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

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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: 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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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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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.”

” A neoplasia in left midbrain in dog”

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Dr Dimitar Ivanov

Dr Dimitar Ivanov,
Veterinary surgeon, Neurology specialist
Dobro hrumvane veterinary clinics
Sofia, Bulgaria

 

 

 

Case report

Dog, Bleki, toy terrier, M, 5 yo.

Came in the clinic on 11.04.2017 with left circle movements, menace deficit on the left and no reaction when stimulating the nasal mucosa.  On the right, spinal reflexes are decreased and there are no conscious proprioception.

Doubt for brainstem problem.

Differential diaggnosis:

V – vascular – it’s with peracute onset

I – inflamatory – it’s possible but no changes in blood sample

T – toxic – The dog did not take any medication, fed the same food and was not seen taking unusual things, but it’s not unpossible

A – anomalous – тhe dog is 5 years old and it is unlikely that there will be any manifestation of these diseases

M – metabolic – there is no other clinical signs or any changes in blood samples.

I – idiopathic – there is no seizures and vestibular signs

N – neoplastic – it’s more possible

D- degenerative – the dog is too young for cognitive dysfunction and too old for other degenerative diseases.

We made MRI on 12.04. and found a lesion in the left mesencephalon.

dhs dhs1 dhs2

 

 

 

 

 

 

 

 

 

 

The final diagnosis is neoplasia in left midbrain.

 

We started to prepare for surgery.

The antibiotic preoperative was Ceftriaxone 30 mg/kg i.v., Manitol 1 g/kg i.v. and Methylprednosolone 20 mg i.v.

The surgery was on 22.04.2017 and we made a left craniotomy and displacement of the temporal lobe dorsolaterally until the lesion was reached.

Bleki preoperative video:

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Pic 1

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Pic 2

The skull was open and we enlarged the hole with Kerrison rongeur (pic 1 and 2)

 

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Pic 3

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Pic 4

We aspirated the brain liquor and very slowly reverse the left temporal lobe.( Pic 3 and 4)

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Pic 5

When we found the lesion we punctured the cyst formation and drew the liquid contents.( pic 5)

 

 

 

 

 

 

 

 

 

 

The reason to do this surgery was to try to reduce the pressure in the tissue and to improve the dog’s condition.

After surgery we continued the antibiotics in the same dose and methylprednisolone in the same dose for three days. After then the dose was reduce to 2 mg /kg.  After few days the methylprednisolone was change with prednisolone and started to reduce the dose.

Until the methylprednisolone is reduced, the patient is better every day, improves motor activity, appetite, but fails to maintain a constant temperature. A corneal ulcer of the left eye appears – I guess the cause is a trauma to the left oculomotor nerve and reduced lacrimation.

On 28.04. we included one more antibiotic – amoxicillin with clavulonic acid.

On 29.04. the prednisolone was reduced to 0,5 mg/kg, the dog was with anisocoria (myosis on the right eye and mydriasis on the left). On 30.04. the circle movements on left started again.

We tried to find Lomustine for chimiotherapy but we couldn’t and increased the dose of the prednisolone to 2 mg/kg

 

Bleki 22 days after surgery:

 

 

Bleki 23 days after surgery

The dog is good, he walk normally but when he stops, he start to make circle movement on the left.

 

1st Bulgarian Dermatology Congress , organised by BAVD

14612382_553114001550481_6070253379668782534_oFirst Congress of Bulgarian Association of Veterinary Dermatology held in 27-28th of April, 2017 at city of Plovdiv, Bulgaria. There were more then 120 veterinarians from Bulgaria, Macedonia, Romania, Greece and Cyprus.

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Dr. Emmanuel Bensignor and Dr. Sebastian Viaud, who impressed the audience with the way information was provided, but also the way all the scientific information was presented so to be useful in every-day-practice. They   discussed which one is the best elimination diet, which medicine is effective in the control of canine atopic dermatitis and how to use them appropriately? How to do Desensibilisation therapy? How to perform biopsy from unusual places? How to recognize vasculite lesion and how to deal with it?18209350_640038969524650_2972147177502418052_o

Vets on The Balkans support BAVD submit one free ticket for 4th Latin American Congress of Veterinary Dermatology to be held in
Merida, Mexico from 13th to 16th of June 2018  and one free ticket for 4th Romanian Dermatology Congress , October, 2017. Their members are presenting clinical reports and the best one will win. All of the cases will be posted in the journal Vets on The Balkans.

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Dr Ana Maria Boncea, Vetderm Therapy in Bucharest, Romania

 

“I would like to thank you one more time for this opportunity. It was great event!! Congratulations for everything! See you soon!!”

 

Dr Daniela Bajenaru, Tazy Vet Veterinary Clinic in Bucharest, Romania

 

“Dear Luba, the 1st Bulgarian Veterinary Dermatology Congress was excellent, the lecturers gave us a lot of useful information and the organization was great!”

 

Dr Adriana Cosma, Conforvet on Bucharest, Romania.

 

“ Hi Luba! I wanted to tell you that we thank you for everything…we had wonderful time. We liked very much the BAVD Congress and the city of Plovdiv!”

 

 

The team of Vets on The Balkans congratulated BAVD for the high professional level of organizing and the brilliant scientific program.

Learn and Travel……. stories from the vets! Dr Daniela Bajenaru at Central Vet Clinic in Sofia

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Dr Daniela Bajenaru and Dr Ivelina Valcheva

Dr Daniela Bajenaru, working in vet clinic Tazy-vet in Bucharest, Romania with the sponsorship of Pamas Trading SRL have done her externship at Cenral Vet Clinic in Sofia, Bulgaria. Let’s her tell us about it :

                   My wonderful experience in Sofia at the Central Vet Clinic

It all started with a simple decision to try my luck at a contest organized by the Vets on The Balkans, that was a first step in a wonderful walk. Dr. Luba Gancheva told me about this possibility of externship at the Central Vet Clinic in Sofia, and I said why not, we always have something to learn from those around us.
At the Central Vet Clinic I met only welcoming and beautiful people. The management is at a very high level, they are very well organized. I admired very much their way of dealing with the hospitalized patients and their X-ray techniques.There the doctors, besides their great experience, have all the necessary equipment to establish a quick diagnosis of certainty.
On my first day I remember that I was very impressed by the large number of patients who walk into the clinic, I think they were around 150. They always manage this with a lot of professionalism.16 5 3
The surgery rooms are very rarely free. I think that the most difficult cases from Sofia (and not only) come to them.
Because my greatest passion in the veterinary field is dermatology, my time spent in the Central Vet Clinic has been allocated , for the most part of it, in the dermatology department with Dr. Iveline Vacheva. For her I have only wonderful words. I see in her a very dedicated doctor, with many ambitions. I had the opportunity to see a lot of interesting cases, one of them was about a young cat with degenerative mucinotic mural folliculitis. I know that this affection is quite rare…so, great job Dr. Iveline!7111 2
My days were my own to plan and fill. I had a little time to visit also Sofia. I took a walk on the Witashe Mountains, I climbed up to the Boulder slopes, called ” stone rivers” or “morains” in Bulgarian and in some English language guidebooks.
It was a great experience for me, I left with a lot of practical ideas for home. I will definitely come back again in Sofia to the Central Vet Clinic!8 9

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Thanks to the all team for all the goodwill they have shown, they always answered to my questions.
Thank you Dr. Ranko Georgiev for all the kindness, for sure in the future you will do more then that for the Central Vet Clinic!
Thank you Vet on The Balkans, Dr. Luba Gancheva, Pamas Traiding and Tazy-vet, because you made this possible!12814393_1673705086236432_1339900710371625092_n

Learn and Travel…..stories from vets!

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Dr Constantin Ifteme

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externship

In March 2017, Dr Nadejda Tsureva, working at Veterinary Clinic ” Dobro Hrumvane” in city of Sofia, Bulgaria, has done her externship at Centru de Endoscopie si Chirurgie Minim Invasiva Veterinara with Dr Constantin Ifteme in city of Bucharest, Romania.endo3endo6

What is the opinion of Dr Nadejda Tsureva:

“Dear colleagues and friends,

I want to thank you for the opportunity of spending some precious time in Centru de endoscopie si chirurgie digestiva veterinara in Romania. Thanks a lot to Vets on the Balkans and the Vet team of the endoscopic center.
I had the chance of meeting new friends and family. Had the chance of learning from great professionals and great people. Working with love for the animals is really important and when combined with knowledge and great skills that is how “magic” is happening. I am really pleased to know that there are more people of that special “breed”.
Thank you all for the knowledge and the smiles you shared with me.
Hope to see you again.
To my Romanian family with love.
d-r Nadezhda Tsureva
We would like to express our gratitude to Dr Constantin Ifteme and brilliant team for everything. We are proud to have you on The Balkans , such a high level of professionalism and big heart!endo4 endo2 endo5