Veterinary Surgery最新文献

Jejunocecostomy (JC), or jejunocecal anastomosis, is arguably the most controversial surgical procedure in equine small intestinal surgery. It is also the only option for resection and anastomosis for a third of small intestinal strangulating lesions in horses. Critics of the procedure identify its low survival and high complication rates as reasons to avoid its use. This review is intended to highlight findings of recent research and clinical studies that validate use of the JC, and to provide some insights into technical aspects of the procedure that might improve its survival rates. Jejunocecostomy is more complicated than most anastomoses used in the equine small intestine, and a review of its complexities could help to improve outcomes with this anastomosis. The negative attitude towards its use is not supported by recent research and clinical studies. If the ileum has incurred ischemic changes that necessitate its being bypassed, JC is a valid treatment if owner- and disease-related issues support the cost of resection and anastomosis. Concerns about poor outcomes with JC can lead to an inappropriate anastomosis or euthanasia whenever this anastomosis is indicated. The different methods used for JC might influence its success rate, but all methods applied with recognition of potential pitfalls can have favorable outcomes.

Objective: To investigate the effects of muscle activation on internal tibial rotation and cranio-caudal translation (CCT) in intact and cranial cruciate ligament (CCL) deficient stifles.

Study design: Ex vivo biomechanical study.

Animals: Eight cadaveric, nonpaired canine stifles.

Methods: Stifles were tested intact and after arthroscopic CCL transection. Quadriceps, biceps femoris, and gastrocnemius forces were simulated with pneumatic actuators in single or cocontraction muscle activation (0%-100% bodyweight [BW]). The tibia was mounted to a linear-torsional tester; the femur to a six-degrees-of freedom fixture. Internal tibial rotation (5 Nm torque) and CCT (30% BW cranial and caudal translation) were recorded via motion tracking system.

Results: Without muscle activation, CCL transection increased internal tibial rotation (34.8 ± 11.8° CCL-deficient vs. 27.9 ± 10.8° intact; p = .041). Across 0%-100% BW activation, internal rotation decreased in both conditions, to 4.3 ± 2.3° (intact; p < .0001 vs. 0% BW) and 2.8 ± 1.3° (CCL-deficient; p = .001 vs. 0% BW) at 100% BW. At 100% BW, biceps femoris reduced internal rotation more than quadriceps and gastrocnemius in both CCL conditions. Muscle activation reduced CCT in CCL-deficient stifles; however, at 100% BW, CCT was 19.1 mm in CCL-deficient versus 2.8 mm in intact (+582%; p < .0001).

Conclusion: Periarticular muscle activation mitigates axial plane rotational laxity but does not prevent CCT.

Clinical significance: Targeted muscle strengthening may help manage rotational laxity; however, surgical stabilization remains necessary to address CCT after CCL rupture. Internal tibial rotation may require additional surgical stabilization in selected cases.

Objective: To macroscopically characterize and compare the open Metzenbaum (FOM) and ultrasound-guided (FUG) plantar fasciotomy techniques for decompression of the hindlimb proximal suspensory ligament (PSL), and to determine whether either approach induces intraligamentous splitting (ILS).

Study design: Cadaveric experimental study.

Sample population: Paired hindlimbs from 10 adult horses with no history of hindlimb lameness.

Methods: Each horse contributed one limb to FOM and the contralateral to FUG. All procedures were performed by a single surgeon, and incision measurements were obtained by a blinded examiner. Skin, fascia, and ILS lengths were recorded after dissection. Integrity of the deep branch of the lateral plantar nerve (DBLPN) was evaluated macroscopically. Paired t-tests compared FOM and FUG values (p < .05).

Results: Both techniques induced PSL ILS. Mean ± SD incision lengths (cm) for FOM versus FUG were: skin 5.02 ± 0.41 versus 1.28 ± 0.18; fascia 5.54 ± 0.44 versus 4.39 ± 0.22; and ILS 5.33 ± 0.42 versus 4.37 ± 0.24. The FUG technique produced 74% shorter skin, 21% shorter fasciotomy, and 18% shorter ILS incisions compared to FOM (all p < .0001). No macroscopic evidence of DBLPN injury was observed.

Conclusion: Both FOM and FUG plantar fasciotomy techniques produced ILS while achieving PSL decompression. FUG required smaller incisions, confirming comparable anatomical efficacy with reduced invasiveness.

Clinical relevance: Intraligamentous splitting appears unavoidable during plantar fasciotomy, but the FUG technique limits its extent and associated soft-tissue disruption, supporting its use as a safer, less invasive alternative in clinical cases of chronic PSL desmopathy.

Objective: The aim of this study was to describe the surgical technique, and the short to medium clinical outcome of dogs treated with temporary glenohumeral joint (GHJ) stabilization following traumatic luxation.

Study design: Short case series.

Methods: Medical records of dogs presented with GHJ luxation and treated with a temporary transarticular locking compression plate and screws were reviewed. Signalment, clinical signs, direction and duration of the luxation, diagnostic imaging, operative technique, complications and clinical outcome were reviewed. Liverpool Osteoarthritis in Dogs (LOAD) and Canine Orthopedic Index (COI) questionnaires were completed by the owners at 6 months after implant removal.

Results: Clinical and radiographic findings were documented for 10 client-owned dogs at a mean follow-up of 42.5 days when implants were removed through a minimally invasive procedure. Two dogs exhibited minor complications identified through radiographs performed at the follow-up appointment consisting of screw loosening or breakage. These did not affect the clinical outcome. Temporary GHJ stabilization resulted in return stability and range of motion for all dogs. At 6 months 9/10 dogs returned to complete function while one died for other causes. In one case, luxation recurred 8 months postoperatively for which the dog underwent glenohumeral joint arthrodesis.

Conclusion: Temporary transarticular GHJ stabilization is a possible treatment option in cases of traumatic glenohumeral joint luxation. Further studies are required to determine the minimum immobilization time necessary to achieve joint stability, to assess the long-term complication rate and the possible risks associated with this technique in a controlled population.

Objective: To describe procedural details of a unilateral or bilateral temporary or permanent ligation of the common carotid artery (CCA) at the level of the medial retropharyngeal lymph node (MRLN), with or without concurrent lymphadenectomy in dogs.

Study design: Computed tomographic (CT) and cadaveric study.

Animals: Medium breed (15-35 kg) client-owned dogs undergoing CT evaluation (n = 10) and cadaver dogs (n = 12).

Methods: A total of 10 dog contrast-enhanced CT scans were evaluated for spatial assessment of the carotid artery, regional lymphocenters, and adjacent anatomy. A total of 12 dog cadavers were randomized to undergo two of four surgical procedures for carotid artery ligation at the level of the MRLN: lateral or ventral approach, with or without lymphadenectomy. Feasibility, consistency of anatomical landmarks, and completeness of carotid isolation were assessed.

Results: CT evaluation consistently identified the CCA dorsomedial to the MRLN and the MRLN medial to the caudodorsal mandibular salivary gland. Both approaches provided reliable access to the CCA and cervical lymph nodes. CCA ligation was successfully performed bilaterally in all cadavers, with and without lymphadenectomy. No gross evidence of vascular trauma was observed.

Conclusion: The described approach may be used to minimize intraoperative bleeding in dogs undergoing maxillofacial surgery and may take advantage of planned unilateral or bilateral lymphadenectomy, minimal additional dissection, and elective permanent ligation.

Clinical significance: CCA ligation at the level of the MRLN may provide an adaptable surgical approach to the CCA and cervical lymph nodes in dogs. Further evaluation of this approach in clinical dogs undergoing maxillofacial procedures is warranted to determine potential intraoperative procedural complications.

Objective: To assess long-term outcome, complications, and return to function in horses with maxillofacial fractures.

Study design: Retrospective observational study.

Animals: A total of 30 horses with skull fractures (2020-2024).

Methods: Clinical records were reviewed for signalment, fracture characteristics, imaging, treatment, and hospitalization. Long-term outcome was obtained via structured owner questionnaires addressing healing, complications, cosmetic appearance, and performance. Descriptive statistics were applied.

Results: A total of 29 of 30 horses received treatment (25 surgical, 4 conservative); one was euthanized. A total of 28 fractures were displaced (and 16 involved the frontal bone). Computed tomography was performed in 11 cases. Postoperative median hospitalization after surgery was 11 days (range: 4-57). Sinus lavage during surgery was performed in 22 of 25 surgically treated horses (84%). Median antimicrobial and non-steroidal anti-inflammatory drug (NSAID) administration lasted 15 (range: 4-26) and 8 days (range: 2-24), respectively. Complications included temporary nasal discharge in nine horses (31%) and wound infection in two horses (6.9%). At a median follow-up time of 830 days (range: 142-1754), 28 of the 29 treated horses (96.6%) were successfully recovered. Cosmetic defects were recorded in 22 animals (75.9%). Of the 26 horses with available performance follow-up, all returned to their previous level of use.

Conclusion: Maxillofacial fractures in horses were successfully managed in nearly all cases, with favorable long-term outcomes and minimal impact on performance, despite frequent cosmetic defects.

Clinical significance: With timely treatment and supportive care, maxillofacial equine skull fractures carry an excellent prognosis for healing and return to use.

Objective: To determine the diagnostic performance of standing computed tomographic tenography (CTT) in detecting naturally occurring intrathecal lesions of the superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), manica flexoria (MF), and in identifying palmar/plantar annular ligament (PAL) desmitis and constriction in horses undergoing tenoscopy.

Study design: Retrospective observational study.

Animals: Client-owned horses of various breeds and use, median age of 12.5 years (range: 6-20 years).

Methods: A total of 24 horses with inconclusive ultrasonographic and contrast tenographic examinations were included. All underwent DFTS anesthesia, CTT, and tenoscopy. CTT images were retrospectively evaluated by one ECVDI radiologist and a third-year ECVDI resident, both blinded to tenoscopy findings, reaching a consensus. For each structure within the DFTS (SDFT; DDFT; MF and PAL), lesions were recorded as present or absent. Diagnostic performance of CTT for lesion detection was calculated using tenoscopy as the reference.

Results: CTT demonstrated high overall diagnostic performance, with a sensitivity and specificity of 93% for detecting intrathecal lesions. Identification was improved for lesions of the DDFT (sensitivity: 100%; 12/12; 95% confidence interval [CI]: 51%-97%; specificity 83%; 95% CI: 51%-97%) and MF (sensitivity: 90%; 9/10; 95% CI: 66%-99%; specificity: 93%; 95% CI: 66-99%), compared to the SDFT (sensitivity: 71%; 5/7; 95% CI: 29%-99%; specificity: 94%; 95% CI: 71%-99%) and PAL (sensitivity: 64%; 14/22; 95% CI: 15%-100%; specificity: 100%; 95% CI: 15%-100%).

Conclusion: CTT demonstrated a high diagnostic performance in detecting intrathecal lesions, particularly those involving the DDFT and MF.

Clinical significance: CTT is a valuable advanced imaging modality for evaluating DFTS pathology, particularly when standard imaging techniques do not provide definitive diagnosis.

Objective: To determine short- and long-term outcomes of core decompression combined with autologous bone marrow aspirate concentrate (BMAC) in treating moderate-to-severe refractory distal sesamoid bone (DSB) trabecular pathology in horses.

Study design: Retrospective observational study.

Animals: A total of 21 client-owned Warmblood horses with DSB pathology unresponsive to conservative management.

Methods: Preoperative diagnosis included lameness localization by diagnostic analgesia and magnetic resonance imaging (MRI) confirmation of DSB trabecular pathology. Horses underwent arthroscopic core decompression via the palmar recess of the distal interphalangeal joint followed by intraosseous BMAC injection. Outcomes were assessed clinically and by follow-up radiography and MRI.

Results: No major intraoperative or postoperative complications occurred in any of the 21 operated horses. Nine horses met inclusion criteria for long-term follow-up, which included clinical, radiographic, and MRI assessments at 6 months and up to 18 months postoperatively. At 6 months, six of nine horses (67%) were sound and returned to training. MRI follow-up demonstrated reduced short tau inversion recovery (STIR) hyperintensity and increased T1-weighted signal within the DSB trabecular bone, consistent with a reduction in active trabecular bone pathology. Three horses remained lame with unchanged MRI findings. At 18 months, six horses remained sound, and three returned to their previous or intended performance levels. Radiographic remodeling of cyst-like lesions was evident in three cases.

Conclusion: Core decompression augmented with BMAC was well tolerated with no unexpected complications in this cohort. This approach allowed horses with advanced DSB trabecular pathology refractory to conservative therapy return to function.

Clinical impact: This combined surgical-orthobiologic approach may offer a viable therapeutic option for horses with advanced refractory navicular bone pathology.

Objective: To evaluate functional and histopathologic outcomes of standing selective laryngeal reinnervation using the spinal accessory nerve (SAN) in horses with experimentally induced recurrent laryngeal neuropathy (RLN).

Animals: Five Thoroughbred mares.

Study design: Prospective cohort study.

Methods: The horses underwent left recurrent laryngeal neurectomy followed 8 weeks later by selective laryngeal reinnervation using the SAN. Follow-up evaluations at 4.5, 6, 8, and 12 months included treadmill exercising endoscopy, ultrasonography of intrinsic laryngeal muscles, and percutaneous electrical stimulation of the SAN. Twelve months postoperatively, the horses were euthanized for macroscopic and histopathologic examination of the cricoarytenoideus dorsalis (CAD), cricoarytenoideus lateralis (CAL), sternomandibularis (SM), spinal accessory and recurrent laryngeal nerves.

Results: Twelve months following laryngeal reinnervation, mean left-to-right quotient angle ratio (LRQ) recovered to 94% of predenervation values with no difference from the baseline (95% CI [90, 98]; p = .69). One horse exhibited a slower and incomplete recovery. Post-mortem examination confirmed successful spinal accessory nerve implantation in the left CAD muscle in all horses. Histopathologic examination revealed axonal regeneration of the spinal accessory nerve and reinnervation of the left lateral CAD muscle belly with fiber type grouping and a shift toward an increased proportion of type I fibers consistent with functional reinnervation.

Conclusion: Selective laryngeal reinnervation using the spinal accessory nerve restored functional arytenoid abduction at exercise in 4/5 horses with experimentally induced RLN.

Clinical significance: In horses with RLN and mild to moderate CAD muscle atrophy, selective laryngeal reinnervation using the SAN represents a physiological and effective treatment option.

Objective: To describe a repeated-measures model permitting evaluation of up to four implants intended for maxillofacial applications in sheep.

Animals: Two-year-old Merino wethers (n = 5).

Methods: A retromandibular subparotid approach was developed through anatomical study of  atlases, predissected models and cadaveric experiments. A purpose-designed surgical guide and test miniplates were produced to improve standardization among test implants. Five sheep were monitored for 6 months postoperatively to demonstrate the safety and practicality of the model.

Results: All animals resumed food intake within 5 min of regaining the righting reflex. The only complication consisted of a mild unilateral swelling over the surgical site in two sheep, which resolved spontaneously within 8 weeks.

Conclusion: The approach provided a safe and reliable surgical corridor to the mandibular ramus in sheep. Surgical site swelling should be assessed by ultrasonography to exclude implant involvement. This model may improve standardization and reduce animal numbers in studies evaluating maxillofacial implants.