CO2 laser entropion and stenotic nares correction in a shar pei

    By Christopher Winkler, DVM, DABLS, For The Education Center
    Originally Published In Veterinary Practice News, June 2018 –
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    A CO2 laser cauterizes blood vessels up to 0.5 mm in diameter as it cuts, allowing excellent visualization of the tissues as the surgery proceeds. The precise incision and hemostasis control that the laser provides are especially valuable when operating near delicate structures such as the eyes, nose, and face. Decreased direct tissue contact and the ability to destroy pathogens (which often can frequent areas such as facial folds) decrease infectious contamination during and following surgery on the face. Nerves and lymphatics also are sealed, decreasing postoperative pain, swelling, and discomfort, and allowing the pet a faster recovery time with less tendency to self-mutilate.[1]

    Case

    Gracie is a 4-year-old spayed female Chinese shar pei suffering from stenotic nares (Figure 1) as well as a severe bilateral entropion of both upper and lower eyelids (Figures 2, 3) and from the very heavy and excessive facial folds on her scalp. On presentation, Gracie was unable to open her eyes without outside assistance and was suffering minor bilateral corneal lesions. It was immediately observed that resection of part of the scalp would be an essential part of her surgical treatment to reduce pressure on the upper eyelids.

    Anesthesia

    The patient was premedicated with dexmedetomidine 125 mcg/m2 IM, cefovecin 3.6 mg/lb SQ, and carprofen 4.4 mg/kg SQ. The patient was induced with Propofol 3 mg/kg IV, and general anesthesia was maintained with isoflurane via endotracheal tube.

    Laser equipment

    A 20 W Aesculight surgical CO2 laser with a flexible hollow waveguide and adjustable hand-piece.

    Laser settings

    • Focal spot size: 0.25 mm
    • Marking: 4 W repeat pulse, 20 Hz, 20 msec, 40 percent duty cycle
    • Scalp incisions: 15 W continuous wave
    • Entropion/Stenotic nares: 6 W continuous wave

    Postoperative care

    A therapy laser was applied to both scalp incisions (297 J each, 40 cm2 x 2) and the nares (157 J, 5 cm2). The patient was administered atipamezole 250 mcg/kg and butorphanol 0.2 mg/kg at surgical recovery. An Elizabethan collar was applied. The patient was discharged later the same day with carprofen 50 mg PO BID for seven days. Postoperative discussion with Gracie’s owners included close observation for any sutures contacting the eyes, observing for drainage or dehiscence of the incisions, and the possibility of removing more skin in the future as required.

    Follow-up occurred at eight days and suture removal at 16 days. Gracie healed quite well with no complications and very satisfactory results (Photos 19 and 20).

    Dr. Christopher Winkler graduated from Ross University School of Veterinary Medicine in 2001 and is the owner of Suffolk Veterinary Group Animal Wellness and Laser Surgery Center in Selden, Long Island, N.Y. He uses both CO2 and diode laser wavelengths in his practice, often combining them when possible. He is a diplomate of the American Board of Laser Surgery, a veterinary medical laser safety officer, and a Fellow of the American Society for Laser Medicine and Surgery. Dr. Winkler is keen to advance laser education in veterinary medicine and surgery and is available for consultation and training in small animal laser surgery and laser therapy.

    References

    1. Berger N, Eeg PH. Veterinary Laser Surgery: A Practical Guide. Iowa: Blackwell Publishing, 2006.

    This Education Center article was underwritten by Aesculight of Bothell, Wash., the manufacturer of the only American-made CO2 laser.