential injuries. Severe injuries may require preputial reconstructive surgery to restore function and aesthetics. The objective is to report the use of the preputial reconstruction technique using the caudal superficial epigastric axial standard flap associated with a single-stage, full-thickness oral mucosa graft in 3 dogs where the loss of the prepuce was significant. Cases: Three dogs were admitted to the Veterinary Teaching Hospital of UFMT with preputial lesions of different etiologies. All cases were referred for preventive reconstruction using a flap in the caudal axial epigastric pattern associated with a single-stage oral mucosa graft. In the 3 reported cases, changes that compromised surgical success, such as suture dehiscence, necrosis, or infection, were not observed during hospitalization. Cutaneous stitch dehiscence, however, was observed in all 3 cases. Dog 1. A small point of dehiscence and tissue necrosis was found and treated with chemical debridement and healed by second intention, which proved to be sufficient on the 30th day. Dog 2.  A half-moon rotation flap was performed, which closed the defect. Dog 3.  A new procedure using the reporting theme technique was necessary in order to cover the cranial portion of the foreskin. The dehiscence present in dogs 2 and 3 was significant. Flap retraction was observed in all 3 cases. In dogs 1 and 3, the retraction was slight, and the exposure of a small portion of the penile glans were observed, showing no changes that required intervention. In dog 2, retraction was important, leading to partial stenosis of the preputial ostium. A larger ostium was obtained by suturing the mucosa to the edge of the wedge. Considering the possibility of adhesion formation, “captons” were made in sterile silicone tubes, and sutures were placed in the dorsal and ventral aspects to prevent adherence of the oral mucosa graft located on the inside of the new foreskin. The captons were removed on the tenth post-operative day, revealing a good opening of the preputial orifice and adequate penile exposure. Discussion: The absence of a foreskin caused by trauma or surgical excision leads to chronic penile exposure, dryness, and ulcerations. The simple covering of the skin with an axial-type flap of the caudal superficial epigastric region tends to fail since only the graft edges are sutured into the abdominal skin. In these circumstances, the subcutaneous region on the penis is exposed and comes in direct contact with urine and the penile mucosa, causing the flap skin to grow to exacerbated retraction. The transplantation of a free-lip mucosa graft allows the subcutaneous region of the transposed skin flap to create adhesions in the fenestrated regions of the lip tissue through the formation of granulation tissue buds, which is performed in a single stage. The permanence of the penis protects the lower urinary system from the occurrence of infections relative to what is normally observed in cases where partial or total penile amputation is practiced in combination with adjunctive scrotal urethrostomy. Given the observations of the 3 cases described here, the technique of pre-facial reconstruction with an axial skin flap of the caudal superficial epigastric region, combined with free-labial mucosa graft, was found to be feasible for the single-stage foreskin technique, but that paraphimosis remanagement may be necessary when cutaneous portions of the penile skin caudal to the glans are removed. Keywords: prepuce, reconstruction, oral mucosa. Título: Reconstrução prepucial com uso de enxerto combinado em cães. Descritores: prepúcio, reconstrução, mucosa oral

Granulomatous Lymphadenitis in a Dog Caused by Mycobacterium intracellulare

Background: Mycobacteriosis is caused by bacteria belonging to the genus Mycobacterium, with considerable zoonotic potential and risk to public health. Infection in dogs is rare and is usually associated with immunosuppression, resulting from eating meat or contact with contaminated soil or fomites. Dogs are also known as potential sources for the spread of atypical tuberculosis in humans and other animals. This paper aims to describe the clinical, cytological, histopathological, and molecular findings of a male canine seen at University Veterinary Hospital of Cuiabá, Mato Grosso, with generalized lymphadenomegaly associated Mycobacterium intracellulare infection.Case: A 2-year-old male Lhasa Apso dog was referred to the University Veterinary Hospital in Cuiabá city, located in the Midwest region of Brazil. The patient had a history of intermittent claudication of the left pelvic limb for approximately 6 months and lymphadenomegaly with progression for approximately 2 months. The dog had wheezing and generalized lymphadenopathy (submandibular, axillary, and popliteal lymph nodes); cryptorchidism was also observed. A complete blood count revealed nonspecific results, and in the serum biochemical profile, the values of urea, creatinine, albumin, and alanine aminotransferase were within the reference range. No changes were observed on the radiography of the femurotibiopatellar joints. Considering the generalised lymphadenopathy, fine needle aspiration cytology and histopathological examination through biopsy of the lymph nodes was performed. On the cytology and histopathology, numerous negative images of moderately refringent bacillary structures distending the cytoplasm from the macrophages was found. The samples were also subjected to special Ziehl-Neelsen staining, which confirmed an accentuated and diffuse granulomatous lymphadenitis associated with alcohol acid-resistant bacilli. The polymerase chain reaction (PCR) was used to amplify the DNA of the lymph node fragment for the hsp65 gene, which was subjected to genetic sequencing and construction of a phylogenetic tree, with 99.77% genetic similarity for the species M. intracellulare. As treatment, doxycycline (10 mg/kg twice a day for 60 days) and enrofloxacin (5 mg/kg once a day for 10 days) were prescribed. However, the canine suffered car trauma leading to a fractured pelvis, which motivated the owner to opt for euthanasia at another veterinary establishment.Discussion: In the reported case, it was not possible to determine the source of infection, as the owners reported that the animal lived inside the house with only sporadic access to the street. The clinical signs manifested by this dog were nonspecific, and only the signs of generalised lymphadenopathy could be correlated with the signs expected in the infection with this mycobacterium. The hematological and biochemical laboratory findings were nonspecific, and it did not demonstrate the involvement of other organs. Considering the findings in cytology and histology, mycobacterial infection can be suspected. The diagnosis was confirmed through pathological and molecular findings. In this case, the PCR technique was used with partial amplification of the hsp65 gene and subsequent genetic sequencing, making it possible to identify a species like M. intracellulare (99.77% similarity). Due to euthanasia for another reason, it was impossible to monitor the dog's treatment and investigate other changes in the post mortem examination, especially the pulmonary lesions frequently described in M. intracellulare infection in humans.Keywords: Mycobacterium avium complex (MAC), canine, infection, non-tuberculous mycobacteriosis