The Microvascular Carpal Foot Pad Flap: Vascular Anatomy and Surgical Technique

The objectives of the study are to describe the vascular anatomy of the carpal foot pad and to describe the surgical technique for its dissection as a free microvascular flap.

Sixteen front legs from ten different dogs weighing from 20 to 30 kg were used for the study. All of the dogs were euthanatized for reason unrelated to the study. Dissection of the carpal foot pad with its dominant arterial and venous pedicle was performed and angiographic studies were performed by injection of barium sulphate and “high detailed” radiography.

The vascular anatomy of the carpal foot pad was consistent in all of the dogs. The arterial pedicle arises from the caudal interosseous artery and venous drainage is provided by the cephalic vein. A branch of the ulnar nerve parallels the arterial blood supply and may be included in flap dissection. Surgical dissection of the carpal foot pad flap is relatively straight forward. The length and diameter of the arterial and venous pedicle are appropriate for microvascular anastomosis.

The carpal foot pad in the dog represents a viable option for microvascular transfer and reconstruction of weight bearing surfaces.

Cadaveric dissection was used to study the vascular anatomy of the carpal foot pad in dogs and to assess its potential use as a free microvascular flap.

A comparison of skin and muscle for cortical revascularization

The purpose of this project was to compare the ability of skin and muscle to revascularize cortical bone segments in the canine distal limb. A model mimicking severe combined soft tissue and orthopaedic injury with bone devascularization involving the canine metatarsus was developed. Soft tissue defects were reconstructed with a reverse saphenous conduit flap or a free trapezius muscle flap. Cortical bone blood flow was determined by the radiolabeled microsphere method at 21 days post-reconstruction. In addition cortical porosity, the amount of fluorescent labelled intracortical new bone, and the maximum depth of periosteal new bone were determined. Significant differences were not detected between skin and muscle reconstructions for any of the measured parameters of cortical revascularization. The mean values for cortical bone blood flow were higher than expected from previous studies, and did not correlate with subjective assessments of adhesion quality between bone and reconstructive tissue onlay. The reverse saphenous conduit flap, and the free trapezius muscle flap, may respectively provide superior blood supply to underlying bone than local random pattern skin and local pedicled muscle. The reverse saphenous conduit flap has a robust and reliable vascular supply, unlike that to random pattern skin. The free transfer of muscle maintains a vigorous blood supply, and has shown improvements in blood flow over pedicled muscle. Blood flow to both tissue types may be favourably affected by the denervation associated with transfer, causing arteriolar vasodilation and reductions in vascular resistance. In this model, comparable revascularization of cortical bone at 21 days was seen beneath reverse saphenous conduit flaps and free trapezius muscle flaps. However, a role for endosteal revascularization cannot be excluded.

Cortical revascularization by skin and muscle reconstruction was compared at 21 days in a canine metatarsal model. Significant differences in cortical bone blood flow were not detected

Effects of reactant heterogeneity and mixing on catabolite repression in cultures of Saccharomyces cerevisiae

An experimental study was conducted into the effect of reactant heterogeneity on glucose-fed continuous cultures of S. cerevisiae, The heterogeneity was altered by varying mixing intensity in the nutrient entry region within a static mixing device. Experimental results confirm simulation predictions based upon a simple growth model, showing that mixing in the entry region can govern macroscopic culture behavior. Specifically, at high dilution rates, the biomass concentration was reduced by mixing patterns that increased the size of regions where glucose exceeded the threshold for catabolite repression. Because the size of such repressive regions is not uniquely determined by reactant segregation, the authors argue that in biological systems (and others involving a threshold response) an alternative measure of mixing quality should be used. Conclusions are drawn concerning the simulation of biological reactors for design purposes, and the importance of nutrient delivery systems to reactor performance.

Brief ex vivo perfusion with heparinized and/or citrated whole blood enhances tolerance of free muscle flaps to prolonged ischemia

This study investigated the use of heparinized and/or citrated whole blood as a perfusate for enhancing muscle tolerance to warm ischemia. Unilateral cutaneous trunci muscle flaps were harvested from Sprague-Dawley rats and stored for 10 hr at 22-24 degrees C prior to transplantation to the groin. One group served as a non-perfused control. In three experimental groups, the flaps were hand-perfused ex vivo with 1.0 ml of heparinized, citrated, or heparinized and citrated autogenous whole blood at physiological pressures. Perfusion was administered over a 10-min period 5 hr into the ischemic period. Flaps were revascularized on the femoral vessels and then harvested 48 hr following revascularization. Tissue injury was assessed by calculation of flap weight change (indicator of tissue edema), histochemical evaluation of muscle dehydrogenase activity (nitroblue tetrazolium assay), and light microscopy. All perfused groups had significantly higher muscle dehydrogenase activity compared with non-perfused controls (P < 0.005). Perfusion with combined heparin-citrated blood was significantly more protective than perfusion with either anticoagulant alone (P < 0.025). The only statistically significant reduction in percent flap edema was seen in the combined heparin-citrate perfusion of flaps compared with nonperfused controls (P < 0.05). Histologic evaluation confirmed a reduction in tissue edema in the perfused flaps. We conclude that mid-ischemic perfusion with heparinized and/or citrated blood limits the deleterious effects of extended warm ischemia.

Effect of ischemia and reperfusion on neutrophil accumulation in equine microvascular tissue flaps

OBJECTIVE

To investigate neutrophil accumulation after ischemia and reperfusion (IR) in microvascular tissue flaps in horses.

STUDY DESIGN

Randomized controlled experiment.

SAMPLE POPULATION

A total of 8 horses between 1 and 10 years of age, 4 of each sex.

METHODS

Control and experimental myocutaneous island flaps based on the superficial branch of the deep circumflex iliac vessels were dissected on each horse. Atraumatic vascular clamps were applied to the pedicle of the experimental flap for 90 minutes and then removed to allow reperfusion. Based on the assumption that rapid infiltration of neutrophils into affected tissues is a hallmark of IR injury, radiolabeled autogenous leukocytes were used to indirectly quantify neutrophil accumulation in flap tissues. Labeled leukocytes were administered through a jugular catheter 30 minutes before flap reperfusion. Biopsies were collected from each flap over a 6 hour postischemia time period; in group 1 (n = 4) from 0 to 6 hours postischemia, and in group 2 (n = 4) from 24 to 30 hours postischemia. Biopsies were examined scintigraphically and histologically for evidence of neutrophil infiltration.

RESULTS

All control flaps survived and 6 of 8 experimental flaps survived. There was no significant evidence of acute neutrophil infiltration into flap tissues after reperfusion in either group.

CONCLUSIONS

The results of this study suggest that equine myocutaneous flap tissues can survive a 90-minute ischemic period and reperfusion. No significant evidence of the occurrence of IR injury in flap tissues was found.

CLINICAL RELEVANCE

The reasons for the previously reported failures of equine free tissue transfer remain uncertain, but they do not appear to be caused by neutrophil mediated injury associated with ischemia and reperfusion.

Microvascular free tissue transfer: results in 57 consecutive cases

OBJECTIVE

To evaluate the outcomes and complications in a consecutive series of animals undergoing microvascular reconstructive procedures at two veterinary institutions.

STUDY DESIGN

Retrospective study.

ANIMALS OR SAMPLE POPULATION

A total of 44 client-owned dogs and one red-necked wallaby.

METHODS

The medical records of all animals undergoing reconstructive microsurgical procedures at the Western College of Veterinary Medicine and Michigan State University were reviewed. Microvascular flap survival and related complications were described. Statistical analysis was performed to determine the significance of relationships between operative factors and outcome.

RESULTS

A total of 57 microvascular procedures were performed on 55 animals. Reconstruction was required after trauma in 42 animals, after ablative cancer surgery in 11 animals and for correction of congenital tissue aplasia in I animal. Donor tissues included the superficial cervical cutaneous, medial saphenous fasciocutaneous or musculofasciocutaneous, caudal superficial epigastric cutaneous, trapezius muscle or musculocutaneous, caudal sartorius muscle, latissimus dorsi muscle or musculocutaneous, cranial abdominal myoperitoneal, carpal footpad, digital footpad, and vascularized ulnar bone flaps. A total of 53 of 57 flaps (93%) survived. There was a significant relationship between flap failure and level of assistant surgeon experience (P < .05). Latissimus dorsi flaps were significantly more likely to fail when compared with pooled data from all other flap types (P < .01).

CONCLUSIONS

The success of microvascular tissue transfer in this case series compares favorably with those reported in human reconstructive microsurgery. Both the primary and assistant surgeon should be practiced in microsurgical technique. Failure of latissimus dorsi flaps was not likely caused by an inherently deficient flap design, but was more likely attributed to the location and severity of trauma at the recipient site, the difficulty in isolating suitable recipient vessels for anastomosis or the absence of a trained assistant surgeon during these procedures. Clinical Relevance-This retrospective study documents the successful application of microvascular technique in a series of clinical cases requiring tissue reconstruction.

Open-heart correction of tetralogy of Fallot in an acyanotic dog

Tetralogy of Fallot was diagnosed in an acyanotic 11-month-old dog. Predicted pressure gradient across the pulmonic valve, as assessed by use of continuous wave Doppler echocardiography, was 94.5 mm Hg. Bidirectional shunting was identified by means of selective angiography. Open-heart correction was performed, using a transatrial approach with limited ventriculotomy and cardiopulmonary bypass. The hypertrophied infundibulum was resected, the ventricular septal defect was closed primarily, and a transannular pericardial patch graft was applied. Pressure gradients across the pulmonic valve were 52.9 and 22.8 mm Hg 2 weeks and 4 months after surgery, respectively. Advances in cardiopulmonary bypass, anesthetic management, and use of the transatrial approach may improve the success of open-heart correction of tetralogy of Fallot in dogs.

Deep hypothermic low flow cardiopulmonary bypass in small dogs

OBJECTIVE

To evaluate the feasibility of and morbidity and mortality associated with cardiopulmonary bypass (CPB) using deep hypothermia and low flow perfusion in adult dogs weighing less than 10 kg.

STUDY DESIGN

Prospective, descriptive study.

ANIMALS

Two groups of three dogs underwent CPB. Group 1 dogs underwent deep hypothermia (15 to 18 degrees C), 45 minutes of low perfusion flow (20 mL/kg/min) and 1 hour of aortic cross clamp time. In group 2, ultrafiltration of perfusate before discontinuation of bypass was added to the standard treatment. Complete blood counts, serum biochemistry, urine output, ejection fraction, and cardiac output were monitored before and for 7 days after surgery.

RESULTS

All dogs were successfully weaned from bypass. Four of six dogs survived, three without major complications. One dog developed and recovered from septic pleuritis. Two dogs died or were euthanatized after surgery because of respiratory or gastrointestinal complications. Minor complications included anemia, hypoproteinemia, and electrolyte disturbances. Transfusion requirements and edema formation were reduced by ultrafiltration.

CONCLUSIONS

The observations in this study support the feasibility of low flow hypothermic CPB. Meticulous tissue handling, precise equipment, ultrafiltration, and aggressive postoperative potassium supplementation are recommended for smaller patients.

CLINICAL RELEVANCE

Increased sensitivity to adverse sequelae of CPB may be associated with small patient size. Further evaluation is necessary before routine clinical application of low flow hypothermic CPB in this patient population.

Focal myasthenia gravis as a paraneoplastic syndrome of canine thymoma: improvement following thymectomy

A 10-year-old, neutered male cocker spaniel-cross experienced regurgitation, dry retching, and weight loss. A large, mediastinal mass and dilatation of the esophagus were seen on thoracic radiographs. Cytological, histopathological, immunohistochemical, and serological findings were consistent with a lymphoepithelial thymoma and focal, esophageal myasthenia gravis. Surgical removal of the mass resulted in rapid resolution of the megaesophagus and a decrease in serum acetylcholine-receptor antibody concentration. The dog was clinically normal until the thymoma recurred six months postoperatively. Clinical signs, diagnostic evaluation, management, and treatment of a dog with thymoma and megaesophagus are described.

Development of a free latissimus dorsi muscle flap in cats

Anatomic and experimental evaluation of the feline latissimus dorsi muscle was performed to assess its potential use as a free muscle flap. In the anatomic study, nonselective angiography of the subscapular artery was performed in nine heparinized feline cadavers. The muscle dimensions and vascular anatomy of the dissected latissimus dorsi muscle were recorded. In the experimental study four cats underwent heterotopic transplantation of a partial latissimus dorsi flap, and three cats underwent orthotopic transplantation of a complete latissimus dorsi flap. The mean length and width of the latissimus dorsi muscle was 19.0 and 5.4 cm, respectively. The dominant vascular pedicle was the thoracodorsal artery and vein. The average length and diameter of the thoracodorsal artery was 2.7 cm and 0.6 mm, respectively. Minor vascular pedicles were provided by branches of the intercostal arteries. Numerous choke anastomoses existed between the two pedicle systems. Viability of muscle flaps based on subjective evaluation, angiography, and histopathology, was 66% and 100% in the heterotopic and orthotopic studies, respectively. Flap failure seemed to be caused by both arterial and venous thrombosis. The latissimus dorsi muscle flap met criteria required for application in microvascular reconstruction. The vascular pattern was appropriate and consistent. Donor site morbidity was low, whereas surgical accessibility was high. The muscle satisfied the physical criteria of a free flap. Long-term anastomotic patency and flap viability was shown.

Arthrodesis of the scapulohumeral joint in a horse

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Intravascular heparin protects muscle flaps from ischemia/reperfusion injury

Heparin has been found to decrease ischemia/reperfusion injury in skeletal muscle and other tissue/organ systems. The timing of heparin administration to the muscle vasculature has not been explored. We investigated the use of heparinized blood as a washout solution during ischemia to reduce ischemia/reperfusion injury. A rat cutaneous maximus muscle free flap was subjected to a 10-hr period of room temperature ischemia, then was heterotopically transplanted to the groin via microsurgical revascularization to the femoral vessels. In three experimental groups, flaps were subjected to brief ex vivo perfusion with autologous heparinized blood, at 2, 5, or 8 hr into the 10-hr ischemic interval. In the two other groups, the flaps were not perfused, and the animals were systemically heparinized either before ischemia or before transplantation, respectively. A control group underwent no flap perfusion or systemic heparinization. After transplantation, flaps were given a 48-hr period of in vivo reperfusion, then were harvested for evaluation. Flaps undergoing ex vivo perfusion or preischemic heparinization had no significant differences in weight gain (edema) compared with flaps receiving posttransplant heparinization or no heparinization (controls). The dehydrogenase staining of muscle biopsies was significantly faster (indicative of viable tissue) for perfused flaps and the flaps for which the animals received preischemic heparinization, when compared with flaps for which the animals received posttransplant heparinization or no heparinization. From these results, we conclude that heparin offers protection from ischemia/reperfusion injury when it can be introduced into the vascular network either prior to or during the ischemia period. These findings suggest the possibility of using heparinized washout solutions to enhance survival in amputated extremities.

Short-term response of epiphyseal plate cell populations following selective devascularization and microsurgical revascularization

The distal femoral epiphyseal plates of 21 8-week-old New Zealand white rabbits were totally or partially (nutrient artery only) devascularized, or devascularized and then microsurgically revascularized. Sacrifice was at 24, 48 or 72 hours postoperatively. The heights of the proliferative and hypertrophic zones of the epiphyseal plates operated upon were compared with the contralateral control epiphyseal plates for both the central and the peripheral regions of the epiphyseal plate. Neither extent of devascularization nor revascularization had a significant effect on the height of the proliferative zone of chondrocytes at any of the follow-up intervals. Selective devascularization of the nutrient artery led to a significant increase in height of the central region of the hypertrophic zone of chondrocytes at 48 and 72 hours. Microsurgical revascularization did not lead to a significant change in the height of either the central or the peripheral regions of the hypertrophic zone of chondrocytes at any of the follow-up intervals. This study is another 'building block' experiment toward vascularized epiphyseal plate transplantation in humans.

The trapezius osteomusculocutaneous flap in dogs

A pedicled osteomusculocutaneous flap, composed of the cervical part of the trapezius muscle with its overlying skin and the central spine and body of the scapula, was elevated on the prescapular branch of the superficial cervical vascular pedicle in four dogs. The flap was replaced in an orthotopic location. Bone viability was evaluated using histology, fluorescence bone labeling, and angiography. Bone from the scapular spines had a high percentage of viable osteocytes, positive fluorescence, and vessels were outlined in the angiographic study. Bone from the body of the scapula was not viable based on similar criteria.

Immunoscintigraphic detection of primary and metastatic spontaneous canine osteosarcoma with F(ab')2 fragments of osteosarcoma-associated monoclonal antibody TP-1

Monoclonal antibody TP-1 has been shown to bind selectively to human and canine osteosarcoma cells in vitro using immunohistochemical stains. This report describes the in vivo administration of radioiodinated F(ab')2 fragments of monoclonal antibody TP-1 in dogs with primary and/or metastatic spontaneous osteosarcoma. Two dogs were injected with 131labeled F(ab')2 TP-1 and two dogs were injected with 123labeled antibody fragments. Immunoscintigraphy successfully demonstrated the radiolabeled antibody fragments in 6/6 known primary or metastatic lesions and in addition detected 4 metastatic lesions not diagnosed by conventional radiographs. Concurrent imaging of 99mTc labeled autologous erythrocytes in two dogs confirmed that the accumulation of radiolabeled antibody fragments was independent of the blood pool. There was no immunoscintigraphic evidence of localization of radioiodine to normal organs or tissues other than those expected to accumulate free iodine. The present study has demonstrated the potential of monoclonal antibody TP-1 F(ab')2 fragments for early detection of metastatic spread of spontaneous osteosarcoma.

The anatomic basis for a trapezius muscle flap in dogs

The anatomy of the cervical part of the trapezius muscle and its dominant vascular supply, the prescapular branch of the superficial cervical artery, was studied by dissection and selective angiography of 16 canine cadavers. The prescapular branch of the superficial cervical artery supplies blood to the skin of the caudal half of the neck and the cervical part of the trapezius muscle and is a minor contributor to other muscles of the neck. In these dogs, the mean length of the vascular pedicles was 4.4 cm and the mean diameter was 1.0 mm. With this information, it is possible to design a broad musculocutaneous flap suitable for reconstructive microsurgery in dogs. The potential for successful incorporation of the scapular spine in such a flap remains uncertain.

Free microvascular transplantation of the trapezius musculocutaneous flap in dogs

A musculocutaneous flap based on the prescapular branch of the superficial cervical artery and including the cervical part of the trapezius muscle and overlying skin was transplanted over a defect created on the medial side of the contralateral tibia in four dogs by using microvascular technique. The donor and recipient sites in three dogs were examined clinically for 21 days, after which they were examined angiographically and histologically. All dogs were free of lameness by hour 48. Seromas formed at the donor site between days 7 and 15. One vascular pedicle was traumatized at hour 40, and the dog was euthanatized. Three flaps survived with minimal necrosis. Edema of the flaps was severe from days 5 to 11. Angiograms showed complete perfusion of the flaps, and survival was confirmed histologically. Esthetic appearance and function were good in one dog at month 7.

Colonic stricture after ovariohysterectomy in two cats

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Physiologic alteration of fibrinogen levels: influence upon patency of microvenous anastomoses

High baseline levels of plasma fibrinogen have been correlated with increased risk for cardiovascular disease. Since fibrinogen plays a central role in both coagulation and platelet aggregation and is a primary component of thrombi, this study was designed to assess the relationship of circulating fibrinogen concentration and vein anastomotic patency. Subcutaneously injected turpentine was used to increase, and intravenous ancrod (snake venom) to decrease, plasma fibrinogen levels. Rat femoral vein anastomoses were performed, and patency was assessed after 120 min of flow. Rat tail bleeding times were obtained, and blood samples were drawn to determine fibrinogen and plasma protein concentrations, Lee-White clotting times, and activated partial thromboplastin times (APTT). Increased patency was found in the ancrod group (88%) (P < 0.05 vs. controls); turpentine-treated and control groups were not significantly different (71% and 63%, respectively). The ancrod group also showed significantly prolonged tail bleeding times and APTT. Fibrinogen levels were significantly decreased in the ancrod group (1.73 mg/ml) and elevated in the turpentine group (4.91 mg/ml) vs. controls (2.34 mg/ml; P < 0.005). These results indicate that elevated fibrinogen levels, in particular when triggered by an acute-phase response, do not appear to predispose small vessel repairs toward thrombosis. Furthermore, this study supports the use of ancrod as an anticoagulant for microvascular surgery.

Metabolic behavior of immobilized aggregates of Escherichia coli under conditions of varying mechanical stress

Experiments were conducted on immobilized aggregates of Escherichia coli cells. Mechanical stress was applied by forcing a convective stream of nutrient medium through the aggregate. It was shown to be possible to maintain uniform exponential growth with this convective supply of nutrients. Analysis of effluent from the system allowed investigation of metabolic responses unambiguously attributable to mechanical stress. A reversible increase in catabolic activity was observed after an increase in mechanical stress. Changes in the level of catabolism were accompanied by an alteration in the total acid yield on glucose and in the spectrum of organic acids produced during glucose fermentation. The behavior observed here was likely due to an osmoregulatory response induced by the mechanically stressed bacteria to counteract changes in shape.

Axial pattern skin flaps in cats

The major direct cutaneous vessels identified in the cat include the omocervical, thoracodorsal, deep circumflex iliac, and caudal superficial epigastric arteries. Axial pattern skin flaps based on the thoracodorsal and caudal superficial epigastric arteries have been developed in cats. Rotation of these flaps as islands allows skin coverage to the carpus and metatarsus, respectively. The thoracodorsal and caudal superficial epigastric flaps provide a practical, one-step option in the reconstruction of large skin defects involving the distal extremities of cats.

Free tissue transfer of digital food pads for reconstruction of the distal limb in the dog

Reconstructive procedures used in salvaging distal limb injuries in the dog are reviewed. Techniques employed to resurface the distal weight-bearing surface include local reconstruction using pedicle flap transposition of foot pads. The development of a previously described free microneurovascular digital foot pad flap is reviewed; the experimental results and potential for clinical use of the free flap are discussed.

Experimental and clinical free cutaneous transfers in the dog

Various reconstructive techniques have been applied to the management of difficult wounds in the dog. Wounds in the distal extremities and on the face are hard to manage by conventional methods. A free cutaneous flap, based on the superficial cervical vessels, was developed and used in a series of experimental and clinical cases. Six of eight experimental orthotopic transfers survived. The two failures were thought to be related to technical error. The seven flaps, used in clinical cases, all survived and successfully resolved the dogs' clinical problems.

Hydraulic Permeability of Immobilized Bacterial Cell Aggregates

A dense aggregate of cells was retained in a reactor by a supported porous membrane. A continuous flow of nutrient medium was maintained through the cell aggregate and membrane. The hydraulic resistance of the cell aggregate was monitored throughout experiments with either growing or chemically cross-linked cells, under conditions of varying flow rates. Digital image analysis was used to characterize the sizes, separations, and orientations of several thousand individual cells in electron micrographs of chemically cross-linked cell aggregates. Two nonlinear phenomena were observed. First, the hydraulic resistance varied in direct relation to and reversibly with flow rate. Second, in constant flow-rate experiments the hydraulic resistance increased with time at a faster rate than could be attributed to cell growth. Both of these phenomena were dependent upon and could be explained by the ability of cells to move with respect to one another, under the influences of Brownian motion and of convection. Such relative motion could allow changes in net alignment of cells in the direction of flow and in the volume fraction of cells in the aggregate. This explanation is consistent with image analysis data. The observed sensitivity of hydraulic resistance to flow rate was inconsistent with a model that assumed elastic deformation of individual cells, and no evidence of cell deformation was found in electron micrographs.

Microsurgical free bone transfer in the dog

Bone grafts have been used extensively for the reconstruction of skeletal injury in dogs. Cancellous and corticocancellous chip autografts are used for their osteoinductive and osteoconductive properties. Fresh, fresh-frozen, freeze-dried, and ethylene oxide-sterilized cortical allografts have been recommended for the reconstruction of segmental cortical defects. Donor sites for microsurgical bone transfer have been identified experimentally in the dog, but these remain to be used clinically. This paper reviews the anatomy and structural characteristics of donor sites for microsurgical bone transfer. Potential clinical indications for microsurgical bone transfer in the dog are described.

Applications of microvascular surgery

The advent of microvascular surgery has radically changed the discipline of human reconstructive surgery over the last decade. The ability to anastomose vessels less than 1 mm in diameter allows the distant transfer of tissues with a known blood supply from one area of the body to another. These tissues can be detached from their local blood supply and reperfused by anastomosing vessels supplying the tissue transfer to vessels near the recipient site. This technique has been used to transfer a variety of tissues and combinations of tissues including skin, muscle, bone, and bowel to solve a variety of difficult reconstructive problems. Applications, potential applications, and problems associated with microvascular free tissue transfer will be discussed in this chapter.

Unilateral stylohyoid disarticulation as a cause of dysphagia in a dog

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Microneurovascular free digital pad transfer in the dog

By cadaver dissections, the fifth digit of the canine hind limb was determined to have a consistent neurovascular anatomy, and therefore be a suitable donor for an axial pattern digital pad flap. The defined digital pad flap was transferred to the region of an excised metacarpal pad by microneurovascular anastomoses in five operations on four dogs. One flap failure was considered to result from failure of the venous anastomosis. In all four successful transfers, cutaneous sensation was reestablished on average in 78 days. There was histologic evidence of nerve regeneration across the anastomosis in one dog at week 24. The transferred pads of three dogs monitored for 15 months underwent hypertrophic changes. There were no complications in two active dogs. In one dog, superficial ulceration of a region of the flap adjacent to the pad required surgical revision. This dog continued to show mild lameness after daily runs of 3 to 4 km.

Acute and short-term toxicoses associated with the administration of doxorubicin to dogs with malignant tumors

One hundred eighty-five dogs with histologically confirmed, measurable malignant tumors were used in a study to determine the toxicity of the anthracycline antitumor antibiotic, doxorubicin, which was administered once or twice (at a 21-day interval) at the rate of 30 mg/m2 of body surface area, iv. During this study, 7 dogs died as a direct result of doxorubicin-induced toxicosis and 16 died as a direct result of the malignant neoplastic disease. Each dog was evaluated for signs of toxicosis for 3 weeks after the last dose was administered (15 dogs received 1 dose, 170 dogs received 2 doses) or until the dog died, whichever came first. The most common signs of toxicosis were vomiting, diarrhea, colitis, anorexia, and pruritus. The probability of doxorubicin-induced toxicosis decreased significantly (P less than 0.0001) in inverse relationship to body weight. Dogs with signs of toxicosis during the 21-day interval from administration of the first dose of doxorubicin were 17.2 times (P less than 0.01; 95% confidence interval; 5.5, 54.2) more likely to develop signs of toxicosis during the 21-day interval from the second dose of doxorubicin. The performance status of each dog was evaluated using a modified Karnofsky performance scheme; the only time the performance status was adversely affected to a significant extent by doxorubicin-induced toxicosis was during the 21-day period, starting with the second dose (P less than 0.0001).

Phase II evaluation of doxorubicin for treatment of various canine neoplasms

One hundred eighty-five dogs with histologically confirmed, measurable malignant tumors were used in a prospective study to determine the response to 2 doses of the anthracycline antitumor antibiotic, doxorubicin. Eighty-three dogs had been refractory to one or more previous treatment modalities (surgery, n = 54; chemotherapy, n = 22; radiation, n = 10; hyperthermia, n = 1; biological response modifier, n = 1). The extent of neoplastic disease was determined immediately prior to and 3 weeks after 2 doses of doxorubicin were administered (30 mg/m2 of body surface area, iv) 21 days apart. Eighty-four percent (n = 157) of the dogs received 2 doses of doxorubicin and were evaluated. Of the 28 dogs ruled ineligible, 4 had serious side effects to the first dose of doxorubicin, and 24 others acquired complications resulting from their malignant tumors. A partial or complete remission was obtained in 41% (64/157) of all evaluable dogs: 26% (11/43) of the dogs with carcinoma, 67% (42/63) of the dogs with lymphoma, and 22% (11/51) of the dogs with sarcoma. Tumors in which there was at least a 50% volume reduction (partial or complete remission) included malignant lymphoma (42/63), fibrosarcoma (1/14), solid follicular thyroid carcinoma (3/13), mammary adenocarcinoma (2/8), hemangiosarcoma (2/8), osteosarcoma (1/6), circumanal carcinoma (3/5), synovial cell sarcoma (2/3), undifferentiated sarcoma (2/3), nasal adenocarcinoma (1/2), liposarcoma (1/2), infiltrating lipoma (1/1), malignant melanoma (1/1), sclerosing mesothelioma (1/1), and neurofibrosarcoma (1/2).(ABSTRACT TRUNCATED AT 250 WORDS)

Medical and surgical management of aortic stenosis in a dog

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Classification of primary lung tumors in dogs: 210 cases (1975-1985)

Two hundred ten dogs that had primary lung tumors diagnosed between 1975 and 1985 were evaluated. The majority of the tumors were classified as adenocarcinoma (74.8%) and alveolar carcinoma (20%). The most common clinical signs of disease were cough (52%), dyspnea (23.8%), lethargy (18.1%), weight loss (12.4%), and tachypnea (4.8%). The clinical methods that were most successful in directly or indirectly leading to a diagnosis of primary lung tumor were thoracic radiography (77.1%) and cytologic examination of fine-needle aspirate specimens (24.8%).

Prognostic factors for tumor remission and survival in dogs after surgery for primary lung tumor: 76 cases (1975-1985)

The association of various prognostic factors with remission and survival after the excision of lung tumors was evaluated in 76 dogs. Overall, the median survival time of treated dogs was 120 days; 72% had tumor that underwent remission (median duration of remission, 120 days). Dogs with tumors that underwent remission had significantly (P = 0.001) increased survival time (median, 330 days vs 28 days for dogs with tumors that did not undergo remission). The finding of normal-sized lymph nodes at the time of therapeutic thoracotomy was significantly (P = 0.001) correlated with increased remission probability (85.4% remission rate vs 43.6% in dogs with large lymph nodes). Use of various diagnostic methods to find normal regional lymph nodes before surgery indicated that such finding was significantly (P less than or equal to 0.01) correlated with increased remission duration (median remission duration, 365 days, vs 60 days for tumors in dogs with large lymph nodes), and the finding of normal lymph nodes at the time of surgery was significantly (P less than or equal to 0.01) correlated with increased survival time (median, 345 days, vs 60 days for dogs with large lymph nodes).

Unsuccessful surgical repair of a short soft palate in a dog

An 8-week-old male Miniature Schnauzer had nasal discharge of milk, food, and water since birth, especially during eating. Examination of the oral cavity revealed a short soft palate. Numerous unsuccessful surgical procedures were performed to construct a shelf of tissue to prevent oronasal reflux. The dog was euthanatized.

A developmental model for free vascularized bone transfers in the dog

An autogenous free vascular bone transfer using a segment of ulna along with its periosteum and vascular pedicle was developed. The vascular pedicle, based on the common interosseous artery and vein, emerged where muscular branches from the cranial interosseous artery enter the extensor carpi ulnaris and lateral digital extensor muscles. Four autogenous heterotopic (ulna to tibia) vascular transfers by microvascular anastomosis and two avascular transfers were performed to compare the osteogenic potential and viability of free revascularized grafts with avascular bone grafts. Successful microvascular anastomosis was demonstrated in three of the four vascular transfers by early bone scanning using technetium-labeled polyphosphate. Radiographically, there was more periosteal new bone and callus formation in the successfully revascularized bone transfers than in the failed vascular transfer and the avascular controls. Histologically, viable bone with an intact medullary and periosteal vascular supply was recognized in the grafts successfully revascularized by microvascular anastomosis.

Transfer of free vascular cutaneous flaps by microvascular anastomosis. Results in six dogs

Skin defects on the distal extremities of six dogs were reconstructed with free vascular cutaneous transfers by microvascular anastomosis. The donor flaps were based on the superficial cervical artery and vein. In five of the dogs, bone was exposed and skin was lost from half of the circumference of the limb. Two had infected fractures with sequestra and three had acute shearing injuries. The sixth dog had sensory denervation of the left antebrachium and a carpal acral lick granuloma. Before surgery, the patency of potential recipient vessels was confirmed with arteriography in five dogs and an ultrasonic doppler in one dog. Microvascular technique was used to reestablish circulation to the flaps after they were transferred to the recipient site. Total ischemic time of the flaps averaged 100 minutes. All flaps survived. Successful reconstruction of the cutaneous defects was achieved in these six cases.

Conservative versus surgical management of gastrointestinal linear foreign bodies in the cat

Twenty-four cases of gastrointestinal linear foreign bodies (LFB) in cats were reviewed. Nine cats were successfully managed conservatively, with passage of the LFB occurring 1 to 3 days after presentation. Ten cats that were initially managed conservatively were subsequently treated surgically. The decision to operate was based on worsening of clinical signs and failure to pass the LFB. Five cats were initially treated surgically. The cats that were managed successfully via conservative treatment had a shorter duration of clinical signs before presentation, decreased incidence of abdominal pain and palpable intestinal plication, and less severe hematologic abnormalities. Radiographic signs were of little benefit in deciding whether to treat the cats conservatively or surgically. None of the cats died.

Proximal urethral reconstruction using a distally based ventral bladder tube flap. An experimental study

Reconstruction of the proximal urethra using a distally based tube flap mobilized from the ventral bladder wall was performed on 12 clinically normal dogs after total prostatectomy and resection of 2 cm of membranous urethra. One dog was euthanized at 6 hours and one at 36 hours after surgery because of surgical complications. Five dogs were euthanized at 10 days, two dogs at 6 weeks and three dogs at 12 weeks. Advancement of the tube flap allowed for tension-free anastomosis to the membranous urethra. Vascular integrity was maintained in all flaps. Intermittent to continuous postoperative urinary incontinence occurred in 7 of 10 dogs. The incontinence was transient in all 6 and 12 week dogs except one in which a persistent stress incontinence developed. Mild to severe dysuria was noted in 8 of 10 dogs, but was also transient in all of the 6 and 12 week dogs, with the exception of one dog. Postoperative urethral closure pressure profilometry revealed decreased tone in the membranous urethra in all 6 and 12 week dogs. It was concluded that proximal urethral reconstruction, using a ventral bladder tube flap, is a viable technique that may permit functional urodynamic recovery in dogs with significant proximal urethral loss.

Multiple cutaneous mast cell tumors in a dog: a case report and brief review

A spayed female yellow Labrador Retriever was presented to the small animal clinic at the Western College of Veterinary Medicine with an ulcerated, draining mass on the caudal aspect of the right thigh. Multiple small, hairless masses were also present on the thorax and in the flank folds. Fine-needle aspiration and cytological examination revealed well-differentiated mast cells and numerous eosinophils. A diagnosis of multiple cutaneous mast cell tumors was made. The clinical and cytological findings of this case are discussed, as well as the treatment and prognosis for mast cell tumors in general.

Ovarian dysgerminoma in a bitch

A nine year old Terrier-Chihuahua crossbred bitch was presented to the Western College of Veterinary Medicine with a history of anorexia, vomiting and diarrhea. A palpably enlarged uterus and purulent vaginal discharge were found on physical examination. Pyometra was diagnosed and ovariohysterectomy was subsequently performed. One ovary was twice the size of the other, firm and mottled grey-white on the cut surface. A dysgerminoma involving the larger ovary was diagnosed on histological examination. This tumor, closely resembling the male seminoma, was characterized by a uniform population of large round cells with scant acidophilic cytoplasm, frequent mitotic figures and focal aggregates of lymphocytes. History and clinical signs were considered to relate to the pyometra rather than the dysgerminoma. No conclusions could be made regarding hormonal elaboration by the tumor because sex hormone levels were not measured. Two years following discharge the dog was reported to be well.