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A team of veterinary surgeons at Pride Veterinary Centre in Derby have performed a life-saving operation on a puppy who was hit by a motorbike.

The surgery – which was a first for Scarsdale Vets – was performed on two-month-old Bella, a German Shepherd who suffered severe head injuries following a collision with a motorbike in Belper, Derbyshire, last October. Bella was rushed to Pride Veterinary Centre, where she was referred for investigations and emergency surgery.

Seven months on, Bella, now nine-months-old, has bounced right back!

Bella 6 weeks after the surgery, after the oral splint removal. Credit Scarsdale Vets.jpg
Bella 6 weeks after the surgery, after the oral splint removal. Credit Scarsdale Vets.jpg

Rosario Vallefuoco, Soft Tissue & Orthopaedic Veterinary Senior Surgeon at Pride Veterinary Centre who performed Bella’s surgery explains, “When Bella first came in it wasn’t that obvious how bad her injuries were, despite the massive impact to her head. Her fur covered a lot of the damage and remarkably she wasn’t showing any neurological deficits nor had any severe injuries elsewhere. She also had no breathing issues, but she was bleeding from her nose which indicated facial trauma.

“She was in shock, so we had to stabilise her before we could do any further examinations or consider surgery. My colleagues in our Diagnostic Imaging department performed a CT scan of her head, which revealed that Bella had severely comminuted maxilla-facial (multiple skull and facial) fractures, with her nose and part of her skull being complete displaced. Until this point the gravity of her injuries, whilst suspected, were not that obvious, but when we saw her CT scan, it was like looking at a jigsaw puzzle.”

Bella intubated after the surgery. Credit Scarsdale Vets.jpg
Bella intubated after the surgery. Credit Scarsdale Vets.jpg

A CT scan also revealed small pieces of bone from Bella’s nose and skull were loose, which need to be removed before they cause further problems. Bella was monitored in ICU for two days before being taken into emergency surgery, where Rosario worked with Ines Gordo, Surgical Resident, to begin reconstruction – which was made easier with the 3D CT scan to refer to during the surgery.

Bella’s teeth had been knocked out of place so Rosario and Ines had to first stabilise her jaw and palate using an interdental wireframe and dental resin, so her teeth would line up post surgery.

Titanium mesh was used to stabilise the fractures and to reconstruct Bella’s mid-face. Rosario had treated other previous cases using titanium mesh, but only for elective oncological or brain surgery. This was the first time this approach had been used in a trauma case in a dog.

Finally, all loose bone fragments were removed to avoid any long-term complications and the mid-face of Bella was entirely reconstructed. In total, the operation took two hours to complete.

Scan of Bella post surgery. Credit Scarsdale Vets
Scan of Bella pre surgery.-Credit Scarsdale Vets
Scan of Bella pre surgery.-Credit Scarsdale Vets

Rosario adds, “This surgery would not have been possible without the expertise and knowledge of the multidisciplinary team here at Pride – particularly our Diagnostic Imaging team, as accurate CT scans were crucial in the management of this case, and our Anaesthetic team for such a critical patient.

“Post-operative care was essential, especially as part of Bella’s skull had been crushed during the accident and couldn’t be fully reconstructed. This, and the fact that her nose had been heavily impacted in the accident and manipulated during the operation, meant controlling her pain relief was paramount, as we had to make sure she was as comfortable as possible.”

Within two days, Bella was able to eat wet food by herself and she did not require extra pain relief, so her owners were able to manage her pain at home. Two weeks later her stitches were removed and six weeks later, her dental frame was removed under a general anaesthetic. Rosario also used an endoscopy to check the inside of her nasal cavity and to ensure that there were no further problems following the operation.

Rosario concludes, “Bella will have another CT scan later this month to check on her progress, but so far the mesh isn’t causing her any problems and her teeth and jaw close perfectly again. She is doing extremely well and cosmetically, you would never know she had been in such an accident – which given her initial CT scans, is something we are very proud of too!”

Rosario plans to publish her case in a scientific publication in the future.

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