Vet Surgery 2024 Flashcards
ACVS LA Phase II
Whisenant et al Vet Surg 2024
“neuroanastamosis PD neurectomy”
Medical records for horses undergoing this procedure at two hospi- tals between 2015 and 2020 were reviewed. Palmar and dorsal nerve branches of the PDN were transected and end-to-end neuroanastomosis was performed by apposition of the perineurium.
-Lameness resolved following surgery in 81/85 (95%) horses with 57/84 (68%) sound at one year. Postoperative complications occurred in 19/85 (22%) cases.
-The main limitations of the study were an incomplete data set, inaccurate owner recall, and variations in procedure.
-Procedure doesn’t offer an advantage over other PDN techniques in terms of reducing neuroma formation, lameness resolution long term was less favorable
Pearce et al.
Vet Surg 2024
“Horner, Cervical Plexus block”
Background: unilateral cervical plexus nerve block is a method of anesthetizing perilaryngeal structures in preparation for laryngoplasty. It involves sonographic identification and guided local perineural anesthetic injection of the ventral branch of the second cervical spinal nerve (C2) between the longus capitis and the cleidomastoideus muscles.1 This is combined with subcutaneous infiltration of local anesthetic in a vertical line caudal to the proposed incision site to block the terminal cutaneous branches of the third cervical spinal nerve (C3).1
Results:
-Five of 37 horses (14%) developed transient signs of Horner’s syndrome postoperatively.
-Obvious clinical signs began 2 to 5 h following local anesthesia and persisted for two to 4 h.
-Profuse unilateral sweating of the head and upper neck was the most apparent clinical sign.
Extra Info:
Horner’s syndrome is an eponym for clinical signs associated with dysfunction of the oculosympathetic
pathway including increased sweat gland activity, cutane- ous vasodilation, pupillary constriction, and decreased eyelid tone in horses
Proposed Mechanism
-The ultrasound-guided C2 block deposited solution between the cleidomastoideus and longus capitis muscles, which could track ventrally along the fascial plane, directly to the carotid sheath. In the opinion of the authors, this is the most likely cause of sympathetic denervation because accurate placement of the block results in clear hydrodistension along the fas- cial plane and it is the location where the largest volume of local anesthetic was used.
-A less likely cause is the subcutaneous line block. This was performed approxi- mately 10 cm caudal to the bifurcation of the external jugular vein into the linguofacial and maxillary veins. The block extended vertically over the omohyoideus mus- cle, the sternomandibularis muscle, and the jugular groove to a point 1 cm to 2 cm
Brandly et al
Vet Surg 2024
“dilute chlorhexidine and suture strength”
There was no significant difference in the breaking force of 2 USP poly- glactin 910 (p = .35, confidence interval [CI] = 0.21–0.59), 3 USP polyglactin 910 (p = .61, CI = 0.41–0.24), or 2 USP polydioxanone (p = .76, CI = 0.63– 0.46) soaked in 0.0005% chlorhexidine and tris-EDTA solution followed by equine serum when compared to each respective suture soaked in equine serum only.
Smanik et al. Vet Surgery 2024
CT and fluoro versus rads for central tarsal bone fractures”
-Time for marker placement was longer for the CT/F group (p = .001), with no difference in total procedure time (p = .12).
-CT/F was not superior to radiography alone (p > .05) for parameters related to screw positioning.
-Based on the 95% CI, there was greater range in relative screw length using radiography (76.5%–91.2%) versus CT/F (78.4%–84.0%).
Kadic et al Vet Surgery 2024
“tension band, MCP arthrodesis”
*Riggs is on paper-exam committee
Objectives: To determine the influence of a stainless-steel cable (SSC) tension band fixation as an adjunct to a locking compression plate (LCP) for arthrode- sis of the equine metacarpophalangeal (MCP) joint.
-In cyclic testing, displacement was not significantly different between the first and last 5% of testing cycles regardless of construct.
-Maximum displacement of each construct during cyclic testing was <1.1 mm.
-In single cycle testing, the observed yield point did not reveal any difference between LCP and LCP-SSC (p = .440).
-The maximum load at failure was significantly higher in LCP-SSC compared to constructs with the LCP alone (p = .046).
-At failure, most screws were bent to varying degrees at the plate bone interface due to bending of the plate at the joint. The most severely and consis- tently bent screw was the sixth screw, being closest to the joint in MC3.
-In this study, the tested 5.5 mm broad 10-hole LCP plate/screw configuration appeared to initially provide an equally strong construct regardless of cable application as cyclic loading of the constructs revealed no difference in the mean displacement between groups or mean displacement over time recorded. This finding is contradictory to the anecdotal belief that the application of the SSC immediately decreases movement
Hopfgartner et al. Vet Surg 2024
“paranasal sinus trephination, standing CT/rads/sinoscopy”
-The six groups did not differ in demographics or disease category, though equids with less weight (p = .0179) and shorter disease duration (p = .0075) were more likely to have radiography and sinoscopy based surgical planning.
-Short-term postoperative complications occurred in 30.1% and were higher in groups using preoperative CT imaging (p = .01), with hemorrhage being the most common surgical complication.
-Following initial trephination surgery, 57.0% (127/223) of cases resolved and there was no difference between the imaging groups. Final resolution after follow-up medical or surgical treatment increased to 94.6% (211/223) and was not different between the imaging groups or between primary or secondary sinusitis.
-Maxillary septal bulla fenestration was performed in 43.7% (100/229) of cases and was more common in the groups using CT (83/160; 71.1%) versus 24.6% (17/69) in the RS and R groups (p = .001).
-Sinonasal fenestration for improved sinus drainage was performed in 21.4% (49/229) of cases and was more common in groups where CT was performed (CTRS 35.7%, CTR 28.9%, CTS 27.3%, CT 21.3%) than in groups where no CT was performed
Elliot et al
Vet Surg 2024
“Fontral, infratrochlear, frontonasal sinusotomy”
For part 1, both line and targeted blocks resulted in at least two times an increase in median MNT values at each of the five sites, as compared to baseline MNT values (p < .0025). In Part 2, incisions could be completed in five of six horses, with median incision size of 6.5 5 cm.
Extra information:
-For the targeted nerve block, 3 mL of 2% mepivacaine hydrochloride was injected directly over the frontal and infratrochlear nerves with a 25 gauge 1.6 cm needle (Figure 1).
-Briefly, the supraorbital fora- men was palpated and used as a landmark to block the frontal nerve as it exits the foramen.
-The trochlear notch of the lacrimal bone was palpated at the medial canthus of the eye and used as a landmark to block the intratro- chlear nerve as it passed through this notch immediately inside the orbital rim.
Bergstrom et al
Vet Surgery 2024
“PET assessment of metacarpal/metatarsal condylar fractures post surgical repair”
-All horses in the latter group had uptake in the lateral palmar condyle of the contralateral limb suggestive of stress remodeling.
-Three horses with PSG fractures had uptake in a similar location in the contralateral limb. Horses with lateral condylar fracture only presented minimal or mild uptake in the medial condyle, which is considered atypical in the front limbs for horses in full training.
-Four horses developed periarticular uptake in the postoperative period suggestive of degenerative joint disease, three of these horses had persistent uptake at the fracture site. These four horses did not return to racing successfully.
Young et al.
Vet Surg 2024
“arthroscopic lag screw MFC bone cysts”
To describe an arthroscopically guided technique for lag screw placement across subchondral bone cyst (SBC) in the medial femoral condyle (MFC) and to compare postoperative racing performance with corticosteroid injection and cyst debridement.
-Twenty-six of 45 (57.8%) horses that underwent transcondylar screw placement raced postoperatively, at a median of 403 days between surgery and first postoperative race.
-There was no difference between treatment groups with regard to racing or preoperative and postoperative lameness.
-Cysts treated with transcondylar screw placement had a greater reduction in cyst size and a reduced period of convalescence in comparison with those that underwent debridement; the results were similar to those treated by intralesional corticosteroid injection.
Bonomelli et al. Vet Surgery 2024
“laparoscopic crypt and self locking loop”
-Median total surgical time was 67 min (range: 43–189 min) and sig- nificantly shortened after the first four horses.
-The loop device was easily glided around 13/20 abdominal testes and required more time and technical skills around larger testes (≥3 years).
-Excellent intraoperative hemostasis was achieved in 17 horses. Three horses demonstrated mild intraoperative bleeding that required retightening, device replacement or adding a second device, respectively.
-Three horses developed mild postoperative hemoabdomen identified ultrasonographically and were successfully managed medically.
Extra Info:
The device is introduced into the abdomen with the loop maximally opened and the free end attached to needle holders. (A) Then, it is glided around the testis with the help of laparoscopic forceps until it reaches (B) the spermatic cord. Device tightening is performed using a needle holder (top instrument) pulling the free end of the device toward the abdominal wall while a Babcock forceps (bottom instrument) is pushed toward the spermatic cord.
(C) Please note that the Babcock forceps are placed just distal to the locking head to facilitate device closure. (D) The locking squares on the device provide a visual control to assess device closure/tightening. Most spermatic cords required 9–10 squares to be through the locking head to achieve appropriate hemostasis. (E) View of the device tightened around the spermatic cord prior to (F) sectioning the cord with laparoscopic scissors. (G) The device is retightened and the cord examined to determine adequate hemostasis. (H) The free end of the device is cut with laparoscopic scissors several millimeters from the locking head.
Lopez et al Vet Surg 2024
“percutaneous desmotomy of accessory check ligament of DDFT”
The procedure met the successful criteria in 18/24 (75%) of the limbs. The median surgical time was 11 min (range 7–25).
-No suture failure or suture remnants were noted in any of the specimens.
-Complications included iatrogenic injury to the medial and lateral neurovascular bundles in 4/24 and 1/24 specimens, respectively.
-Complete transection of the AL-DDFT was achieved in 22/24 (92%) of the specimens; however, the neurovascular bundles were injured in 5/24 (21%) of the specimens.
Lalanne et al
Vet Surg 2024
“minimally invasive transection DDFT”
To evaluate the feasibility and limitations associated with a mini- mally invasive ultrasound-assisted cutting thread technique for tenotomy of the deep digital flexor tendon (DDFT) in horses.
-The DDFT was completely transected in all cases. Minor lesions of the superficial digital flexor tendon were found in 11/20 limbs and considered clinically irrelevant. However, the neurovascular bundle was damaged in 6/20 limbs (four limbs had nerve damage and two limbs had a nerve and either a palmar artery or vein damaged). However, vascular injuries did not occur after additional ultrasound windows were added to the protocol.Finally, the carpal sheath was penetrated during transection in one limb.
-The skin puncture hole sizes ranged from undetectable to 5 mm long. The average duration of the procedure was 7 min and 38 s (range: 4 min 56 s to 10 min 19 s).
Francois et al Vet Surgery 2024
“short term survival acquired inguinal hernias”
Manual reduction was attempted in a third of the cases (32/98, 33%) and emergency surgery to reduce the hernia was performed in 64 of 98 (65%) cases.
-Concurrent small intestinal (SI) volvulus was identified in 26 (26/98, 27%) cases. Castration was the most common technique used to prevent recurrence (64/94, 68%). Overall AIH recurrence rate was 11% (11/98).
- A total of 59 (59/98, 60%) cases survived to hospital discharge and 49 of 52 (94%) cases were still alive after 12 months.
-Cases admitted within 10 h of colic signs had increased odds of survival (72%) compared to those admitted after 10 h (26%; p < .001).
-Draft breeds (p = .021), high heart rate on admission (p = .001) and concurrent SI volvulus (p = .048) were associated with reduced survival to hospital discharge.
