SURGERY
All General Surgery Requirements
At Blair Street Veterinary Hospital, we are able to perform most surgeries on your animal. These range from the routine desexing of both sexes and all species large and small, to much more complicated surgeries, such as broken bones, eye surgery and everything else in between. We only refer to specialists in Perth when we have to, but this is very rare and a last resort. We try to keep up with all the latest techniques.
At Blair Street Vets we pride ourselves on doing as much surgery “in house” as possible, to save you the expense and hassle of unnecessary referrals.
As an integral part of surgery, we maintain the highest standards in anaesthesia. According to the latest research, the biggest danger in anaesthetics is not using the “wrong” drugs, but using drugs and drug combinations in which the anaesthetist is not totally familiar and experienced with. We do thousands of operations each year and are very familiar with how each drug we use works, what the potential side-effects and interactions are, and which drugs can be used to address complications. As such, we are confident of our anaesthetic regime and this means we can concentrate on the surgery we are doing.
There are some things you should know when you bring your animal in for surgery. The first is that they need to be fasted on the morning of their surgery (except for small rodents, rabbits and birds). This is standard procedure in case your animal vomits. However, it is also important that your dog has the chance to go to the toilet on the morning of their surgery so please take them for a walk or allow them time to let them use their bowels and bladder!! This will make our nurses very happy!
Many people ask about Elizabethan collars for their animals. Unlike other clinics, we very seldom use them. Owners hate them and animals hate them even more! When we operate, we make sure tissues are handled delicately to minimise damage and we use dissolving sutures which we hide under the skin so your animal has nothing to grab their attention when they lick. Of all the operations we do each year, only a handful need to go home with a collar.
Pain relief is very important for your animal and all animals receiving surgery will have pain relief included as a normal part of their surgery. If we feel more is required, you will be sent home with more to use as part of their post-op medication package but this will be different for each animal and each operation. Most animals will be up and running around again after their surgery with the minimum of fuss.
Cruciate repair
MMP Method of Cruciate Repair
Various methods of repair of a cruciate ligament in dogs and cats have been tried over the years and this really means there is no perfect way to fix the rupture of this ligament in animals. One of the newer techniques has been a method called a Tibial Tuberosity Advancement or TTA. This has been around for close to a decade now and works by redirecting the force generated by the large quadriceps muscles to compensate for the failed cruciate ligament. This muscle is the one at the front of the hind leg and works through the knee cap and patellar tendon which attaches to the top of the tibia at the tibial tuberosity. The bone is cut in what is called an osteotomy and the piece of bone released is moved forward a few millimetres and traditionally fixed in place with a metal implant, plates and screws. Although very successful, the TTA method has been associated with a high rate of complications and implant failure.
The Modified Maquet Procedure (MMP) uses a very high tech titanium foam wedge developed for human use to fill the gap of the osteotomy. This foam, called Orthofoam, promotes rapid bone ingrowth and healing; the wedge is actually incorporated into bone. This means a reduced period of convalescence and minimal pain when compared to other procedures. However, the main advantage over traditional TTA techniques is the much lower rate of complications and, when these do happen, they tend to be minor without the need for revision surgeries
The technique has been developed in Europe over the past few years and roughly ten thousand cases have been done to validate and perfect the technique.
We have been using this method at Blair Street Veterinary Hospital and have been impressed with the results. It offers a very safe and cost effective way to treat the rupture of the cranial cruciate ligament in medium to large dogs and is a valuable addition to the range of surgeries which we can do here at the hospital. It is a great way to bring advanced techniques to more patients and we would recommend it to our clients.
Securos X-gen PROS/BOSS Orthofiber Cruciate Surgery
The Securos X-gen CCR system is a new system for fixing a ruptured cruciate ligament in small to medium breed dogs. It uses a special type of braided artificial fibre called Orthofiber, which is extremely strong and durable. This fibre is carefully placed at isometric points on the outside of the stifle (knee) joint, which mimics the action of the cruciate ligament to stabilise the knee joint but also allows full movement of the joint. Bone tunnels are drilled through the bottom of the femur and top tibia to pass the suture through. These tunnels are strengthened by special PROS implants.
The PROS implant is a hollow titanium screw with a smooth, curved exit to prevent wear and fraying that would otherwise lead to breakdown of the Orthofiber which passes through the PROS implant. The PROS implants are also raised up 1.5mm so that the fibre that bridges between the two PROS implants causes less crushing and friction injury to sensitive underlying tissues, which includes the sensitive joint capsule. The Orthofiber is anchored on the inside (medial) side of the knee by titanium BOSS button implants which have a carefully rounded and smooth surface to minimise wear on the fibre.
The Orthofiber is looped through the BOSS buttons on the medial side and threaded back through the bone tunnels and out of the PROS bone tunnel implants.
The fibre is then tightened using a special tensioning device to the correct tension which provides optimal stabilisation of the knee yet still allows full range of movement.
A titanium crimping tube is placed over the two ends of the Orthofiber and a crimping tool is used to crimp (crush it closed) securing it.
Use of a crimp tube avoids the risk of the Orthofiber snapping where it is knotted, if a surgical knot is tied instead of crimping.
The result is a doubled Orthofiber prosthesis that is extremely strong, yet durable.
Benefits Over Lateral Suture Stabilisation Technique
Isometrically placed Orthofiber allows much more normal movement of the knee after surgery.
Isometric fixation points reduce the outward turning of a dog's leg often seen with De Angelis.
Much more accurate and optimal tension to best stabilise the knee.
Less loosening of the Orthofiber because it is not crushing and cutting through underlying tissue.
Much longer lasting Orthofiber that, as yet, has never broken.
Benefits Over Other Techniques
Stabilises the knee where as TTA (Tibial Tuberosity Advancement) or a TPLO (Tibial Plateau Levelling Operation) does not thus reducing damage to the menisci.
Less confinement required during recovery and healing (2 weeks compared to 8-10 weeks for TTA).
No catastrophic breakdown (the leg bone may fracture after a TTA surgery).
We have been extremely impressed with the results seen on dogs treated using this system. They have a much faster return to function and minimal loss of muscle mass on the affected leg. We believe this to be a winner all round and represents the best value for money currently in cruciate repair treatments.
The Securos CCR cruciate repair system is very similar to the Tightrope repair method. These methods in the studies done so far have achieved the best outcomes coupled with minimal complications and fastest recovery from surgery.
Please do not hesitate to contact us and arrange a cruciate ligament assessment on your dog, where we can provide you with all the necessary information and if needed, perform the surgery at a very competitive price and save you the hassle of referrals and travelling to Perth