Author: Kiram Veterinary Surgery - The Animal Clinic,Pet Travel Services

SURGICAL TREATMENT Of NON HEALING SKIN DEFECT

A 12years old male lovely golden retriever was presented to Kiram veterinary surgery with a long time non healing skin defect at the elbow.

Wound one month before second opinion

At our surgery we did a thorough physical and clinical exam, we realized the the wound had formed a granulation tissue ,the defect was too huge for it to heal as an open wound .Attempts of bandaging were carried out ,preventing licking using E-collars and T-shirts where done but in vain. So we decided to do SKIN FLAPS using H-PLASTY.

Wound before surgery

The patient was surgically prepared and placed in lateral recumbence with the affected limb upwards and anchored on the raised support. A wider surgical site was aseptically prepared , draped and General anesthesia protocol for old patients was given.

We opted for localized skin flap ,after critical consideration of blood supply to the flaps ,location and the diameter of our defect.

We did H – Plasty,this is involves using two advanced localized subdermal skin flap created by undermining skin together with its blood supply. Due to the tension on the skin covering the limb we modified the cranial part on the flap with epidermal slits relieve tension.

During the surgery we did debridement,undermined the secretory granulation tissue part of it which was septic and necrotic. We created new fresh wound edges and stitched well in H-plasty way.

Post operative care, the patient was put on o.15mg / kg of meloxicam for pain medication , given abroad spectrum antibiotics for 14 days, the patient was bandaged with Robert jones , the bandage was changed every two days .

Robert Jones bandage

After two weeks he was discharged and sent home with his wound sealed well.

Surgery site after three weeks .

Jersey’s first time snow experience!

This lovely gal was taken by her owner to Canada. She is a 1.5years Border collie, she means a lot to her mother.

Her mother contacted us and asked us to guide her on how to take her furry family member as she was planning return to Canada .We had to plan in time to avoid last minute panic that comes with pet travels, most especially in this COVID 19 pandemic.

We microchipped her this helps to permanently identified in case of anything , updated her rabies shots, regular deworming for endorsing parasites control and external parasites were treated .

Last visit at our Surgery for health check.
She is enjoying the first snow experience .

We thank God we were able to do all paperwork , state vet clearance, health checks and guidance . All went well and the owner was glad.

DEW CLAWS REMOVAL IN DOGs $ CATs: IS it necessary? When is it or Not

To start with dew claws are extra vestigial appendages on your pup’s fore and rear legs . These extras digits are vestigial and don’t reach the ground when your dog is moving. Compared to the human hand, they take a position of human thumb though not necessarily the very purpose of thumb on human hand.

Picture showing a daw dew class

Why are they called dew claws?

Well the name comes from the dew which is found on the grass in the morning. When a dog walks through grass field in the morning when dew is still on the grass , she or he comes out from the grass and you will find drops of water on the tip of these extra claws on your dog’s leg hence the name dew claw.

Is it normal for dogs to have them?

Anatomically dogs and cats have dew claws on their front legs ,and they serve purposes in helping them hold their bone and toys when biting on them. Usually on the front legs they are firmly attached on the bone except in case of double dew claws.

Rear dew claws are considered to be abnormal except in some dog breeds like Brairds and Great Pyrenees.

Dew claws usually don’t touch the ground when your dog is walking and the nail attached on them tends to grow and curves inward and enter the leg or a toe on which creates pain and some times abscess.

Why REMOVAl and When should it be done?

At our surgery we don’t recommend removal of front dew claws because they help the dogs in holding their bones and toys. However we do recommend removal of Floppy , loosely attached and hanging dew claw on rear legs.

The best time to do this is when the puppy is around three days old using local anesthesia and only when the intention of the breeder or owner is to raise working dog.

We can also remove them in mature dogs especially when we are doing elective procedures like neutered and spays. Incase of infected dew claws or a severely injured dew claw we can attempt removal under General anesthesia.

What happens during the surgery

In cases of severely injured dew claws or infected dew claw in adult dogs or cats . We do follow all our aseptic surgical procedures from anesthesia evaluation of patient , preparation and surgery. The procedure is done under General and local anesthesia.

After care involves giving pain meds , antibiotics ,regular bandaging and antibiotics till the surgery wound heals.

Patient movement , activities are limited for seven days and the patient puts on Elizabethan collars.

How can I care for dew claw if I feel like not removing them?

Care is all about keeping the nail on the dew claw trimmed as often as possible.

Avoid walking your dog in places where his or her claws can get trapped and then injured.

Don’t attempt removal if they are very attached to the toe.

SINGLE PUPPY syndromes

This is condition where a dog gives birth to only one pup. The puppy is called a singleton , some times people nick name them solo , unit or only.

A case report of a two year female old Maltese

This mother was Reffered to us after being in labor for more than 18 hrs and she was straining.

The owner told our team that his lovely dog was mated by a slightly bigger Maltese two months back. It was almost 65 days and he noticed her behavior had changed. She was inappetent , lethargic and constantly straining with discharge from vulva.

Physical examination

we physically examined the patient,Her blood work was good, temperature was sub normal. She was discharging greenish fluids from her vulva. She was dull, recumbent and breathing heavily. We did virginal exam with a speculum and digital palpation and there was no pup in the birth canal.

Procedure

Before surgery we did anesthetic assessment , found her fit for anesthesia and stabilized the mother with intravenous fluids . She was premedicated with muscle relaxant , we prepared her for emergency c-section and intubation was done to her by a cuffed E T tube.

The mother was placed in dorsal recumbency after pre – surgery preparation and premedicated. We induced with iv anesthesia and opened up the lady.

Upon entry to the abdomen we assed the uterine horns and we found out that she was pregnant in one horn. The graved uterus was exteriorized , incision was made at less vascular area and the pup was delivered. With help of our nursing team he made his first sound and started suckling.

The puppy had fully grown and big , he was stuck at the opening of the cervix. The pup was weak , it to our team some time to resuscitate him.

The uterus was closed with absorbable suture and inverting suture pattern. The abdominal muscles were closed , subcutis and skin respectively.

Post surgery care.

At our surgery we usually recommend a bland food after surgery, we told the client to keep her in clean environment and restrict activity.

We strongly advised the owner to make sure he socializes with the pup and the mother to avoid behavioral problems which manifested in Singleton pups.

Discussion

Dogs and cats are known to be able to produce more than two offsprings by nature.

This usually contributes to enough stress and hormonal balance which facilitates the deliver of pups when time is due. When a dam is carrying pregnancy of one pup or kitten it usually takes time for the mother to give birth to this pup because their is less nutrition stress which usually initiate whelping process. This also contributes to low uterine inertia hence contributing to dystocia in Singleton mothers.

For puppies which are born as Singleton usually turn to be aggressive and protective to their mothers . They usually face a challenge in socializing because they lack litter mates which usually contributes to behavioral modifications in early stages of development. They also tend to grow fat because of excess nutritional supply and this causes to be lazy.

The owners are usually advised to give more time to these pups most especially in their early stages to contribute to their growth. Some times we advises mixing them with foster puppies of the same age .

Parvovirosis in Dogs

Simba is a four months old Maltese . He came to see us last weekend.He was very sick had no appetite and no history of his puppy shots .

He presented with nausea,lethargic , bloody diarrhea mixed with blood .

His blood work showed neutropenia ,elevated PCV .

Simba was diagnosed with parvovirosis a life threatening disease common in young dogs from 6 weeks to 6 months. Parvovirosis is a viral disease there is no specific treatment .

We managed simba with our supportive treatment plans and protocols and prevention of secondary infection we managed to save his life.

Parvovirus is really challenging disease , critical care and monitoring is really needed.

Fluid therapy, anti nausea , anti diarrhea and antibiotics are needed .

At our surgery we recommend vaccination for all puppies at six weeks of age and subsequent follow up shots.

Sick animals should be isolated treated.

Simba relaxing on our sofa

My dog has bad smelling discharge

Pyometra is secondary bacterial infection in dogs and cats ,it’s one of life threatening medical reproductive health emergencies we counter at our surgery.Pyometra simply means pus in the uterus . This is a life threatening disease in old and intact (un spayed) female cats and dogs. It occurs between two weeks and eight weeks post estrus (heat cycle).

How does this happen?

There are many factors which contribute to this condition in intact female cats and dogs. When your female cat or dog goes into heat and you don’t serve them (allowing her to mate) there is an increased progesterone level in blood in estrus. This causes hormonal imbalance which causes thickening of the uterine wall and formation of cysts. This cause a condition called cystic endometrial hyperplasia, these cysts get filled with fluid from secretions which creates and ambient environment for bacterial growth. Due to thickened uterine wall there is reduction in uterine contraction so this fluid can not be expelled out. Another factor that favors pyometra is the fact that white blood cells which woul have protected the uterus from getting infection are inhibited from reaching the uterus during this period due to progesterone influences. At the same time the cervix is relaxed and open this allows entry of bacteria in the uterus.

Cause of pyometra

Use of progesterone based anti puppy birth control methods in dogs. Hormonal imbalances as results unserved dogs during estrus and progesterone surge in late estrus. Use of estrogen based medication in intact female cats and dogs. How do I know that my dog has pyometra?

For dogs which are intended for breeding medical treatment is possible with variable out comes . We recommend surgical treatment which involves removal of the uterus and ovaries. With this method your furry friend will not be able to conceive.

It’s important to note from our experience that closed pyometra is more life threatening than open pyometra. The prognosis is usually poor due to spread of these bacterial toxins in blood which usually results into systemic inflammatory response and septic shock.

Prevention

By serving you dog when they come on heat . Avoid use of hormonal birth control injection which are progesterone based.

Surgical treatment of pyometra.

Cystic endometrial hyperplasia Uterus filled with pus

Discharge from the vulva

Discharge from the vulva above . Cat’s uterus filled with pus .

Amazing Dog adopts Walking on three legs


Case report of amputation of pelvic limb In a 4 year old male German shepherd

For confidentiality purpose my patient’s name is Blacky . Mr . X blacky’s  Dad called our offices from up country and requested  us to check on his lovely boy blacky.

The an appointment was scheduled and Blacky was brought at our surgery in Ggaba Kampala.

History

Blacky  was involved in an accident few years ago and he got fractures in  part of his tibia  , metatarsal and stifle joint.

 He was referred to a clinician who opted for amputation of his hind leg at mid shaft of tibial bone.

Blacky took long to heal and in the process he started walking and  using his partially amputated limb. 

Due to friction at the skin covering stifle joint , chronic arthritis this area became weak and developed non healing skin and bone infections.

Blacky has been progressively losing weight and had chronic illness .

Clinical examination.

Upon arrival at our surgery we checked all the physical parameters and most of them were in the normal ranges except elevated PCV , low platelet count,neutropenia, monocytosis , lymphocytosis  and external parasites (ticks) were observed.

We treated Blacky and stabilized him for general anesthesia and surgery was performed after 72hrs.

Procedure

Blacky was pre-medicated with 2% xylazine at a rate of 1.6mg per kg ,he was also induced with 4.4mg/kg ketamine and 0.4mg /kg of Valium . 

The anesthesia was maintained with ketamine ,diazepam and xylazine , critical anesthetic monitoring of Blacky’ s vitals was done using pulse oximeter  and intravenous fluids were also connected with pain medication.

After premedication, the fur  around the affected limb was clipped and aseptically prepared and cleaned using concentrated chlorohexidine solution and providone iodine. 

Blacky was laid on the operating table in lateral recumbency with affected limb up wards , the surgical field was draped using sterile drapes.

An elliptical incision was made running from the inguinal fold  up to proximal aspect of the stiffer joint. 

Second incision was made on the medial aspect of femur joining the first incision in non parallel manner.

The muscles musculature was bluntly dissected minimizing bleeding, blood vessels were clumped using hemostatic forceps and also double ligated .

After careful blunt dissection the shaft of the femur was exposed and amputated at proximal third portion using a bone cutting wire.

 The femoral stump was covered with surrounding muscle bellies using horizontal mattress suture pattern of 3metric absorbable suture. 

Several muscular layers were sutured together from medial and lateral side minimizing the dead space.

A  two metric monofilament suture was used to close the subcutis and 3 metric monofilament non absorbable suture was placed on the skin using simple interrupted suture pattern. 

  • Patient draped and laid in lateral recumbency

An elliptical incision made on the lateral aspect of the femur.

  • The musculature is bluntly dissected and bleeding vessels ligated.

  • Femur shaft exposed and amputated using bone cutting wire
  • Muscles sutured  in carefully in horizontal mattress suture pattern while minimizing dead space and skin closed using simple interrupted pattern using non absorbable suture. The patient was given a E-collar to prevent him from licking his wound.

Hygromas In dogs

  • HYGROMA IN DOGS
  • These are fluid filled sacs which develop in large dogs at areas of bony prominence at the elbow and tarsal joint
  • They develop due to reaction to pressure and friction between the hard surface and skin at these points.
  • This stimulates an inflammatory reaction and development of a thick walled cavity which can be filled with fluid or pus.
  • At our practice we usually see these cases in in large breeds and over weight dogs above 3years.
  • In most case these are painless swelling and they don’t bother your furry friend, however some can be complicated, lacerated and painful.
  • At our surgery we have seen uncomplicated and complicated hygromas which are very painful and infected.
  • Theses present with partial weight bearing lameness in affected limb , lethargy, exercise intolerance , increased white cell counts and some time fever.
  • Theses are non specific signs which can be seen in other diseases,however with aspiration of the swelling you noticed fluid mixed with pus.
  • TREATMENT
  • Your veterinarian will be able to discuss with you the best treatment of plan.
  • Conservative treatment by drainage and bandaging can be done though with this method recurrence in unavoidable.
  • We don’t recommend injection of steroids at these sights since these can worsen the process.
  • Surgery is the most appropriate , your experienced veterinary surgeon can do this and drain the infected cyst. Care must be taken to avoid dead spaces and proper planning and manipulation of the skin to close nicely.
  • Prevention
  • Hygroma can be prevented by providing soft padded surfaces for your furry friends.
  • Your large breed should be monitored to avoid unnecessary weight on him or her.
  • Provide a variety of soft bedding in most of corners where your dog rests.
  • Exercise your dog regularly most especially spayed and neutered dogs.
  • After surgery
  • Aflatoxicosis in DoG food

    AFLATOXINS IN DOG FEEDS

    We have experienced many case of aflatoxins poisoning in dogs in this season.

    Many people are selling poorly stored prepared corn mixed with fish products.

    Aflatoxins are invisible toxic substances found in moldy cereal products , peanuts and corn.

    These toxins are produced by a toxigenic strain of Aspergillus flavus and Aspergillus parasiticus . These grow in cereals, soya beans , peanut and small fish commonly know as “mukene” in Uganda.

    How does this enter your dog of furry friend.

    These toxins multiply in these food ingredients during storage, drying and also in the field under favorable moisture and constant temperatures below 21 degrees Celsius.

    When you feed your pet with food containing these toxins , it enters the body and then it gets metabolized in the liver into epoxides, these affect the nucleus acid and nucleoproteins.

    This results into necrosis of liver cells hence hindering the functions of the liver.

    Signs

    All signs associated with liver disease will be evident. Vomiting, lethargy, depression , elevated liver enzymes , low protein levels , yellowing of mucus membranes and fluid in the abdomen.

    Prevention

    Don’t feed your pets on corn products most especially from feed stores where they don’t mind about moisture control.

    Store your pet’s food in Air tight containers.

    Don’t buy cheap and unprofessionally formulated pet food products .

    Always read on the pack to check the aflatoxins frees status on pack and don’t buy damaged packs.

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