Michele C. Fritz

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.

The Effect of Negative Pressure Wound Therapy on the 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.

Effects of a Cross-linked Hyaluronic Acid Based Gel on the Healing of Open Wounds in Dogs

OBJECTIVE To compare effects of a cross-linked hyaluronic acid (HA) based gel (CMHA-S) to a standard wound management protocol on the healing of acute, full-thickness wounds in dogs. STUDY DESIGN A prospective, controlled, experimental study. ANIMALS Purpose-bred, adult, female beagles (n = 10). METHODS Two 2 × 2 cm wounds were surgically created bilaterally on the trunk of each dog and each side randomized to treatment (CMHA-S) or control (CON) groups. Total and open wound areas were measured with digital image planimetry at 15 time points. From these data, percent contraction and percent epithelialization were calculated. Tissue biopsies were obtained at 6 time points and histologic features were scored. RESULTS Total wound area was significantly larger and percent contraction was significantly less in CMHA-S compared to CON wounds at all data points between days 9 and 18. At day 25, and for the remainder of the study, CMHA-S wounds were smaller and contracted more than CON wounds, reaching significance at day 32. Percent epithelialization was significantly less in CMHA-S compared to CON wounds at all data points after day 11. Histologically, fibroblastic cellular infiltration was significantly higher in CMHA-S wounds at day 21. CONCLUSIONS CMHA-S wounds healed more slowly than CON wounds. This HA-based gel is not indicated in acute, full-thickness skin wounds in dogs as administered in this study. However, treatment may be beneficial in the mid-to-late repair stage of healing, or if scar minimization is desired. Further studies to evaluate the effects of the CMHA-S gel on canine wounds are indicated.

The Effect of Low‐Level Laser Therapy on the Healing of Open Wounds in Dogs

OBJECTIVE To evaluate the effects of low-level laser therapy (LLLT) on acute, full-thickness wound healing in dogs. STUDY DESIGN Randomized block (dog); historical control. ANIMALS Adult male Beagles (n = 10). METHODS Two 2 × 2 cm(2) wounds were surgically created bilaterally on the trunk of each dog. Each side was randomized to receive LLLT (laser, LAS) or standard-of-care management (control, CON), 3 times weekly for 32 days. The LLLT consisted of a dual diode laser (7.5 mW/diode) at 635 nm and total energy density of 1.125 J/cm(2). Wound planimetry was performed on the caudal wounds, from which percent contraction and percent epithelialization were calculated. Histologic features were evaluated at 7 time points from cranial wound biopsies. Experimental data were also compared to wounds from a historical female control cohort (historical control, HCON). RESULTS There was no difference between LAS and CON wounds for all parameters, including histology. The HCON wounds had significantly greater contraction and epithelialization compared to LAS and CON wounds. The LAS and CON wounds had significantly less inflammation than HCON wounds early in wound healing, but inflammation was significantly greater in LAS and CON wounds by day 21. Fibroblast infiltration and collagen deposition were significantly less in LAS and CON wounds than HCON wounds. CONCLUSION There are no apparent beneficial effects of LLLT on the healing of acute wounds in healthy dogs using this LLLT protocol. Gender may influence wound healing in intact dogs.

Improving transitions in acute stroke patients discharged to home: The Michigan stroke transitions trial (MISTT) protocol

BackgroundFor some stroke patients and caregivers, navigating the transition between hospital discharge and returning home is associated with substantial psychosocial and health-related challenges. Currently, no evidence-based standard of care exists that addresses the concerns of stroke patients and caregivers during the transition period. Objectives of the Michigan Stroke Transitions Trial (MISTT) are to test the impact of a social worker home-based case management program, as well as an online information and support resource, on patient and caregiver outcomes after returning home.MethodsThe Michigan Stroke Transitions Trial is a randomized, pragmatic, open (un-blinded), 3-group parallel designed superiority trial conducted in 3 Michigan hospitals. Eligible participants are adult acute stroke patients discharged home directly or within 4 weeks of being discharged to a rehabilitation facility. The patient’s primary caregiver is also invited to participate. Patients are randomized on the day they return home using a randomized block design. Consented patients discharged to a rehabilitation facility who do not go home within 4 weeks are dropped from the study.The 2 study interventions begin within a week of returning home and conclude 3 months later. The 3-group design compares usual care to either a home-based social worker stroke case management (SWSCM) program, or a combination of the SWSCM program plus access to an online information and support resource (MISTT website). Outcomes data are collected at 7-days and 90-days by trained telephone interviewers. Primary patient outcomes include the PROMIS global 10 score (a generic Quality of Life scale), and the Patient Activation Measure (PAM). Caregiver outcomes include the Bakas Caregiving Outcomes Scale. Final analysis will be based on 214 randomized acute stroke patients. To accommodate subjects excluded due to prolonged rehabilitation stays, as well as those lost-to-follow-up, up to 315 patients will be consented.DiscussionThe MISTT study will determine if a home-based case management program designed around the needs and preferences of stroke patients and caregivers, alone or in combination with a patient-centered online information and support resource can improve stroke survivor and caregiver outcomes 3 months after returning home.Trial registrationClinicalTrials.gov: NCT02653170 (Protocol ID: 135457). Registered April 9, 2015.

Effects of prophylactic incisional gastropexy on markers of gastric motility in dogs as determined by use of a novel wireless motility device

OBJECTIVE To evaluate effects of laparoscopic-assisted incisional gastropexy (LAIG) on gastric motility in dogs by use of a wireless motility device (WMD). ANIMALS 10 healthy client-owned large or giant-breed dogs. PROCEDURES 10 dogs owned by clients interested in prophylactic LAIG were enrolled. To determine effects of LAIG on gastrointestinal motility in dogs during the nonfed state, each dog was evaluated by use of a noninvasive WMD before and > 4 weeks after LAIG. All dogs underwent LAIG, with or without concurrent elective gonadectomy. Data obtained before and after LAIG were analyzed by use of proprietary software to determine the gastric emptying time, small bowel transit time, large bowel transit time, whole bowel transit time, and motility index. RESULTS No changes in variables were detected between measurements obtained before and after prophylactic LAIG. CONCLUSIONS AND CLINICAL RELEVANCE In this study, prophylactic LAIG did not have an effect on gastrointestinal motility. The WMD was tolerated well by all dogs and appeared to be a safe and effective method for evaluating gastrointestinal motility in this population of dogs.

Improving stroke transitions: Development and implementation of a social work case management intervention

ABSTRACT Strokes impact over 800,000 people every year. Stroke care typically begins with inpatient care and then continues across an array of healthcare settings. These transitions are difficult for patients and caregivers, with psychosocial needs going unmet. Our team developed a case management intervention for acute stroke patients and their caregivers aimed at improving stroke transitions. The intervention focusses on four aspects of a successful care transition: support, preparedness, identifying and addressing unmet needs, and stroke education. This paper describes the development and implementation of this program, and is an example of the synergy created between neuroscience and clinical practice.

Congenital laryngeal paralysis in Alaskan Huskies: 25 cases (2009–2014)

OBJECTIVE To characterize congenital laryngeal paralysis (CLP) in Alaskan Huskies. DESIGN Prospective case series. ANIMALS 25 Alaskan Huskies with CLP. PROCEDURES Data were collected for each dog regarding signalment; history; results of physical, orthopedic, neurologic, and laryngeal examinations; esophagraphic findings; treatments; histologic findings; and outcomes. RESULTS Severely affected dogs were profoundly dyspneic at birth or collapsed after brief exercise; less affected dogs reportedly tired easily or overheated with minimal exercise. Mean age at initial onset of clinical signs was 6.4 months. Blue eyes, white facial markings, and oral mucosal tags or tissue bands were noted in 23 (92%), 19 (76%), and 13 (52%) dogs. Neurologic examination revealed signs of mononeuropathy of the recurrent laryngeal nerve but not of polyneuropathy. Histologic examination revealed neurogenic atrophy of the cricoarytenoideus dorsalis muscle but no polyneuropathy. Eight (32%) dogs underwent unilateral cricoarytenoid lateralization, resulting in substantial clinical improvement, including ability to compete in sled dog races. Without surgery, 4 (16%) dogs died of asphyxiation, 10 (40%) had spontaneous improvement of clinical signs (but insufficient improvement to race), and 3 (12%) remained affected. Results of pedigree analysis suggested an autosomal recessive mode of CLP inheritance, with variable penetrance. CONCLUSIONS AND CLINICAL RELEVANCE CLP in the evaluated Alaskan Huskies involved mononeuropathy of the recurrent laryngeal nerves, without polyneuropathy. Most affected dogs had blue eyes, white facial markings, and oral mucosal tags or tissue bands. Given the apparent genetic component to CLP in this breed, we recommend that dogs with these features be prevented from breeding.