Case Description—A 1-year-old castrated male German Shepherd Dog was evaluated because of a history of hematuria and stranguria secondary to recurrent urinary tract infections.
Clinical Findings—Physical examination revealed hypospadias with penile and preputial aplasia. The urethral orifice was just ventral to the ventral aspect of the anocutaneous junction. Ascending urinary tract infections, secondary to fecal contamination of the urethral orifice, were the presumed source of recurrent bouts of cystitis that developed despite periodic antimicrobial treatment.
Treatment and Outcome—A 1-cm-diameter urethral extension was constructed from the urethral mucosal remnant located along the midline of the perineum (urethral trough). Two parallel 4-cm incisions (3 cm apart) were made lateral to that urethral trough. The borders were sutured to form an inverted, epithelium-lined tube (bipedicled flap) attached to the dorsal urethral orifice. The lateral skin margins were sutured over the reconstructed urethral extension, completing the procedure. Postoperative swelling necessitated temporary catheterization of the urinary bladder. After closure of a small fistula from the reconstructed urethral segment, the dog subsequently had only 2 episodes of cystitis during a 3-year period. To minimize skin irritation secondary to urine exposure, the dog's owner regularly trimmed the hair around the new urethral orifice.
Clinical Relevance—In dogs, correction of perineal (subanal) hypospadias via urethral reconstruction should be considered among treatment options. By use of an inverse tubed urethral extension, direct fecal contamination to the lower urinary tract may be effectively eliminated, dramatically reducing the incidence of ascending urinary tract infections in dogs with hypospadias.
Case Description—4 large-breed dogs were referred because of nonhealing skin wounds involving the elbow joint area of several weeks to months in duration. One additional large-breed dog was evaluated because of a draining abscess with overlying skin necrosis.
Clinical Findings—Previous attempts at closing each wound over the elbow joint area had been unsuccessful. At the time of hospital admission, open wounds had variable degrees of bacterial contamination and infection.
Treatment and Outcome—Open wounds over the elbow joint area were closed by use of bipedicle advancement flaps or direct suture apposition of opposing sides of the wound. Lengths of pipe insulation were applied to the forelimb in a fashion to prevent contact pressure to the olecranon for a prolonged period (4 to 13 weeks) after surgery. All wounds healed completely. Release incisions (donor areas) healed by second intention within 3 weeks after surgery. One dog developed periostitis of the olecranon, which responded to antimicrobial administration. A second dog developed a skin bacterial infection below the surgical area that was markedly resistant to antimicrobials.
Clinical Relevance—The layered application of commercially available foam pipe insulation provided a simple and economical protective device after closure of problematic skin wounds involving the elbow joint area. Prolonged protection of the olecranon area helped to assure healing was complete and skin coverage was sufficiently stable to reduce the risk of reinjury after removal of the device. Each patient was able to use the involved forelimb during the treatment period. Paired bipedicle advancement flaps (release incisions) were particularly useful for closing small to moderate defects overlying the olecranon in which simple apposition was not feasible.
An 18-year-old domestic medium-hair cat (cat 1) and a 16-year-old domestic shorthair cat (cat 2) were evaluated because of obstructive skin lesions involving the perimeter of the left external auditory canal.
Otitis externa was present in affected ears secondary to obstructive soft tissue growths involving the outer margin of the external auditory canal and outer third of the vertical ear canal. Histologic examination of a preoperative biopsy sample revealed multiple ulcerated ceruminous gland adenomas in the affected ear of cat 1. Histologic examination of the submitted tissue from cat 2 confirmed ceruminous cystomatosis with surface colonization of yeast compatible with Malassezia spp.
TREATMENT AND OUTCOME
Both cats underwent partial resection of the upper third of the affected vertical ear canal and associated diseased skin. The incised margin of the pinna was sutured to the margin of the remaining portion of the vertical ear canal with absorbable sutures. Both cats were disease free over a 12-month (cat 1) or 10-month (cat 2) follow-up period. Cat 1 later developed a small ceruminous gland adenocarcinoma in the adjacent rostrolateral margin of the vertical ear canal 1 year after surgery; the mass was resected, and the patient was free of recurrence 4 months later.
Partial resection was an effective alternative to complete vertical ear canal resection for lesions involving the upper third of the vertical ear canal in these cats; the partial resection procedure was deemed simpler to perform and less traumatic to the cat. Functional and cosmetic results were excellent, with preservation of the overall anatomy of the external auditory canal.
Case Description—5 dogs (a Newfoundland, Golden Retriever, Shiba Inu, Staffordshire Terrier, and Vizsla) were referred for evaluation and treatment of unilateral aural hematomas within a week after their formation.
Clinical Findings—Aural hematomas involved the left (3) or right (2) ears.
Treatment and Outcome—With patients under anesthesia, the aural hematomas were approached surgically from the convex, or lateral, pinnal surface. Two small incisions were used to position a vacuum drain into the incised hematoma cavity. The drain exited at the base of the pinna and adjacent cervical skin. The free end of the drain was attached to a vacuum reservoir for 18 to 21 days. Drains and skin sutures were removed at this time along with the protective Elizabethan collar. All hematomas resolved and surgical sites healed during the minimum 6-month follow-up period. Cosmetic results were considered excellent in 4 of 5 patients. Slight wrinkling of the pinna in 1 patient resulted from asymmetric enlargement of the cartilaginous walls of the hematoma, where vacuum application resulted in a slight folding of the redundant lateral cartilage wall.
Clinical Relevance—The described treatment was efficient, economical, and minimally invasive and required no bandaging or wound care. Placement of the drain tubing on the convex (lateral) aspect sheltered the system from displacement by patients with an Elizabethan collar in place. Overall cosmetic results were excellent; asymmetric enlargement of the cartilaginous walls of the hematoma with slight folding of the pinna was seen in 1 patient.
To describe the author’s surgical guidelines for the effective use of a modified von Langenbeck technique, utilizing bilateral bipedicle mucoperiosteal flaps in the dog.
12 client-owned dogs with cleft palate defects of the hard and soft palates.
12 dogs with cleft palate were presented to the Angell Animal Medical Center from May 20, 2015, to March 24, 2022. The patient’s ages ranged from 5 months to 3 years. All 12 dogs had closure of the hard palate clefts by use of modifications of the original von Langenbeck technique in this prospective study.
Successful closure of the cleft (hard and soft) palate defects was achieved in all 12 dogs in a single surgical procedure. A small residual opening was noted at the level of the incisive papilla in each dog; this was of no clinical consequence in this report.
The von Langenbeck technique, using the simple closure modifications reported, was effective in closing both narrow and wide defects. Successful execution requires the complete elevation of each flap, which facilitates their tension-free advancement over the palatal cleft. Vertical mattress sutures evert the flap margins, allowing for direct collagen surface contact for proper healing. Placement of sutures in the rugal folds increases the tissue purchase to reduce the risk of suture cut-out. Fine interrupted sutures, placed between the vertical mattress sutures, maintains the proper alignment of the incisional margins. The author waits a minimum of 5 months before closing cleft palate defects, enabling the donor areas time to mature and improving their ability to retain sutures more effectively.
Case Description—A 1.4-year-old sexually intact male Standard Poodle was evaluated with a history of urinating on its left forelimb and lower portion of the thorax.
Clinical Findings—Physical examination revealed that the dog had an unusually elevated (tucked) abdominal wall and prominent dome-shaped thoracic wall. These anatomic changes altered the angle of the urine stream, resulting in the dog's soiling the xiphoid region of the thorax and left forelimb.
Treatment and Outcome—The dorsal half of the preputial ostium was closed surgically to divert the urine stream in a ventral direction. The ventral portion of the ostium was reciprocally enlarged. Postoperatively, the dog urinated in a downward direction, eliminating urine contact with the body.
Clinical Relevance—The preputial orifice (ostium) plays an important role in the shape and direction of the urine stream exiting the penile urethra. Dogs with an elevated abdominal wall and prominent dome-shaped thorax may be prone to contamination of the lower portion of the thorax and forelimbs with urine during normal micturition. Partial closure of the dorsal preputial ostium, with reciprocal enlargement of the lower half of the orifice, can create a deflective barrier that effectively diverts the urine stream in a ventral direction.
Case Description—A 6-year-old castrated male Shih Tzu was evaluated because of intermittent bleeding during urination.
Clinical Findings—Necrosis of the cranial portion of the penile shaft extended distally from the preputial fornix. Penile necrosis secondary to strangulation from paraphimosis was diagnosed.
Treatment and Outcome—A midline preputiotomy incision was used to expose the penile shaft; amputation was performed caudal to the preputial fornix. The terminal portion of the urethra was anastomosed to the preputial mucosa, which allowed the dog to urinate through the preputial orifice.
Clinical Relevance—Unlike the more conventional urethrostomy procedures performed in dogs, preputial urethrostomy eliminates the potential for local skin irritation during urination. Preputial urethrostomy is also easier to perform in those dogs in which penile amputation is required adjacent to the preputial fornix. A release incision cranial to the prepuce can be used to facilitate caudal displacement of the preputial mucosa, which facilitates urethral anastomosis to this structure. A midline preputiotomy incision provided excellent exposure of the penile shaft for this surgical procedure.
A 14-year-old 5.6-kg (12.3-lb) castrated male Toy Poodle was evaluated because of high serum activities of alkaline phosphatase and alanine amino-transferase and the presence of a hepatic mass.
Abdominal CT revealed a large (approx 6.8 X 7.1 X 6.5-cm) soft tissue mass along the midline of the liver. The mass either originated from the papillary process of the caudate lobe or the left medial liver lobe.
TREATMENT AND OUTCOME
A partial liver lobectomy was performed, and approximately a third of the mass was successfully removed and submitted for histologic examination. Consultation with the oncology service was advised to determine whether radiation therapy could be used to treat the residual disease. On 5 consecutive days, the dog underwent imaging-guided intensity-modulated radiotherapy-stereotactic body radiation therapy (4 Gy/treatment) with a simultaneous integrated boost to the center of the tumor. The dog received a base dose of 20 Gy that was then boosted to 28 Gy. In the 10-month period after completion of radiation therapy, the hepatocellular mass continued to decrease in size, and overall improvements in the dog's serum liver enzyme abnormalities were evident.
There are few treatment options for dogs with incompletely excised hepatocellular carcinomas. On the basis of the positive outcome in this case, radiation therapy could be useful following incomplete surgical removal of hepatocellular carcinomas in dogs. (J Am Vet Med Assoc 2021;259:392–395)
Describe surgical guidelines for a new technique to correct stenotic nares in brachycephalic cats.
8 client-owned brachycephalic cats with stenotic nares between April 2017 and July 2022.
8 brachycephalic cats with severe stenotic nares presented to the Angell Animal Medical Center with the patient age ranging from 2 years to 9 years of age. Surgical correction was performed on each cat with the combined use of the “Alar Fold Lift-Up” and “Sulcus Pull-Down” techniques.
Successful correction of the stenotic nares was achieved, enabling each cat to breathe normally.
The combined use of the “Alar Fold Lift-Up” and “Sulcus Pull-Down” techniques is simple to perform on an outpatient basis. Surgery is restricted to the adjacent skin and does not require the surgical alteration of the external nose or nares. Long-term follow-up indicates the procedure is effective in improving nasal breathing in each cat.