Bryden J. Stanley

Effects of negative pressure wound therapy on healing of open wounds in dogs.

OBJECTIVE To compare the effect of negative pressure wound therapy (NPWT) with standard-of-care management on healing of acute open wounds in dogs. STUDY DESIGN Prospective, controlled, experimental study. ANIMALS Adult dogs (n=10). METHODS Full-thickness 4 m × 2 m wounds were surgically created on each antebrachium and in each dog were randomized to receive either NPWT or standard wound dressings (CON) for 21 days. Dressing changes and wound evaluations were made at 8 time points. First appearance of granulation tissue, smoothness of granulation tissue, exuberance, percent epithelialization, and percent contraction were compared. Biopsies for histopathology were taken, and histologic scores determined, at 5 time points, and aerobic bacterial wound cultures performed at 2 time points. RESULTS Granulation tissue appeared significantly earlier, and was smoother and less exuberant in NPWT wounds compared with CON wounds. Percent contraction in NPWT wounds was less than CON wounds after Day 7. Percent epithelialization in NPWT wounds was less than CON wounds on Days 11, 16, 18, and 21. Histologic scores for acute inflammation were higher in NPWT on Day 3, and lower on Day 7, than CON wounds. Bacterial load was higher in NPWT on Day 7. CONCLUSION NPWT accelerated appearance of smooth, nonexuberant granulation tissue; however, prolonged use of NPWT impaired wound contraction and epithelialization.

Esophageal Dysfunction in Dogs with Idiopathic Laryngeal Paralysis: A Controlled Cohort Study

OBJECTIVES To compare esophageal function in dogs with idiopathic laryngeal paralysis (ILP) to age and breed matched controls; to determine if dysfunction is associated with aspiration pneumonia over 1 year; and to compare clinical neurologic examination of dogs with ILP at enrollment and at 1 year. STUDY DESIGN Prospective controlled cohort study. ANIMALS Dogs with ILP (n=32) and 34 age and breed matched healthy dogs. METHODS Mean esophageal score was determined for each phase of 3 phase esophagrams, analyzed blindly. After unilateral cricoarytenoid laryngoplasty, dogs with ILP were reexamined (including thoracic radiography) at 1, 3, 6, and 12 months. Neurologic status was recorded at enrollment, 6 and 12 months. RESULTS Esophagram scores in dogs with ILP were significantly higher in each phase compared with controls, most notably with liquid (P<.0001). Dysfunction was more pronounced in the cervical and cranial thoracic esophagus. Five dogs that had aspiration pneumonia during the study had significantly higher esophagram scores than dogs that did not develop aspiration pneumonia (P<.02). Ten (31%) ILP dogs had generalized neurologic signs on enrollment and all ILP dogs developed neurologic signs by 1 year (P<.0001). Conclusions- Dogs with ILP also have esophageal dysfunction. Postoperative aspiration pneumonia is more likely in dogs with higher esophagram scores. Dogs with ILP will most likely develop generalized neuropathy over the course of 1 year. CLINICAL RELEVANCE Esophagrams and neurologic examinations should be performed on all dogs with ILP.

Effects of negative pressure wound therapy on healing of free full-thickness skin grafts in dogs.

OBJECTIVE To compare healing of free, full-thickness, meshed skin grafts under negative pressure wound therapy (NPWT) with bolster dressings in dogs. STUDY DESIGN Randomized, controlled experimental study, paired design. ANIMALS Dogs (n = 5) METHODS: Full-thickness skin wounds (4 cm × 1.5 cm) were created bilaterally on the antebrachia of 5 dogs (n = 10). Excised skin was grafted to the contralateral limb. Grafts were randomized to NPWT or bolster dressings (control; CON). NPWT was applied continuously for 7 days. Grafts were evaluated on Days 2, 4, 7, 10, 14, and 17, biopsied on days 0, 4, 7, and 14, and had microbial culture on Day 7. Outcome variables were: time to first appearance of granulation tissue, percent graft necrosis, and percent open mesh. Significance was set at P < .05. Histologic findings, culture results, and graft appearance were reported. RESULTS Granulation tissue appeared earlier in the NPWT grafts compared with CON grafts. Percent graft necrosis and remaining open mesh area were both greater in CON grafts compared with NPWT grafts at most time points. Histologic results showed no significant difference in all variables measured, and all cultures were negative. CONCLUSIONS Variables of graft acceptance were superior when NPWT was used in the first week post-grafting. Fibroplasia was enhanced, open meshes closed more rapidly and less graft necrosis occurred with NPWT application. More preclinical studies are required to evaluate histologic differences.

Effect of porcine small intestinal submucosa on acute full-thickness wounds in dogs.

OBJECTIVE To evaluate the effects of porcine small intestinal submucosa (PSIS) on the healing of full-thickness wounds in dogs, specifically the appearance of granulation tissue, percent epithelialization and contraction, histologic variables of inflammation and repair, and aerobic culture results. STUDY DESIGN Prospective, controlled, experimental study. ANIMALS Purpose-bred, female dogs (n=10). METHODS Wounds were created bilaterally on the trunk; 1 side as a control and 1 treated with PSIS. First appearance of granulation tissue was recorded. Total wound area, open wound area, and epithelialized area were measured at 21 time points-wound contraction and percent epithelialization were calculated. Aerobic cultures were taken at 4 time points and wound biopsies at 8. Histologic features were graded into an Acute Inflammation Score and Repair Score. RESULTS There was no difference in first appearance of granulation tissue between PSIS-treated and control wounds. Wound contraction was significantly faster in control wounds as was percent epithelialization after day 21. Histologic Acute Inflammation Scores were significantly higher in PSIS-treated wounds compared with control wounds on days 2 and 6. There were no differences in Histologic Repair Scores between PSIS-treated and control wounds or in aerobic culture results. CONCLUSION Wounds treated with PSIS contract more slowly, epithelialize less, and have more pronounced acute inflammation after implantation than control wounds. CLINICAL RELEVANCE Acute, full-thickness wounds in dogs do not benefit from treatment with PSIS.

Survival after surgery for tracheal collapse and the effect of intrathoracic collapse on survival.

Objectives To determine (1) long-term survival of dogs with tracheal collapse (TC) receiving cervical extraluminal prosthetic rings (ELR) and (2) whether intrathoracic collapse effects long-term survival of dogs receiving ELR. Study Design Retrospective case series. Animals Dogs (n = 33) with TC that had ELR. Methods Medical records (July 2002–July 2008) were searched for TC dogs treated with ELR. Age, breed, gender, location of TC, and age at follow-up (death or censor) were recorded. Kaplan–Meier survival curves were generated. Results Of 114 TC dogs, 33 had ELR. Breeds and gender were consistent with previous reports; mean (±SD) age at presentation was 6.3±2.6 years. TC was categorized as cervical or cervical and intrathoracic. All dogs had cervical TC and 15 had concurrent intrathoracic collapse; 8 of these had collapse of mainstem bronchi. Median survival time was >2500 days (median not reached) for cervical TC alone and 1500 days for cervical and intrathoracic TC with no difference in median survival time between groups (P = .26). Conclusion Dogs with TC have a median survival time of 1680 days (4.6 years) after ELR and no differences were seen when dogs had intrathoracic collapse. Intrathoracic collapse does not exclude a dog from receiving ELR.OBJECTIVES To determine (1) long-term survival of dogs with tracheal collapse (TC) receiving cervical extraluminal prosthetic rings (ELR) and (2) whether intrathoracic collapse effects long-term survival of dogs receiving ELR. STUDY DESIGN Retrospective case series. ANIMALS Dogs (n = 33) with TC that had ELR. METHODS Medical records (July 2002-July 2008) were searched for TC dogs treated with ELR. Age, breed, gender, location of TC, and age at follow-up (death or censor) were recorded. Kaplan-Meier survival curves were generated. RESULTS Of 114 TC dogs, 33 had ELR. Breeds and gender were consistent with previous reports; mean (±SD) age at presentation was 6.3±2.6 years. TC was categorized as cervical or cervical and intrathoracic. All dogs had cervical TC and 15 had concurrent intrathoracic collapse; 8 of these had collapse of mainstem bronchi. Median survival time was >2500 days (median not reached) for cervical TC alone and 1500 days for cervical and intrathoracic TC with no difference in median survival time between groups (P = .26). CONCLUSION Dogs with TC have a median survival time of 1680 days (4.6 years) after ELR and no differences were seen when dogs had intrathoracic collapse. Intrathoracic collapse does not exclude a dog from receiving ELR.

Negative pressure wound therapy: experience in 45 dogs.

OBJECTIVE To report experience with negative pressure wound therapy (NPWT) in 45 consecutive dogs admitted with extensive cutaneous wounds and to determine if NPWT is feasible in veterinary hospital practice. STUDY DESIGN Prospective descriptive study. ANIMALS Dogs (n = 45). METHODS Collected data were organized into 6 categories: patient data, wound data, NPWT data, adjunctive treatments, complications, and final outcome. RESULTS Wounds (53 in 45 dogs) were largely traumatic in origin, and distributed fairly evenly to the trunk, proximal and distal aspects of the limbs. Most wounds (34 dogs, 76%) had no granulation tissue and were treated a mean of 4.2 days after wounding, whereas 11 dogs had granulating wounds that were initially treated a mean of 87 days after wounding. Median NPWT use was 3 days with a mean hospitalization of 7.8 days. Most wounds (33; 62%) were closed surgically after NPWT and were healed by 14 days. The other 18 wounds healed (mean, 21 days) by second intention after hospital discharge. Overall, 96% of the wounds healed; 2 dogs died before definitive closure could be attempted. CONCLUSION NPWT is applicable to a wide variety of canine wounds, is well tolerated, allows for several days between dressing changes, and can used to optimize the wound bed for surgical closure or second intention healing.Objective To report experience with negative pressure wound therapy (NPWT) in 45 consecutive dogs admitted with extensive cutaneous wounds and to determine if NPWT is feasible in veterinary hospital practice. Study Design Prospective descriptive study. Animals Dogs (n = 45). Methods Collected data were organized into 6 categories: patient data, wound data, NPWT data, adjunctive treatments, complications, and final outcome. Results Wounds (53 in 45 dogs) were largely traumatic in origin, and distributed fairly evenly to the trunk, proximal and distal aspects of the limbs. Most wounds (34 dogs, 76%) had no granulation tissue and were treated a mean of 4.2 days after wounding, whereas 11 dogs had granulating wounds that were initially treated a mean of 87 days after wounding. Median NPWT use was 3 days with a mean hospitalization of 7.8 days. Most wounds (33; 62%) were closed surgically after NPWT and were healed by 14 days. The other 18 wounds healed (mean, 21 days) by second intention after hospital discharge. Overall, 96% of the wounds healed; 2 dogs died before definitive closure could be attempted. Conclusion NPWT is applicable to a wide variety of canine wounds, is well tolerated, allows for several days between dressing changes, and can used to optimize the wound bed for surgical closure or second intention healing.

Technique and Outcome of Nares Amputation (Trader’s Technique) in Immature Shih Tzus

Dogs with brachycephalic conformation frequently suffer from stenotic nares. This study investigated the clinical effects of stenotic nares resection in shih tzu puppies using an amputation technique first described in 1949. The authors hypothesized that surgical correction of the stenotic nares would result in improvement of nasal discharge/noise, breathing difficulty (dyspnea), and exercise limitations (exercise intolerance), and that the technique would provide a cosmetic result. Based on the results of this study, the authors recommend early surgical correction (amputation) of stenotic nares in shih tzu puppies as an effective and cosmetic technique.

Prevalence and risk factors for canine post-anesthetic aspiration pneumonia (1999-2009): a multicenter study

OBJECTIVE To determine the incidence of canine post-anesthetic aspiration pneumonia (AP) and to identify anesthetic agents, procedures and management factors associated with the development of AP. STUDY DESIGN Multicenter, randomized, case-controlled retrospective study. ANIMALS Two hundred and forty dogs affected with AP and 488 unaffected control dogs. METHODS Electronic medical record databases at six Veterinary colleges were searched for dogs, coded for anesthesia or sedation and pneumonia from January 1999 to December 2009. The resultant 2158 records were hand-searched to determine eligibility for inclusion. Diagnosis of AP was made radiographically. Two unaffected control dogs were randomly selected for each affected dog, from a list of dogs that underwent sedation or anesthesia in the same time period and did not develop aspiration pneumonia. Fifty-seven factors were then evaluated for association with aspiration pneumonia. Data analysis was performed using univariate Chi-square or student t-tests, then multivariate logistic regression. RESULTS Incidence of post-anesthetic AP was 0.17%, from 140,711 cases anesthetized or sedated over the 10 year period. Two anesthesia-related events were significantly associated with development of AP: regurgitation and administration of hydromorphone at induction. Administration of anticholinergics was not associated with AP. Procedures associated with increased odds of aspiration pneumonia included laparotomy, upper airway surgery, neurosurgery, thoracotomy and endoscopy. Orthopedic surgery, ophthalmologic surgery, dental procedures, MRI, CT, bronchoscopy, cystoscopy, tracheoscopy and neutering were not associated with development of AP. Three patient factors were associated with the development of AP: megaesophagus, and a history of pre-existing respiratory or neurologic disease. Sixty-nine% of dogs with two or more of the above independent predictive variables developed AP. CONCLUSION AND CLINICAL RELEVANCE Most anesthetic agents and procedures were not associated with the development of AP. We need to devise and evaluate strategies to protect at risk patients.

Enterocutaneous Fistula in a Dog Secondary to an Intraperitoneal Gauze Foreign Body

A 6-year-old, spayed female German shepherd crossbreed had a 6-month history of a draining fistula in the left flank. Fistulography demonstrated an enterocutaneous fistula. Surgery revealed a granuloma that was enveloping the left ureter and caudal mesenteric artery and adhering to multiple loops of bowel. The granuloma centered on a gauze sponge inadvertently retained at time of ovariohysterectomy. Retained surgical foreign bodies can be avoided, and their frequency is likely underestimated. Risk factors identified in human medicine include emergency surgery, changes in surgical procedure, and obesity. A foreign body should be considered a potential cause of draining tracts in veterinary patients.

Long-term prospective evaluation of topically applied 0.1% tacrolimus ointment for treatment of perianal sinuses in dogs.

OBJECTIVE To evaluate effectiveness of a combination of topically applied tacrolimus, orally administered prednisone, and a novel-protein diet for treatment of perianal sinuses in dogs and to monitor clinical progress and owner management of the condition for 2 years. DESIGN Noncontrolled clinical trial. Animals-19 dogs with perianal sinuses. Procedures-Perianal sinuses were diagnosed during physical examination, and dogs were placed on a 16-week treatment protocol consisting of topically applied 0.1% tacrolimus ointment, orally administered prednisone (tapering dose), and a novel-protein diet. Metronidazole was orally administered for the first 2 weeks. Anal sacculectomy was recommended whenever anal sacs were involved. Dogs were evaluated every month for the first 4 months and then every 6 to 12 weeks for 2 years. RESULTS Perianal sinuses resolved completely in 15 of 19 dogs during the 16 weeks. In the remaining 4 dogs, the lesions markedly improved but failed to completely resolve. Three of these had anal sac involvement, and the owner of 1 dog had complied poorly with treatment instructions. During the 2 years following treatment, all dogs were maintained on intermittently applied tacrolimus ointment, 4 dogs also received prednisone every other day, and 11 dogs remained on the novel-protein diet. At the conclusion of the study, 13 of the 15 dogs that survived to that point were free of perianal disease. CONCLUSIONS AND CLINICAL RELEVANCE The described protocol was effective and economical for resolving perianal sinuses. Dogs maintained on intermittent medications were unlikely to redevelop lesions. When the anal sacs were involved, anal sacculectomy appeared to improve the outcome.