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.
Este trabalho descreve um caso de rotina onde um cao, srd, 3meses de idade, com 3,7kg de peso corporal, macho que apresentava persistencia do ducto aortico. Os principais sinais clinicos eram desidratacao e regurgitacao pos-prandial. Ao exame radiografico contrastado observava dilatacao do esofago cranial a base do coracao com um ponto de constricao esofagica sugestivo de persistencia do 4o arco aortico direito. No entanto, o proprietario nao quis realizar a correcao cirurgica sendo realizada a eutanasia do animal onde no exame de necropsia pode-se constatar a presenca do ducto aortico persistente.
A criocirurgia, muitas vezes referida como crioterapia ou crioablação, é uma técnica cirúrgicaque emprega substâncias em temperaturas criogênicas para destruir tecidos ou célulasindesejáveis, principalmente neoplásicas. A morte celular ocorre devido aos efeitos docongelamento e descongelamento, a curto e longo prazo. Em todos os métodos de tratamentocirúrgico a complicação é inerente ao procedimento e a criocirurgia não é exceção. O presentetrabalho tem como objetivo apresentar as reações e complicações pós-tratamento decorrentesda aplicação da criocirurgia como tratamento curativo, adjuvante ou paliativo em cães e gatos.Muitas mudanças ocorrem no tecido tratado criocirurgicamente, que levam à destruição dalesão cutânea, e a resposta tecidual varia de acordo com a intensidade e profundidade dainjúria criogênica. Alguns sinais, que podem ser interpretados como “efeitos colaterais” dacriocirurgia, são esperados e considerados normais porque representam a progressão doprocesso fisiológico do congelamento do tecido. Alguns efeitos imediatos observados são:dor, hemorragia, insuflação pelo gás e edema; efeitos a curto prazo: formação de bolhas,infecção, granuloma piogênico, e reações sistêmicas, como febre; efeitos a longo prazo:hiperplasia pseudoepiteliomatosa, hiperpigmentação, leucodermia, danos a nervos, alteraçãonos pelos, estenose de orifícios naturais devido a retração cicatricial e necrose cutânea. Osefeitos pós-tratamento dependerão da técnica de congelamento utilizada no local, da afecçãopresente, do tamanho da lesão a ser tratada e da resposta individual do paciente. Apesar daocorrência de complicações e efeitos colaterais, a criocirurgia deve ser empregada, quandoindicada, pois os benefícios ultrapassam, quando executada corretamente, os da técnicacirúrgica convencional.
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.
Abstract This study aimed to evaluate the association between biologic behavior and survival time of dogs with cutaneous mast cell tumor (MCT) with prognostic indicators. This prospective and longitudinal study followed 37 dogs with MCT. We correlated clinical factors (age, gender, time of onset, number of lesions, ulceration, tumor size, lymph node and distant metastasis, recurrence rate, and survival time) with histologic grading, immunohistochemical staining for Ki67 (samples were classified as > 23 or ≤ 23 cells positive cells/5 high-power fields) and tyrosine-protein kinase KIT pattern (cytoplasmic or membranous). The comparison between clinical data and prognostic factors was assessed individually for each variable. Multivariate analysis by logistic regression compared variables to outcome. The survival functions were calculated using the Kaplan-Meier method. There was a significant correlation between high-grade MCT and occurrence of lymph node and distant metastasis and recurrence (p < 0.05). Recurrence was also correlated with grade II and III MCTs (p = 0.03). Kappa coefficient revealed considerable agreement with significant correlation between Ki67 and KIT (p = 0.03). There was no significant association between Ki67 or KIT pattern and histologic grading or survival time. The mean overall survival time of dogs with high-grade tumors was 279 days and significantly shorter than those with low-grade (406 days) (p = 0.03). This study suggests that two-tier histologic grading is a reliable prognostic factor for dogs with MCT. KIT pattern and Ki67 index may act in association with histologic grade for the screening of these patients.
Background: Pulmonary aspiration of gastric content can result in intraoperative and postoperative complications, such as regurgitation, gastro-esophageal reflux and esophagitis. There are variations among authors about the ideal period of solid and liquid fasting. Determination of the appropriate amount of food abstinence in surgical patients is important, because of the metabolic disorders that interfere in response to anesthetic protocol or surgical intervention. Thereby, this research aimed to evaluate the appropriate period of fasting for elective anesthesia and surgical procedures in cats, by analysis of gastric emptying time based on the daily energy requirement.Materials, Methods & Results: Seven cats of mixed breed, health and with an average weight of 2.857 ± 0.3780 were evaluated by gastroscopy for the presence of food and obtaining tissue samples. To evaluate the gastric emptying time, dry and moist food were offered at two different times, 8 h and 4 h before each evaluation, with an interval of seven days between each food treatment (dry and moist). There was no significant difference in all biochemical parameters evaluated (cholesterol, glucose, and lactate) in both fasting times and food types (P > 0.05). All animals underwent gastric biopsy for histological evaluation and urease test, to discard morphological changes. After 4 h it was observed dry food in all cat’s stomach, however just five cats presented food in their stomach after eight hours. In other hand all the animals, which ate moist food, did not present any gastric content after four hours and eight hours of feeding. Gastric mucosa were considered normal in all cats with moderate amount of Helicobacter sp.Discussion: The difficulty of a consensus on the fast time in cats, and the great variability of the emptying time according to the feeding type, makes this study useful as basis for future studies on fasting with wet food, as well as providing immediate clinical application in surgical routine. Only a moderate gastritis related to helicobacter sp. was detected, but even healthy animals can carry Helicobacter sp. Four h of fasting time if feed the patient with 80% humidity ration improve anesthetic security of the patient with typical biochemical values. As shown, the appropriate preoperative fasting directly implies on decrease in the number of complications related to full stomach. Thus, always should take into account the possibility to perform fast in an appropriate period to prevent vomiting and aspiration, without the risk of hypoglycemia benefiting the patient and reassuring the anesthesiologist, especially in situations requiring urgent or emergency intervention. As observed through endoscopy, even eight hours of fasting with dry feed is inappropriate due to significant gastric volume of food in almost all cats. This suggests that prolonged preoperative fasting is no guarantee of low stomach volume. Wet feed can be an option for elderly and debilitated patients requiring surgical intervention within a short period of fasting. The time varies with type and volume of food that is variable according patients and different species and digestive conditions. The research were conducted with none complications. By means, this experiment it was concluded that the fasting time of 4 h with 80% humidity moist food allows complete gastric emptying without any complication.
Background: The nervous system is one of the most affected by congenital malformations. These can occur during neural tube formation or failed neurogenesis. Segmental spinal cord hypoplasia commonly involves two or three spinal segments in the thoracolumbar region. It is characterized by incomplete formation of the spinal cord and may also be followed by spine column malformations. Clinical signs usually include functional impairment of the hindlimbs. Diagnosis is based on history, clinical signs, age, radiographs and is confi rmed with necropsy and histopathological fi ndings. There is no treatment for this condition and the animals present low life quality. This paper aims to report the clinical, radiographic and histopathological aspects of multiple segmental spinal cord hypoplasia in a domestic cat. Case: A 52-days-old, female, Persian breed, domestic cat weighing 0.55 kg was treated presenting a history of pelvic limb paraplegia associated with urinary and fecal incontinence since birth. On clinical examination there were fl accid paraplegia of hind limbs associated with absence of proprioception, anal refl ex and tone and postural defi cits. Also, all spinal refl exes of pelvic limbs and deep and superfi cial pain were absent. There was no clinical history of muscular tremors, nystagmus, seizures or other central nervous system signs. The other animals of the litter showed no apparent changes. Radiographic examination of the thoracolumbar and lumbosacral region showed enlargement of the spinal cord canal extending from the caudal portion of L1 to L7 and flattening of the dorsal and ventral blades. It was observed that the height of the L5 spinal canal, the larger dilatation site, was about 300% higher than the cranial portion of L1, considered the last normal segment. Due to low life quality, the animal was euthanized and samples were collected. Histopathological examination showed neuronal loss in the gray matter, thickening of the dura mater and loss of definition of gray and white matter, confirming the diagnosis of spinal segmental hypoplasia in multiple regions of the spinal cord. Discussion: Based on the clinical signs reported, the cat had lower motor neuron lesion, with absence of nerve conduction on femoral, sciatic, pudendal and pelvic nerves, associated with absence of afferent sensory nerve fi bers to the brain. The medullary measurement model proposed in this paper may be useful in quantifying, with no need of advanced imaging, the enlargement of the spinal canal, which is currently an empirical and subjective evaluation. The prognosis for the animal is reserved, considering that there is no specifi c treatment for the correction of spinal changes. Few reports show follow-up after diagnosis and in most cases euthanasia is indicated due to the weakness of the animal and low life quality. Intestinal and urinary infections are common, besides the appearance of scars because of paraplegic members dragging. The disease is rarely reported in the veterinary medical literature in pets and many features remain unknown. In this case, the data obtained during the history and physical examination corroborated significantly in suspicious for congenital thoracolumbar and lumbosacral spinal cord disease. The radiographic sign of dilatation of the lumbar spinal canal in multiple vertebrae is strongly suggestive of multiple congenital abnormalities. Due to low quality of life and prognosis, the animal was euthanized, allowing the post-mortem diagnosis of multiple segmental spinal cord hypoplasia.
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