Soft Tissue Surgeon Research Articles

Characterizing Exposure to Physical Risk Factors during Veterinary Surgery with Wearable Sensors: A Pilot Study

OCCUPATIONAL APPLICATIONS Veterinarians provide comprehensive health services for animals, but despite exposure to similar occupational and safety hazards as medical physicians, physical risk factors for these doctors and healthcare teams have not been characterized. In this pilot study, we used wearable sensor technology and showed that veterinary surgeons commonly experience static and demanding postures while performing soft tissue and orthopedic surgeries. Observations showed that muscle activation was highest in the right trapezius. Job factors such as surgical role (attending vs. assisting) and surgical specialty (soft tissue vs. orthopedics) appeared to influence exposure to physical risk factors. These findings suggest a need to consider the unique demands of surgical specialties in order to address the key risk factors impacting injury risks among veterinarians. For example, static postures may be a priority for soft tissue surgeons, while tools that reduce force requirements are more pressing for orthopedic surgeons.

Sustainability and the environment

Zoë Halfacree, Soft Tissue Surgeon at Davies Veterinary Specialists and Chair of the greener veterinary practice working group, Vet Sustain, focuses on environmental sustainability, including climate change, loss of biodiversity, plastic pollution and resource scarcity and explains what steps your practice can take to reduce your carbon footprint for a brighter, more considerate sustainable future.

Variability in Recommendations for Cervical Lymph Node Pathology for Staging of Canine Oral Neoplasia: A Survey Study.

There is no clear guideline regarding the indication for routine lymph node extirpation and pathologic evaluation during staging of canine oral tumors, despite a relatively high reported nodal metastatic rate for select tumor types. It is particularly unclear if clinicians recommend removal of lymph nodes only when there is confirmation of metastasis, defined as the N+ neck, or if elective neck dissection (END) is routinely recommended to confirm the true pathologic metastatic status of lymph nodes in the clinical N0 neck (no evidence of metastasis on clinical staging with diagnostic imaging or cytology). When clinicians are recommending END as a staging tool to confirm nodal status, there is also ambiguity regarding the surgical extent for subsequent histopathologic evaluation. The objective of this cross-sectional survey study was to determine the current recommendations given by practicing specialists regarding lymph node removal for dogs with oral tumors. Overall, 87 responses were obtained from 49 private practices (56%) and 38 academic institutions (44%). Respondents identified as oncologists (44%, N = 38), soft tissue surgeons (40%, N = 35), and dentists (16%, N = 14). Regardless of tumor type and stage, extirpation and histopathology were most commonly recommended in the clinical N+ neck only. The recommendation to routinely perform END in the N0 neck was significantly associated with tumor type. Bilateral removal of the mandibular and retropharyngeal lymph nodes was recommended more often for oral malignant melanoma (OMM) than for oral squamous cell carcinoma (OSCC; p ≤ 0.0039) or for oral fibrosarcoma (OFSA; p ≤ 0.0007). The likelihood of recommending END increased with increasing tumor size. Academic clinicians were significantly (p < 0.01) more likely to recommend END compared to private practitioners for canine T1–T3 OMM, T3 OSCC, T2 OFSA, and MCT. This study highlights the variability in recommendations for lymph node pathology for dogs with oral tumors. While tumor type and size influenced the decision to pursue END, it was not routinely recommended, even for tumor types with a known propensity for metastasis. Prospective studies are warranted to determine the potential diagnostic and therapeutic value of END in the N0 neck in veterinary patients such that a consensus approach can be made.

Radiation exposure of dogs and cats undergoing fluoroscopic procedures and for operators performing those procedures.

To evaluate radiation exposure of dogs and cats undergoing procedures requiring intraoperative fluoroscopy and for operators performing those procedures. 360 fluoroscopic procedures performed at 2 academic institutions between 2012 and 2015. Fluoroscopic procedures were classified as vascular, urinary, respiratory, cardiac, gastrointestinal, and orthopedic. Fluoroscopy operators were classified as interventional radiology-trained clinicians, orthopedic surgeons, soft tissue surgeons, internists, and cardiologists. Total radiation exposure in milligrays and total fluoroscopy time in minutes were obtained from dose reports for 4 C-arm units. Kruskal-Wallis equality of populations rank tests and Dunn pairwise comparisons were used to compare differences in time and exposure among procedures and operators. Fluoroscopy time (median, 35.80 minutes; range, 0.60 to 84.70 minutes) was significantly greater and radiation exposure (median, 137.00 mGy; range, 3.00 to 617.51 mGy) was significantly higher for vascular procedures than for other procedures. Median total radiation exposure was significantly higher for procedures performed by interventional radiology-trained clinicians (16.10 mGy; range, 0.44 to 617.50 mGy), cardiologists (25.82 mGy; range, 0.33 to 287.45 mGy), and internists (25.24 mGy; range, 3.58 to 185.79 mGy). Vascular fluoroscopic procedures were associated with significantly longer fluoroscopy time and higher radiation exposure than were other evaluated fluoroscopic procedures. Future studies should focus on quantitative radiation monitoring for patients and operators, importance of operator training, intraoperative safety measures, and protocols for postoperative monitoring of patients.

Survey of surgical specialists' content preferences in radiology reports for extrahepatic portosystemic shunts.

The aim of this prospective, survey study was to assess the opinions of specialist surgeons as to the preferred content, nomenclature, and classification of extrahepatic portosystemic shunts for inclusion in radiology reports. A link to an online survey was sent by email to members of the European College of Veterinary Surgeons and the Association of Veterinary Soft Tissue Surgeons, and was made available on the American College of Veterinary Surgeons web forum and Facebook page. There were 93 respondents (survey sent to over 2500 email addresses and made available in two online locations). Most respondents agreed that they both review the images themselves (87/92, 95%) and read the radiology report (82/92, 89%) prior to surgery. Most respondents believed that the radiology report should contain a detailed anatomic description of the insertion (83/92, 90%), origin (54/91, 59%), and course (70/92, 76%) of the shunt, as well as a measure of the diameter of the shunting vessel at its insertion (54/92, 59%). Most respondents (70/90, 78%) disagreed that a brief description of shunt type, such as portocaval or portophrenic, was sufficient. Respondents were undecided regarding the use of an alphanumeric classification system (36/92, 39% agree; 32/92, 35% disagree). There was agreement that details of the presence or absence of urolithiasis (91/93, 98%), renomegaly (54/93, 58%), and peritoneal fluid (72/92, 78%) should be included in the report. The results of this study will help to guide reporting radiologists in providing descriptions of extrahepatic portosystemic shunts that include information most preferred by the recipient surgeons.

A Review on the Orthoplastic Approach to Lower Limb Reconstruction.

Just as in the craft of carpentry, a stable foundation and framework are absolutely essential to the final function of a building, but no more important than the drywall, trim, and paint that make the building functional, durable, and livable. Reconstruction of the lower extremity is similar; the orthopaedic surgeon must obtain stable fixation of the damaged or diseased bone once a thorough debridement of nonviable bone is performed, while the plastic or orthopaedic soft tissue surgeon must provide vascularized, stable coverage. These two components are complementary and both contribute to the success or failure of functional limb restoration. The stability of bone repair will predict the ultimate functional status, while the vascularized envelope will enhance the biology of bone and soft tissue healing. When both components are properly attended to, the result is often a functional limb with an acceptable appearance. While a single surgeon need not perform both of these tasks (although some may choose to do so), the orthopaedic and plastic surgeon involved in this care must have a clear understanding of each other's role and their importance for a good outcome. This is what we call the orthoplastic approach to reconstructive surgery of the extremities, that is, the application of principles and practice of both specialties applied simultaneously to optimize the outcomes in limb reconstruction. In this review article, we discuss the history of orthoplastic surgery, the key elements of orthoplastic surgery, and thoughts on factors that lead to good outcomes through select cases.

Ergonomics in Veterinary Surgery-Risk Assessment With Intraoperative Motion Tracking

Musculoskeletal pain and discomfort are common occupational hazards in surgery, but limited studies have quantified these discomforts in veterinary medicine, where surgeries are performed on large and small animals. The objective of this study is to assess the upper extremities of attending and assisting surgeons soft tissue and orthopaedic small animal surgeries. Inertial measurement units (IMUs) and workload surveys were used to assess the physical workloads. Findings showed that orthopaedic surgeons experienced higher perceived workload and was observed more often in demanding posture than soft tissue surgeons. These results provide understanding of surgeons’ workload that can inform alterations of surgical work environments to reduce musculoskeletal pain and discomfort in the workplace.

Ask the expert

Catharine Sturgeon is an RCVS and ECVS recognized specialist in veterinary soft tissue surgery and President of the Association of Veterinary Soft tissue Surgeons, an affiliate group of the BSAVA. Here she answers your soft tissue surgery questions.

Specialist Groups at Congress

Abstract Affiliated groups such as the Association of Veterinary Soft Tissue Surgeons and International Cat Care hold their own meetings at BSAVA Congress. Here’s what to expect.

BSAVA Congress affiliate meetings

Twelve affiliate groups ranging from the Association of Veterinary Soft Tissue Surgeons to the British Veterinary Zoological Society will give presentations at Congress.

Development, implementation and benefits of a rheumatology‐specific electronic medical record application with automated display of outcome measures

To make a rheumatology-specific electronic medical record (EMR) application for easy clinical data entry, automated display of outcome measures in real-time that generates well laid-out print-outs; and provides an easily retrievable database for clinical analysis and research. Highly labour-intensive 'MS-WORD ' template used earlier provided the basic framework for developing rheumatology-EMR applications. The authors, a rheumatologist and a soft tissue surgeon with expertise in developing medical software, successfully created a rheumatology-EMR application over a period of 2½ years using the same basic flow of work as used in the old 'MS-WORD ' template. The resulting EMR application form has a standard medical record documenting demographic data, complete diagnosis, appropriate dates, visit number, disease status, history, physical examination, investigations, follow-up and prescription page (with automatic updates wherever applicable). Mathematical calculations required for outcome measures (DAS, DAS28, CDAI, SDAI, AS-DAS, BASDAI, BASFI, BASMI, SLE-DAI and others) are embedded in the software, with automated updating as the examination of the musculoskeletal system proceeds in real time. Following implementation of this EMR application, more patients are being seen, patient waiting lists have been reduced; more time is available for academic and teaching work, without compromising the quality of notes, and print-outs for patients. Data retrieval has simplified clinical research with increased numbers of abstracts being presented and research papers being published. Healthcare workers with understanding of the basic principles of computers and softwares should interact with software engineers who are either themselves medical doctors or are familiar with the workflow and clinical evaluation processes to create an efficient speciality-specific EMR application.

You say ‘trykia’ I say ‘trakea’

Abstract Soft tissue surgeon Geraldine Hunt moved from the University of Sydney to the Veterinary Medical Teaching Hospital at UC Davis and shares her experiences.

Carbon Dioxide Laser Skin Resurfacing

Numerous modalities have been used to achieve facial rejuvenation. The carbon dioxide laser is an instrument long familiar to the soft tissue surgeon that has recently been adapted for use in facial rejuvenation. The laser achieves this goal by ablating the epidermis and superficial dermis, while producing a limited amount of thermal damage in the underlying dermis. Actinic damage and certain forms of dyspigmentation and scarring may be improved or eliminated, and skin tone is improved. Although portions of the face may be treated in certain situations, the best aesthetic results are generally achieved with full-face treatment. Clinical results are excellent, but both patient and physician must anticipate a 12 to 16 week period of erythema in the treated region. Early complications including infection, hyperpigmentation, and scarring have been recognized for several years, but late complications such as significant hypopigmentation have been recognized more recently.

The treatment of hernias

INTRODUCTION Hernias and hernia repair (herniorrhaphy) are of interest to the small animal soft tissue surgeon. Cats and especially dogs have hernias affecting various components of the abdominal wall, including the diaphragm and perineum, that may produce severe morbidity and even mortality and it is for this reason that an understanding of hernias and their repair is important. In our experience at the University of Sydney Veterinary Teaching Hospital, all hernias combined occurred in dogs at a rate of 6.1 per 1000 hospital cases and in ca at 4.7 per 1000 hospital cases. A hernia is the protrusion of an organ or part through a defect in the wall of the anatomical cavity in which it lies (9). The most important part of this definition is the defect in the wall of the anatomical cavity, for the contents may vary considerably. Hernias are conventionally classified according to their anatomical site, as to whether they are congenital or acquired, and whether they are reducible or incarcerated and/or strangulated. The three parts of a hernia are: the ring, which is the boundary of the defect in the wall of the anatomical cavity, the sac, which may or may not be present, and the contents. The aims of hernia repair are as follows: