POTW June 14 thru June 18, 2010

Our winner for POTW last week was Corrie:

Who will it be this week?

PATIENT SUMMARY:

Willie is a Labrador Retriever. He weighs 101# and is 8yrs old.  Dr. Blair Willman of North Hills Animal Clinic is is referring veterinarian. Willie has a previous right CCL injury addressed with a intra-articular fascial strip at another facility. The right leg has not improved significantly from the time of the October surgery, and he is now acutely off on the left rear. He was able to rise and walk with a very stilted gait on both rear limbs, but had significant bilateral muscle atrophy. Radiographs of stifles and hips demonstrated moderated hip dysplasia and changes in the stifles consistent with CCL injury. Positive anterior drawer and medial buttress were present in both stifles, with meniscal click in the left. Dr. Dew discussed TTA (tibial tuberosity advancement) and EFS (external fascial strip) procedures, unilateral and bilateral. After consideration the owners wished to proceed with bilateral TTA.

TREATMENT:
Dr. Dew used a medial approach with medial arthrotomy for Willie’s surgeries. Kyon hardware used for advancement and stabilization on each stifle were as follows: 12x22mm basket, 7 hole plate & fork, and 4 titanium screws. Willie’s prognosis is good for healing, improved function and decreased progression of degenerative joint disease (arthritis). Nursing care, physical therapy, exercise restriction and the use of Glycoflex will play critical roles in an uncomplicated recovery and optimization of long term function. With the TTA procedure, it is not uncommon to see some bruising and edema around the hock (ankle) and on the inside of the leg below the incision. These changes are not painful and will resolve without treatment in 3-10 days. Due to having both stifles corrected simultaneously a harness was supplied to assist Willie in rising and walking for the next 1-10 days.

PATIENT SUMMARY:
Layla is a 6mo old 54# German Shepherd. Dr. Amanda Barnett at All Animal Health Center referred her to us. Layla has shown left forelimb lameness which gets worse after activity. Dr. Barnett identified left UAP (ununited anconeal process). Dr. Dew discussed the bilateral nature of this disease, as well as UAP removal or ulnar osteotomy to promote closure. Due to pet activity planned for Layla and 25% failure of closure after surgery, the Champion's wished to proceed with Bilateral UAP removal, if after radiographs were taken, the right showd UAP as well.
TREATMENT:
Radiographs demonstrated bilateral UAP. Dr. Dew called and discussed his findings.  Dr. Dew used a lateral approach with anconeal myotomy for both elbows. Large UAPs were removed from both sides in a single piece.

PATIENT SUMMARY:
Louis is a 5.7# 1yr 8mo old Toy Poodle. He was sent to us by Dr. Laura Mehaffy at Pinnacle Valley Animal Hospital. Louis jumped from his owners arms and was subsequently acute non-weight bearing lame on the left forelimb. Dr. Mehaffy identified a left radius/ulna fracture. Dr. Dew discussed plate, KE and pin fixation, and would proceed with most applicable stabilization after radiographs are obtained.
TREATMENT:
Dr. Dew used a craniomedial approach for Louis surgery. The fracture was stabilized with 6-hole 6.5mm plate and 6 2.0mm screws. Louis prognosis is good for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing.

PATIENT SUMMARY:
Ching is a Siamese mix weighing 8# and is 8yrs old. Dr. Carolyn McCutcheon of Park Avenue Animal Hospital is the referring veterinarian. Ching has had a rapidly enlarging cervical mass which Dr. McCutcheon had biopsied, and was suggestive of carcinoma. Upon examination by Dr. Dew, the mass was 8x5cm and was firmly fixed to the tissue immediately caudal to right mandible. He discussed the lack of ability to obtain surgical margins, thus surgery would be debulking to remove > 95% of tumor mass and improve quality of life. Ching’s owners decide to proceed with surgery as long as the tongue does not have an obvious tumor present.
TREATMENT:
Dr. Dew used a lateral approach with elliptical incision encompassing the previous biopsy site. The mass appeared to originate from hyoid or caudal aspect of ramus, necrotic center. It involved major nerves and vessels. Dr. Dew excised the mass attempting to maintain pseudocapsule and preserve major nerves and vessels. Tissue was submitted to the AR-State Lab. A 1/4" penrose drain was placed, as well as a 12 french red rubber esophagotomy tube. Ching’s prognosis is fair for uncomplicated healing and positive response to treatment. Tumor recurrence is to be expected, the biopsy findings may help delineate the prognosis more accurately.

PATIENT SUMMARY:
Simone is a 66# 11yr and 10mo old Standard Poodle. Dr Graham Johnson of Forest Hill Animal Hospital is her referring veterinarian. A previous exam and review of pathology was suggestive of thyroid carcinoma; due to ill-defined margins surgery was not pursued in August of 2009. Since that time the mass had continued to increase in size but Simone has done clinically well. Upon examination, Simone’s stridor had become more prominent and the mass margins, while increased in size, seemed better defined. The mass was 18x12x12cm, and firmly fixed to left thyroid, perilaryngeal tissue. Her owner wished to pursue surgical excision/debulking in an effort to alleviate stridor and improve her quality of life. Tumor recurrence will be definite.
TREATMENT:
Dr. Dew used a lateral approach to the tumor. He was unable to define any border of the mass. The soft tissue surrounding the mass was extremely vascular and friable. Multiple attempts to create a plane of dissection resulted in severe hemorrhage. An aspirate of perilaryngeal swelling yielded frank blood. A superficial biopsy sample was obtained and will be sent for evaluation. Dr. Dew called Simone’s owner and offered ligate her carotid and attempt removal with 30% likelihood of intra-operative mortality. Her owner decided to abort further attempts at debulking and will allow Simone to recover without further intervention. Her prognosis is fair for uncomplicated recovery from surgery. The long term prognosis remains guarded/poor as it is likely that the tumor will continue to progress.

PATIENT SUMMARY:
Hannah is a 4# 3yr old Yorkie. She was referred to us by Dr. Terry Barnett of Millington Animal Hospital. Distal radius/ulna fracture treated with a splint had resulted in atrophic non-union. Dr. Dew discussed methods of fixation, ESF (external stabilization Fixator) and bone graft most applicable. The owners wished to have Hannah transported to Russellville for stabilization and bone graft.
TREATMENT:
Dr. Dew used a craniomedial approach for Hannah’s surgery. He debride fracture ends to bleeding bone. The fracture was stabilized with 8 wire type II acrylic fixator, 3 enhanced thread wires, and 5 smooth. The cancellous allograft was placed to fill in the nonunion of the fracture. Hannah’s prognosis is good for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing.