1 - Patella Luxation
Despite popular belief, patella luxation surgery carries a high risk of complications (roughly 20-40% in dogs, higher in cats). The main major complication in dogs is re-luxation. This is multi-factorial, but can be due to under recognition of the bony deformities with an immediate jump to performing traditional techniques (tibial tuberosity transposition, trochleoplasty and soft tissue techniques).
Therefore, it is important to critically evaluate imaging to determine the appropriate techniques. If CT is not available, the best way to assess for deformities (ie distal femoral varus +~ external rotation, proximal tibial valgus, tibial rotational deformity etc) is with WELL positioned radiographs. Take time to ensure the femurs are parallel with the table - this often involves lifting the pelvis with a towel or foam wedge. Take time to ensure you get a straight lateral view through the stifle, and this also often involves a slight lift of the pelvis +~- rotation of the distal limb. This will allow the surgeon to make the calculations necessary to fully assess the pelvic limb conformation, in preparation for successful surgery.
2 - Evening lecture tips by anaesthetist Dr Keely Wilson.
Fentanyl Patches should NOT be placed on skin that has been cleaned with chlorhex or alcohol as this has removed the lipids which is needed for absorption.
She is not a fan of subcutaneous premedication. Try to give IM, which has a much more predictable uptake.
3 - Surgical Margins Talk (back to me)
Sentinel lymph node mapping is actually a procedure that can be performed in general practice, utilising radiography. The procedure is described in an excellent free access article "Indirect lymphography for sentinel lymph node detection in dogs with mast cell tumors" Haas et al Can Vet J 2023
In short - Omnipaque contrast is used to inject around a tumour (north, south, east, west) and then radiographs are taken at intervals after injection. This will detect the sentinel lymph node around 60% of the time. If you can identify the sentinel lymph node, extirpation for histopathology is more accurate than cytology in terms of detecting a metastatic node. Palpation alone is not a good determinant of whether a lymph node is metastatic. For some tumours (for example mast call tumours, anal sac adenocarcinoma, mammary gland tumours), removal of metastatic lymph nodes increases median survival time.
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