WSAVA Targets Welfare with Release of First Global Guidelines for Companion Animal Practitioners

AW GuidelinesThe World Small Animal Veterinary Association (WSAVA) has highlighted the key role of veterinarians as advocates for animal welfare with the launch of its Animal Welfare Global Guidelines for Companion Animal Practitioners and the Veterinary Team.

The Guidelines, launched during WSAVA World Congress 2018 in Singapore, aim to bridge differing perceptions of welfare around the world and help veterinarians to tackle the ethical questions and moral issues which impact welfare. They also offer guidance to ensure that, in addition to providing physical health advice and therapy to their patients, veterinarians can advocate for their psychological, social and environmental wellbeing. The WSAVA already offers Global Guidelines in key areas of veterinary practice, including pain management, vaccination, nutrition and dentistry.

shane ryanDr Shane Ryan, incoming President of the WSAVA and former Chair of the WSAVA Animal Wellness and Welfare Committee, said: “As veterinarians, our responsibility extends far beyond the physical health of our patients. Animal welfare as a science is a new and rapidly developing discipline and veterinarians need current, evidence-based information to enable them to maintain the highest welfare standards and to provide knowledgeable, accurate advice for pet owners and communities.

“Our new Guidelines provide recommendations, checklists and other tools to promote optimal levels of welfare throughout the veterinary visit. They also offer guidance on increasing welfare beyond the doors of the clinic through outreach activities.”

He continued: “As levels of pet ownership increase in many regions of the world, including Asia, it is essential that veterinarians champion animal welfare and the WSAVA hopes that these new Guidelines will encourage our members to adopt best practice and set the highest standards.

“I would like to thank the members of the Animal Welfare Guidelines team, who worked so hard to create them and, of course, our sponsor, Waltham®, whose constant support was instrumental in enabling us to deliver them.”

The WSAVA has called on its members to develop an animal welfare charter for their members and to adopt the Guidelines into daily practice. 32 WSAVA member associations have already endorsed the Guidelines with more expected to follow shortly.  During 2018-19, the WSAVA will develop relevant continuing education (CE) and provide additional tools and translations of the Guidelines text.

The Animal Welfare Global Guidelines for Companion Animal Practitioners and the Veterinary Team are available for free download at: https://bit.ly/2D3RAoc

The 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 represents more than 200,000 veterinarians through 110 member associations.

 

WSAVA World Congress 2018 is being attended by more than 3,000 veterinarians from around the world and brings together globally respected experts to offer cutting edge thinking on all aspects of companion animal veterinary care.  WSAVA World Congress 2019 takes place in Toronto, Canada, from 16-19 July.

WSAVA Vaccination Guidelines Group Project Continues in Latin America

logo-white-backgroundArtboard-1The World Small Animal Veterinary Association (WSAVA) Vaccination Guidelines Group (VGG) has held a series of meetings and continuing education (CE) sessions in Mexico.  It was the final country visit in its three-year project aimed at enhancing levels of understanding of infectious diseases across Latin America and advising veterinarians on ‘best practice’ in vaccination.

PNCQE5648

Members of the VGG at one of the small group meetings in Mexico. Left to right: Dr Richard Squires (James Cook University, Australia), Dr Cynda Crawford (University of Florida, USA), Emeritus Professor Michael Day (Chairman, UK) and Dr Mary Marcondes (São Paulo State University, Brazil).

The VGG visit to Mexico took place during August 2018 and included meetings in Mexico City, Guadalajara and Monterrey. Committee members, including VGG Chairman, Emeritus Professor Michael Day, met with veterinary association leaders, academics, first-opinion practitioners and government regulators. They also made site visits to practices in all three cities. To support veterinary education, they delivered three evening CE sessions. The CE session in Mexico City was also live-streamed and made available to registrants for 30 days after the presentation. Altogether, over 2,000 veterinarians were reached by the live or on-line programme.

 

In advance of the visit, the VGG circulated an online questionnaire to collect data on veterinary demographics, infectious disease occurrence and vaccination protocols.  The survey was completed by 552 veterinarians with the data presented during the CE events.

 

The VGG develops globally relevant recommendations for best practice in the vaccination of dogs and cats.  It has also created the World Small Animal Veterinary Association (WSAVA) Global Vaccination Guidelines, the latest version of which was released early in 2016.  WSAVA Global Guidelines aim to support veterinarians by setting minimum standards for care and recommending best practice in key areas of veterinary medicine.

 

The WSAVA represents more than 200,000 veterinarians worldwide through 104 member associations and is focused on enhancing the clinical care of companion animals.

 

Commenting on the visit, Emeritus Professor Day said: “The VGG was delighted with the success of this visit to Mexico; a country with an estimated 45,000 veterinarians with students graduating from approximately 45 public and private veterinary schools.”

 

“Mexican veterinarians are accustomed to the principle of annual revaccination of dogs and cats with multicomponent products, but those we spoke to were excited by the new concepts of less frequent and individualized vaccination, incorporated into a preventive healthcare package for pets. Vaccine-preventable infectious diseases such as canine distemper and parvovirus infections, remain highly prevalent in Mexico.  Increasing herd immunity by improving vaccination coverage is clearly an important goal for the Mexican veterinary community.”

 

He added: “We are pleased to acknowledge the financial and logistical support provided by MSD Animal Health for the work of the VGG and for this visit in particular. Colleagues from MSD worked tirelessly behind the scenes to ensure that our independent scientific programme ran faultlessly in Mexico.”

 

The VGG ran a similar programme of activity in Argentina (2016) and Brazil (2017) and, during 2019, a final white paper on the findings of the Latin America project will be prepared for publication.

 

Craniomandibular osteopathy in a young dog

421347_10151629937179640_1038846606_nDr Miroslav Todorov

Blue Cross Veterinary Hospital

Sofia, Bulgaria

Case report

40542605_382709382264902_1711454165768601600_nCraniomandibular osteopathy in a young Labrador retriever.

A 4 months old Labrador retriever was presented at the BlueCross Veterinary Hospital in Sofia, Bulgaria, with the owner complaining about painful episodes after touching the head of the animal.

Clinical examination: the dog is in a good clinical stage, no pathological heart or lung sounds.

The temperature was 39,5 C. No abdominal pain or other abnormalities.

The palpation of the skull was painful for the dog, there was slight dome shape of the cranium. The masseter muscles were atrophied. After palpation of the mandibula it was noted that the lower jaw of this dog looked enlarged. Pic 1

Considering the age, breed and the affection of the specific bones, the following list of differential diagnosis was made:

  1. Craniomandibular osteopathy
  2. Osteomyelitis
  3. Calvarial Hyperosthosis
  4. Neoplasia

We took a blood sample for CBC and biochemistry analysis.

On the CBC there was a slight decrease of the RBC – 5,36 (5.5- 8.5 x10/12/L) but this could be normal for younger animals.

On the biochemistry there was a slight decrease of the Total protein – 49 (51- 78) g/L and Albumin – 20(26- 41) g/L. Everything else was WNL.

The patient was sent for CT of the head to search for additional characteristics of the bones of the head and confirm my suspicion about the disease. We put an injection of NSAID for the pain until the test was done.

On the CT we discovered symmetrical bone proliferation of the rami of the mandubule and bone thickening of the calvarium of the animal. No underlying bone lysis was noted. Fortunately, till this moment affection of the temporomandibular joints was not discovered, but it is possible that this could happen during the next months.40574303_322560345178752_5208200230733873152_n 40589358_286835962116167_5128061020073361408_n 40589364_655681474803526_9092529697882898432_n 40623237_513632389060326_2736220804109828096_n 40764141_2203859333191397_5014338687031312384_n

There were not clear signs of neoplastic process or osteomyelitis. As a result, considering the information that we had, a diagnosis of craniomandibular osteopathy was made.

Craniomandibular osteopathy is a non neoplastic proliferative bone disease affecting immature dogs.

Usually the clinical signs start between 3 and 8 months of age. Common clinical presentation is pain episodes, fever, trouble chewing food, drooling and in more advanced cases – inability to open the mouth and eat. The etiology of this disease is unknown.40530022_1906226039680267_8977683290295107584_n

The first written description of CMO appeared in 1958.(9) It was described in five West Highland white terriers affected within a 2-year period. The most common breeds that are affected are West Highland white Terrier, Scottish Terrier, Cairn Terrier. The disease is described in other breeds – in Labradors, Boxers, Great Dane and a few more.

It is believed that this could be an inherited disease (autosomal recessive inheritance pattern) and as such it is advised for such animals to be neutered.

Commonly the affected dogs have bilaterally symmetrical enlarged mandibles and tympanic bulles, and affection of other bones of the calvarium. In severe cases those structures could fuse and this will lead to decreased range of motion of the temporomandibular joint. On examination, the temporal and masseter muscles may be atrophied.

In advanced cases, the diagnosis of craniomandibular osteopathy can be done with good positioned x-rays of the head of the animal. The advance imaging techniques, such as CT or MRI, improve the visualization and confirm the extension of the process.

On x- ray or CT increased irregular bone density is commonly observed –  symmetrical periosteal proliferation, in most of the cases primary affection of the mandibules- 84%; tymplanic bulles – 51% and in some of the cases bones of the calvarium -13%.

The treatment plan is symptomatic with painkillers and anti-inflammatory drugs – commonly used drugs are NSAID and Steoids. Such drugs are needed during pain episodes and fever. Placement of an esophagostomy or gastrostomy feeding tube may be considered in patients that have difficulty eating and their nutritional requirements are not being met. Soft or liquefied food may be easier for some patients to eat. A high protein, high caloric food should be offered in order to meet nutritional needs.

Surgery of the bone proliferated tissues is not helpful in those cases.

The prognosis for these patients depends of the extent of progression of the disease. In those cases where a severe bone proliferation develops, the result is fusion of the temporomandibular joint and the prognosis is poor. Most of those dogs are euthanized because of the extent of the disease. It has been a common observation that when the affected dog is approximately 11 to 13 months of age, the disease may become self-limiting. The growth of abnormal bone slows, often regresses, and sometimes recedes completely. This period of self-limitation coincides with the time of completion of regular endochondral bone growth and ossification.

Our patient felt great after one injection of meloxicam. He is feeling active and has no signs of pain and temperature. Unfortunately, we cannot say whether his condition will progress to the extent to affect the temporomandibular joints and lead to inability to open its mouth.

The owner will return the dog to the breeder. It was advised to watch the dog for any additional signs and painkillers were prescribed.

FIRST REPORTED CASE OF SYMPTOMATIC DIROFILARIA IMMITIS INFECTION IN A HOUSOLED DOMESTIC FERRET (MUSTELA PUTORIUS FURO) IN BULGARIA.

32480642_1950070525005966_7673581144482250752_nMihaylova L. DVM1.

1Veterinary surgeon in United Veterinary Clinic Bulgaria Varna 9000,

email: lillyvet@gmail.com

Heartworm disease in dogs and cats is well known in many European countries including Bulgaria. There are furthermore studies confirming dirofilariosis in wild foxes and Canis aureus i reports about heartworm disease in domestic ferrets in our country.

History

A 5 year old male, entire, pet ferret (Mustela putorius furo), weight 0,9 Kg was presented with labored abdominal breathing. The owner reported reduced appetite, difficulty breathing and restlessness. The ferret was not able to sleep or lie down for more than few minutes.  The ferret was used to live mainly indoor and allowed during the summer to be outside in the garden, for just few hours during the day, to be exposed to natural sunlight.

Clinical presentation and collateral exams

On presentation ferret was lethargic with abdominal breathing and breathing rate up to 90/minute. There was clear subcutaneous edema more prominent on the front and hind legs and ventral part of the abdomen. Mucous membranes were pale, while CRT was not possible to be assessed. Heart rate ranged in between 120-180 bpm. Pulses were weak even if assessing on the femoral artery was difficult due to the subcutaneous edema. Abdominal palpation was unremarkable, lymph nodes were normal in size. Thoracic radiograph showed loss of detail into thoracic cavity consistent with pleural effusion. Thoracic US was performed confirming pleural effusion and one hundred and twenty ml of modified transudate was drained. Brief screening echocardiography showed normal left atrium and left ventricle and severely dilated right atrium containing double line hyperechoic objects suggesting the presence of few adult Heartworms. (Fig 1). Right atrium was larger than left atrium. Doppler study and any further detailed investigation of the heart were not possible to be performed due the fact ferret became aggressive and owner declined any sedation or anesthesia. Snap® HTWM Antigen test (Idexx) on blood yielded negative result and at fresh blood smear examination no microfilariae were possible to be identified.  Knott test was not possible to be performed due to limited amount of sampled blood.

Diagnosis

On the basis of echocardiography findings diagnosis of HW disease was done.  Negative HW antigen test was assumed to be due probably due to juvenile D.immitis worms and right atrium localization to the small size of pulmonary arteries as described in cats and ferrets.

Therapy and Follow up

The ferret was treated with Advocate® spot on >4kg (half tube), Furosemide 2mg/kg twice a day and Prednisolone 1mg/kg daily both of them orally. The ferret was stable on that therapy. He was eating and drinking well regain the normal body weight 1.5 kg. no breathing difficulties were reported. He was rechecked 35 days after initial presentation. Echocardiography showed right mildly dilated atrium but no presence of HW (Fig 2). Only 10 ml of fluid was drained from the thoracic cavity. From that time he was stable with no owners complain for 6 month. Suddenly he developed respiratory distress and on presentation was with cyanotic membrane. Pulmonary thromboembolism connects to HW disease was suspected Owner elected euthanasia and no more investigations. Necropsy was declined.

Comments

1

Fig 1

2

fig 2

This case shows the in endemic area even indoor domestic ferrets may be infected by Dirofilaria immitis. and that the disease is difficult to be diagnosed and can lead to death. Suspicion about this problem and monthly chemoprophylaxis should be warranted in this situation as in dogs and cats.

Ilinca Zarinschi, our tech vet, and Learn and Travel with Vets on The Balkans

38912475_442896726119256_1830507085800931328_nIlinca Zarinschi, a tech vet from Cluj, Romania has done her externship at Clinica Veterinara Lago Maggiore, Italy with Dr Luca Formaggini and his amazing team. She will tell us more about this experience:

 

“How it all started
I had the pleasure to meet Dr. Luba Gancheva for the first time at the Feline Medicine Congress in Bucharest, talking about her amazing project, Vets on the Balkans. I was so impressed I decided to approach her and find out more.
She explained to me that, as veterinary technician, I could improve my knowledge and skills by signing up for her amazing programme and she thought the best option for me might be Clinica Veterinara Lago Maggiore from Dormeletto, Italy.
So, two months later, I was finding myself flying over the Italian Alps not knowing what to expect from this new adventure.

39008939_498327340608678_2724608909053526016_nGetting there
I took off from Cluj-Napoca, Romania on the 1st of August.
After a long flight and many delays, I landed on Malpensa Airport. Alberto, one of the nicest vet techs I’ve ever met, was waiting for me. He drove me to the Clinic and then to the Crazy Pub where Dr. Luca, Dr. Sara, Dr. Marta and Dr. Giulia and Dr. Cecilia were waiting for me, with arms wide open. It was such a lovely evening, I could hardly wait for the next day to start!

38997000_1870135039950117_1318943628642484224_nThe clinic and the team
My first impression was that the clinic is well equipped and highly organized. Everyone was really eager to explain and share their knowledge with me, even though there were certain subjects I was not familiar with (like operating the Radiology and CT units).
I was very impressed with the surgical ward, Dr. Luca being one of those doctors that you can learn a lot from, having both the patience and experience to share from.
One thing that I am very grateful for is that they taught me how to preform and epidural, something I don’t get to do everyday.
We had various discussions about protocols regarding anaesthesia, vaccinations, post-op therapy and I learned a lot of useful information, which I already passed on to my colleagues.

38750936_433439873818272_1938692870990987264_nA little piece of Italian heaven

During the 12 days I was there, I got the chance to experience a bit of the Italian lifestyle, I travelled to Milan and explored the surrounding area. I fell in love with Italian cuisine and warm summer nights spent with the girls, we shared stories and experiences and the most important part, I got the chance of rediscovering myself and what I was capable of.
Saying goodbye
I was really sad I had to leave, it was the best experience I’ve had abroad, I would love to be able to go back one day and I highly recommend it to everyone who is willing to broaden their horizons.
A big special THANK YOU from the bottom of my heart to Luba, who encourages and empowers me everyday, to Dr. Luca and his lovely, amazing team, to Giulia – who is also the best room-mate that anyone could want , to Marta, Sara, Mariangela, Cecilia, Anna, Chiara, and Alberto (Nayra and Nina too). And a big thanks to Pamas Trading, for making this happen, of course. 12814393_1673705086236432_1339900710371625092_n
Also, I would love to remind you, guys, again, that we have better cannulas but you have prettier pink alcohol, haha.
My best regards and warmest hugs,

Ilinca, “the hybrid” vet tech

39017847_235779323940471_323580860395683840_n 39020903_1823190841099828_7740281119005736960_n 39095656_505572619865056_8953206293150040064_n 39096436_1326484624154769_2308858991083520000_n

Generalised demodicosis, cahexia, pioderma with multiple purulent wounds

27657905_1767922679940615_5207571160505979701_nDr. Nadasan Giulia
VetPoint Vest
Arad, Romania

 

Patient: Ava

Species: canine
Age: 6 months old
Environment: found in a forest
Clinical findings: normal temerature, present apetite
                         weight: 7,8 kg
                         Multifocal alopecia
                         Ulcerations and crusting on the neck,head, limbs and trunk
36311521_2252347564779988_378779891753025536_n 37279743_2252347544779990_5950344865513472000_n
Skin scrapings positive for Demodex canis
Diagnosis: generalised demodicosis, cahexia, pioderma with multiple purulent wounds
Cause: malnutrition, imunosupression 37358779_2252347538113324_2271135992675041280_n
Treatment: first day: hair clipping + clorhexidine 4% bath
baths repeated 1×3 days for 2 weeks
co-amoxiclav 12.5 mg/kg, 2x/day 14 days
afloxaner+ milbemicine oxyme (nexgard spectra)
superpremium dog food 4x/day
after 4 weeks: fluralaner (bravecto)
Weight after 3 weeks: 16 kg
In the last pictures you can see how much she has improved after only 3 weeks. Case in progress37349376_2254048444609900_3767674350048641024_n 37388617_2254048884609856_663487681757446144_n

The rhomboid flap

22264908_689114241295076_1764003733_nFlorin Cristian Delureanu

DVM, MRCVS

 

 

ABSTRACT

 

In plastic and reconstructive surgery flaps have an important place not only for the aesthetic results obtained but also because they can be used to cover an area without producing tension. The flap mechanism mainly consists of moving a piece of skin from the donor site and moving it to the recipient site (primary defect). The rhomboid flap have a big versatility because can be done anywhere on the surface of the body. Filling small and large wounds with tissue similar in texture, colour and thickness is the ideal objective of the flap. This article describes the surgical approach of two cases, one with an abscess and the other with a benign tumor located at the cutaneous level, both of which are approached by the use of the rhombic flap.

 

 

Introduction

A skin flap represent a partial detachment of a piece of skin and the adjacent subcutaneous tissue with its vascular supply intact. All skin flaps have a pivot point or base. Survival of the skin flap is made by blood circulation through its base during the procedure. From this point of view, it is important that the base of the flap be large enough to prevent necrosis.

Local flaps are based on two types of vascularization: the subdermal plexus or a vein and an artery (figure A; right side- island flap).

Classification of skin flaps is based on blood supply, transfer mode (primary motion), location, composition and configuration (most described in human medicine). Depending on the transfer method, local flaps are classified as follows: -advancement flaps: those who advance forward; -rotational flaps: describe a rotation motion (curvilinear configuration) to the primary defect.

Classification of skin flaps is based on blood supply, transfer mode (primary motion), location, composition and configuration (most described in human medicine).
Depending on the transfer method, local flaps are classified as follows:
-advancement flaps: those who advance forward;
-rotational flaps: describe a rotation motion (curvilinear configuration) to the primary defect.

 

 

The rhombic flap was invented by a human maxilofacila surgeon called Limberg Alexander Aleksandrovich in 1946. By name, the flap has rhomboid shape with two angles of 120 degrees and two angles of 60 degrees. Depending on the primary defect / lesion pattern which require coverage, the flap angles may change. It is often used in reconstructive surgery of the face in humans: eyelid, floor of nose, alar rim and chin defects with good cosmetic results. This skin flap also called Limberg flap is a transposition flap – the elevated skin will have both advancement and rotation movement when is applied over the primary defect.

 

How to design the rhombic flap

 

Whether it is a wound or a tumor, around a defect is drawn a diamond with angles of 120 degrees and 60 degrees as mentioned above. First, the short diagonal that joins the 120 degree angles (BD) must be measured and then extended in the desired direction. The extension (DE) to the outside must have the same length with the short diagonal (BD) and with the sides of the diamond. The next step is to extend another line wich is equal and parallel with the closest side of the diamond (EF). Finally the skin flap is obtained (ADEF).

Figure 1. The sketch of the rhomboid flap.The primary motion of the flap is the motion placed on it to close the primary defect; the secondary motion is the motion placed on the tissue surrounding the primary defect by the flap.

Figure 1. The sketch of the rhomboid flap.The primary motion of the flap is the motion placed on it to close the primary defect; the secondary motion is the motion placed on the tissue surrounding the primary defect by the flap.

37818621_835276563345509_3163451809612169216_n

Figure 2. Transferring the flap to the primary defect. The direction of rotation of the flap is indicated by the purple arrow. After rotation in point A dog ear will occur (yellow elipse). During the rotation the flap describes a 120 degree movement. The higher the angle, the dog ears will be more prominent. The secondary defect will be closed following the transfer of point F to the initial position of the D point

 

37818589_835276556678843_353770464692142080_n

Figure 3. The final shape of the rhomboid flap. Point D reached point B, point E reached point C and point F reached point D. A is the only point which maintain the initial position.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The surgical defect created can be covered with the rhomboid flap from 4 sides (Picture 4).

Figure 4. The variants of flap usage. The best choice is to select the side with the most laxity because in this way the adjacent anatomical structures will not be disturbed. The flap has a mathematical formula in which all sides are made to be equal.

Figure 4. The variants of flap usage. The best choice is to select the side with the most laxity because in this way the adjacent anatomical structures will not be disturbed. The flap has a mathematical formula in which all sides are made to be equal.

 

 

 

 

 

 

 

 

 

Case 1

                  

History

 

Daisy, a six years old female cat of the Maine Coon breed presented with a sebaceous cyst, 2 cm diameter, round shape, locatad on the dorsal lombo-sacral area. The owner says that the cat have a decreased appetite. The pacient was rescued and adopted and was vaccinated just when was young. The cat lives with another 3 cats in the same house, all with the same vaccination status.

General Examination

At clinical examination, apart from the wound, dehydration 6%  and a small buccal ulcer behind the last molar on the right mandible were detected. The patient was initially treated with clindamycin and meloxicam for 7 days but no improvement observed. The cyst was infected, with bad smell, partially covered with agglutinated hair and inside soft tissue necrosis was present.

Figure 5. The initial appearance of the wound, 24 hours prior to surgery.

Figure 5. The initial appearance of the wound, 24 hours prior
to surgery.

After inspection, dead space was noticed under the skin around the wound. One day before the surgery we noticed fever (40,1°C) and dehydration 8%. CBC, serum biochemistry and FeLV/FIV test were performed. Neutropenia (0.15 x 109/L, normal range: 1.48 – 10.29) and hyperglobulinemia (57g/L, normal range: 28-51) and decreased ALKP (<10 U/L, normal range: 14-111). IDEXX Snap FeLV/FIV was negative. The cat was hospitalized 24 hours for fluid therapy and i.v. antibiotic (Cefuroxime-Zinacef). After stabilizing the patient the intervention was performed.

 

 

 

Descripting the surgical steps

 

The area was clipped and clorhexidine was used for local antisepsis. Sterile marker was used to draw the rhombic shape around the primary defect.

Figure 6. Appearance of the wound after cleaning. Necrotic tissue and pus was present in the middle of the wound;

Figure 6. Appearance of the wound after cleaning. Necrotic tissue and pus was present in the middle of the wound;

 

 

 

 

 

 

 

 

 

 

Due to the presence of dead spaces   under the skin, the round shape of the primary defect was converted to a rhomboid and the rhombic lines were positioned about 1 cm from the wound margin. In this way the tissue that was not healthy was removed. Identifying the area with the highest laxity is the next step. This was done by pinching the skin around the primary defect. After choosing the appropriate area, the flap that must be transferred was drawn.

The first side of the flap (the extended line outward of the defect) and the second side of the flap (line that is the same length as the first, to the adjacent side of the defect and makes an angle of 60 degrees at the flap apex) were cut and the flap was elevated after undermining

Figure 8. The rhomboid flap is designed. The blue arrow describe the direction in which the flap will be rotated.

Figure 8. The rhomboid flap is designed. The blue arrow describe the direction in which the flap will be rotated.

Figure 9. The primary lesion was excised and the underlying tissues are undermined.

Figure 9. The primary lesion was excised and the underlying tissues are undermined.

Figure 7. The picture illustrates the extension to outside of the short diagonal of the diamond

Figure 7. The picture illustrates the extension to outside of the
short diagonal of the diamond

 

 

 

 

 

 

 

 

 

Skin cuts were made perpendicular with No.10 scalpel blade and and the flap was mobilized with help of Metzenbaum scissors. The surrounding tissues are widely undermined to avoid any tension and the flap is rotated into the recipient site. After rotation, the flap is locked in place by fixing its corners by subcutaneous sutures. The donor site is closed as the flap moves over into the new location. Finally the skin was closed with 4/0 PDX in simple interrupted suture pattern.

Figure 10. Elevation of the flap. Stay suture are used to decrease the risk of flap tip necrosis. This inconvenience usually occurs due to faulty handling during the transfer procedure (usually crushing between fingers).

Figure 10. Elevation of the flap. Stay suture are used to decrease the risk of flap tip necrosis. This inconvenience usually occurs due to faulty handling during the transfer procedure (usually crushing between fingers).

Figure 11. The flap is rotated in the desired place and the first stich is applied on the maximum point of tension. The second and the third stich are placed on the other two corners of the flap (yellow dots).

Figure 11. The flap is rotated in the desired place and the first stich is applied on the maximum point of tension. The second and the third stich are placed on the other two corners of the flap (yellow dots).

Figure 12. Immediate postoperative appearance of the flap. Simple interrupted sutures are used for skin closure

Figure 12. Immediate postoperative appearance of the flap. Simple interrupted sutures are used for skin closure

 

 

 

 

 

 

 

 

 

 

 

 

A common unaesthetic appearance after transposed flap was the “dog ears” at the pivot point. In this situation, dog ear was corrected by excising one triangle along one side of its base.

Figure 13. The aspect of the flap at 48 hours after surgery

Figure 13. The aspect of the flap at 48 hours after surgery

Figure14. The aspect of the flap in the eighth day after surgery. The direction of the hair grow is change because of the rotation.

Figure14. The aspect of the flap in the eighth day after
surgery. The direction of the hair grow is change because of the rotation.

 Figure 15. Seventeen days post surgery. The stiches were removed after ten days. No complicatios were encountered. Is very difficult to distinguish the change of the hair growth direction


Figure 15. Seventeen days post surgery. The stiches were removed after ten days. No complicatios were encountered. Is very difficult to distinguish the change of the hair growth direction

 

 

 

 

 

 

 

 

 

 

 

 

Case 2

 

History

 

Coco, a mix breed male dog, three years old was brought to the clinic because a lump was identified on the skin. Owner reports that the mass was seen some days ago and does not believe it has increased significantly. Also says it makes itching and that the dog often scratch there and bleeds. This was the owner’s only concern.

 

General examination

 

No abnormalities were detected after clinical examination except the lump. With a cauliflower aspect, the lump had a small base of implantation and 1,2/1,4 cm in diameter. After palpation of the skin around, no pain or local temperature were identified. FNA and blood tests were recommended before surgery and histopathological examination after. The owner declined for financial reasons the FNA and blood test but accepted the histopathological examination. In this situation, a two centimeter safety margin clearance was decided.

 

Surgical approach

 

            Surgical steps along with flap drawing were described above except for asepsis. In this case  iodine povidone was used.

Figure 16. The mass is identified on the left scapular area after clipping; local asepsis was made.

Figure 16. The mass is identified on the left scapular area after clipping; local asepsis was made.

Figure 17. The diamond is designed around the mass; The mid-third skin of the cranial chest was chosen for transfer

Figure 17. The diamond is designed around the mass; The mid-third skin of the cranial chest was chosen for transfer

Figure 18. Sectioning on contour lines.Control of bleeding is done by hemostat forceps

Figure 18. Sectioning on contour lines.Control of bleeding is done by hemostat forceps

 

 

 

 

 

 

 

 

 

Figure 19. The final aspect of the flap; the skin is closed with 3/0 PGA in simple interrupted pattern.

Figure 19. The final aspect of the flap; the skin is closed with 3/0 PGA in simple interrupted pattern.

 

 

 

 

 

 

 

 

Histopathological result

               Description: Cutaneous/ subcutaneous mass composed of  chistic masses well delimited by a cheratinized multilayered epithelium with epithelial cells with squamous differentiation oxifiles, mixed with abundant, granular and amorphous keratin; multifocal with the tendency of confluence, inflammatory infiltration with neutrophils, macrophages and epithelial cells is observed. Malignant neoplastic cells are not present in the examined sections.

 

               Interpretation: Benign follicular tumor – pilomatrixoma with associated granulomatous inflammatory process.

 

Figure 20. Wiev of the flap 4 days after surgery; small necrosis was noticed on the tip of the flap (green arrow).

Figure 20. Wiev of the flap 4 days after surgery; small necrosis was noticed on the tip of the flap (green arrow).

Figure 21. The aspect of the flap 23 days after surgery; the hair was cut to facilitate flap view. Small crusts are present on the tip of the flap and on the pivot point (blue arrows).Notice the cosmetic scar lines (yellow arrows).

Figure 21. The aspect of the flap 23 days after surgery; the hair was cut to facilitate flap view. Small crusts are present on the tip of the flap and on the pivot point (blue arrows).Notice the cosmetic scar lines (yellow arrows).

 

 

 

 

 

 

 

 

 

 

Common complication of the flap

 

  • Hematoma;
  • Bleeding;
  • Flap necrosis;
  • Secondary infection.

 

Short indications for proper surgical procedure

 

  • The sides of the rhomboid must have the same length;
  • The sides of the flap must must have the same length;
  • Depending on the shape of the primary lesion, the diamond angles may vary in degrees;
  • Any defect in rhombic shape shows 4 variants in which it can be covered.
  • The lowest laxity region should be chosen and as far as possible so as not to alter anatomical plans.

 

 

WSAVA Endorses FVE/FECAVA Position Paper on Healthy Breeding Global companion animal veterinary association warns of the health and welfare risks of extreme breeding

 

Waltnew

The World Small Animal Veterinary Association (WSAVA) is the latest veterinary association to highlight concerns about the impact of extreme breeding in dogs by supporting a Position Paper launched in June 2018 by the Federation of Veterinarians of Europe (FVE) and the Federation of European Companion Animal Veterinary Associations (FECAVA).

The FVE/FECAVA Position Paper is a response to the explosion in popularity of dog breeds with exaggerated traits or genetic disorders and, in particular, those with extreme brachycephalic conformation, such as French and English bulldogs and pugs. While these breeds are increasingly popular with owners, they can suffer severe health and welfare issues.  The Position Paper calls for health and welfare to be given priority over looks and offers detailed recommendations to address both the rising demand for these dogs and the increase in supply. They include:

Measures to reduce demand

  • Addressing demand for brachycephalic and other affected breeds through educating owners about the health issues they face
  • Working with influencers, such as media and celebrities, to encourage owners to choose a healthy, high welfare dog which is suitable for their life style.

Measures to reduce supply

  • Introducing the mandatory registration of breeders, pre-breeding screening programs and the sharing of data on conformation-altering surgeries and caesarean sections
  • Educating stakeholders and revising breeding standards and practices to put the health and welfare of dogs first.

FVE and FECAVA have also produced an infographic explaining the causes and consequences of extreme breeding and listing a number of recommendations.

“Extreme breeding is a global concern with our members seeing the results of brachycephalic conformation in practice on a regular basis. The suffering it causes is beyond dispute,” said Dr Walt Ingwersen, President of the WSAVA.

“Following detailed review by our Hereditary Disease Committee, our Animal Wellness and Welfare Committee and the WSAVA’s Executive Board, we are delighted to endorse the joint FVE/FECAVA Position Paper and congratulate both associations on highlighting the issue and setting out a clear strategy to tackle it.  It builds on momentum established by the Brachycephalic Working Group (BWG), an initiative which brings together all of the major stakeholders in dog welfare in the UK to improve the welfare of brachycephalic dogs.”

Dr Ingwersen continued: “Lasting change requires commitment and collaboration between veterinarians, breeder associations and other stakeholders on a global basis.  We are ready to play our part and look forward to working with our colleagues in the FVE and FECAVA and our member associations to deliver on the recommendations made in the Position Paper.”

Dr Wolfgang Dohne, FECAVA President, commented: “We’re delighted that the WSAVA has offered its support to the joint FVE/FECAVA Position Paper. It is important for veterinarians to speak up on this important welfare issue and together we are stronger.”

The 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 represents more than 200,000 veterinarians through 104 member associations.  Its annual World Congress brings together globally respected experts to offer cutting edge thinking on all aspects of companion animal veterinary care.

 

Notes to editors:

 

The Federation of Veterinarians of Europe (FVE) is an umbrella organisation of 44 veterinary organisations from 38 European countries, representing a total of around 240 000 veterinarians. The FVE strives to promote animal health, animal welfare and public health across Europe.

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

Plasma cell pododermatitis, an imune-mediated dermatosis

27657905_1767922679940615_5207571160505979701_nDr. Nadasan Giulia
VetPoint Vest
Arad, Romania 
Patient: Mufi

Species: feline
Age: 6 years
Environment: household with 15 other cats
Clinical findings: soft, scaly swelling of all the 4 paws, one of them apears with crusts.Only the footpads were afected. The lesions appear to be painful, no pruritus.
Diagnosis: plasma cell pododermatitis, an imune-mediated dermatosis
37296260_2252346914780053_1791624317373513728_n 37303145_2252346888113389_763843415149379584_n 37357272_2252346874780057_3680124293577965568_n
Frequency: rare
Cause: it is idiopatic but asociated with FIV infection
Treatment: steroids.
first 4 days prednisolon-acetate 4 mg/kg i.m, next 7 days at home metilprednisolone 2 mg/ kg

Learn and Travel with Vets on The Balkans…. vets speak about it!

30706127_1869730476410629_6001501177299075072_n Dr Ivana Jovandin, veterinarian from Serbia, attened our education program Learn and Travel with Vets on The Balkans. She did her externship at Central Vet Clinic in Sofia, Bulgaria. Let her tell more about it:

 

Thanks to Vets from Balkan and Luba Gancheva, I had a chance to spend a week in April at a great Central Veterinary Clinic in Sofia, Bulgaria. The clinic is spacious, well equipped and the place where you can see the “state of art” veterinary medicine, and colleagues who work there are exceptional in various fields and together make a great team that is capable of finding the best solutions even for the most serious and difficult situations. It was a special pleasure to get to know and spend time with Dr. Melinda De Mul and Dr. Georgina Georgieva who work with exotic animals that I am professionally interested in. 30741558_1869730456410631_4343028306459754496_nIt was great to exchange our experiences, since in Serbia number of colleagues who are interested in exotic animals is very low. In addition to the work that is closely related to the profession, it was extremely useful to see the organization of work in such a large team where every person knew their task at all times, and everything was managed in order to provide better quality prevention, diagnostics and therapy of pets. Although the time I spent at the clinic was short, it will serve as motivation to strive to improve myself constantly, since the knowledge I got from working there with my colleagues is the experience that cannot be measured. 30712306_1869730686410608_5926180383073763328_nThe acquaintances and contacts made during the stay at the clinic are also something that is invaluable and something that will last for a long time. Enriched with this wonderful and unique experience, I believe that I have moved in the direction of what we all strive for, and that is to be, above all, better people and only then better veterinarians. And that’s why I am so thankful to Dr. Ranko Georgiev, Luba Gancheva and Vets from Balkan on everything!30688606_1864092660307744_6888695709592190976_n