Full thickness mesh graft in a cat with degloving wound – case presentation

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Delureanu FlorinCristian

Dr Delureanu FlorinCristian

Veterinary Center Otopeni

Bucharest, Romania

 

 

Introduction

An ample loss of skin with underlying tissue and exposure of deep components (eg. tendons, ligaments, bones) define a degloving injury. This kind of wounds are most frequent seen on the distal limbs, medial tarsus/ metatarsus. The main cause of deglowing wounds is car accident, special when the animal is dragged or pushed by a moving car. In all of the cases bacteria and debris are present in the wound.

Free grafts are described as a piece of skin detached from an area of the body and placed over the wound. There are two tipes of free grafts when we talk about graft thickness: full thickness (epidermis and entire dermis); partial/split thickness (epidermis and a variable portion of dermis). Skin grafts are using when exist a defect that cannot be closed by skin flaps or direct apposition. Two factors influence skin graft survival: revascularization and absorbtion of the tissue fluid.

Case report

A 4 years old female shorthair cat, weighting 3,25kg was presented to our clinic. Before that, the owner was at another clinic for consult and he was disappointed because they recommended euthanasia or amputation of the limb. Besides, the first vet treated the cat with Amoxi+Clavulanic Acid and Nekro Veyxym. The owner said that she went missing for about 10 days.

Clinical examination

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Picture 1. Dorsal aspect of the metatarsal wound Deep tissue is affected; low to moderate discharge is present.

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Picture 2. Ventral aspect of the wound; Note the big swelling and the holes at the base of the fingers (red arrows)

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Picture 3. Deep wound with circular aspect, approximate 1,5cm diameter located near saphenous vein

After a thorough clinical exam we found that all was normal excepting the degloving injury. The back right leg was affected. There was a massive inflammation with infection and a lot of debris on the dorsal surface of metatarsal area and ventral, above metatarsal pad. On the dorsal surface of metatarsal area (Picture 1). Besides, also in the ventral area, another wond proximal to the metatarsal pad and 3 deep holes was identified at the base of second, third and fourth finger (Picture 2). It could be distinguished the chronic aspect. A third lesion was registrated on the same leg, in the medial aspect of the thigh. This wound was deep with a circular shape (Picture 3). We estimated that the lesion occurred about two weeks ago. We register pain and high local temperature after palpation. The cat was stable, normothermic, with normal color on mucous membrane, CRT 3seconds and normal superficial lymph nodes.

 

 

 

 

 

 

 

Radiograph of the affected back limb

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Picture 4a

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Picture 4b

Two x-ray views was made to eliminate bone changes or foreign bodies (Picture 4a, Picture 4b).

Picture 4a, 4b- Specialist describe: Suspected slight thickening of phalanges cortical 1 fingers 3-4 and gently bending them. Soft tissue swelling of the tibio-tarso-metatarsian region.

 

 

 

 

 

 

 

Approach 

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Picture 5a

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Picture 5b

After evaluation, the initial recommendation include a good wound management under anesthesia. Before surgical debridment (Picture 5a, 5b), culture was done.

Picture 5a and Picture 5b – Dorsal and ventral aspect of the lesions after surgical debridment

 

Next, wound lavage was initiated with one bag of 500 ml of worm saline (the most easy way to deliver fluids on the wound is to connect the saline bag with a administration set to the syringe and needle with a 3-way stop cock a large amount of liquid is needed to be effective).

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Picture 6. Wound closure by simple interrupted suture.

Finally, this first stage ends with a wet to dry bandage. A primary wound closure was performed for the lesion placed on the medial aspect of the thigh (Picture 6), after intensive cleaning, removal of foreign bodies and dead skin .

Empirically the cat receive Cefquinome until the result arrive and for pain management we administered Tramadol 3mg/kg and Meloxicam 0,1-0,2mg/kg. The cat recover well after anesthesia.

 

 

 

Culture result

One day before performing surgery, we recived the culture result. Streptococcus canis (++++) was identified and was sensible to many antibiotics. Amoxicilin+Clavulanic Acid (Synulox) was initiate for general therapy and chloramphenicol ointment (Opticlor-Pasteur) for local therapy.

Next, a full thickness mesh graft was used on the dorsal aspect of the limb due to the length and depth of the wound and the other wound was left for healing by second intention, both being protected by bandages. In the next 10 day the limb wounds was treated in the same manner. Removal of bacteria, granulation tissue formation and the beginning of epithelization were supported by next bandages as follows: ·

Day 1 – wet-to-dry bandage was used after surgical debridment. (this kind of bandages adhere to the wound and remove the little layer of dead tissue when we take off). Soaked in warm saline 1-2 minutes before removing, they were changed after 24hours one to the other. Cotton gauze was the primary contact-layer of the bandage.

  • Day 2 and day 3
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    Picture 7a Fresh Sorbalgon is applied on both wounds. This dressing can absorb 20-30 times its weight in fluid, stimulate fibroblast and macrophage activity.

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    Picture 7b Calcium alginate dressing must be changed when the fibres transforms in gel.

– moisture retentive dressing (MDR) – calcium alginate (Sorbalgon-Hartmann) was the primary contact-layer. It is good to use when it exist high exudate like in our patient (Picture 7a, 7b).

 

 

 

  • Day 4,6 and day 9
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Picture 8. Hydrocolloid is indicated because he stimulate granulation and epitelisation and have a good autolytic debridment

– moisture retentive dressing (MDR) – hydrocolloid (Hydrocoll-Hartmann) was the primary contact-layer because the discharge decreased (Picture 8).

 

 

 

 

 

Describing surgical procedure:

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Picture 9. The wound is refreshed by removing the new epithelium formed around the whole wound

Preoperative surgical site preparation: The cat was placed in left lateral recumbency, with the wound exposed. The limb was clipped entirely and povidone iodine and alcohol was used for aseptic surgery. Sterile warm saline 0.9% was use for wound lavage. Meanwhile a colleague prepare the donor site in the same manner- lower cranio-lateral thorax (right side). Almost 1mm of epithelium that has started to grow from the wound edges over the granulation tissue was removed using a thumb forceps and a no. 10 scalpel blade (Picture 9). A perpendicular incision was made right at the edge of haired skin with epithelium. The wound was incised all around and after that the epithelium was removed by advancing the scalpel blade under the epithelium around

the wound. Then, undermining was performed around the wound edges. A fragment of sterile surgical drape was used over the wound to get the exact shape. The drape “pattern” was placed to the donor area.

 

 

To maintain the wound moist, i placed over it a cotton gauze moistened in warm sterile saline 0.9% while the graft is transferred.

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Picture 10. The donor site-removing the skin; black arrow show the direction of the hair groth.

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Picture 11a. Skin from dorsal thorax is advanced

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Picture 11b. Simple interrupted suture is used for skin closure.

The direction of hair groth was marked with a black arrow above the donor site so that the direction of the hair groth on the graft will be the same as the hair groth direction on the skin surrounding the wound. After that, the margins of the drape “pattern” was traced on the skin. The skin of the donor bed was incised with No.10 scalpel balde and removed using thumb forceps and Metzenbaum scissors (Picture 10). The defect left after removing the graft was primary closed by undermining and advancing the skin edges with walking sutures using 3-0 monofilament absorbable suture material and finally the skin was sutured in a simple interrupted suture manner using 2-0 monofilament absorbable suture (Picture 11a, 11b).

 

 

 

 

 

 

 

 

 

 

Preparing the graft

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Picture 12. Final aspect of the skin graft after removal

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Picture 13. The skin is stretched on the receiving bed so the incisions made in it expand.

The dermal side of the graft was placed on a polystyrene board with a thickness of 10cm covered with a sterile drape and after that we fixed and stretched with 21G needles. The subcutaneous tissue was removed from the graft. Next, made parallel incisions was made in the graft, 0.5-0.7cm long and apart (Picture 12). At the end, the graft was placed on the granulation bed and sutured with 4-0 monofilament nonabsorbable suture in a simple interrupted suture manner. Additional tacking suture was placed to ensure the expansion of the mesh incision and allow the fluid drainage (Picture 13).

 

 

Choosing the right bandage after grafting and aftercare

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Picture 14. Grassolind is ointment free of medication, broad mesh, air permeable and exudate; impregnated with neutral ointment. Ointment contain petroleum jelly, fatty acid esters, carbonate and bicarbonate diglycerol, synthetic wax.

It is important to use a nonadherent primary dressing. My initial choise was Grassolind (Hartmann), is sufficiently porous to allow easy passage of exudate from the wound surface, preventing maceration of surrounding tissue (Picture 14). The ventral metatarsal wound maintain hydrocolloid dressing (Hydrocoll-Hartmann) as primary layer. After that, a thin layer of chloramphenicol oinment (Opticlor-Pasteur) was used all around both wounds and over the graft.

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Picture 15. Note that the “half clamshell” is extended with approximately 1cm toward fingers (red arrow) so the leg does not touch the ground

Over the first dressings was applied 5cmx5cm compress (Medicomp-Hartmann) and a roll gauze was the second layer. After a few laps of gauze stirrups was placed to secure the bandage in place. Extemporaneous half “clamshell” splint (Picture 15) was made from plastic material wich was curved in such a way that the limb was fixed in semi flexion. The splint is a little bit longer than the extremity of the pelvic limb (“toe-dancing” position), thus provide a maximum relief pressure. In the proximal area, under the splint, I put cotton to prevent pressure injuries on the caudal aspect of the thigh. Applied from proximal to distal and with moderate tension, elastic warp was the final protective layer of the bandage and it was secured at the proximal end with tape.

 

 

 

 

Changing bandages

The bandage was changed in day 1, 3, 5, 7 and 10 post op. In day 10 the suture material was removed from the graft and from the donor site. From day 17 to day 29 hydrogel (Hydrosorb-Hartmann) was used as primary bandage layer and the bandage was changed from 4 to 4 days. In day 29 no discharge was present in the bandage; the wound was completely healed and 0,2-0,4 mm of hair was present in the center of the graft.

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Picture 16. Delayed healing on day 45 – epitelization stopped at this level.

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Picture 17b. Honey improve wound nutrition, promotes the granulation tissue and epithelization, reduce inflammation and edema. Also it has a wide antibacterial effect.

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Picture 17a. DTL laser type is alaser light emitting diode in the red field (wavelength 650 nm) and infrared (wavelength 808 nm) of the light spectrum with next clinical effect: anesthetic effect; decreases edema and inflammation; activates microcirculation; stimulates wound healing; improves tissue trophicity; reflexogenic effect.

A delayed healing occurred at the wound in the ventral region (Picture 16). From day 29 to day 59 epithelization has advanced very hard and granulation tissue has captured an appearance of ulcer (in this time the wound was asepseptic prepared and hydrocolloid and hydrogel was used as primary layer bandage and without the splint). In day 59 the wound was refreshed on the surface with a scalpel blade and laser therapy (Picture 17a) and medical Manuka honey (Picture 17b) was used daily for 14 days. After that, a complete healing was reached.

 

 

 

 

 

 

 

Illustrating wounds evolution after surgery

 

Day 1

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Day 11

 

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Day 28

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Day 35

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Day 49

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Day 11 after honey and laser therapy

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 Day 16 after honey and laser therapy

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Comparing day 1 and after 3 Months

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Vets must ‘dare to speak out’

WSAVA imageVets must ‘dare to speak out’

Urgent action on brachycephalic dogs called for during panel discussion at FECAVA/WSAVA/DSAVA Congress in Copenhagen

 

The rise in the popularity of so-called brachycephalic (flat-faced) breeds, including pugs and French bulldogs, is linked to concerning trends for dog health and welfare, according to the Federation of European Companion Animal Veterinary Associations (FECAVA), the World Small Animal Veterinary Association (WSAVA) and the Danish Small Animal Veterinary Association (DSAVA/FHKS).

 

Experts from around the world discussed the issues facing these breeds and the implications for veterinarians during a panel session following a lecture stream dedicated to hereditary disease and the importance of responsible breeding on Tuesday 26 September during FECAVA-WSAVA Congress in Copenhagen. More than 200 delegates attended, including Danish TV celebrity, Sebastian KIein, well known for his interest in animal welfare issues. At the end of the session, panel members issued a number of recommendations to help veterinarians to take steps to improve the health and welfare of brachycephalic dogs (see below).

 

During discussions, panel members were questioned on strategies to help address the problem in particular countries. Panellist Helle Friis Proschowsky explained that The Nordic Kennel Union had issued recommendations and breed-specific guidelines for judges but acknowledged that the majority of brachycephalic dogs in all countries were unlikely to be registered with a kennel club. Panellist Peter Sandøe confirmed that only 15% of French bulldogs in Denmark were registered, the majority coming from unregistered breeders.  “The education of owners remains the most important priority,” commented Helle Friis Proschowsky.

 

‘Dare to speak out’

Soft tissue surgeon and panellist Laurent Findji said he had seen the explosion in the popularity of French bulldogs at first hand because of the number he was now operating on. FECAVA Vice President Wolfgang Dohne called on vets to help brachycephalic dogs but to advise owners to neuter their animals if they have conformation-altering disorders. Panellist Gudrun Ravetz, Senior Vice President of the British Veterinary Association said that, in the UK, owners and breeders now consent to having conformation-altering surgery reported: “However, while a recent BVA survey showed that 67% of vets say they see breed-related problems, few submit conformation-altering data to the Kennel Club though this would support the development of evidence-based solutions.” She added: “As veterinarians we must educate ourselves.”

 

“Vets should dare to speak out,” commented panellist Kristin Wear Prestrud. “We must educate owners on all health and welfare matters, whether we are simply advising them that their dog is overweight or if we need to give advice on breeding or refuse planned Caesarean sections.”

 

Urge advertisers to stop using images of flat-faced dogs

Toril Moseng, President of the Norwegian Veterinary Association, highlighted initiatives carried out in Norway, including an awareness-raising petition signed by 1,700 veterinarians; a press release urging advertisers not to use brachycephalic breeds in campaigns and a hand-out produced for brachycephalic breed owners, letting them know ‘what to expect.’ Similar work has been done by the British Veterinary Association explained Gudrun Ravetz. “We contacted advertisers and many apologised saying that they were simply unaware of the problems.”

 

Commenting on the session, DSAVA President Anne Sørensen said: “The fact that so many participated so actively in the discussion shows the seriousness with which veterinarians view this issue. There is no easy answer but by working together and sharing experiences and successes, we will start to change the minds of pet owners who think that these animals are cute when many of them are, in fact, born into a life of suffering. We thank all those who joined us to highlight this important issue and especially Sebastian Klein. His attendance has helped us to highlight the issue to the dog-owning public in Denmark.”

 

Education and raising awareness

FECAVA President Jerzy Gawor commented: “As veterinarians, we put the best interests of our patients first. For affected animals – including flat-faced dogs but also cats and rabbits – this may involve performing surgical procedures to correct or overcome conformational disorders, such as enlarging the nostrils, shortening the soft palate, correcting the bite or performing Caesarean sections. We are concerned that these procedures – which should be exceptional – are becoming the norm in many brachycephalic breeds.”

 

WSAVA President Walt Ingwersen added: “Our members see the results of extreme brachycephalic confirmation in practice on a regular basis and it is one of our top animal welfare concerns. The discussion panel helped to highlight the complex issues raised by the popularity of these breeds and to explore potential solutions. A reduction in the health problems faced by these breeds will be most effectively achieved through the education of veterinary professionals, breeders and owners and through leadership and consensus-building between stakeholders.”

 

Vets should ‘show leadership’

All three associations committed to develop and contribute to initiatives that aim to address the health and welfare of these animals. Panellist Professor Åke Hedhammar, member of the WSAVA Hereditary Disease Committee and scientific advisor to the Swedish Kennel Club, stressed: “We will continue to work with all stakeholders who can positively influence and improve the health and welfare of brachycephalic breeds. Extreme phenotypes should be avoided and, in the show ring, moderation of such phenotypes should be rewarded. Animals showing extremes of conformation that negatively impact their health and welfare should not be used for breeding.”

 

FECAVA past president Monique Megens, who chaired the discussion, concluded: “As advocates of and experts in animal health and welfare, veterinarians should speak up and show leadership in taking action against the breeding of dog with excessive traits leading to health and welfare problems. The great attendance at the panel discussion shows the willingness of the profession to do so. We hope that the recommendations prepared by our panellists will be adopted by veterinarians and by veterinary associations all over the world, leading to a future with healthy and happy dogs.”

 

 

 

 

Notes for Editors

 

  • The World Small Animal Veterinary Association (WSAVA) aims to advance the health and welfare of companion animals worldwide through creating an educated, committed and collaborative global community of veterinary peers. It currently represents more than 200,000 veterinarians through 105 member associations. Its annual World Congress brings together globally respected experts to offer cutting edge thinking on all aspects of companion animal veterinary care.

 

  • The Federation of European Companion Animal Veterinary Associations (FECAVA) is the platform for the promotion of the professional development and representation of companion animal veterinarians in Europe. Founded in 1990, it currently has 40 national member associations and 13 associate member associations. FECAVA represents over 25,000 companion animal practitioners throughout Europe.

 

  • The Danish Small Animal Veterinary Association (SvHKS) represents small animal veterinarians in Denmark and has around 1,000 members. It was the host organisation for the 2017 FECAVA/WSAVA Congress.

 

  • Members of the expert panel were:
  • Peter Sandøe (DK) – professor of ethics and welfare
  • Helle Friis Proschowsky (DK) – vet working with the Danish Kennel Club
  • Laurent Findji (FR/UK) – specialist in soft tissue surgery
  • Gudrun Ravetz (UK) – Senior Vice President, British Veterinary Association
  • Kristin Wear Prestrud (NO) – veterinary scientific director of the Norwegian Kennel Club
  • Åke Hedhammar (SE), professor em. in internal medicine (companion animals), veterinary consultant for the Swedish Kennel Club and member of the WSAVA Hereditary Disease Committee.

 

  • Media contacts:

Karin de Lange, FECAVA Press officer kdelange@invivo.edu

Rebecca George, WSAVA Press Officer Rebecca@georgepr.com

Anne Sørensen, President, DSAVA (SvHKS) anne.dsava@gmail.com

 

 

 

 

Expert recommendations: the vet’s role

 

Following the panel discussion on the health and welfare of brachycephalic dogs on 26 September, the expert panel issued a number of recommendations for veterinarians as below:

 

As advocates of, and experts in, animal health and welfare, veterinarians should speak up and show leadership in taking action against the breeding of dogs with excessive traits which can lead to health and welfare problems, such as brachycephalic obstructive airway syndrome (BOAS).

 

At a PRACTICE level, veterinarians should:

 

  1. Advise the public not to buy animals with extreme conformation. This applies both to breeds and to individual dogs.

 

  1. Raise awareness among dog owners and advise them about health and welfare issues in dogs with extreme conformations.

 

  1. Raise awareness among breeders, breed clubs and show judges and advise them as to health and welfare issues in dogs with extreme conformations. Take an active role in pre-breeding examinations and in giving advice regarding potential breeding stock.

 

  1. Inform dog owners and breeders about breeding restrictions if a dog is surgically treated for BOAS or other problems related to extreme traits linked to breeding. (In countries where no such restrictions exist, strongly advise against breeding.) Advise neutering at the time of surgery if good practice allows.

 

  1. Share data on health and welfare issues related to extreme breeding. Where a national submission system exists, submit details on conformation-altering surgery and caesarean sections related to extreme breeding traits.

 

 

At PROFESSIONAL ORGANISATION level, veterinarians should:

 

  1. Implement a communication campaign to proactively raise awareness among the public in general and to advise them about health and welfare issues in dogs with extreme conformations.

 

  1. Work together with national cynological organisations and other stakeholders to set up registers of confirmation-altering surgeries and caesarean sections as well as relevant screening programmes (ie pre-breeding examinations).

 

  1. Call for the revision of breed standards to help prevent BOAS and other brachycephalic-related disorders. Breed standards should include evidence-based limits on physical features (eg muzzle length) and approaches such as outcrossing should be considered.

 

  1. Launch and distribute veterinary health certificates for puppies and/or checklists for prospective buyers in support of responsible, healthy breeding.

 

  1. Develop evidence-based international standardised protocols for the examination of breeding animals regarding respiratory function and thermoregulation.

 

  1. Set up systems allowing the gathering of data from veterinary practices regarding health and welfare-related issues in dogs with extreme conformations.

 

  1. Set up undergraduate training / CPD to equip vets to take a more active role in providing breeding advice to breeders, breeder organisations and judges, related to extreme conformation and screening procedures.

 

Copenhagen, 26 September 2017.

Fourth Bulgarian Congress for Veterinary Cardiology Sofia, 2017 is about to happen

04-05 th  November 2017

A two day summit organized by the Bulgarian Association for Veterinary Cardiology (BAVC).

 

Main topic

lector

Dr Luca Ferasin

Feline Cardiology

 

Main Congress speaker:

Dr Luca Ferasin

DVM PhD CertVC PGCert(HE) DipECVIM-CA (Cardiology) GPCert(B&PS) MRCVS

European & RCVS Specialist in Cardiology

Lumbry Park Veterinary Specialists, UK

 

Dr Ferasin graduated with honours in 1992 from Bologna University. After 3y research in endocrinology in Cambridge he was awarded his PhD in 1996. Following 3y as Assistant Professor at Padua University, he moved to Bristol University, where he taught cardio-respiratory medicine of the dog and cat for 7 years. In 2005-2007 was Associate Professor in Cardiology at the University of Minnesota. Between 2008 and 2014 he ran his own cardiology consultancy company, comprising a mix of private clinical referral work, telemedicine and post-graduate teaching. In March 2014 he joined CVS Referrals and he is currently Clinical Director of Lumbry Park Veterinary Specialists, in Hampshire, UK. He obtained RCVS certificate in cardiology in 2001, certificate in Teaching & Learning in Higher Education in 2002, ECVIM diploma (cardiology) in 2004 and certificate in Business & Professional Studies in 2011. He has vastly contributed to the veterinary literature with articles, abstracts, and book chapters, including the recent chapter on coughing in the Ettinger’s textbook of Internal Medicine. He is a regular speaker at National and International veterinary conferences.logo

Scientific program

04 November 2017, Saturday

9.00 – 9.45           Registration

9.45 – 10.00        Welcome from the current Chairman of BAVC – Ranko Georgiev, DVM

10.00 – 11.30      Clinical approach to the feline cardiac patient. – Luca Ferasin, DVM

11.30 – 11.45      coffee break

11.45 – 13.15      Approach to cats with dyspnoea, arrhythmia, syncope and hyperthyroidism.” – Luca Ferasin, DVM

13.15 – 14.00      lunch break

14.00 – 16.00      Short clinical case presentations – “From vets to vets”

16.00 – 16.30      coffee break

16.30 – 17.00      open panel discussion – “How many cats with a heart disease I see in my every day practice? How many see me? J”

 

05 November 2017, Sunday

9.15 – 10.00        coffee and free communications

10.00 – 11.30      Feline cardiomyopathy and arterial thromboembolism.” – Luca Ferasin, DVM

11.30 – 11.45      coffee break

11.45 – 13.15      Management of feline heart failure – Luca Ferasin, DVM

13.15 – 14.00      lunch break

14.00 – 16.00      Short clinical case presentations – “From vets to vets”

16.00 – 16.30      coffee break

16.30 – 17.00      open panel discussion – “My approach for treatment and long term management of Feline Cardiomyopathies.”

17.00 – 17.15      Closing words from the current Chairman of BAVC – Ranko Georgiev, DVM

 

General Information

When                                   The first weekend of November – 04 and 05.11.2017

Where                                  Vitosha Park Hotel Sofia – see the map below for instructions

Language                             English, translation not provided

Price                                      BAVC 2017 members      free (registration still mandatory)

Vet students                      free (10 places available, registration still mandatory)

Non BAVC members      100 lv (50 EU)

Registration                       Maximum number of participants – 90; early registration/payment will guarantee your participation; if places still available, the payment could be on    site, at the day of the Congress

How to                                 Fill the registration form (at www.bavc.bg); the fee should be transferred in the bank account provided there in advance

More                                     Every participant will receive a Certificate of attendance, together with the Congress proceedings and a T-shirt.

If you have other questions and/or suggestions concerning the summit, please contact Dr Ranko Georgiev – rankoge@gmail.com

Venue                                  Vitosha Park Hotel, Rosario 1 str., Studentski grad, Sofia 1700, BG

Erythema multiforme or TEN (toxic epidermal necrolysis – toxic shock syndrome)

stef art

Marina-Ştefania Stroe, DVM

Marina-Ştefania Stroe, DVM

Romania

History

Dog, half breed, M, intact, 4 years old, unvaccinated and without treatment for intestinal parasites, fleas and ticks, 10.2 kg.

The main concern was the ophthalmologic problem.

Three weeks ago he had problems with the hind limbs and he had difficulty in moving. Previous treatments: meloxicam, gentamicin, steroidal anti-inflammatory.

The possibility of ingestion of a toxic (plant / substance) is not excluded.

Clinical exam

-white mucous membranes, no lesions in the oral cavity;

-necroses in the auricular pavilions with a visible marginal line, foreskin necrosis, yellow crusts and areas of necrosis predominantly on the posterior limbs, tail, dry-looking fur, which is easily detached;

-after detachment, the skin is denuded, ulcerated, very painful on palpation;

-cutaneous hyperesthesia;

-minimal normal auricular secretion;

-corneal erosions, dry eyes, agglutinated secretions at this level;

-faded cardiac noise; imperceptible pulse;

-rectal examination: doughy feces consistency, normal color;

-abdomen in tension;

-blood pressure (indirect oscilometric metod): 138/102 (112 mmHg).

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TESTS

-Chest and abdomen rx and ultrasonography: free fluid; enlarged spleen.

-Ultrasound guided abdominal puncture: yellowish ascitic fluid, orange tint, after spinning small, white deposit. Protein: 1 g / 100 ml.

-Blood tests: low red blood cell counts, thrombocytopenia, leukocytosis, granulocytosis; elevated liver transaminases, bilirubin and amylase normal values, normal kidney parameters.

-Bleeding time: normal.

-Negative tests for infectious diseases.

-Abdomenocentesis: 335 ml of ascitic fluid and cytological exam: MODIFIED TRANSSUDAT WITH ERYTHROCYTE POLLUTION

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Fig 10

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Fig 9

Fig. 9: Cutaneous cytology, direct impression smear from necroses of the pinnae (Fig.10): nonsegmentated immature young neutrophils, lymphocytes, few macrophages in whose cytoplasm are found bacilli, bacterial population predominantly represented by bacilli, but also cocci, oxyphilic cell matrix

Fig. 11: Cutaneous cytology, direct impression smear from yellow scale, tail (Fig. 12): neutrophils in all stages: mature segmented, degenerative stage, but also young with eukromatic nucleus and evident nucleoli, macrophages with basophilic cytoplasm, slightly vacuolized, eucromatic nucleus, nucleic streamming, erythrocyte infiltrate.

Fig. 14: Tape prep from yellow scale, hind limb

keratinocytes on the surface of which are attached cocci, degenerate inflammatory cells

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Fig. 13: Trichogram – hair with normal structure, some hair with degraded cuticle, rap A / T: 4/6, follicular cast, negative for demodex and dermatophytes.

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Fig 13

Superficial and deep skin scrapes: negative.

 

 

 

 

 

 

 

 

 

 

 

 

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Fig. 15:

-Direct and consensual pupil reflex present;

-Reduced visual acuity;

– Schirmmer test 0 mm / min;

-Florescein test: Positive

Diagnosis: OU Corneal melting ulcer F +

Diagnosis and other differentials

Blood smear, cell morphology: moderate, hypochromic, regenerative anemia,; leukocytosis, neutrophilia, moderate non-specific cellular toxic status, eosinopenia, lymphopenia. In this case, the leukogram (neutrophilia, eosinopenia and lymphopenia) may suggest treatment with corticosteroids, stress, hyperadrenocorticism, severe inflammation (chronic) with various etiologies (viral, bacterial, fungal).

Skin biopsy: histopathological aspects advocate for hyperkeratosis with paracheratosis and chronic inflammatory response involving the epidermis, jonctional area and superficial epidermis.

Final diagnosis

Histopathological aspects may show Erythema multiforme or TEN (toxic epidermal necrolysis – toxic shock syndrome), which is a late reaction, surprised in a chronic, secondary phase due to fibroblast proliferation.

 

The toxic shock syndrome may be a reaction to drugs, chemicals or food

 

Treatment

Enrofloxacin (dose: 5 mg / kg) at 12h po;

Amoxicillin and clavulanic acid (dose: 20 mg / kg) at 12h po;

Furosemide (dose: 5 mg / kg) at 12h iv;

Tramadol (dose: 2mg / kg) at 12h iv;

Parenteral nutrition;

Bathing (chlorhexidine);

Acetylcysteine, Tobrex, Corneregel 6-7 times / day (lack of tears).

 

What are WSAVA and FECAVA? Who are these people? World Award for the Balkans veterinarians or something much more?

22045765_10214950207297979_2320859194427414874_nWhat are WSAVA (World Small Animal Association) and FECAVA (Federation of European Companion Animal Veterinary Associations)? Me, as a local veterinarian from the Balkans (East Europe) these two names were something far away from my daily job and my daily professional work. I am sure many veterinarians from my region are the same.

 

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FECAVA Board

 

 

 

 

When you have the possibility to be part of their event, in fact, it is the product of their job, you are able to realize what really means WSAVA and FECAVA. To be able to create that kind of event you need to have a lot of people who really love their job and who strongly believe in their idea.WSAVA Board

 

 

 

 

 

 

Yes, it is a huge veterinary congress, very well organized, with thousand of possibilities , subjects and full of knowledge, but this is not the point. They create a meeting, a space, where you are able to speak with veterinarians all over the world, to understand where you are in that world.  You get new ideas, how to make your job better, how to make your daily work easier and to have more time to be happy, which is the most important in life. For me, this means “global vet”.

 

They have teams for every subject and field of veterinary medicine, all these people try to learn you something that will help you to refresh your daily work and to have better results for every single case in your practice. So, are they huge associations, far way from our job? You do not know these people, but they are the people who give their time and their life to help you every day. You do not see their help, you think , they are some people who have totally different job from your, but it is exactly the opposite.

 

And I am so proud to say that between this group of people, there are some veterinarians from the Balkans. Dr Denis Novak, Dr Lea Kreszinger , Dr Gizem Taktak and Dr Robert Popa are part of that important group who really care about us.

 

 

 

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Dr Lea Kreszinger, Croatia

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Dr Denis Novak, Serbia

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Dr Robert Popa, Romania

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Dr Gizem Taktak, Turkey

 

 

 

 

 

 

 

 

 

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Dr Ann Criel

 

 

 

 

 

 

 

 

 

I wish all the veterinarians from the Balkans to have the chance to meet the board of WSAVA and FECAVA, to feel the pleasure to speak with them and to realize how close they are to all of us. The pleasure to hug Dr Katharina Brunner from Switzerland, to enjoy funny and deep friendly chats with Dr Ann Criel from Belgium is priceless experience in life.

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Dr Katharina Brunner

 

 

 

 

 

 

 

 

 

 

I would like to express my gratitude to WSAVA Board and Hills Pet Nutrition ( and personality  to Dr Jolle Kirpensteinjn and Dr Iveta Becvarova)  for the possibility to realize these things that I have shared with you. Thank you, FECAVA for such a kindly attitude to me. It was more than award and honour, it is something for a life time. THANK YOU!

With Love

Dr Luba Gancheva

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Dr Jolle Kirpensteinjn and Dr Iveta Becvarova

 

Learn and Travel……. stories from the vets! Dr Florin Cristian Delureanu at Clinica Veterinaria Lago Maggiore!

Let’s them to tell us:

 

Dr Luca Formaggini:

Florin Cristian Delureanu is a young Romanian veterinarian who came to Clinica Veterinaria Lago Maggiore as a member of a two-week-externship project created in collaboration with Vets On The Balkans.

It was a wonderful experience for all of us to have the possibility to work and confront with Florin. He showed devotion and proficiency in a lot of fields during his stay at Clinica Veterinaria Lago Maggiore; in fact when we met him, Florin first told us he was interested in soft tissue surgery, but he also showed passion for intensive care unit, internal medicine, diagnostic imaging and he took part to all the activities of our Clinic.

He was able to confirm that passion for study and continuous professional upgrade can help advance the level of practice and the ability to do the best for our patients.

One of the most interesting parts of this project is the opportunity to deal with different realities and compare the various guidelines and protocols adopted by different veterinary structures.

“Hand by hand we all will be better” is the endearing motto of the project and we hope this will lead to further future collaborations between Vets from different countries.

 

Dr Florin Cristian Delureanu:

First of all I want to say that I felt lucky that I had the opportunity to spend two weeks in Clinica Veterinaria Lago Maggiore and I will tell you why.

f1From the first day I was greeted with smiles and open arms, and after I met the whole team, we began to discuss clinical cases in the clinic and ways of approach. I realized they are polite and friendly. They were very careful with me from the beginning until the last day (when we celebrated with a special cake tasting).

The members of the clinic are well organized, they treat with great importance and care of each patient and I enjoy seeing that they work as a well-connected team.

The clinic is well structured with many rooms equipped with special equipment useful for many procedures. I was very excited about the equipment of the clinic and I said “yes,” surely there will be a lot of action here and so it was. With a large number of cases, the team devotes a lot of time to saving the animals.

 

 

f2Speaking of relaxation, Lake Maggiore gave me an unforgettable view, spending a few breaks on the shore. We also relaxed spending the evening in town. In one of the evenings I was with some colleagues in Rocca Borromeo Park to admire the lights on the other bank of the lake. I decided at the end of the period to miss half a day from the clinic to visit the Borromean Islands.

 

 

f3Due to my desire for plastic surgery and reconstructive and wound management, I stayed close to Dr. Luca Formaggini. He answered all my questions, was opened to all of my discussion topics. He explained to me in detail and with patience every step which should be followed in all of the surgical interventions that took place over the two weeks. I also want to thank him for allowing me to use one of the endoscopes. I have greatly appreciated this aspect. He is funny and have open mind.

 

 

 

f8I also thank Dr. Sara Manfredini for having been patient with me and it was a pleasure for me to put pressure on her shoulders. He explained my anesthetic protocols and other procedures. I was like a needle in her spine. I think the best word to describe her is – kindness.

I want to appreciate the other team members: Mariangela De Franco, Luigi Venco, Andrea, Giuditta, Elisa, Paolo, Margherita, Marta and Salvo. I also received the science from you

Thanks for science and for memories!!!!!!!!

 

 

 

 

 

f6I have a message for the team : The bat will return more “aggressive”!

 

Thanks Vet on the Balkans and to all people who support this program. You do a great job. Well done!

 

 

 

 

 

The team of  Vets on The Balkans express their gratitude to Clinica Veterinaria Lago Maggiore and Dr Luca Formaggini, as well to the company which support our project PAMAS TRADING, Romania! 12814393_1673705086236432_1339900710371625092_n

 

 

Hypothyroidism in dog

10615967_4509428271902_7318235873151930765_nDr. Marta Todorova

Veterinary Clinic Ruse, Bulgaria

 

Clinical case

Case description

Dog , male , entire, five years old was evaluated because of signs of hair loss. The name of the dog is Ares. He lives in apartment with his owners.

History

About two years ago the dog has easily epilated hairs. The coat is typically thin on the neck  , on the head and on the trunk symmetrically. The is crusts  on the all body. Some parts of the skin are depigmented. Alopecia is growing to the tail. Hair regrowth non  existent.It was unhappy dog.

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Diagnostic approach

  • Skin tests
  • Brushing test- a lot of crusts
  • Scotch test – negative
  • Cytology – negative
  • Scratch test – negative
  • Trichogram – more hairs in telogen phase
  • Blood test – FT4 7.84 pmol/l

 

 

Therapy

-Levothyroxine 10micrograms/ kg/2twise daily

-Dermoscent – ones a week, for four weeks

-Dermacomfort

– washing with Sebolytic

 

There are visible results two months after therapy and the dog regained his previous behavior.

Blood test after therapy – FT4 19.17pmol/l

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1st Conference of ASAEE – Association for Small Animal Endoscopy and Endosurgery

20664825_1357492001030820_2489513405628295553_nEndoscopic procedures are not new inventions. History of today modern endoscopy starts at the beginning of the 19th century. Today two hundred years after it’s still evolving and that make’s  it one of the most exciting parts of veterinary medicine.

Endoscopic procedures have recently been introduced to veterinary practitioners on a larger extent in East and South-East Europe. More and more vetrinarians on the Balkans were interested in endoscopic procedures. For us that was a breaking point which led to formation of ASAEE (Association for Small Animal Endoscopy and Endosurgery) and 1st ASAEE Conference that is going to be held in Belgrade

on 14th October.

The aim of the conference is to provide the platform for students, veterinary practitioners and Academicians to share the knowledge and ideas. The idea is that the 1st Conference becomes „ to know each other“ meeting of people interested in endoscopy.

To summarize, we can say that despite all the technological advances and endoscopy’s extensive history, it still pushes us to always remain vigilant student.

 

On behalf of the Organizing Committee

Emil Ofner

WSAVA, Hill’s 2017 Announce ‘Next Generation’ Veterinary Award Winner

wsava logoJudges praise commitment to raising standards of veterinary care in the Balkans

TOPEKA, Kan. (21 July 2017) – Dr. Luba Gancheva, a Bulgarian veterinarian who now lives and works in Romania, has been named by the World Small Animal Veterinary Association (WSAVA) and Hill’s Pet Nutrition as the winner of the 2017 ‘Next Generation’ Veterinary Award.  The award acknowledges the work of a veterinarian who graduated within the past ten years and who has contributed significantly to the betterment of companion animals, the veterinary profession and society at large.

 

“Millennial vets carry the future of the profession with them,” said Dr. Jolle Kirpensteijn, ‎Chief Professional Relations Officer at Hill’s Pet Nutrition.  “Luba has demonstrated a strong commitment to improving the experiences and education of early-career veterinarians. She has also taken positive steps to connect these next-generation professionals with ones who are already established in the field.”

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Dr Luba Gancheva

Dr. Gancheva will be presented with her award at the WSAVA World Congress 2017, which takes place Sept. 25-28 in Copenhagen, Denmark.  She will also give a lecture entitled: ‘A high professional level of veterinary medicine is offered in the Balkans.  True or false?’

The Balkan Peninsula extends from Central Europe to the Mediterranean Sea and includes the countries of Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Macedonia, Montenegro, Romania, Serbia, Slovenia and the European part of Turkey.

Dr. Gancheva graduated from the Faculty of Veterinary Medicine of the University of Forestry in Sofia, Bulgaria, in 2010, and began working in a small animal practice in the city. She demonstrated her commitment to continuing education and received a Master of Science in Infectious Diseases from Triaka University in Bulgaria.  She now lives in Bucharest, Romania, and works at the Cabinet Filip Veterinarul animal hospital.

 

Her PhD thesis, entitled ‘Clinical Manifestation of Brucellosis in Dogs, caused by Brucella Canis,’ was based on a study she conducted on the incidence of this disease in the Balkans.  As a result of her thesis, Dr. Gancheva was invited to speak at two congresses in the Balkans, where she realized how enthusiastic her colleagues in the region were to continue their professional development.

 

In 2015, she launched an online veterinary journal called ‘Vets on the Balkans,’ with the goal of helping regional veterinarians work more collaboratively and share their experience and knowledge.  The journal has presented more than 90 cases and has developed a strong readership. It has also built partnerships with many of the key companion animal veterinary associations in the region.

Building on this success, Dr. Gancheva in 2016 launched an initiative called ‘Learn and Travel with Vets in The Balkans’.  The program enables veterinarians to increase their knowledge and experience by working in clinics in nearby countries. The first placements were made earlier this year, and they were supported through sponsorships and donations from 12 participating practices in Bulgaria, Turkey, Romania, Belgium, Italy and Croatia.

Dr Käthi Brunner, Chair of the WSAVA’s Leadership and Nomination Committee, said: “Tackling the inequality of education and resources available to veterinarians depending on where in the world they are working is one of the key challenges facing the profession.  Dr. Gancheva has taken some very practical steps to support the development of the profession in the Balkans, both through launching the journal and through the new ‘Learn and Travel’ scheme.  We congratulate her and hope that both of these initiatives continue to prove successful.  She is a great example of a Next Generation veterinarian who is showing a very personal commitment to raising standards of veterinary care.”

 

As the winner of the 2017 ‘Next Generation’ Veterinary Award, Dr. Gancheva will receive a monetary gift, an engraved plaque and a WSAVA certificate.

 

Dr. Gancheva said: “I would like to express my gratitude for the Award. It is the biggest honour of my life and I am excited to be part of WSAVA World Congress this year.  During my lecture, I will present clinical reports from my journal from each country in the Balkans to show that, while we may have economic difficulties, our passion for knowledge and love for animals give us strength.  When you cure an animal, you change the world for someone, so veterinarians change the world. Thank you WSAVA!”

 

Hill’s will fund Dr. Gancheva’s attendance at the 2017 WSAVA World Congress so that she can accept her award.

 

Candidates for the WSAVA, Hill’s Next Generation Award can come from any country and must meet the following criteria:

  • Graduated within the past 10 years
  • Active in continuing education
  • Have a strong record in community service
  • Working to bridge the gap between their generation and others

 

The WSAVA’s 101 member and affiliate associations represent more than 200,000 individual veterinarians from around the globe.  They work together to advance the health and welfare of companion animals.  Hill’s is the WSAVA’s most long-standing and significant industry partner.

 

Candidates for the 2018 Next Generation Award can nominate themselves by sending an email to yourwsava@wsava.org by Jan. 1, 2018. They should include a letter of intent, a CV and at least one reference letter. Further information can be found at www.wsava.org.

 

 

About Hill’s Pet Nutrition

 

Founded more than 75 years ago with an unwavering commitment to pet nutrition, Hill’s mission is to help enrich and lengthen the special relationships between people and their pets.  The right nutrition, combined with the devotion of veterinary professionals can transform the lives of pets; and healthier and happier pets can transform the lives of pet parents.  Hill’s is dedicated to pioneering research and ground-breaking nutrition for dogs and cats based on a scientific understanding of their specific needs.  HILL’s® Prescription Diet® therapeutic pet foods. HILL’s® Science Diet® and HILL’s® Ideal Balance™ wellness pet foods are sold through veterinarians and pet speciality retailers worldwide.  For more information about Hill’s, our products and our nutritional philosophy, visit us at HillsPet.com, HillsVet.com for Facebook, keywords “Hill’s Pet Nutrition.”

Fibrosarcoma in rabbit

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Dr Spas Spasov

Dr Spas Spasov

United veterinary Clinic Varna, Bulgaria

 

Fibrosarcoma in rabbits are malignancy rapidly grow soft tissues tumor. Can affect cats dogs and rabbits . The couse of fibrosarcoma in rabbit also can be a viral infection (polyomavirus, malignant rabbit fibroma virus)

Clinical case

Case description
Rabbit, female , entire , 5 years old was evaluated because of sings of anorexia and apathy .
History
The owners reported  that a week ago the rabbit progressively stops  eating. The last two days it didn’t eat at all. Тhe rabbit has regularly deworming and vaccination.
The rabbit eats hay and rabbit granules only and lives in an apartment and  never go outside, there are no others animals in the apartment.

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Clinical manifestations
Anorexia, cachexia, apathy, unilateral uveitis, normal temperature (38.5).
Clinical examination revealed all of the body (back, neck, abdomen and all the legs) nodules, which are not painful, mobile, not tempered and pigmented .The size of the nodules was variable from 1 to 5 centimeters.
Some nodules were ulcerated and bleeding, and still painless. Such formations are not observed in the nose and the ears, and the front part of the head.
Diagnostic approach:
We did not find any abnormalities on the X-ray examination of the chest and abdomen. A nodule was surgically removed by cutting.
Symptomatic therapy was appointed until the results of the histopathological examination:
Metoclopramide-0,5mg / kg
Ranitidine-4 mg / kg
Simethicone-65mg / rabbit
Meloxicam-1mg / kg
Enrofloxacin, 10 mg / kg
Intravenous infusion Hartman 4ml / kg / hour.
So designated therapy lasted about 10 days pending the results of pathological examination The condition of the animal slightly improved, which is expressed in phrases in appearance of appetite. The animal took small amounts of food.

Diagnosis:

Fibrosarcoma
The prognosis for this type of tumors is garded to poor. Because of poor condition of the patient and the prognosis owners decided to euthanased the rabbit.