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Closed fractures of the proximal aspect of the ulna were repaired in 10 horses younger than or equal to 6 months of age by application of a hook plate using a tension band principle. Ulnar fractures were classified as type 1A (2 horses), type 1B (4 horses), type 2 (1 horse), type 3 (1 horse), and type 4 (2 horses); all fractures had displacement of a proximal fragment. Complications were implant deformation (4 horses), screw pullout (1 horse), osseous sequestration (1 horse), ulnar fracture through a hole used to apply a tension device (1 horse), and metacarpophalangeal deformity associated with a displaced anconeal fragment (1 horse). Hook deformation was likely associated with failure to insert screws in all of the proximal holes of the plate and also in two horses, possibly with difficult recovery from anesthesia. Seven horses were discharged from the hospital and were being used for athletic activities. Insertion of the hook through the tendon of the triceps muscle and incorporation of the fragment within the hook can be used to effectively reduce and stabilize a fragment that might otherwise not hold screws.

Five modifications of a cricoarytenoid lateralization and two modifications of a thyroarytenoid lateralization laryngoplasty technique were evaluated for their effect on rima glottidis area. All procedures and evaluations were performed on canine cadaver larynges. Cricoarytenoid lateralization (CAL) techniques provided a greater increase of the size of the glottic opening than did any of the thyroarytenoid lateralization techniques. Cricoarytenoid and interarytenoid disarticulation associated with CAL did not significantly increase glottic size compared with normal. After disarticulation of the cricoarytenoid joint, there was no difference in glottic enlargement whether the suture was placed through the muscular process or through the articular facet of the arytenoid cartilage. Transection of the sesamoid band combined with cricoarytenoid diarticulation distorted the dorsal margin of the rima glottidis.

The need for alternative methods of teaching veterinary medicine and surgery has increased in recent years because of increasing costs and changing public opinion. For these reasons a hemostasis model was developed that mimics the arteries and veins of the peripheral vascular system, and can be used to teach the basic skills involved in blood vessel ligation and division. This study evaluated the effectiveness of the fluid hemostasis model compared with using live animals for teaching these skills. Forty sophomore veterinary students participated in the study. Two groups of 20 students each received identical instruction in the basic techniques required for vessel ligation and division. The students then completed various exercises using inanimate models to objectively evaluate their psychomotor skills. Both groups then practiced the techniques for equal time periods; one group used the hemostasis model and the other performed a splenectomy on live dogs. After the practice session, the students were videotaped (for later evaluation), as they performed vessel ligations and divisions. The students then repeated the exercises using the inanimate models for evaluation of skills improvement. Questionnaire responses before and after the project were obtained to determine the students' views on the need for inanimate models for teaching purposes. Results of this study indicate that the hemostasis model was as effective as live animals for teaching the basic skills involved in blood vessel ligation. The students' opinions regarding the use of properly designed inanimate models for teaching these skills were dramatically changed.

To determine the relationship between students' perceptions of 2 assessment methods and academic performance.A 2-year prospective survey study in a 4-year Doctor of Veterinary Medicine (DVM) curriculum.Year 3 DVM students (n = 44).An assessment of learning gain questionnaire was used to investigate students' perceptions regarding multiple-choice examination (MCE) versus take-home case-based continuous assessment (CA) in a 3rd year small animal surgery lecture course. Academic performance and student assessment of learning gain in the 2 course components were compared. Relationships between student perceptions and academic performance were examined. A follow-up survey was conducted during clinical rotations in 4th year to determine change in student perceptions over time.Academic performance in 3rd year was significantly enhanced by use of CA, particularly for students with weaker grades. Academic performance in 4th year clinical rotations was not closely related to 3rd year performance. Many students preferred an instructional approach with provision of comprehensive notes and assessment with multiple-choice questions based on the notes. However, students recognized that feedback on work submitted for CA grading significantly facilitated learning. Student assessment of learning gain was correlated with academic performance in the 3rd year course component examined by CA, but not the component assessed using MCE.Our data suggest that perceptions of learning gain, academic accomplishment, and clinical performance in 4th year are weakly correlated. Teachers should better explain to veterinary students that learning to be a clinician is more than replication of knowledge.

Objective To provide a brief introduction into Critical Incident Reporting Systems (CIRS) as used in human medicine, and to report the discussion from a recent panel meeting discussion with 23 equine anaesthetists in preparation for a new CEPEF‐4 (Confidential Enquiry into Perioperative Equine Fatalities) study. Study Design Moderated group discussions, and review of literature. Methods The first group discussion focused on the definition of ‘preventable critical incidents’ and/or ‘near misses’ in the context of equine anaesthesia. The second group discussion focused on categorizing critical incidents according to an established framework for analysing risk and safety in clinical medicine. Results While critical incidents do occur in equine anaesthesia, no critical incident reporting system including systematic collection and analysis of critical incidents is in place. Conclusions and clinical relevance Critical incident reporting systems could be used to improve safety in equine anaesthesia – in addition to other study types such as mortality studies.

Vasectomized mice are needed in the production of genetically-modified animals. The BVAAWF/FRAME/RSPCA/UFAW Joint Working Group on Refinement recommended that vasectomy should be performed via an incision in the scrotal sac, rather than via laparotomy, arguing that the former could be less painful due to minimal tissue trauma. This study was undertaken to assess the validity of this recommendation. Mice underwent vasectomy via either abdominal or scrotal approach surgery. Mice were filmed for 15 min presurgery and at one, 24 and 48 h postsurgery. Data were obtained using automated behaviour recognition software (HomeCageScan). Meloxicam was administered either alone or combined with acetaminophen prior to surgery. A third group received only saline subcutaneously. Postsurgery behaviour changes were compared between groups at each time point. Exploratory behaviours such as rearing, walking and sniffing were most greatly reduced at one hour following surgery whereas the duration of grooming increased. By 48 h these changes had largely subsided. Results indicated mice undergoing scrotal approach surgery fared better at one hour postsurgery, but the magnitude of this was relatively insignificant compared with the overall effects of surgery. If the observed behaviour changes resulted from pain, results suggested there was no significant advantage of scrotal versus abdominal approach vasectomy. These and other recently obtained data on the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in mice suggest considerably larger doses of these or more potent analgesics, more precise monitoring of surgical outcomes, or a combination of these factors are needed to determine the extent of pain experienced by mice undergoing vasectomy.

Lower oesophageal pH was monitored in 270 dogs under anaesthesia. There were 47 episodes of gastro-oesophageal reflux (17.4 per cent), most of which occurred shortly after the induction of anaesthesia. The refluxate was usually acid (pH4.0), but in four of the episodes (8.5 per cent) it was alkaline (pH7.5). Gastric contents with a pH below 2.5 were refluxed on 27 occasions (10 per cent) for an average period of about 44 minutes. Regurgitation occurred in two of the dogs. Increased age seemed to be associated with an increased incidence of reflux and an increased gastric acidity. Body position (sternal, dorsal and left or right lateral) and the tilt of the body during surgery (horizontal or tilted to an 8 degrees head-up or head-down position) had no influence on the incidence of gastro-oesophageal reflux. Dogs undergoing intra-abdominal surgery had significantly more reflux episodes than dogs undergoing non-abdominal surgery.

The federal law through the United States Department of Agriculture (USDA) Code of Federal Regulations (9 CFR) confers program authority on the Institutional Animal Care & Use Committee (IACUC). Part of that program authority is the decision about who is sufficiently qualified to perform experimental surgery using animals. At this time there is no clear standard reference for minimum criteria or minimum credentials. Thus each IACUC must establish its own standards for surgical privilege.

Tumors directly consume nutrients and produce paraneoplastic pathometabolic changes in food use efficiency. In combination with anorexia, negative energy balance and nutrient depletion can be extensive. Refeeding against catabolic changes supports general and specific host defenses. Enteral feeding methods are preferred to parenteral techniques and nutrient profiles are available that appear to favor host repletion.

Surgical oncology patients are often high-risk patients that require careful perioperative management for a successful outcome. Prophylactic antibiotics are needed to prevent infection in tissues compromised by disease, radiation, or chemotherapy. Pain control is needed to prevent the stress response to surgery from worsening the outcome and to aid in the maintenance of patient comfort.

Objectives Ligature failure is an important complication following ovariohysterectomy in the bitch. The aim of this study was to assess the differences between five individual ligation techniques in their ability to attenuate a bulky vascular model. Methods A vascular model was constructed that enabled the occlusive ability of five different ligation techniques to be measured including the square knot, surgeon's knot, slip knot, modified transfixing ligature and the single-double other side knot. Each was constructed using both USP-0 polyglyconate and polyglactin 910 suture material. The extent of attenuation of the vascular model that was achieved by each technique was assessed using pressure transducers. Results In this model, the slip knot, modified transfixing ligature and the single-double other side knot outperformed the square and surgeon's knots. Clinical Significance The results of this study suggest that utilising a knot design that has more inherent resistance to slippage of the first throw (e.g. the modified transfixing ligature, slip or single-double other side knots) may be preferable over square and surgeon's knots when tying a ligature on a bulky vascular pedicle like the ovarian stump in a large bitch.

Objective—To identify a list of core surgical skills and determine the frequency of use and proficiency in performance of these skills expected of entry-level veterinarians by general practitioners. Design—Mail-based survey. Sample—750 general practitioners randomly chosen from the AVMA membership database. Procedures—Survey respondents rated the proficiency and frequency of use expected of entry-level veterinarians in regard to 26 surgical skills. Demographic information (gender; graduation year; practice type, geographic location, and setting; number of veterinarians in practice; number of surgical procedures performed per week; and number of new graduates mentored in the past 5 years) of respondents was obtained. Results—387 (52%) general practitioners responded to the survey. Greater than 60% of respondents expected new graduates to have high proficiency and require minimal supervision for 21 of 26 skills. Greater than 60% of respondents assigned 6 of the skills a low expected frequency of use rating. Orthopedic skills, creation of square knots by use of a 1-handed tie technique, and use of electrosurgical and laser instruments received some of the lowest ratings. Conclusions and Clinical Relevance—Core surgical skills were identified. Results indicated a broad consensus among general practitioners independent of demographic characteristics. Results may aid veterinary colleges in identification of the surgical skills that are most important to include in surgical curricula and for which new graduates should attain proficiency according to general practitioners.

SummaryIn the face of increasing incidence of multidrug resistant implant infections, local antibiotic modalities are receiving increased attention for both infection prophylaxis and treatment. Local antibiotic therapy that achieves very high antibiotic drug concentrations at the site of the implant may represent an avenue for treatment of biofilmforming bacterial pathogens. Randomized controlled trials in human patients have demonstrated an infection risk reduction when antibiotic-impregnated cement is used for infection prophylaxis in implanted joint prostheses, and when a gentamicin-impregnated collagen sponge is used for infection prophylaxis in midline sternotomy. The other modalities discussed have for the most part yet to be evaluated in randomized controlled trials in veterinary or human patients. In general, the in vivo pharmacokinetics and appropriate dosing profiles for local antibiotic modalities have yet to be elucidated. Toxicity is possible, and attention to the dose applied is warranted.

To compare level of difficulty, deviations from technical description and postoperative assessment during the training of veterinary students, small animal surgical residents, and a board certified surgeon for Tightrope® (TR) and percutaneous lateral fabella suture (pLFS) techniques for cranial cruciate ligament (CCL) repair.Prospective study.Cadaveric canine pelvic limbs (n = 32).Sixteen 3rd year veterinary students, 6 small animal surgical residents and a Diplomate of the American College of Veterinary Surgeons performed the TR and pLFS techniques on paired limbs. Perceived level of difficulty, duration of surgery, and technical deviations were assessed by questionnaire, radiographs, and dissection. Results were compared between techniques with McNemar's test.The TR procedure was perceived as more technically demanding than the pLFS by veterinary students and residents. Technical deviations were overall more common after TR than pLFS, and in limbs repaired by students, regardless of procedure. The most difficult aspect of the TR consists of the bone tunnels whereas for pLFS it was passing the suture around the femorofabellar ligament. The sensitivity of radiographs for detection of technical deviations was 39% after TR and 50% after pLFS.Technical deviations are more common during the training phase of TR than pLFS, and the sensitivity of radiographs to detect those is low. Repeated practice on cadavers followed by dissection is recommended before use in patients.

EVIDENCE-BASED medicine (Sackett and others 2000) and veterinary medicine (Cockcroft and Holmes 2003) have been emphasised in recent years as essential to both the maintenance and advancement of high standards of clinical practice. In particular, the evidence-based approach must be distinguished from ‘eminence-based’, or even ‘celebrity-based’ (Ernst and Pittler 2006) medicine, where individual practitioners uncritically adopt the practices of articulate and well-known colleagues because of the reputation of the individual rather than the underlying scientific basis of a treatment being promoted (Wood 1999, Greenhalgh 2001). Critics of the modern evidence-based medicine school have been quick to point out the difficulties in its application to every case in busy clinical practice (Ghali and others 1999). Much is undertaken based on received professional wisdom that begins to be adopted from the earliest years of clinical education. This apparent inconsistency has recently been highlighted by a final-year medical student: ‘throughout studies for our medical degrees, we are taught that evidence-based medicine is the way forward … yet, within the medical profession, there are many techniques and conventions that have been handed down from teacher to student, the origins of which have been lost, and there is also little evidence base for them’ (Jones 2008). For many years, I have been intrigued by the predominance of the left flank approach for ovariohysterectomy in the female cat in the UK (eg, Hickman and others 1995) in contrast to the predominance of the ventral midline approach (eg, Gourley and Gregory 1992) in other parts of …

SummaryObjective To quantitatively assess the learning curve for the tibial tuberosity advancement (TTA) procedure performed by a single surgeon using the cumulative summation (CUSUM) technique and to determine if surgeon performance remained under control (i.e. within specified quality boundaries) after the learning curve had been climbed. Study design: Retrospective study.Animals Dogs (n = 122) with cranial cruciate ligament deficient stifles (n = 167).Methods Records of all dogs that had a TTA procedure performed by the same surgeon were reviewed. Cases were included if the following information was available: weight, breed, date of surgery, presence of partial or full cruciate rupture, meniscal pathology, occurrence and description of postoperative complications and treatment with a minimum of 12 months follow-up. Patients were excluded if they had a concurrent illness. Major complications were defined as those requiring revision surgery. The CUSUM technique was used to determine the time taken for the surgeon to reach a pre-defined level of competency and to monitor ongoing performance.Results Major complications occurred in 15 out of 167 procedures (9%) within 12 months of TTA surgery. The complication rate decreased as surgical experience was gained with the technique, however the learning curve continued until the 22nd procedure. Thereafter, despite the target complication rate being re-set at a lower level, the surgeon's performance remained acceptable, i.e. within the revised quality boundary.Clinical significance The CUSUM technique was used for clinical audit, to determine the learning curve for the TTA procedure for a single surgeon, and to monitor ongoing performance. An experienced general practitioner had a learning curve of 22 procedures and complication rates were within the published ranges.

For practical, ethical and economic reasons, veterinary surgical education is becoming increasingly dependent on models for training. The limited availability and high cost of commercially produced surgical models has increased the need for useful, low-cost alternatives. For this reason, a number of models were developed to be used in a basic surgical skills course for veterinary students. The models were low fidelity, having limited resemblance to real animals. The aim of the present study was to describe the students' learning experience with the models and to report their perception of the usefulness of the models in applying the trained skills to live animal surgery. One hundred and forty-six veterinary fourth-year students evaluated the models on a four-point Likert scale. Of these, 26 additionally participated in individual semistructured interviews. The survey results showed that 75 per cent of the students rated the models ‘useful’/'very useful'. Interviews revealed that tactile, dimensional, visual, situational and emotional features are important to students' perception of a successful translation of skills from models to live animal. In conclusion, low-fidelity models are useful educational tools in preparation for live animal surgery. However, there are specific features to take into account when developing models in order for students to perceive them as useful.

I AM involved in a study into what suture materials veterinarians are commonly using in practice, what influences their decisions and how the sutures are …

ACVS Diplomates were surveyed to identify a complete list of core surgical skills, determine the expected frequency of use of these skills, and ascertain the level of skills proficiency expected of entry-level practicing veterinarians.Internet-based survey.Randomly chosen ACVS Diplomates (n = 750).Rating scale items were used to construct the main portion of the survey with 26 skills that were scored by participants based on rankings of proficiency expected of entry-level veterinarians, as well as expected frequency of use of these skills. Additional demographic questions were included to gather information regarding gender, practice type, year of veterinary school, year of ACVS membership, job description, primary surgical discipline, practice location, average number of procedures performed on a weekly basis, and number of new graduates mentored in the last 5 years.Of 337 Diplomates (44.9%) who responded to the survey,60% expected entry-level graduates to have good skills with minimal supervision or complete skills for 21 of the 26 skills categories listed. More than 60% of respondents ranked 7 skills with a lower frequency score (seldom or occasionally use). Orthopedic instrument handling and fixation skills as well as electrosurgical and laser skills received some of the lowest expected proficiency and frequency rankings. No additional skills categories were identified in the open-ended survey questions.A complete list of core surgical skills was identified. There was broad consensus between boarded surgeons irrespective of their practice type, experience, or discipline for ranked proficiency and frequency scores among the core surgical skills expected of entry-level veterinarians.

To evaluate the effect of measurement technique and limb positioning on quadriceps (Q) angle measurement, intra- and interobserver reliability, potential sources of error, and the effect of Q angle variation.Cadaveric radiographic study and computer modeling.Pelvic limbs from red foxes (Vulpes vulpes).Q angles were measured on hip dysplasia (HD) and whole limb (WL) view radiographs of each limb between the acetabular rim, mid-point (Q1: patellar center, Q2: femoral trochlea), and tibial tuberosity. Errors of 0.5-2.0 mm at measurement landmarks alone and in combination were modeled to identify the effect on Q angle. The effect of measured Q angles on the medial force exerted on the patella (F(MEDIAL)) was calculated.The HD position yielded significantly (P.001) more medial Q angles than the WL position. No significant difference was observed between Q1 and Q2, but Bland-Altman plots indicated they were not equivalent. Intra- and interobserver agreement was substantial. Q2 errors were inherently greater than Q1: the mid-point and tibial tuberosity are the most important sources of Q angle variability. Increasing Q angles significantly increased the exerted F(MEDIAL) (P.0001, gradient 1.7%).Measurements are reliable, but Q2 is more prone to error than Q1, and the 2 measurement techniques are not interchangeable. Positional errors must be kept below 1.3 mm (Q1) or 0.8 mm (Q2).

Veterinarians working under remote field conditions are routinely presented with variety of surgical interventions in equines like castrations, management of wound, traumatic and congenital hernias and musculoskeletal disorders thus necessitating the use of general anaesthesia for management of these conditions. The present study was carried out to evaluate and recommend the suitable short term anaesthetic technique for Spiti ponies under field conditions. Seven clinically healthy male Spiti ponies presented for castration were evaluated for short term Total Intravenous Anaesthesia (TIVA) using detomidine (0.02 mg kg(-1)), butorphanol (0.01 mg kg(-1)), 5% guaifenesin (20 mg kg(-1)) and ketamine (2.0 mg kg(-1)). The studies conducted were open label trials and all the animals received same treatment. After proper tetanus prophylaxis and preanesthetic fasting, detomidine was administered intravenously. Subsequently at head down position the animals received butorphanol intravenously. Thereafter, guaifenesin was administered intravenously. As soon as the signs of ataxia developed, the induction of surgical anaesthesia was achieved by intravenous administration of ketamine hydrochloride. The onset of sedation was observed in 2.43 +/- 0.53 min following detomidine administration and the animals were ataxic in 1.43 +/- 0.43 min after butorphanol and guaifenesin administration when ketamine was injected. The ponies were in surgical plane of anaesthesia within 2.28 +/- 0.42 min following ketamine administration. During recovery the limb/head movement and sternal recumbency were attained in 18.71 +/- 1.98 and 26.14 +/- 1.62 min, respectively whereas standing ataxia and normal gait were seen at 29.42 +/- 3.21 and 71.14 +/- 4.74 min, respectively. There was excellent to good muscle relaxation. The surgical anaesthesia remained for 22.57 +/- 1.48 min. The recovery was smooth. Moderate to good suppression of palpebral and corneal reflexes were observed immediately after induction and during anaesthesia. The analgesia was excellent. A highly significant (p < 0.01) to significant (p < 0.05) decrease in respiration rate was observed after induction, during anaesthesia and after recovery. The mean SpO2 value in equines of this group was 76.50 +/- 4.14 and 83.33 +/- 4.18% after induction and during anaesthesia, respectively. Some of the blood biochemical parameters like plasma alanine amino transferase (ALT), total proteins and glucose showed significant increase without clinical consequence. It was concluded that detomidine (0.02 mg kg(-1)), butorphanol (0.01 mg kg(-1)), guaifenesin 5% (20 mg kg(-1)) and ketamine (2.0 mg kg(-1)) combination can safely be used for short term total intravenous anaesthesia in equines under field conditions where the monitoring facilities are meager.

Forty students were randomly assigned into two study groups (traditional, T; and simulator, S) of 20 students each for a core operative practice laboratory. Students were randomly paired and their group assignment and identity remained anonymous to the evaluators throughout the study. Questionnaires were distributed to students to evaluate prior surgical experience and obtain learning resource use information. Before the evaluation sessions, both groups were given identical learning resource opportunities except students in Group S received hollow organ simulators and practice materials for gastrotomy closure. All students were forewarned that surgical instruction would not be available during the evaluation sessions. In the first live animal evaluation session, all student pairs were videotaped after which stomachs were harvested for gross evaluation of the surgical site. Group T performed an additional gastrotomy for video and gross evaluation 2 weeks later. Questionnaire, and gross and video evaluation results were compared statistically between groups and sessions. The hollow organ model did not suitably simulate live stomach tissue; the material was more fragile and stiff and suture cut-out was a problem even with appropriate suture tension and technique. The model was effective for teaching needle placement, instrument usage, creating proper tissue inversion, and methods to minimize instrument handling of tissue during gastrotomy closure. Prior practice with models did not boost student confidence during their live gastrotomy session. The autotutorials (ATs) were well received by students but did not sufficiently address how to manage mucosal eversion, suture tension, and bleeding encountered during live gastrotomy. AT viewing time positively correlated with mean total video score for Group T during both sessions. None of the students had prior experience performing hollow organ closure and no significant difference in experience level was evident between groups. Mean closure time was not significantly different between groups for session one (Group T, mean, 31.5 minutes, range, 18.4 to 53.4; Group S, mean, 28.2 minutes, range, 16.8 to 36), but was significantly reduced for session two (Group T, mean, 21.3 minutes, range, 13.9 to 31). This AT/simulator program does not significantly influence students' overall gastrotomy closure technique; gross and video evaluation scores were not significantly different between groups. Without instructor supervision, an additional gastrotomy experience did not improve surgical technique appreciably for Group T; however, these students performed the second procedure with more confidence and speed.(ABSTRACT TRUNCATED AT 400 WORDS)

Summary Post operative surgical wound infection rates were determined for 452 cases of equine orthopaedic surgery performed at the Western College of Veterinary Medicine, Saskatoon, Saskatchewan, between January 1, 1981 and December 31, 1990. Only surgical procedures classified as clean or clean-contaminated by the National Research Council were included in this study. The overall post operative infection rate was 10.0% (45 of 452). Clean surgeries (n=433) had an 8.1% infection rate while clean-contaminated surgeries (n=19) had a 52.6% infection rate. Information collected from the medical records was used in univariate and multivariate logistic regression models to evaluate significant determinates of post operative infection. Significant determinates of post operative infection were: surgical classification, orthopaedic involvement, duration of surgery, administration of preoperative antibiotics and gender. Clean-contaminated surgeries had an increased risk of infection compared to clean surgeries (odds ratio (OR)=24.3), procedures involving long bones had an increased risk of infection compared to procedures involving articular surfaces (OR =5.1), surgeries lasting 90 minutes or longer had an increased risk of infection compared to those less than 90 minutes (OR =3.6), administration of preoperative antibiotics was associated with an increased risk of infection (OR =4.6) and female patients were 2.6 times more likely to develop post operative infection than male patients.

Objective—To compare tension of 3 cerclage wire knots tied by surgeons of various abilities and experience. Design—Cross-sectional study. Sample Population—Participants and faculty at a postgraduate course in veterinary orthopedics. Procedure—Subjects tied a cerclage of their choice on an instrumented tying stand that displayed the tension on a computer. Mean tensions in cerclage wires tied with twist, single loop, or double loop knots were compared. The relationship between level of surgeon experience and tension achieved was examined. Results—29 twist, 30 single loop, and 16 double loop wires were analyzed. Mean ± SD tension for twist knots was significantly less than for single loop knots (82.3 ± 46.1 vs 166.6 ± 42.2 N, respectively). Double loop knots achieved significantly greater tension (392.0 ± 116.6 N) than twist and single loop knots did, even though few participants had ever tied this knot previously. There was no correlation with experience of the participant. For twist knots, wiggling the wire during cutting and pushing the twist over to flatten it to the bone further reduced tension. Conclusions and Clinical Relevance—Cerclage applied with a twist knot does not compress fracture fragments as effectively as cerclage applied with single loop or double loop techniques. Because greater compression of fragments will improve the stability of a fracture, a surgeon should strive to maximize the tension in the cerclage that they use. Experience and abilities of the surgeon are not associated with ability to tie cerclage wires tightly. (J Am Vet Med Assoc 2002;220:334–336)

To (1) determine suction tip (intermittent and continuous mode) contamination rate in orthopedic surgery in dogs and cats; (2) examine the effect of surgical time on contamination; and (3) report bacteria isolated.Clinical study.Clean orthopedic surgeries (n = 50).Surgical procedures were assigned to 1 of 2 groups: (1) continuous (n = 25) or (2) intermittent suction (n = 25). A control suction was operated in each surgery. Samples for aerobic and anaerobic bacteriologic examination were collected from the surgical suction at 0, 20, 60 minutes, and at the end of surgery, and from the control suction at the end of the surgery only. Comparison of continuous and intermittent suction data, and the effect of surgical time on contamination rate were analyzed using a Kaplan-Meier survival analysis followed by a Cox proportional hazards model. P.05 was considered significant.Aerobic contamination occurred in 22 of 50 surgical procedures and there was no anaerobic growth. There was no significant difference between continuous and intermittent suction mode groups (P = .40). Surgical time did not influence the contamination rate (P = .79). Bacterial cultures mainly revealed coagulase-negative Staphylococci, however multiresistant bacteria were isolated.We failed to find superiority of the intermittent operation mode of the suction tip over the continuous mode. A safe time frame before contamination of the suction tip occurs that could not be defined.

Summary Objective: To present a novel technique for the treatment of severe congenital flexural forelimb deformities in calves. Methods: Thirteen calves of different breeds and sex with severe congenital flexural forelimb deformities were enrolled in the study. A semicircular external skeletal fixation system composed of 6-hole, 45° carbon-fiber arches, 6 mm threaded rods, half-pin fixation bolts, 6 mm hexagonal nuts, and negative profile end-threaded half-pins were used for pancarpal arthrodesis. Complications, time to first use of the limb, fixator removal time, preoperative and postoperative sagittal plane angles of the fused joints, and functional outcomes were evaluated clinically and radiographically. Final assessments were determined according to functional and cosmetic outcomes. Results: All of the surgically treated carpal joints obtained fusion. Seven of the calves started to use the limb immediately after recovering from anesthesia. In the other six calves, the time ranged from one to two days. Time to fixator removal ranged from 25 to 36 days (mean 30 days). Final outcome was excellent in 11 cases, and good in two cases. Clinical significance: The technique was found to be a useful method for the treatment of severe congenital flexural forelimb deformities in calves. The cost of the operation is negligible compared to the economic value of beef cattle.

To identify incidence and risk factors for surgical glove perforation in small animal surgery.Observational cohort study.Surgical gloves (n = 2132) worn in 363 surgical procedures.All gloves worn by operative personnel were assessed for perforation at end-procedure using a water leak test. Putative risk factors were recorded by a surgical team member. Associations between risk factors and perforation were assessed using multivariable multi-level random-effects logistic regression models to control for hierarchical data structure.At least 1 glove perforation occurred in 26.2% of procedures. Identified risk factors for glove perforation included increased surgical duration (surgery1 hour OR = 1.79, 95% CI = 1.12-2.86), performing orthopedic procedures (OR = 1.88; 95% CI = 1.23-2.88), any procedure using powered instruments (OR = 1.93; 95% CI = 1.21-3.09) or surgical wire (OR = 3.02; 95% CI = 1.50-6.05), use of polyisoprene as a glove material (OR = 1.59, 95% CI = 1.05-2.39), and operative role as primary surgeon (OR = 2.01; 95% CI = 1.35-2.98). The ability of the wearer to detect perforations intraoperatively was poor, with a sensitivity of 30.8%.There is a high incidence of unrecognized glove perforations in small animal surgery.

Surgical site infections (SSIs) are a significant source of morbidity, mortality, and cost associated with small animal surgery. The most well-established strategies to reduce the impact of SSI are preventive, focusing on bolstering host immunity while decreasing wound contamination during surgery. When SSI is identified, the use of consistent definitions and culture-based therapy help to facilitate surveillance and appropriate management. Debridement and open wound management of infected wounds are important for successful treatment.

With respect to the founding of the AOVET in 1969, the development of the systematic osteosynthesis in large and small animals is reviewed. With the introduction of the stable OS techniques corresponding to the principles and operative techniques developed by the organization of ASIF/AO (hum), the systematic operative fracture treatment in animals expanded remarkably. The application of the "absolutely" stable compression osteosynthesis was the basis for the successful fracture treatment in large animals. The systematic osteosynthesis in small animals was realized through the generation of a multitude of stabilization techniques for the different fracture types in the various anatomical areas and for special orthopaedic interventions. This was achieved through a specifically developed implant- instrument system and corresponding operation methods. This development was supported by instruction courses, published manuals and visiting fellowships. The extensive collaboration in research and development led to an increasing understanding of the diverse bone healing processes. The AOVET enjoyed a progressing integration into the AO/ASIF (hum) organization.

Transtracheal access enables researchers to obtain diagnostic samples from or infuse materials into the lower respiratory tract. This column describes transtracheal aspiration and infusion of horses.

To assess current habits for surgical hand preparation among veterinary surgical specialists and to compare data with current guidelines for hand asepsis techniques.Survey of veterinary surgical specialists.Diplomates of the American (ACVS) and European Colleges of Veterinary Surgeons (ECVS).An internet-based survey of hand preparation methods before surgical procedures was conducted of 1300 listed ACVS and ECVS Diplomates.A 42.6% response rate was obtained. Approximately, 80% of respondents use disinfecting soaps as a primary method for hand antisepsis. Of those, 81% use chlorhexidine-based scrubs and 7% use a neutral soap followed by a hydroalcoholic solution.Contrary to current recommendations of the World Health Organization and scientific evidence supporting use of hydro-alcoholic rubs for presurgical hand preparation, veterinary surgical specialists still use surgical scrub solutions containing disinfecting soaps.

Current models of spinal cord injury (SCI) have been ineffective for translational research. Primate blunt SCI, which more closely resembles human injury, could be a promising model to fill this gap.Graded compression SCI was produced by inflating at T9 an epidural balloon as a function of spinal canal dimensions in a non-uniform group of monkeys.Sham injury and cord compression by canal invasion of 50-75% produced minimal morpho-functional alterations, if at all. Canal invasion of 90-100% resulted in proportional functional deficits. Unexpectedly, these animals showed spontaneous gradual recovery over a 12-week period achieving quadruped walking, although with persistent absence of foot grasping reflex. Histopathology revealed predominance of central cord damage that correlated with functional status.Our preliminary results suggest that this model could potentially be a useful addition to translational work, but requires further validation by including animals with permanent injuries and expansion of replicates.

To compare 2 preoperative surgical site protocols for standing laparotomy in cattle in a field setting.Cohort study.Dairy cows (n = 73) undergoing a clean standing laparotomy (no visceral perforation during surgery).Cows were randomly assigned to 1 of 2 preoperative skin-preparations protocols with chlorhexidine used as an antiseptic. A standard protocol (3 minutes [min] cleansing scrub, tap water rinse, 3 minutes surgical scrub with a sterile one-use chlorhexidine scrub and alternate passage of alcohol and 2% chlorhexidine solution (7 minutes; n = 32) was compared with a 3 minutes abbreviated preoperative protocol, consisting of two 90 seconds period of cleansing scrub and 3 passages of 0.5% chlorhexidine gluconate in 70% in isopropyl alcohol solution (4 minutes; n = 32). Pre- and postoperative skin bacterial counts and clinical assessment of wounds 10-15 days after surgery, as well as standardized interview with the producers focused on wound infection 30 days after the surgery were used to compare both protocols.There was no difference between protocols for absolute colony forming units (CFU) and percentage CFU reduction perioperatively as well as for surgical wound clinical score 10-15 days after the surgery. The infection rate at 30 days was 10.5% (6/57) but no significant difference was observed between protocols 10% (3/30) versus 11.5% (3/27).An abbreviated preoperative protocol using nonsterile reusable material can be as effective as a standard protocol using sterile one-use brush in reducing skin microflora and preventing surgical wound infection.

There are few published data regarding the success rates of cheek tooth (CT) removal by lateral buccotomy in the horse.A retrospective study of 114 horses admitted to 2 private equine referral hospitals over a 10 year period (1999-2009), which underwent CT removal via a lateral buccotomy.Hospital records were analysed and details including case details, presenting complaint and results of all diagnostic tests and surgical reports were documented. Information obtained during post operative reassessment was also available for analysis. Long-term follow-up information (2 months) was obtained for 112 horses.Short-term complications (2 months) occurred in 24/77 horses (31%) undergoing exodontia of the maxillary CT and 10/37 horses (27%) involving mandibular CT, with the majority arising from partial wound dehiscence and infection following 16 extractions (47%). All healed well by second intention. Other complications included both temporary (n = 6) and permanent (n = 3) facial nerve paralysis, myositis (n = 4) and the inadvertent establishment of an oroantral fistula (n = 4). One myositis case was subjected to euthanasia 24 h post operatively. Five horses had persistent sinusitis following surgery due to dental remnants (n = 2) and excessive packing material (n = 1) found in the sinuses. No inciting cause could be found in the remaining 2 horses. One further horse suffered a fatal cardiac arrest at induction of anaesthesia. Of all horses, 92% operated on had returned to their previous level of work after2 months with no complications.Horses with CT removal by a lateral buccotomy have a reasonable prognosis for long-term outcome.Performing a lateral buccotomy is a justified treatment alternative for the surgical removal of equine CT following unsuccessful attempts by standing oral extraction, offering advantages over alternatives such as retropulsion, endodontic therapy and periapical curettage.

Minimizing the pain or discomfort of research animals through refinement of surgical techniques is inherent in the humane use of animals in investigative studies. The current approach for intraperitoneal implantation of radiotelemetry devices in mice is a ventral midline incision. An optional surgical approach is a flank incision. We used multidimensional analysis to compare midline and flank approaches for implantation of radiotelemetry devices in regard to time of surgery, activity, temperature, food intake, gel intake, body weight, and vitality scores. A third group was used to evaluate the effects of buprenorphine in healthy mice. The study demonstrated positive benefits related to the flank approach, including quicker surgery times, improved activity levels, more stable temperature homeostasis, smaller losses in body weight, and quicker return to presurgical baseline levels of food intake. In addition, direct effects of buprenorphine included decreases in food intake and body weight, with the effects on body weight lasting approximately 8 d after treatment. Collectively, these results suggest that implantation of intraperitoneal radiotelemetry devices by using a flank approach is beneficial to mice.

Reptiles used for research and instruction may require surgical procedures, including biopsy, coelomic device implantation, ovariectomy, orchidectomy, and esophogostomy tube placement, to accomplish research goals. Providing veterinary care for unanticipated clinical problems may require surgical techniques such as amputation, bone or shell fracture repair, and coeliotomy. Although many principles of surgery are common between mammals and reptiles, important differences in anatomy and physiology exist. Veterinarians who provide care for these species should be aware of these differences. Most reptiles undergoing surgery are small and require specific instrumentation and positioning. In addition, because of the wide variety of unique physiologic and anatomic characteristics among snakes, chelonians, and lizards, different techniques may be necessary for different reptiles. This overview describes many common reptile surgery techniques and their application for research purposes or to provide medical care to research subjects.

Objectives of this study were to evaluate plasma concentrations and analgesic efficacy of fentanyl administered transdermically in dogs undergoing spinal surgery. At the end of the surgery and before awakening, a fentanyl-patch was applied and was maintained in situ for 72 h. Blood samples were taken before the application of the patch, at 2, 4, 6, 8, 10, 12, 18, 24, 32, 40, 48, 60, and 72 h after application and then 2, 4, 6, 8, 10, and 12 h after its removal. Before each blood sampling, pain evaluation was carried out using the Glasgow pain score, appropriately modified. Plasma concentrations of fentanyl were determined using a specific immuno-enzymatic kit. In this study, the minimum analgesic plasma concentration (0.23 ng ⁄ mL) required to achieve analgesia in human and considered to apply also for dogs was reached in all animals. No animal showed pain in the range of ‘intense pain’; in two cases, the level of the pain was slight or moderate. No undesired effects were found. Results suggest that the use of transdermic patches could represent a valid aid in pain therapy in small animals; in particular, it contributes to the postoperative well-being of patients undergoing major surgery.

The aim of our study was to compare the electrocardiographic recordings in an experimental open-chest swine model before and after left-sided thoracotomy to detect any surgery-induced fluctuations that might interfere with subsequent experimental interventions. We obtained electrocardiograms from 8 deeply anesthetized domestic swine and compared the respective ST-segment potentials obtained after vascular surgery and after left-sided thoracotomy and dissection of the left anterior descending coronary artery. Compared with baseline recordings, no significant ST-segment deviation on any of the electrocardiographic leads occurred after vascular surgery. However, statistically significant ST-segment depression was observed after thoracotomy. Invasive surgical procedures in open-chest swine models may lead to morphologic changes in the ST segment. The physiologic mechanism of these changes is not fully understood.

A 7-year-old mare presented with facial deformities associated with oral discomfort and weight loss was found to have bilateral, palatal, developmental displacements of the maxillary 08s, with secondary diastema. Following repulsion of both displaced teeth, the horse regained weight and resumed training. Bony deformities remained visible 9 mo after discharge.

Summary Objectives: To retrospectively evaluate the outcome of internal fixation of trauma-related pelvic floor fractures using a ventral abdominal approach in cats. Methods: Clinical examination and radio-graphic findings at presentation, after surgery, and at follow-up were assessed. Information gathered included concurrent injuries, surgical technique used, lameness and pain scores, and radiographic signs of implant stability. Results: Ten European shorthair cats were included in the study. Pelvic floor fractures were stabilised using locking plates in nine cats, and symphyseal separation was fixated using hemicerclage wire in one cat. Additional procedures included reduction of sacroiliac luxation in nine cats with positional screws placed in six cats, and plate stabilization of sacral fractures in one cat.All cats were able to walk within five days of surgery. No orthopaedic or neurological deficits were observed in seven cats at follow-up. Neurological deficits were observed in one cat. Signs of pain at implant sites due to inadequate surgical technique were noted in two cats. Anatomical reduction of the pelvic floor was achieved in eight cats. Clinical significance: Stabilization of the pelvic floor and repair of sacroiliac luxation and other injuries by a ventral abdominal approach in cats led to an overall successful outcome. Fixation of the pelvic floor in cats with intact acetabular and ilial bones should be considered in patients with multiple pelvic fractures in combination with sacroiliac joint luxation or sacral fracture, pelvic canal narrowing, traumatic abdominal hernia, and other abdominal injuries.

Models of the canine spleen, kidney, and liver were made from soft plastic to simulate the organs of the live animal as closely as possible in appearance and tissue handling properties. Each organ model was independently evaluated by five small animal surgeons who performed several common surgical procedures on each model. All models had a realistic appearance and, with the exception of one tissue handling problem with the kidney model, and one with the liver model, tissue handling properties of the models were comparable to those of the organs in the live animal. All models were useful for teaching each of the procedures evaluated.