Non-selective cutaneous sensory neurectomy as an alternative treatment for auto-mutilation lesion following arthrodesis in three dogs

Summary

Objective: To describe an alternative method for the treatment of non-responsive self-mutilation injuries in three dogs after carpal/tarsal arthrodesis. Study design: Case series Animals: Two dogs with carpal injury and one dog with tarsal injury treated by arthrodesis Methods: All dogs developed self-mutilation injuries due to licking and/or chewing of the toes within 21–52 days of surgery. Clinical signs did not resolve within one week after conservative treatment with wound debridement and protective bandages. Following general anaesthesia, a deep horseshoe-shaped skin incision, including the subdermal tissue, was performed proximal to the selfmutilation injury transecting the sensory cutaneous afferent nerves. The skin incision was closed with simple interrupted sutures. Results: All wounds healed without complication. Self-mutilation resolved completely within 24 hours after surgery in all dogs. No recurrence was observed (5 months to 3 years). Conclusion: Non-selective cutaneous sensory neurectomy may lead to resolution of self-mutilation following arthrodesis in dogs. Clinical relevance: Failure of conservative treatment in self-mutilation injuries often leads to toe or limb amputation as a last resort. The technique described in this case series is a simple procedure that should be considered prior to amputation. The outcome of this procedure in dogs self-multilating due to neurological or behavioral disturbances unrelated to carpal or tarsal arthrodesis is not known.

Keywords

Neurectomy - sensory nerve - automutilation - arthrodesis

• References

• 1 Scott DW, Miller WH, Griffin CE. Acral lick dermatitis. In: Muller and Kirk’s Small Animal Dermatology. 6th ed. Philadelphia: WB Saunders; 2001: 1058-1064.
• 2 White SD. Naltrexone for treatment of acral lick dermatitis in dogs. J Am Vet Med Assoc 1990; 196: 1073-1076.
• 3 Gross TL, Ihrke PJ, Walder EJ. et al. Skin Diseases of the Dog and Cat. Clinical and Histopathologic Diagnosis. Oxford, UK: Blackwell Science Ltd; 2005: 140-142.
• 4 Wynchank D, Berk M. Fluoxetine treatment of acral lick dermatitis in dogs: a placebo-controlled randomized double blind trial. Depress Anxiety 1998; 8: 21-23.
• 5 Carlotti DN, Fourrier P, Magnol JP. Les pyodermites superficielles. Prat Med Chir Anim 1988; 23: 473-484.
• 6 Denerolle P, White SD, Taylor TS. et al. Organic diseases mimicking acral lick dermatitis in six dogs. J Am Anim Hosp Assoc 2007; 43: 215-220.
• 7 Gnirs K, Prelaud P. Cutaneous manifestations of neurological diseases: review of neuro-pathophysiology and diseases causing pruritus. Vet Dermatol 2005; 16: 137-146.
• 8 Virga V. Behavioral dermatology. Vet Clin North Am Small Anim Pract 2003; 33: 231-251.
• 9 Newton CD. Elective orthopedic surgery. In: Lipowitz AJ, Caywood DD, Newton CD, Schwartz A, Complications in small animal surgery. Baltimore: Williams and Wilkins; 1996: 599-610.
• 10 Roch SP, Clements DN, Mitchell RAS. et al. Complications following tarsal arthrodesis using bone plate fixation in dogs. J Small Anim Pract 2008; 49: 117-126.
• 11 Rapoport J, Ryland DH, Kriete M. Drug treatment of ca-nine acral lick: an animal model of obsessive-compulsive disorder. Arch Gen Psychiatry 1992; 49: 517-521.
• 12 van Ness JJ. Electrophysiological evidence of sensory nerve dysfunction in 10 dogs with acral lick dermatitis. J Am Anim Hosp Assoc 1986; 22: 157-160.
• 13 Budras KD Claw. In König E, Liebig HG. eds Veterinary Anatomy of domestic mammals, Stuttgart: Schattauer. 2004: 609-13.
• 14 Kubba R, Taylor JS, Marks KE. Cutaneous complications of orthopedic implants. A two-year prospective study. Arch Dermatol 1981; 117: 554-560.
• 15 Rostoker G, Robin J, Binet O. et al. Dermatitis due to orthopaedic implants. A review of the literature and report of three cases. J Bone Joint Surg Am 1987; 69: 1408-1412.
• 16 Hallab N, Merritt K, Jacobs JJ. Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg Am 2001; 83 A 428-436.
• 17 Holden CEA. The pathology and prevention of Volksmann´s ischaemic contracture. J Bone Joint Surgery Br 1979; 61: 296-300.
• 18 Aggarwal ND, Singh B, Gureja YP. Compression ischaemia of limbs from tight splintage. J Bone Joint Surg Br 1969; 51: 779-780.
• 19 Anderson DM, White RAS. Ischemic bandage injuries: a case series and review of the literature. Vet Surg 2000; 29: 488-498.
• 20 Ikoma A, Rukwied R, Ständer S. et al. Neurophysiology of pruritus – interaction of itch and pain. Arch Dermatol 2003; 139: 1475-1478.
• 21 von Frey M. Zur Physiologie der Juckempfindung. Arch Neerland Physiol 1922; 7: 142-145.
• 22 Andrew D, Craig AD. Spinothalamic lamina I neurons selectively sensitive to histamine: a central neural pathway for itch. Nat Neurosc 2001; 4: 72-77.
• 23 Schmelz M, Schmidt R, Bickel A. et al. Specific C-receptors for itch in human skin. J Neuroscience 1997; 17: 8003-8008.
• 24 Drzezga A, Darsow U, Treede RD. Central activation by histamine-induced itch: analogies to pain processing: a correlational analysis of O-15 H2O positron emission tomography studies. Pain 2001; 92: 295-305.
• 25 Ghez C. Voluntary movement. In: Kandel ER, Schwartz JH eds. Principles of Neural Science, 2nd edn. New York: Elsevier 1985; 653-673.
• 26 Coderre TZ, Katz J. Peripheral and central hyper-excitability: differential signs and symptoms in persistent pain. Behav Br Sc 1997; 20: 404-408.
• 27 Schmelz M, Schmidt R, Weidner C. et al. Chemical response pattern of different classes of C-nociceptors to pruritogens and algogens. J Neurophysiol 2003; 89: 2441-2448.
• 28 Ikoma A, Fartasch M, Heyer G. et al. Painful stimuli evoke itch in patients with chronic pruritus. Neurol 2004; 62: 212-217.
• 29 Oliver JE, Lorenz MD, Kornegay JN. Pain, 3rd ed. Philadelphia: W.B. Saunders; 1997
• 30 Plumb DC. Gabapentin. In: Plumb’s veterinary drug handbook, 5^th ed. Ames: Blackwell 2005; 513-515.
• 31 Ballinari U, Montavon PM, Huber E. et al. Pectineus myectomy, tenotomy of the iliopsoas and neurectomy of the joint capsule as symptomatic therapy for coxarthrosis of the dog. Schw Arch Tierheilkd 1995; 137: 251-257.
• 32 Kinzel S, von Scheven C, Buecker A. et al. Clinical evaluation of denervation of the canine hip joint capsule: a retrospective study of 117 dogs. Vet Comp Orthop Traumatol 2002; 15: 51-56.
• 33 Kinzel S, Hein S, von Scheven C. et al. 10 years experience with denervation of the hip joint capsule for treatment of canine hip joint dysplasia and arthrosis. Berl Munch Tierarztl Wochenschr 2002; 115: 53-56.
• 34 Foucher G, Pretz PL, Erhard L. La denervation articulaire, une réponse simple à des problèmes complexesde chirurgie de la main. Chir 1998; 123: 183-188.