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Bringing advanced surgical procedures to primary care veterinary practices, both orthopaedic and soft tissue, for the benefit of our friends on four, of their owners and of the veterinary practice.

Another day...two nice TPLO procedures in two nice separate vet practices with multiple nice staff....
12/06/2024

Another day...two nice TPLO procedures in two nice separate vet practices with multiple nice staff....

All in a day's work for the S.A.S. - in two vet practices 60km (36 miles) apart...A cruciate tear with 35 degree TPA is...
05/06/2024

All in a day's work for the S.A.S. - in two vet practices 60km (36 miles) apart...A cruciate tear with 35 degree TPA is steep...fixed with a TPLO procedure, making sure adequate tuberosity thickness maintained. Young cat with radial short oblique fracture fixed with a 2.0mm mono-axial locking plate (from N2). Both are expected to recover well....

A cat with comminuted tibial fracture: used 2.4 mono-axial locking plate (N2 UK) +i.m. pin (pin/plate combo).
17/05/2024

A cat with comminuted tibial fracture: used 2.4 mono-axial locking plate (N2 UK) +i.m. pin (pin/plate combo).

Remember this nasal tumour radical excision 3 weeks ago? Now almost completely healed and doing great (as long as he doe...
17/05/2024

Remember this nasal tumour radical excision 3 weeks ago? Now almost completely healed and doing great (as long as he doesn't look in the mirror...).

Today's TPLO case in a 10Kg small breed dog with an excessive tibial plateau angle (eTPA). As long as the osteotomy is d...
15/05/2024

Today's TPLO case in a 10Kg small breed dog with an excessive tibial plateau angle (eTPA). As long as the osteotomy is done in a way that leaves an adequate tibial tuberosity thickness (as seen here) then there is no or very minimal risk of a tuberosity avulsion. Used a 2.4mm locking plate with two compression screws.

Nasal neoplasia - resection all the way back to the maxilla.
25/04/2024

Nasal neoplasia - resection all the way back to the maxilla.

Last minute Saturday afternoon op before flying off on holiday in a few hours...traumatic sacroiliac subluxation in a ca...
13/04/2024

Last minute Saturday afternoon op before flying off on holiday in a few hours...traumatic sacroiliac subluxation in a cat. Repaired with 2.7mm cortical screw in lag fashion.

An excessive tibial plateau angle (eTPA) of 39 degrees in a pug, addressed with a TPLO procedure. As long as the osteoto...
11/04/2024

An excessive tibial plateau angle (eTPA) of 39 degrees in a pug, addressed with a TPLO procedure. As long as the osteotomy is done in a way that leaves adequate tibial tuberosity thickness (as in this case) then rotating beyond the patella tendon insertion point is not a problem. However if the saw blade used is too big then tjere is a risk of leaving a narrow tuberosity, which runs the risk of a tuberosity avulsion fracture complication...

Tibial tuberosity avulsion in a 7 months old pup, repaired two pins. This is a common injury in pups and obviously affec...
05/04/2024

Tibial tuberosity avulsion in a 7 months old pup, repaired two pins. This is a common injury in pups and obviously affects the ability of the quariceps to exert its pull on the tibia. Repair is usually straightforward.

The Ridgestop implant is my go-to technique in cats. It is a prosthetic patellar groove ridge augmentation (made from Hi...
02/04/2024

The Ridgestop implant is my go-to technique in cats. It is a prosthetic patellar groove ridge augmentation (made from High Molecular Weight Polyurethane and fixed in place by cortical screws). It's basically a super effective alternative to sulcoplasty, being effective all along the ridge including the proximal part where most medial luxations actually occurr and where traditional sulcoplasties tend to flatten off. It of course needs to be combined with re-alignment tuberosity transposition in cases that require it, however in many cats like in this case the cause is traumatic and therefore the Ridgestop alone is sufficient, and has been shown to be highly successful procedure in cats with followups of up to 9 years now (peer reviewed papers available and a retrospective study is currently in the pipeline).

Extreme case of Vaginal Hyperplasia in an 8 month old bitch in season, already with a necrotic leasion. Treatment is ova...
19/03/2024

Extreme case of Vaginal Hyperplasia in an 8 month old bitch in season, already with a necrotic leasion. Treatment is ovariectomy which will cause regression after several days, but in cases like this where the protrusion is extreme and necrosis is already present, surgical excision of the hyperplastic part is neccessary (usually with a dorsal episiotomy to enable adequate exposure and access, like in this case).

You're not really sure you did a good job till you see the post-op xrays...
19/03/2024

You're not really sure you did a good job till you see the post-op xrays...

Can't resist those eyes....this is Scooter who had medial patella luxation (MPL) for a long time that was not corrected,...
13/03/2024

Can't resist those eyes....this is Scooter who had medial patella luxation (MPL) for a long time that was not corrected, and now has torn his cranial cruciate ligament (CCL). An uncorrected MPL causes extra strain on the CCL, thereby predisposing it to rupture. Once the CCL is torn, there is even more internal tibial rotation, making the existing (or even a subclinical) MPL worse, which is what has occurred here. A TPLO pricedure was performed, reducing the tibial plateau angle (TPA) from 33 degrees to 3 degrees, then a tibial tuberosity transposition was done to lateralize the patella and re-align it withbits groive. Additionally, a lateral slidung imbrication if the jount capsule was also done to add stability to the patella tracking. (the meniscus was of course also examined and was found to be intact).

This is lovely Sookie who had bilateral medial patella luxation, one side had to have a patella groove replacement (PGR)...
04/03/2024

This is lovely Sookie who had bilateral medial patella luxation, one side had to have a patella groove replacement (PGR) combined with a tuberosity transposition, in the other stifle a standard tuberosity transpostion was sufficient. Advantage of the PGR is that it can be positioned abaxially and proximo-distally as required to align accurately with the patella's tracking.

An excessive tibial plateau angle requires quite a large rotation, but this carries the risk of tibial tuberosity avulsi...
24/02/2024

An excessive tibial plateau angle requires quite a large rotation, but this carries the risk of tibial tuberosity avulsion and therefore the tuberosity needs to be thick enough. Here its ok but probably just about.

Multiple ligament injury due to acute trauma in a 42Kg dog. Hit by a car, both the anterior and posterior cruciate ligam...
13/02/2024

Multiple ligament injury due to acute trauma in a 42Kg dog. Hit by a car, both the anterior and posterior cruciate ligaments torn, medial collateral ligament torn, lateral meniscal tear and the medial meniscus though intact, has detached completely from tje joint capsule which has torn completely medially..
Surgical treatment: lateral partial mensicectomy, medial mensicus sutured to capsule, medial collateral ligament sutured with a loop technique to itsbirigin at proximal tibia, joint capsule sutured. This already added substantial stability so stifle valgus was a lot less than before. A TPLO procedure was tjen done and a tension band figure of 8 wire was passed around the TPLO plate's most proximal screw (between the plate and the bone), and around a screw placed in the distal femoral condyle at the point of origin of the medial collateral ligament to augment and suppot the sutured collateral.
At the end of the procedure full and smootj range of motion was achieved, normal valgus of stifle, and tibial thrust wad neutralized.
Using the most proximalmTPLO screw may be a novelty although I habe not browsed through the whole literature, but was perfect in this case as it was located exactly at the collateral ligament's insertion on the proximal tibia.

The tiniest of dogs (2Kg) sometimes need ortgopaedic surgery, which is often more challenging than operating on bigger d...
09/02/2024

The tiniest of dogs (2Kg) sometimes need ortgopaedic surgery, which is often more challenging than operating on bigger dogs as all implants and bones are tiny and the margins of error are much smaller. An example is this cutie here which had a grade 3 medial patella luxation and had to have tibial tuberosity transposition.

Another day at the office...another two happy dogs regaining their mobility....
05/02/2024

Another day at the office...another two happy dogs regaining their mobility....

Back to having fun (work)....after a stressful holiday break. TPLOs are a form of meditation...
30/01/2024

Back to having fun (work)....after a stressful holiday break. TPLOs are a form of meditation...

Was great today to do a TPLO practical teaching session on a real case back in Israel for an old friend I have known for...
16/01/2024

Was great today to do a TPLO practical teaching session on a real case back in Israel for an old friend I have known for 30 years!

09/01/2024

Traumatic diaphragmatic hernia in a cat, suspected on xrays and diagnosed by ultrasound done by my amazing ultrasonographer colleague Aleksandra Kozacinski at Anderson Vets in Orpington. The liver is clearly visible adjacent to the heart. Following this did surgical correction to close the torn diaphragm, and although he did give us a scare at the end of the surgery with a full cardiac arrest and getting the whole rescucitation protocol at the 24 h centre at Medivet Beckenham where the whole team chipped in as a group effort, he is now doing well and able to again breathe without effort.

First day after Christmas...two fractures, one a Greyhound with a comminuted distal radioulnar one where the distal frag...
27/12/2023

First day after Christmas...two fractures, one a Greyhound with a comminuted distal radioulnar one where the distal fragment itself had a large fiasure line across it - fixed with a locking T-plate plus an additional orthogonal locking plate placed medially, the other one a cat with an unstable but minimally displaced mid tibial transverse fracture with an intact fibula - i.m.pin placed normograde plus a 2.4 mono-axial locking plate medially, with the plate tunneled sub cutaneously from a proximal incision to a distal incision, without exposure of the fracture site.

To all our Veterinary Practices on the frontlines of treating pets everywhere, we wish you all a Merry Christmas and a H...
25/12/2023

To all our Veterinary Practices on the frontlines of treating pets everywhere, we wish you all a Merry Christmas and a Happy New Year! Thank you for your continued trust over the years, entrusting us with fixing their bones, joints, airways and the variety of soft tissue procedures that they need. We take this trust very seriously and will continue to do our best to not let you down!

Last fracture before Christmas break... orthogonal plates for a very distal tibial fracture, MIPO principles applied, so...
22/12/2023

Last fracture before Christmas break... orthogonal plates for a very distal tibial fracture, MIPO principles applied, so all implants applied without displacing fragments and without disrupting the soft tissue envelope.

What do an anti-stereotypical cuddly huge Rottie, a playful Golden Retreiver and a Boder Terrier energy ball have in com...
21/12/2023

What do an anti-stereotypical cuddly huge Rottie, a playful Golden Retreiver and a Boder Terrier energy ball have in common? They all had TPLO done for their torn cranial cruciate ligaments within the same 24 hours...(no punchline, this is not a joke.. .).

Need the work...at Vets4Pets Gillingham, popped in to wish them Merry Christmas, putting in some extra hours while I am ...
19/12/2023

Need the work...at Vets4Pets Gillingham, popped in to wish them Merry Christmas, putting in some extra hours while I am there anyway...

Really cute 13 week old cockapoo with a long oblique midshaft closed femoral fracture. Stabilized initially with a 2.0mm...
18/12/2023

Really cute 13 week old cockapoo with a long oblique midshaft closed femoral fracture. Stabilized initially with a 2.0mm lag screw, which was then removed after applying a 2.4 mono-axial locking biological healing plate (with no screw holes in the mid section), and avoiding crossing the growth plates. Should make a quick recovery...

Lip-to-lid rotational flap to close skin after sarcoma mass removal from upper eyelid of this cat. The hairless mucocuta...
12/12/2023

Lip-to-lid rotational flap to close skin after sarcoma mass removal from upper eyelid of this cat. The hairless mucocutaneous junction of the lip commissure is used to reconstruct the upper eyelid which had to be removed completely. Like with all closures, tension free skin closure is key...

This is not surgery, but still doing occasional stuff from previous interests ...here a dog heart scan showing an enlarg...
09/12/2023

This is not surgery, but still doing occasional stuff from previous interests ...here a dog heart scan showing an enlarged left atrium.

Nothing like a nice TPLO in the morning...
07/12/2023

Nothing like a nice TPLO in the morning...

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Videos

Traumatic diaphragmatic hernia in a cat, suspected on xrays and diagnosed by ultrasound done by my amazing ultrasonographer colleague Aleksandra Kozacinski at Anderson Vets in Orpington. The liver is clearly visible adjacent to the heart. Following this did surgical correction to close the torn diaphragm, and although he did give us a scare at the end of the surgery with a full cardiac arrest and getting the whole rescucitation protocol at the 24 h centre at Medivet Beckenham where the whole team chipped in as a group effort, he is now doing well and able to again breathe without effort.

Large sarcoma on upper eyelid removed with wide margins and the gap closed with a "lip-to-lid" rotational flap technique, positioning the lip mucocutaneous edge with no hairs as the "replacement" upper eyelid. Again, tension free skin apposition is key.

Maggie and Olive both had their second TPLO surgeries within a few months of their first, giant Maggie double plated to account for her 80 kilos, and friendly Olive combined with a tibial tuberosity transposition to sort the secondary medial patella luxation. Both done the same day at the awesome Pawvet Clinic.

The multiple fragments removed....

Multiple fragments of the medial coronoid process removed arthroscopically from an 11 month old Labrador....followed by a bi-oblique ulba osteotomy to reduce the load on the mefial coronoid process which is thought to be the underlying cause for this in elbow dysplasia in dogs.

Remember this chap from 3 months ago? Could barely move as was completely plantigrade on both carpuses, on the verge of being euthanased, so had a bilateral pan-carpal arthrodesis. Is now confidently weight bearing on both front leg...nothing more satisfying to see than giving a new lease on life!

Another young 9 months old Labrador with ED (Elbow Dysplasia in case you were wondering...). A fragmented medial coronoid process and marked cartilage erosion can clearly be seen. I see this very commonly in this breed, so still a lot of work for the breeders to try to eliminate (use the ED screening scheme, do xrays and send to the BVA).

Malignant sarcoma resection, with a thoracodorsal axial skin flap transpostion.

5 months old Labrador elbow dysplasia with incongruency and fragmented coronoid, removed via arthroscopy, and treated with distal ulna ostectomy.

Laryngeal paralysis (bilateral) in a 10y old Great Dane. Paradoxical arytenoid motion (vocal chords move inward at inspiration rather than outward, as the recurrent laryngeal nerve does not "instruct" the cricoarytenoid muscle to pull them outwards). Surgery is needed to regain quality of life although risk of aspiration pneumonia is relatively high. A laryngeal tie-back (arytenoid lateralization surgery was done and hopefully will do well...

3 year old Lab with bilateral elbow dysplasia - xrayssuggested and arthroscopy confirmed fragmented mexial coronoid process with multiple four large fragments (all removed arthroscopically). PRP therapy was added as well. The long term prognosis for these though is not great....

Shoulder arthroscopy on a lame dog with positive (painful) biceps tendon test...biceps tendon amd sheath extremely well visualized, as is the Y shaped medial collateral ligament and the caudal aspect of the humeral condyle and caudal compartment.

This is 1 year old Boo. He had bilateral elbow dysplasia with marked incongruency of the joints (meaning that the joint surfaces did not match up correctly), which caused quite marked lameness on both legs, hardly something a young pup should be faced with. In order to correct this developmental abnormality a bilateral bi-oblique ulna osteotomy was performed, staged 8 weeks apart, which off-loaded the extra strain on the medial compartment of the elbow. Now about 8 weeks after the second leg was done Boo is a different dog, enjoying life as any young dog should be able to (seen on tje videoclip)!

Same Bulldog after soft palate shortening and everted laryngeal saccules resection ...

Bulldog before soft palate + everted laryngeal saccules resection....

Severe stenotic nares
Severe stenotic nares

Avivid example of the obstructive respiratory effect of stenotic nares in this 50kg Bullmastiff (listen to the sound as well, quite striking).

Fragmented medial coronoid process
Fragmented medial coronoid process

Large fragment of the medial coronoid process (in elbow joint), arthroscopically removed.

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