Today's Veterinary Practice

JAN-FEB 2016

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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Today's VeTerinary PracTice | January/February 2016 | tvpjournal.com PracTice To PracTice Peer reviewed 122 LIMB SALVAGE & PROSTHETICS Indications neoplasia and severe trauma are common reasons for amputation; however, giant breeds or dogs with concurrent orthopedic disease may respond poorly to amputation. 3 Forelimb (Figure 14, page 121) and hindlimb (Figure 15) prostheses offer an alternative to full-limb amputation. To be a candidate for a prosthetic, a partial limb amputation must be performed (see Prosthesis Success). Types Multiple types of prosthetics are available for veterinary use. every external prosthesis requires some type of suspension system to keep it from falling off the residual limb. s uspension systems may include: • s elf-suspension of the socket, which makes use of the anatomic shape of the residual limb (knee disarticulation) (Figure 16) • suction suspension, which includes the use of an appropriate suction socket design of a gel suspension liner (Figure 17) • suspension devices or harnesses, such as belts, cuffs, wedges, straps, and sleeves. osseointegrated prosthetics have also become available recently for use in dogs. osseointegration involves threading the prosthesis onto a titanium bolt, which is implanted into the bone of the residual limb and protrudes through the skin. Use of these devices is still currently under investigation. 3,9 Construction similar to braces, the most important step when constructing a prosthesis is making a proper cast mold of the affected limb (see Constructing a Custom Canine Stife Brace). in addition, padded sockets are often needed to create a more intimate ftting device. FIGURE 15. Hindlimb prosthesis for a patient after limb-sparing surgery for a highly comminuted fracture. FIGURE 16. Patient wearing a forelimb prosthesis with self-suspension of the socket, which makes use of the anatomic shape of the residual limb. FIGURE 17. Patient wearing a hindlimb prosthesis with a suction suspension system with a gel suspension liner. prosthesis success A recent study in humans showed that the level of amputation is a critical factor in prosthesis success. Patients in this study had better outcomes when the amputation was performed distal to the carpus or tarsus. 8 However, this is not always practical. Ideally, the elbow and tarsus should be spared. Surgical technique is also thought to have a signifcant impact on the success of prostheses. 3 Correct incision placement, proper soft tissue technique, and meticulous management of nerve and vascular structures are vital to achieving a successful outcome. 3 Thus, consultation with a small animal veterinary surgeon is recommended. However, both surgeons and general practitioners are instrumental in the postoperative management of the patient outftted with a prosthetic.

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