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Lens luxation is a common and potentially blinding disease of dogs. If left untreated, degenerative changes in the pathways for aqueous humor result in glaucoma; however, if the lens is removed by ICLE before significant secondary changes occur, vision can be preserved. In addition, it is now possible to restore excellent vision by replacing the luxated lens with a synthetic IOL.

Review of the functional anatomy of ocular adnexal tissues is followed by presentation of surgical procedures aimed at correcting conditions of the eyelids, conjunctiva, and third eyelids of small animals. Procedures used effectively by the primary author are described in detail including instances where combination procedures may be indicated. Some newer, recently described techniques are also briefly discussed. Illustrations of applied anatomy and multiple surgical techniques are provided by illustrator and coauthor Dr. Gheorghe Constantinescu. References are given to encourage readers to further explore alternative techniques focusing on the surgical correction of adnexal diseases of dogs and cats.

Corneal surgery is a common and essential part of veterinary ophthalmology and ranges from simple linear keratotomy for indolent ulcers to penetrating keratoplasty for restoration of optical clarity. Success in corneal surgery relies on an understanding of corneal anatomy, physiology and wound healing, meticulous attention to detail, microsurgical equipment and techniques, and use of appropriate preoperative, intraoperative, and postoperative medications. Surgical management of corneal disease is indicated for corneal ulceration, excision of a mass lesion, reconstructive procedures, therapeutic indications, optical restoration, and cosmetic purposes.

Most cases of glaucoma in small animals ultimately require surgical treatment for long-term control of intraocular pressure. Surgical procedures that have the potential to preserve vision in acute cases are categorized into those that reduce aqueous production (cyclodestructive techniques). Salvage procedures for irreversibly blind eyes include enucleation, implantation of an intraocular prosthesis, and pharmacologic ciliary body ablation. The indications, surgical technique, and complications of these procedures are discussed in this article.

Objective: This study documents the results of non-surgical treatment and treatment by superior check desmotomy in Thoroughbred racehorses with superficial digital flexor (SDF) tendonitis., Design: A prospective study was made of 124 thoroughbred racehorses with unilateral or bilateral SDF tendonitis., Procedure: The flexor tendons were assessed by physical and ultrasonographic examination before treatment, and the lesions detected in affected tendons were characterised according to lesion type, length and cross-sectional area. Ninety three horses were managed non-surgically and 31 by superior check desmotomy. Recurrent or new injuries were defined as injuries affecting a previously injured superficial digital flexor tendon, the contralateral SDF tendon, or the suspensory ligament (interosseous muscle) in either forelimb., Results: No statistically significant difference was found in ultrasonographic lesion severity between treatment groups. Horses managed by superior check desmotomy were 1.3 times more likely to complete five or more races than horses managed non-surgically (95% confidence limits 0.93-1.82). Horses treated surgically were 1.2 times more likely to develop recurrent or new injuries after returning to training than horses managed non-surgically (95% CL 0.95-1.55). Horses undergoing superior check desmotomy were 5.5 times more likely to develop suspensory desmitis than horses treated non-surgically (95% CL 1.13-26.4). There was no difference in the time to recurrent or new injury between treatment groups., Conclusion: There was no statistically significant difference between treatment groups in the proportions of horses able to complete five or more races after an episode of superficial digital flexor tendonitis. Superior check desmotomy did not appear to offer an advantage over non-surgical treatment in preventing recurrent or new injuries in Thoroughbred racehorses. Horses undergoing superior check desmotomy appeared to be at greater risk of developing suspensory ligament injuries than horses managed non-surgically.

Esophagostomy tubes were placed surgically in 13 dogs and 16 cats. The placement technique used was rapid and only required curved forceps, a scalpel blade, and suture material. Flexible tubes (5- to 30-French) were used for feeding liquids or blenderized diets for up to 557 days. Additionally, esophageal and gastric decompression were accomplished using these tubes. Following tube removal, all ostomy wounds healed by second intention without evidence of esophageal stricture or esophagocutaneous fistula. Complications included kinking, placement in an inappropriate location, obstruction, inflammation or infection of the ostomy site, and reflux of feedings.

Retinal detachment surgery in human patients is currently 90% successful, with most detachments amenable to treatment by scleral buckling procedures. The main obstacle to achieving comparable results in veterinary patients is the active nature of our patients during the postoperative convalescent period. Adapting current techniques to include short-term chorioretinal adhesion by way of tacking, cyanoacrylate adhesives, or other methods has shown substantial promise and should be further investigated in veterinary species. The technology and methods are currently available to produce success rates comparable to those achieved in human patients, and the near future promises to bring further refinements in veterinary applications.

Objective: The objective of this study was to determine the effectiveness of a 5-minute surgical scrub using either a one-brush or a two-brush technique in clean and dirty surgical procedures, and to compare the efficacy of povidone iodine with chlorhexidine as surgical scrub solutions., Study Design: Prospective clinical trial., Methods: Nine veterinarians scrubbed their hands on eight separate occasions using either povidone iodine or chlorhexidine gluconate. A 5-minute scrub and either a one-brush or two-brush technique used in both clean and dirty operations were evaluated by taking glove juice samples before scrubbing, immediately after scrubbing, and 30, 60, 90, and 120 minutes after scrubbing. Glove juice samples were cultured and the colonies were counted. Percent reductions of bacterial forming units were calculated for all eight scrub procedures., Results: All scrub procedures provided an adequate percent reduction in colony forming units (CFU) during the 2-hour sampling period. The number of CFU immediately after scrubbing were significantly lower than prescrub. At 120 minutes, there were significantly fewer CFUs than presecrub, but there were more than immediately after scrubbing. No significant difference in reduction in CFUs were detected between one-brush and two-brush techniques. Both chlorhexidine and povidone iodine scrub solutions adequately reduced bacterial colony counts for 120 minutes after scrubbing regardless of the amount of contamination before skin preparation., Conclusions: Bacterial counts after a hand scrub procedure using a one-brush technique were not significantly different than after a procedure that used a two-brush technique. Povidone iodine and chlorhexidine are equally effectively in decreasing bacterial numbers on the skin, given a variety of contamination levels present before the scrub procedure., Clinical Relevance: Surgeons may use either chlorhexidine or povidone iodine for antiseptic preparation of their hands before surgery. A two-brush technique is not necessary.

The number one rule of phacoemulsification and aspiration cataract surgery is to know your machine. This chapter is designed to help the surgeon who is currently using phacoemulsification, or those who wish to understand more about technique, learn the basics and technology of the various types of phacoemulsification machines. Fluidics, pump design, handpiece mechanics, phacoemulsification needles, and fundamentals of phacoemulsification of cataracts will be reviewed.

Orbital surgery is performed infrequently but when necessary, requires detailed understanding of orbital anatomy and the probable biologic behavior and extent of the pathologic process affecting the orbit. Thorough preoperative characterization of an orbital disease allows the surgeon to develop a surgical strategy. Inaccurate or hasty preoperative localization, determination of extension, and diagnosis may result in selection of an inappropriate surgical approach or discretionary surgery when medical treatment is indicated. In most instances, diagnostic images (MR, CT, echography) should always be made and fine-needle aspiration be done before orbital surgery is performed. The choice of surgical approach or combination of approaches is determined primarily by the type, location, size, and extent of disease present. Extensive surgical exposure of the orbit is limited to centimeters or fractions of a centimeter because of the compact anatomy and tight confines of the orbital region. Careful tissue manipulation, surgical dissection, and postoperative assessment are necessary to preserve the globe and functional vision when orbital disease endangers function.

Chronic septic tenosynovitis with concurrent, associated focal osteomyelitis of the lateral proximal sesamoid bone was diagnosed in a seven-year-old thoroughbred gelding. Surgical management of this case consisted of open annular ligament desmotomy and curettage of the affected sesamoid. Following lavage of the digital sheath the incisional wound was closed but a 2 cm gap was left distally to allow for postoperative open drainage. The distal limb was bandaged and the horse treated with antibiotics and non-steroidal anti-inflammatories. Sepsis resolved and the horse made a gradual return to full work.

A 3-year-old female Standardbred was admitted for evaluation of a firm swelling on the right side located rostral to the facial crest and a firm intraoral swelling located rostral to the erupted cheek teeth. Examination of skull radiographs revealed a supernumerary cheek tooth rostral to the erupted third premolar. The supernumerary tooth was removed via lateral buccotomy. The horse did not have complications after surgery and resumed racing. Lateral buccotomy should be considered for removal of rostrally located maxillary or mandibular cheek teeth. Supernumerary cheek teeth can be found in locations in the upper dental arcade, other than caudal to the last molar.

Objective: To describe the short- and long-term survival rates in horses undergoing ovariectomy for granulosa cell tumors by use of the diagonal paramedian approach., Design: Retrospective case study., Animals: 12 horses with granulosa cell tumors., Procedure: A diagonal paramedian approach for unilateral ovariectomy was used for removal of each mare's granulosa cell tumor. Information about complications and outcomes was analyzed., Results: Only minimal complications were detected postoperatively when the diagonal paramedian approach was used, regardless of the preferred technique for ovarian pedicle ligation or incisional closure and the use of pre- and postoperative medications. Clinical signs of moderate or severe postoperative abdominal pain were not evident in any of the 12 horses. Short- and long-term survival rates were 100%., Clinical Implications: The diagonal paramedian approach was advantageous for ovarian tumor removal, because the ovary was immediately adjacent to the body wall at a portion of the incision site. Size of the ovary was not a limitation, because muscle tissues at the edges of the incision were flexible and easily retractable. All of these factors improved exposure, decreased traction on the ovary, increased our ability to observe the vasculature, and decreased postoperative morbidity, aiding in the removal of granulosa cell tumors in mares.

Gastric electrical and contractile activities were assessed in healthy adult dogs on the eighth day after circumcostal gastropexy surgery, using serosal electrodes and strain gauge force transducers. Recordings were analysed to determine gastric slow wave frequency, presence of gastric slow wave dysrhythmias, gastric slow wave propagation velocity, coupling of gastric contractions to slow waves, a gastric motility index based on relative contractile amplitudes, and onset of gastric contractions after a standardised meal. Overall, gastric electrical and contractile activities were relatively unaffected by circumcostal gastropexy.

Five cats underwent lobectomy for the management of pneumonia. The mean presurgical duration of treatment was eight months. A potentially immunosuppressive disease process was present preoperatively in two of the five cats. Preoperatively, two of the cats had radiographically diffuse pneumonia, while three had focal pneumonia. A single pulmonary lobe was removed in four cats, with one cat having two pulmonary lobes removed. There were no life-threatening complications and no clinical recurrence noted during a mean follow-up period of 37.8 months. The benefit of pulmonary lobectomy in focal pneumonia may lie in removing the nidus of infection. In diffuse, chronic or medically refractory pneumonia, obtaining an aetiological diagnosis may be the main benefit of lobectomy. Selective lobectomy for the treatment of pneumonia may be beneficial but a thorough preoperative evaluation is warranted.

Diagnosis and removal of a nasal polyp in a horse using standing chemical restraint and readily available equipment are described. Histopathology of the polyp and differential diagnoses are discussed.

The history, clinical features, radiological findings, treatment and outcome of 15 horses with chronic tenosynovitis of the carpal extensor tendon sheaths are reported. The condition was seen most commonly in horses used for jumping and penetration of the tendon sheaths by thorns was the most common aetiology. Treatment involved surgical resection of the hyperplastic synovial membrane, and adhesions within the tendon sheath, with primary closure. When combined with early postoperative physiotherapy this was found to be an effective method of treatment. All horses in this series were not lame at follow-up, with 14 horse returning to their former level of athletic performance.

Objective: To document presence of endotoxin in portal and systemic blood in a model of canine multiple portosystemic shunts (PSS), and compare values in clinically normal dogs, before and after vena caval banding., Animals: 6 control dogs and 10 dogs with dimethylnitrosamine-induced multiple PSS that were subjected to vena caval banding., Procedure: Dimethylnitrosamine was administered orally (2 mg/kg of body weight, twice weekly) to the 10 dogs in the diseased group until multiple PSS developed. Surgery was then performed on all 16 dogs (both groups), and shunts were confirmed in the diseased dogs. Blood was collected from the portal vein, hepatic vein, and caudal vena cava baseline endotoxin determination and aerobic and anaerobic blood culturing. Baseline pressure measurements were taken from the portal venous catheter; then vena caval banding was performed. Blood for endotoxin determinations was taken from all vessels 20, 40, 60, 120, 240, and 360 minutes after banding; portal pressure measurements were taken at the same time as sample acquisition. Blood for culturing was taken from the portal and hepatic venous catheters at 120, 240, and 360 minutes after banding., Results: Dogs in the diseased group had significantly greater overall presence of endotoxin in the portal vein (P < or = 0.0002), hepatic vein (P < or = 0.0001), and caudal vena cava (P < or = 0.0004) than did control dogs. With respect to time, endotoxin presence was greater in the diseased group before banding (P < or = 0.0002), and at 20 (P < or = 0.0008), 40 (P < or = 0.002), 60 (P < or = 0.006), and 120 (P < or = 0.01) minutes after banding., Conclusions: Endotoxemia is more frequently present in catheterized dogs with dimethylnitrosamine-induced hepatic disease and multiple PSS, compared with clinically normal dogs. Additionally, portal pressure changes induced by vena caval banding did not affect endotoxemia., Clinical Relevance: Endotoxemia may exist in dogs with hepatic disease and multiple PSS, and should be kept in mind when formulating treatment (particularly antimicrobial selection) for dogs with suspected endotoxemia.

Inadequate peripheral nerve regeneration as a result of trauma contributes greatly to the morbidity of surgical patients. Animals admitted as an emergency often have concurrent orthopaedic injuries that impair mobility and may mask peripheral nerve dysfunction if a thorough neurological examination is not performed. This article reviews the pertinent anatomy of the peripheral nervous system as well as the degenerative and regenerative responses that occur in traumatized nerves. Physical examination and electrodiagnostic techniques that characterize the extent of nerve impairment are described. The management of peripheral nerve lacerations for open and closed wounds is detailed, as well as the presenting clinical signs and prognosis for brachial plexus avulsions, sciatic nerve damage, and sacrococcygeal injury.

Traumatic disruption of the spine and supporting soft tissue structures may result in vertebral fracture or luxation and subsequent spinal cord compromise. An understanding of the regional anatomy is important to the discussion of pathophysiology and treatment of traumatic disorders. Various traumatic forces result in disruption of specific anatomic structures and reflect inherent stability or instability of the vertebral column. The neurological examination, and sequential neurological examinations, reflect the degree of spinal cord damage and vertebral instability. Patients in whom radiographs show instability, have severe neurological signs or worsening neurological signs, should be treated surgically. Several spinal stabilization techniques are available and their choice is contingent on the location in the spinal column, size of the patient, and the surgeon's experience. The prognosis is determined primarily by the severity of neurological signs, and the stability of the fixation technique.

The collection of corticocancellous from the ilium using an acetabular reamer has been described in humans. The technique was used clinically and in a post mortem study in dogs. The quantity of cancellous bone graft obtained with an acetabular reamer was greater than the cancellous bone graft obtained from the wing of the ilium with the curette.

Brain tumors occur commonly in small animals. The clinical history and physical examination findings can strongly suggest their presence. Specifically, an older dog with onset of seizures and behavioral changes, or an older cat with behavioural changes and weakness, should be further evaluated for the presence of a brain tumor. A thorough neurological examination should be performed to localize the lesion(s). Groups of neurological signs will suggest the tumor to be cerebral, cerebellar, or brainstem. Cerebral tumors without brainstem signs carry the best prognosis, especially for cats. Patients suspected of having brain tumors should be imaged with computed tomography, or magnetic resonance imaging. Initial medical therapy includes anticonvulsants and glucocorticosteroids. Cerebral tumors not located on the floor of the calvarium can be successfully excised. These and other tumors can also be treated with radiation therapy.

Neurological deficits suggesting trauma to the spinal cord in the thoracolumbar area are the most common clinical presentation of neurosurgical conditions. By far, the most common cause of thoracolumbar spinal cord dysfunction is intervertebral disc disease. Disc herniation and subsequent spinal cord compression usually requires prompt medical treatment, then referral for high detail radiographs, myelogram, and surgical decompression. Other causes of thoracolumbar spinal cord dysfunction include neoplasia, discospondylitis, fibrocartilaginous embolism, and degenerative myelopathy.

The surgical and medical records of 67 dogs and nine cats which underwent median sternotomy over a five-year period were reviewed. The indication for median sternotomy and the short and longer term complications were recorded. Twenty-six of the dogs died or were euthanased within 48 hours of the surgery as a consequence of the pre-existing disease or complications of the intrathoracic surgical procedure. A further four dogs were enthanased between 48 hours and 14 days following confirmation of neoplastic processes. Thirty-seven dogs were alive at 14 days: of these, seven dogs (19 per cent) experienced short-term wound complications, including haemorrhage, wound infection, thoracic limb neurological deficits and excessive postoperative discomfort. Of the 37 dogs alive for longer term follow-up, eight dogs (22 per cent) experienced wound complications, including haemorrhage, sternal fracture, sternal osteomyelitis and delayed wound healing. No complications were noted in the cats.

Lumbosacral conditions are now recognized as compromising a significant percentage of problems for dogs and cats with rear limb abnormalities. Diagnosis is based on logically ruling out the more common maladies and then performing specific diagnostic procedures that definitively show the lesion(s).

This article reviews the four most common surgical conditions of the cervical spinal cord other than vertebral fractures including atlantoaxial instability, cervical disc disease, caudal cervical spondylomyelopathy, and spinal cord tumors. Each disease is reviewed by signalment, history, neurological examination, differential diagnosis, pertinent diagnostic testing, treatment, postoperative care, and prognosis.

Proper medical care before and after surgery play an important role in the overall care of patients requiring neurosurgery and will have an impact on the neurological recovery. Prevention of spinal cord destruction resulting from the cascade of events which occur secondary to central nervous system trauma is a critical part of a patient's preoperative care. High doses of methylprednisolone sodium succinate given within the first 8 hours of trauma are currently recommended to provide protection to neural tissue after trauma. Other promising drugs for patients with spinal trauma, such as 21-aminosteroids and GM-1 gangliosides, may become available in the near future. Knowledge of potential complications after surgery and methods to prevent complications from occurring is an important part of the postoperative care of neurosurgical patients. This includes management of micturition and defecation dysfunction, management of postoperative pain, physical therapy to speed recovery, and providing good supportive care to the recumbent patient.

This paper describes an investigation to evaluate the properties and uses of the different casting materials available for small animals. After a consideration of the properties that make an 'ideal cast', clinically relevant tests were performed on tubular casts of the various products. No single product demonstrated consistent superiority by all the criteria. All the products tested can be useful in a variety of situations, and suggestions for their uses are set out.

Nonstrangulating indirect scrotal hernias were corrected in two 4-week-old Percheron foals by a laparoscopic technique. After laparoscopic reduction of herniated nonstrangulated small intestine each testes was retracted through the vaginal ring. The ligament of the tail of the epididymis was transected by electrocautery. The testicular vessels and nerves were isolated by cautery of the mesenteric portion of the mesorchium and then ligated. Staples were used to close the opening of the inguinal canal by apposing the peritoneal edges of the vaginal ring. Resection of umbilical stalk remnants via celiotomy performed in one foal after laparoscopic observation of enlargement of the right umbilical artery and urachus. No complications or recurrence of herniation had occurred 16 weeks after surgery.

Static locked nailing was used to repair fractures of the femoral diaphysis in 15 dogs. The implant consists of a 5, 6, or 7 mm diameter stainless steel rod made up of two parts: the body of the nail, in which there are 13 threaded holes, and a piece without holes that contains a slot for anchoring the jig. Good limb function was obtained after less than 3 weeks in 12 dogs and these dogs remained sound throughout the study. Radiographic examination revealed fracture healing in 11 of the dogs, between 8 and 16 weeks after surgery. One dog was not returned for follow-up evaluation until 22 weeks after surgery; complete healing was apparent from radiographic examination. The remaining three dogs had to have additional operations, one because of lameness caused by excessive length of the distal screws, one because of a nonunion, and the third because of a sequestrum. Fracture healing in these dogs was observed at 18, 21, and 24 weeks respectively. Loosening of one screw and angulation of the bone occurred in one dog. These complications had no adverse effects on clinical outcome.

Using standard material testing techniques (bending stiffness, torsional stiffness, and maximum torque to failure or yield torque), the structural properties of interlocking nails (IN), canine femora, and IN/femur constructs were determined. Specimens that were tested included: 6 and 8 mm diameter IN with 5 to 10 screw holes (n = 18), and intact canine femora (n = 10), which also, with an IN inserted, formed the intact construct (IC) group, (n = 10). Specimens in the IC group were first tested with an 8 mm diameter IN with zero screws, followed by one and two screws (4.5 mm diameter) in the proximal and distal femur. A fracture model construct (FMC), (n = 14), consisting of a transverse femoral osteotomy with a 3 mm gap, was used with either 6 mm or 8 mm IN. In the 6 mm FMC, one and two 3.5 mm screws were used sequentially in the proximal and distal femoral segment. In the 8 mm FMC, one and two 3.5 mm screws and one and two 4.5 diameter screws were used similarly. When bending forces were applied parallel to IN screw holes, mean IN stiffness was 20% less than with forces perpendicular to the holes (n = 18), (P < .05). Eight-millimeter IN were 220% stiffer in torsion and 270% stiffer in bending than 6 mm IN (P < .05). Six-millimeter IN had approximately 32% of the bending stiffness and torsional stiffness of intact femurs (P < .05). Eight-millimeter IN had 93% and 79% of the bending stiffness and torsional stiffness, respectively, of intact femurs. Intact femur constructs (8 mm IN with four, 4.5 mm screws) had 147% of the bending stiffness (P < .05), and similar torsional stiffness and maximum torque, as intact femora (P > .05). The mean values of 6 mm FMC with four screws (3.5 mm) were 21% and 33% in torsional stiffness and bending stiffness, respectively, of intact femora values. When tested in torsion, 8 mm FMC failed by bone fracture; 6 mm FMC, in contrast, underwent plastic deformation. In comparing FMC stabilized with an 8 mm IN with two screws (4.5 mm diameter) in each bone segment, to intact femurs, the maximum torque was similar, FMC torsional stiffness was 40% (P < .05), and FMC bending stiffness was 65% (P < .05). These 8 mm FMC percentages are comparable to human IN fracture model construct values, indicating that the 8 mm IN/four screw construct should provide adequate stabilization for many canine diaphyseal femoral fractures.

Two dogs had right divisional intrahepatic portacaval shunts within the right lateral lobe of the liver. In both dogs, an extrahepatic portacaval vascular anastomosis was created, using an autologous right external jugular vein graft. The intrahepatic shunts were completely attenuated using a prehepatic intravascular caval approach. The creation of the vascular graft allowed postattenuation rises in portal pressure to be controlled, preventing the development of life threatening portal hypertension. Both dogs recovered from the procedure. One dog is clinically normal and does not require medication (8 months postoperatively); the other dog was euthanatized 5 months after surgery because of renal failure. Scintigraphy studies, performed before surgery, showed significant shunting of portal blood away from the liver (shunt indices 65% and 59%), whereas, similar studies done 4 weeks afterwards showed almost normal portal blood flow (shunt indices 16% and 18%, respectively).

Five dogs were diagnosed as having unilateral separation of the otic cartilages (auricular and annular). Four dogs had sustained prior trauma (hit by a car). Clinical signs were typical of ear canal stenosis and included swelling at the base of the ear (n = 2), periotic fistulation (n = 2), head tilt toward the affected side (n = 2), and pain when opening the mouth (n = 1). Palpation revealed separation of the horizontal and vertical ear canals. Otoscopic findings included a shallow ear canal and a pseudotympanic membrane across the proximal end of the auricular cartilage. Findings at surgery confirmed the diagnosis of cartilage separation and included an exudate-filled horizontal ear canal and a blind-ending vertical ear canal. Surgical treatment involved isolating the distal end of the annular cartilage (horizontal ear canal), opening and evacuating the horizontal ear canal, and suturing the open end of the annular cartilage to the skin. The length of annular cartilage was variable among the dogs, although each dog had sufficient horizontal canal to appose skin to otic epithelium. The vertical ear canal was not surgically dissected or manipulated. The mean follow-up period was 46 +/- 14 months (range, 31 to 68 months). All five dogs had patent horizontal ear canals when examined at the follow-up examination.

Nasotracheal intubation can be accomplished in calves by use of a silicone nasotracheal tube of a Murphy design. For intubation, the calf's head and neck should be extended to facilitate tube passage through the naris into the ventral meatus and then through the larynx into the trachea. Preanesthetic medication may assist in tube passage by decreasing the alertness of the calf and decreasing the ability of the calf to swallow the tube into the esophagus. Nasotracheal intubation allows the inhalant anesthetic agent to be delivered with minimal room pollution and less stress to the calf. It would be useful for oral surgery when an orotracheal tube would obstruct the surgical site.

In recent years fracture fixation in the horse has changed significantly. New devices, mainly adapted from the human field, have been successfully introduced into large animal surgery. Examples of such implants include the DCS/DHS implant system, the self-tapping screw, the cannulated screw, and the pinless external fixator. However, new devices have also been developed exclusively for equine fracture management, including the interlocking intramedullary nail and the external skeletal fixation device. With these devices the surgeon has more options for repairing fractures in horses. Nevertheless, many problems are still unsolved. Indications exist that during the next few years new, exciting fracture fixation systems will be developed, providing further advancements in the quest for the ideal implant for horses. However, the development stages of these devices are such that mentioning the possibilities here is premature.

In this article, videoendoscopy in conjunction with high-speed treadmill exercise and other specialized diagnostic techniques used to measure upper airway function are reviewed as they pertain to the four most commonly diagnosed functional upper airway obstructions: (1) laryngeal hemiplegia, (2) arytenoid chondritis, (3) epiglottic entrapment, and (4) intermittent dorsal displacement of the soft palate. Using experimental and clinical findings obtained with these new instruments and diagnostic techniques, current recommendations for surgery of these obstructions are presented.

Equine surgery continues to benefit from advances in laparoscopic techniques. Descriptions of the normal anatomy of the standing horse and advances in instrumentation have improved our ability to perform laparoscopic surgery in both standing and dorsally recumbent horses. The common uses for laparoscopy are diagnostic laparoscopy, cryptorchidectomy, ovariectomy, and diagnostic thoracoscopy. Other reported uses include inguinal hernia repair, ruptured bladder repair, and ventral colopexy.

Recent advances in instrument sterilization include the introduction of gas plasma sterilization and the increased use of glutaraldehyde. Gas plasma sterilization has the advantages of no toxic residue effects, reduced turnover time, and applicability for sterilization of heat- and moisture-sensitive instruments. Chlorhexidine gluconate (4%) appears to be a superior preoperative surgical scrub for both the surgeon and the patient because of its increased antimicrobial efficacy, residual activity, and minimal tissue reactions. There are many new wound dressings and topical medications for treatment of wounds, but the efficacy of most of these preparations has been evaluated only in humans, dogs, and cats. The ideal topical wound preparation and dressing for equine wounds, particularly wounds affecting the distal limb, have not yet been found.

The carbon dioxide laser has become an important surgical instrument in human and veterinary medicine. The unique properties of this laser make it the instrument of choice for precise incision, coagulation, and vaporization of tissue at the body surface with minimal morbidity to the patient. This article describes the instrumentation and techniques used to perform a variety of equine general surgical procedures with the carbon dioxide laser. The benefits of surgery using the carbon dioxide laser include precise dissection with minimal trauma to adjacent tissues, good hemostasis, and the ability of the laser beam's thermal properties to kill bacteria or tumor cells in the operative field.

Transendoscopic laser surgery provides equine surgeons with a safe, reliable, and minimally invasive method of performing many surgical procedures in the upper respiratory tract. Although the Nd:YAG laser has proven efficacy, other newer lasers such as the diode and holmium: YAG lasers may prove to be useful tools for equine upper respiratory tract surgery. Long grasping forceps and a high quality fiberoptic or video endoscope are critical components necessary for performing transendoscopic laser surgery. For many of the most common upper respiratory tract abnormalities, a laryngotomy can be eliminated, morbidity is minimal, the horse can often return to normal exercise in approximately 7 to 14 days, and trainer and owner acceptance is excellent. Transendoscopic laser surgery is most likely to be cost effective in large referral practices or in a university setting.

Orthopedic infections-those involving bones, joints, tendon sheaths, or bursae-are some of the most difficult problems for equine surgeons to treat successfully. Sources of the infection are usually hematogenous, traumatic, or iatrogenic and knowledge of the most likely causative bacteria is very useful in selecting the most appropriate antimicrobial(s) to either prevent or treat these infections in horses. This article discusses the clinical findings, diagnosis, treatment, and prevention of orthopedic infections in horses. More recent treatment methods such as synovial drainage techniques (arthroscopy and arthrotomy), intrasynovial antimicrobials, regional perfusion of antimicrobials, and antimicrobial-impregnated polymethylmethacrylate (PMMA) beads or cylinders are also addressed.

The medical records of 58 patients that had undergone ventral rhinotomies were reviewed to determine the long-term outcome and sequelae of this procedure. The signalment, history, and postoperative survival of these patients were found to be similar to other reports in the literature. The deaths of 2 cats immediately postoperatively were attributed to the use of carotid artery tourniquets. Postoperative complications included 1 oronasal fistula, and a persistent mucopurulent or serous discharge in 76% of the patients that had a primary rhinitis before surgery. Ventral rhinotomy was useful as a diagnostic modality for the removal of foreign material and the curettage of focal lesions, and it may be useful in the palliation of nasal tumors in cats.

A new method for reversible reentrant cannulation of the parotid duct in cattle by use of an injectable anesthetic regimen is described. Ruminal contents were removed before anesthesia instead of food deprivation. The parotid duct was dilated by means of a long hemostatic forceps: its jaws were encased in a piece of plastic tube, and the tip was extended by a piece of flexible wire. A polyethylene parotid catheter was inserted into the dilated duct and passed through the cheek. The saliva was re-directed back into the mouth via a silicone tube through another fistula in the cheek. The cannulations were maintained for 3 to 11 wk and two cows were recannulated three to five times in both parotid ducts without problems. No pathological changes of the mouth epithelium were found at slaughter. The rate of flow from the ducts during rest, ruminating, and eating were 5 to 20, 25 to 50, and 40 to 75 mL/min, respectively.

A sutured tenorrhaphy technique that incorporated an autologous tendon graft was compared mechanically and histologically with a sutured tenorrhaphy at 6, 12, and 24 weeks after repair. Tenorrhaphy was performed in the forelimb tendon of the deep digital flexor muscle and the graft was taken from the hindlimb tendon of the lateral digital extensor muscle; one forelimb site included the graft, whereas the other forelimb site was not grafted. Tenotomies were made immediately proximal to the insertion of the accessory ligament into the tendon of the deep digital flexor muscle. Grafted and nongrafted tenorrhaphies were sutured with 2 polydioxanone in a modified double locking-loop pattern. Limbs were supported with a bandage and an extended elevated heel shoe that maintained the dorsal hoof wall angle at 70 degrees to 75 degrees; this support was removed at 12 weeks and dorsal hoof wall angle was maintained at 40 degrees to 45 degrees for the remainder of the study. Gap formation (2.5 +/- .3 cm) was evident at all tenorrhaphy sites at 3 days on ultrasound examination. In grafted repairs, the breaking stress was increased (P < .001) between 6 weeks (2.56 +/- .44 MPa) and 12 weeks (17.69 +/- 7.68 MPa), with grafted tendon having a greater breaking stress than nongrafted tendon (8.77 +/- 2.5 MPa; P < .05). No differences in breaking stress were evident at 24 weeks. At 12 weeks, repair tissue in grafted tendon was histologically more mature, had less cellularity, better fibroblast orientation and more homogeneous collagen matrix than nongrafted tendon. Polydioxanone suture was still evident histologically at 24 weeks and was associated with minimal cellular reaction. Incorporation of an autologous tendon graft improved the mechanical properties and histological quality of the repair tissue in equine flexor tenorrhaphies at 12 weeks but not at 24 weeks after repair.

Objective: To compare the strength of the sutured linea alba, in vitro, using 2 suture patterns., Animals: 12 clinically normal llamas., Procedure: 2 incisions in the linea alba of 12 llamas were closed with a simple continuous or inverted cruciate pattern, and tissue was harvested after 10 days. In 6 llamas the simple continuous line was intact; the inverted cruciate specimens contained 6 sutures. In 6 llamas, 1 knot was excised in the simple continuous pattern to simulate a failed line; the cruciate pattern contained 5 knots. Tissue sections were taken from cranial, between, and caudal to the linea alba incisions to compare fascial thickness. The sutured specimens were mounted in a mechanical testing system and tested to failure. A mixed-model ANOVA was used to evaluate the effects of suture pattern and incisional position on mechanical properties., Results: Significant differences were not found between suture patterns or between location for yield force, failure force, or yield strain, whereas failure strain was lower for the intact simple continuous pattern than the inverted cruciate pattern (P = 0.003). From histomorphometric analysis, the caudal tissue specimens were significantly thinner than the middle tissue specimen cranial to the umbilicus (P = 0.006)., Conclusion: There was no significant difference in monotonic breaking strength of the linea alba sutured with the simple continuous or inverted cruciate pattern., Clinical Relevance: These results justify the use of the simple continuous pattern over the cruciate pattern for ventral midline closure in llamas because of the ease of placement and speed.