What is your experience of amputating 2 digits in a Labrador?

RE: What is your experience of amputating 2 digits in a Labrador?

niamhjl — Wed, 16 Sep 2020 17:51:15 GMT

I watched the virbac webinar on Stelfonta the other day, and specifically thought of this case (having read your post earlier in the day), sounds like he might be the perfect candidate for it. The webinar is free on the webinar vet website and definitely worth a watch.

RE: What is your experience of amputating 2 digits in a Labrador?

Julie Innes — Wed, 16 Sep 2020 12:29:47 GMT

Interesting, I had a similar case recently in a lab. Discussed digit removal, eventually went for excision as widely as possible and LN biopsy. FNA of lymph node unfortunately showed evidence of spread, and not good margins on original mass. We did talk about amputation, but if there is already spread to the LN...We are treating with palladia and will see how she does (although annoyingly the owner took weeks to make up their minds what they wanted to do, so feels like there may be some recurrence at the original op site too.

RE: What is your experience of amputating 2 digits in a Labrador?

Mark Holmes — Sat, 12 Sep 2020 18:50:18 GMT

[quote userid="9440" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/29345/what-is-your-experience-of-amputating-2-digits-in-a-labrador/225355#225355"]how does cost of stelfonta compare?[/quote]

I think I would explore this option. Never used it but it sounds interesting and may save the dog’s foot.

RE: What is your experience of amputating 2 digits in a Labrador?

Emily Rainbow — Fri, 11 Sep 2020 06:55:07 GMT

Have you tried any medical treatment in the meantime? I’ve had some amazing responses to prednisolone/piriton combinations prior to surgery or with some coming in for surgery and we’ve struggled to find the original mass to excise!

RE: What is your experience of amputating 2 digits in a Labrador?

janine redman — Wed, 09 Sep 2020 23:01:05 GMT

how does cost of stelfonta compare?

RE: What is your experience of amputating 2 digits in a Labrador?

Dinu Catilina — Wed, 09 Sep 2020 22:02:53 GMT

I would excise the mass first and amputate the digits only if it comes back. I understand the money issue but still amputating two toes is a bit extreme. Maybe try preds first and see if it's reducing size?

I have nothing against staging but I wouldn't spend the owner's money on scans and aspirates from organs before grading the mass.

But then the dog will be fine on two toes, it's amazing what dogs can cope with. I've see an one toe dog running like crazy (one toe on one limb not one toe in total, just to be clear).

RE: What is your experience of amputating 2 digits in a Labrador?

Beats — Wed, 09 Sep 2020 18:49:23 GMT

Outside 2 digits.

There's always alternatives, but I reckon this is probably best option in this case - a judgement call and I could certainly be wrong on it.

It's an interdigital mast cell tumour on dorsal aspect of web between digits 4 and 5 on a hindleg - first noticed within last 3 weeks and ulcerated in appearance and probably about 1cm diameter. The popliteal LN feels palpably larger than the contralateral leg, but could be reactive.

My current plan (funds/time permitting...) would be to amputate the two outer toes and save a bit of skin from the lateral aspect of digit 5 and medial aspect of digit 4 ["phalangeal fillet"?] to close the defect and bandage up for couple of weeks until healed. Probably excising the popliteal lymph node at same time. As funds would certainly not permit any further treatment beyond this, I would not be doing histopathology on the excised tissues, so would not know how appropriate the surgery had been to feed back I'm afraid.

Alternatives I've considered so far would be to do an excisional biopsy for histopath grading (e.g. separation podoplasty cutting the web away between digits 4 and 5 probably) and then go back to take the 2 toes if was "bad" [though there wouldn't be funds/time for 2 surgeries and a histopath, so really is an either or scenario in reality]; to aspirate or excise the popliteal lymph node for cytology/histopathology to assess whether spread and digital amputation more likely to be in vain before doing digit amputation [again wouldn't be funds/time for this approach in reality]; to scan abdomen and aspirate spleen and liver and any other staging wish to do to estimate whether surgery likely to be in vain [pointless unless would leave funds/time to do more afterwards]; to give any of the fancy medical treatments [stelfonta being perhaps the most interesting to consider and a bit of an unknown to me but probably too much of a stretch financially anyway]; to leave and do nothing. Of these the 2 most viable options I think are amputation of both digits +/- popliteal LN excision, or do nothing; I would put stelfonta as a third possibility that I haven't seriously considered but may be a valid alternative [looks quick, but is very expensive and I would be unsure if really a suitable case and the speed of injecting it versus surgery could be eaten up in spending time deliberating on its merits or otherwise for the case... still I'll give it a bit more thought]

RE: What is your experience of amputating 2 digits in a Labrador?

janine redman — Wed, 09 Sep 2020 14:11:51 GMT

The outside or inside digits ? It will affect weight bearing, although a lecturer a long time ago told us that you could remove any two toes form any limb and the dog would cope. However seeing the effects of the removal of a single digit it may depend on why and what the expectations are of the dog for the future? The other two digits and joints will than take over the forces that had been applied across the toes and joints that are removed . So I would say that it can be done but does it need to Ben or are there alternatives?

RE: What is your experience of amputating 2 digits in a Labrador?

Julian Earl — Wed, 09 Sep 2020 10:53:07 GMT

Hello,

Personally I would be worried about the resultant instability on that foot with the reduced number of toes. Are the hips both sound? The stifles? Increasing any twisting forces on those joints could be very problematic? Better a hindleg than front one though with relatively less weight on the hind legs than on the front. I would be very interested to know of the outcome of this case. Thanks in anticipation. Good luck.

Sorry if I come across as pessimistic.