TUGAS ILMU BEDAH KHUSUS VETERINER

Teknik Operasi Oesophagotomy dan Oesophagostomy

Oleh :

Kelompok A4

Dwi Arso Purba 1509005047

Ni Made Hani Pujaswarini 1509005056

Ni Ketut Mega Hendrayanti 1509005057

Brigita Galilea Adu 1509005058

Muhammad Alfian Dinika 1509005078

2015 A

LABORATORIUM BEDAH VETERINER

FAKULTAS KEDOKTERAN HEWAN

UNIVERSITAS UDAYANA

TAHUN 2018
 RINGKASAN

Sistem digesti (digestive system) adalah sistem organ dalam tubuh hewan yang
menerima makanan, mencernanya menjadi energi dan nutrisi, serta mengeluarkan sisa proses
tersebut melalui rectum. Sistem digesti antara satu hewan dengan yang lainnya berbeda-beda.
Bedah sistem digesti adalah bedah yang dilakukan pada pasien (hewan) yang mengalami
gangguan atau kelainan pada sistem digesti. Salah satunya yaitu Oesophagotomy dan
Oesophagostomy yang merupakan pembedahan pada esofagus. Oleh karena itu, penulis akan
membahas tentang tekhnik operasi Oesophagotomy dan Oesophagostomy pada hewan.
Oesophagotomy adalah tindakan operasi yang dilakukan dengan mengincisi pada dinding
esophagus untuk membuka lumen esophagus. Pada dasarnya oesophagostomy memiliki
kesamaan dengan esophagotomy, yang membedakan di antara keduanya adalah hasil akhir dari
proses pembedahan tersebut.

SUMMARY

Digestion system (digestive system) is a system of organs in the body of animals that
receive food, digest it into energy and nutrients, and remove the rest of the process through the
rectum. The digestion system between one animal and another varies. Digestive system surgery
is a surgery performed on patients (animals) who experience disorders or abnormalities in the
digestive system. One of them is Oesophagotomy and Oesophagostomy which is surgery on
the esophagus. Therefore, the author will discuss the technique of operating Oesophagotomy
and Oesophagostomy in animals. Oesophagotomy is an surgical procedure performed by filling
in the esophageal wall to open the esophageal lumen. Basically oesophagostomy has
similarities with esophagotomy, the difference between the two is the end result of the surgical
process..
 KATA PENGANTAR

Puji syukur kehadirat Tuhan Yang Maha Kuasa karena atas berkat dan rahmat
Nya sehingga paper yang berjudul “Teknik Operasi Oesophagotomy dan
Oesophagostomy” ini bisa diselesaikan dengan baik dan tepat pada waktunya.
Tulisan ini dibuat untuk memenuhi tugas atas selesainya dilakukannya
kuliah Ilmu Bedah Khusus Veteriner, Fakultas Kedokteran Hewan, Universitas
Udayana.
Penulis menyadari bahwa tulisan ini tidak terhindar dari berbagai macam
kekurangan. Dan dengan kekurangan yang ada segala kritik dan saran sangat
penulis harapkan demi kebaikan dari tulisan ini, dan tak lupa penulis mengucapkan
banyak terimakasih.

Denpasar, 30 September 2018

Penulis

i
 DAFTAR ISI

Sampul
Ringkasan/Summary
Kata Pengantar .................................................................................................... i
Daftar Isi ............................................................................................................. ii
Daftar Gambar ...................................................................................................iii
BAB I PENDAHULUAN ................................................................................. 1
1.1 Latar Belakang .................................................................................... 1
1.2 Rumusan Masalah ............................................................................... 1
1.3 Tujuan ................................................................................................. 2
1
1.4 Manfaat ............................................................................................... 2
BAB II TINJAUAN PUSTAKA ...................................................................... 3
2.1 Definisi Oesophagotomy dan Oesophagostomy ................................. 3
2.2 Preoperasi ............................................................................................ 4
BAB III PEMBAHASAN ................................................................................ 6
3.1 Teknik Operasi Oesophagotomy .......................................................... 6
3.2 Teknik Operasi Oesophagostomy ........................................................ 7
3.3 Pasca Operasi ..................................................................................... 10
BAB IV PENUTUP ........................................................................................ 13
4.1 Kesimpulan ....................................................................................... 13
4.2 Saran ................................................................................................. 13
DAFTAR PUSTAKA
Lampiran

ii
 DAFTAR GAMBAR

Gambar 1. Irisan midline ventral cervicalis .......................................................... 6

Gambar 2. Muskulus strenohyoidus dan sternocleidomastoidus kiri dan kanan

dipreparasi .............................................................................................................. 6

Gambar 3. Irisan pada esophagus dibuat secara longitudinal ................................ 7

Gambar 4. Aplikator esophagus tube ..................................................................... 8

Gambar 5. Membuat sayatan kecil sampai mengenai ujung forceps bagian kanan
. ............................................................................................................................... 8

Gambar 6. Membuka forceps, pegang ujung distal dari saluran esophagostomy, dan
mengunci forceps ................................................................................................... 9

Gambar 7. Gunakan hemostat untuk meligasi saluran esophagus ......................... 9

Gambar 8. Ketika sudah ditempatkan dengan benar, akhir feeding selang akan
"dibengkokkan" dari caudal ke cranial. ............................................................... 10

iii
 BAB I
PENDAHULUAN

1.1 Latar Belakang

Sistem digesti (digestive system) adalah sistem organ dalam tubuh
hewan yang menerima makanan, mencernanya menjadi energi dan nutrisi, serta
mengeluarkan sisa proses tersebut melalui rectum. Sistem digesti antara satu
hewan dengan yang lainnya berbeda-beda.
Secara spesifik, sistem digesti berfungsi untuk mengambil makanan,
memecahnya menjadi molekul nutrisi yang lebih kecil, menyerap molekul
tersebut ke dalam alirah darah, kemudian membersihkan tubuh dari sisa-sisa
makanan.
Organ-organ yang termasuk di dalamnya yaitu : mulut, faring, esofagus,
lambung, usus halus serta usus besar. Dari usus besar makanan akan dibuang
keluar tubuh melalui rectum.
Adapun organ pencernaan tambahan yang berfungsi untuk membantu
saluran pencernaan dalam melakukan kerjanya, yaitu : Gigi dan lidah terdapat
dalam rongga mulut, kantung empedu serta kelenjar pencernaan akan
dihubungkan kepada saluran pencernaan melalui sebuah saluran. Kelenjar
pencernaan tambahan akan memproduksi sekret yang berkontribusi dalam
pemecahan bahan makanan.
Bedah sistem digesti adalah bedah yang dilakukan pada pasien (hewan)
yang mengalami gangguan atau kelainan pada sistem digesti. Salah satunya
yaitu Oesophagotomy dan Oesophagostomy yang merupakan pembedahan
pada esofagus. Obstruksi esofagus adalah kejadian umum pada sapi dan ini
disebabkan kebiasaan makan mereka sehingga menyebabkan benda asing
tersanggut di organ esophagus (M.A. Semieka, 2015). Namun hal ini juga
terjadi pada hewan kecil seperti anjing dan kucing. Oleh karena itu, penulis
akan membahas tentang tekhnik operasi Oesophagotomy dan Oesophagostomy
pada hewan.
1.2 Rumusan Masalah
1. Apa yang dimaksud dengan Oesophagotomy dan Oesophagostomy?

1
 2. Bagaimana teknik operasi Oesophagotomy dan Oesophagostomy?
1.3 Tujuan
Tujuan penulisan paper ini adalah untuk mengetahui tentang teknik operasi
oesophagotomy dan oesophagostomy. Selain itu, penulisan paper juga dilakukan
untuk memenuhi salah satu tugas kelompok mata kuliah Ilmu Bedah Khusus
Veteriner, Fakultas Kedokteran Hewan Universitas Udayana.

1.4 Manfaat
Melalui paper ini diharapkan pembaca, khususnya mahasiswa kedokteran
hewan Universitas Udayana memiliki ilmu pengetahuan yang lebih mengenai
teknik operasi oesophagotomy dan oesophagostomy.

2
 BAB II
TINJAUAN PUSTAKA

2.1 Definisi Oesophagotomy dan Oesophagostomy

Oesophagotomy adalah tindakan operasi yang dilakukan dengan
mengincisi pada dinding esophagus untuk membuka lumen esophagus
(Sudisma, 2016). Indikasi terjadi bila terdapat obstruksi esophagus atau untuk
mengeluarkan benda asing (Sudisma, 2016). Tempat operasi dapat ditentukan
dengan cara palpasi untuk menentukan letak sumbatan esophagus oleh adanya
benda asing.
Oesophagotomy dapat dilakukan secara longitudinal atau transversal
tergantung dari tujuan dilakukannya esophagotomy tersebut. Incisi sebaiknya
di buat pada bagian esophagus yang sehat dengan panjang incisi yang di
sesuaikan dengan kebutuhan pembedahan. Untuk pengeluaran benda asing
tarikan perlahan pada esophagus dapat dilakukan.
Sedangkan Oesophagostomy adalah pembukaan pada lumen esophagus
bertujuan untuk memasukkan feeding tube atau selang untuk pemberian pakan
secara langsung ke lambung.
Pada dasarnya oesophagostomy memiliki kesamaan dengan
esophagotomy, yang membedakan di antara keduanya adalah hasil akhir dari
proses pembedahan tersebut. Kelebihan penggunaan feeding tube
dibandingkan dengan penggunaan infuse adalah komplikasi pasca pemasangan
infus seperti infeksi akibat cateter yang tidak steril maupun karena
ketidakseimbangan elektrolit pada tubuh hewan tersebut.
Pemasangan feeding tube pada esophagus lebih dipilih karena
kemudahan dalam proses pemasangan dan juga sedikitnya komplikasi yang
akan terjadi, dan juga karena proses pemberian pakan dapat dilakukan oleh
pemilik.

3
 Gambar 1. Oesophagotomy. A: Insisi pada Ventral Midline Cervic. B dan C:
Preparasi Muskulus. (Sumber : Fossum, 2009).

2.2 Preoperasi
1. Persiapan ruang operasi
Ruang operasi dan meja operasi di desinfeksi menggunakan
desinfektan. Selain itu, perlengkapan alat juga di desinfeksi. Kemudian
difumigasi dengan formalin 10% dan KMnO4 1% dan di biarkan selama
15 menit.

2. Persiapan Alat
Peralatan yang digunakan dalam pembedahan ini adalah meja bedah,
spuit 2 ml, pinset anatomis, alis forcep, scalpel holder, needle holder, towel
clamp, blade, jarum, needle, drepe, tampon, benang operasi (silk untuk
kulitdan chromic untuk organ dalam), kain kasa, sarung tangan, stetoskop
dan thermometer.

3. Persiapan Bahan Operasi

Bahan-bahan yang digunakan antara lain premedikasi, yaitu Atropin.
Bahan anastesi, yaitu Xylazine dan Ketamine. Dalam pembedahan ini,
hewan dianestesi dengan anestesi umum. Selain itu juga bahan yang

4
 digunakan adalah alkohol 70%, NaCl fisiologis, iodium tincture 3%, tampon
serta benang catgut.

4. Persiapan operator
Operator harus menggunakan alat pelindung diri, untuk tujuan
sterilitas prosedur pelaksanaan operasi.

5. Persiapan Pasien
Pasien yang akan menjalani operasi esophagotomy dapat dipuasakan
selama 12 jam sebelum operasi dengan tujuan untuk menghindari muntah
akibat dari pemberian anestesi dan juga untuk mengosongkan esophagus
agar tidak terkontaminasi saat dilakukan pembedahan.

6. Premedikasi dan Anestesi

Premedikasi yaitu Atropin. Anestesi yang digunakan yaitu anestesi
umum menggunakan Xylazine dan Ketamine.

5
 BAB III

PEMBAHASAN

3.1 Teknik Operasi Oesophagotomy

Bulu dicukur dan kulit dipersiapkan secara aseptis. Setelah dianestesi,

hewan dibaringkan pada punggungnya. Dibuat irisan pada bagian tengah ventral
leher (ventral midline cervic) dari larynx ke sternum. Muskulus sternohyoideus dan
sternocleidomastoideus kiri dan kanan dipreparasi secara tumpul sehingga terlihat
trachea. Oesophagus terletak di sebelah kiri daripada trachea dan dengan preparasi
tumpul terlihat lebih jelas. Irisan pada oesophagus dibuat secara longitudinal dan
benda asing (corpora alinea) dikeluarkan. Oesophagus dijahit dengan 4-0 chromic
catgut secara simple interrupted. Muskulus tidak perlu dijahit, kulit dijahit dengan
benang non absorbable secara simple interrupted (Sudisma, 2016).

Gambar 1. irisan midline ventral cervicalis

Gambar 2. Muskulus strenohyoidus dan sternocleidomastoidus kiri dan kanan

dipreparasi

6
 Gambar 3. Irisan pada esophagus dibuat secara longitudinal

3.2 Teknik Operasi Oesophagostomy

• Persiapan hewan memiliki kesamaan dengan prosedur pada esophagotomy yaitu

hewan di baringkan secara lateral recumbency dan semua rambut yang mungkin
mengkontaminasi daerah insisi atau dapat mengganggu daerah insisi dapat di
cukur.
• Untuk menentukan bagian yang di insisi dapat dimasukkan forceps kedalam
rongga mulut menuju esophagus.
• Setelah berada di esophagus forceps di angkat ujungnya untuk membuat
benjolan pada esophagus yang menandakan bagian yang akan di insisi.
• Insisi dilakukan untuk membuka kulit dan kemudian esophagus yang besar
sayatannya bergantung pada besaran tube yang akan dipasang.
• Tube dimasukkan dengan bantuan forceps tadi kemudian di balikkan menuju
lambung. Setelah itu tube dapat di fiksasi dengan menggunakan bantuan perban
ataupun plester agar tidak bergerak ataupun berpindah.

7
 Gambar 4. Aplikator esophagus tube

Gambar 5. Membuat sayatan kecil sampai mengenai ujung forceps bagian kanan

8
Gambar 6. Membuka forceps, pegang ujung distal dari saluran esophagostomy,
dan mengunci forceps

Gambar 7. Gunakan hemostat untuk meligasi saluran esophagus

9
 Gambar 8. Ketika sudah ditempatkan dengan benar, akhir feeding selang akan
"dibengkokkan" dari caudal ke cranial.

3.3 Pasca Operasi

Perawatan pasca operasi yang dapat diberikan yaitu :

a. Pemberian Obat
 Antibiotika. Antibiotik sangat penting dalam proses perawatan pasca operasi.
Fungsi antibiotik dalam perawatan pasca operasi adalah untuk mencegah
terjadinya infeksi pada bekas operasi yang disebabkan oleh bakteri.Antibiotik
juga dapat menghambat pertumbuhan dan perkembangan
mikroorganisme.. Pemberian salep tetrasiklin 1 %, chlorampenical 1%,
nebacetin 1%, lokal anestesi dengan kokain 2% selama beberapa hari.
 Antiradang. Obat anti inflamasi (anti radang) adalah suatu golongan obat yang
memiliki khasiat analgesik (pereda nyeri), anti piretik (penurun panas), dan anti
inflamasi (anti radang).
 Analgesik. Analgesik merupakan obat yang penting dalam pasca operasi,
karena analgesik adalah obat yang dapat mengobati rasa nyeri pasca operasi
dan komplikasinya seperti mual dan muntah.

10
 Vitamin A, Vitamin B Kompleks, Vitamin C (untuk terapi
supportif). Pemberian vitamin B. Kompleks, vitamin A, vitamin C merupakan
hal yang penting. Pemberian vitamin ini bertujuan untuk meningkatkan daya
tahan tubuh dari pasien (hewan).
 Cairan infus (LR, Dextrose 5-10%). Laktat Ringer dan dextrose 5% merupakan
perawatan pasca operasi yang bertujuan untuk menjaga kondisi pasien agar
tetap stabil.
 Hemostatika. Obat hemostatika merupakan obat yang diperlukan unutuk pasca
operasi, karena obat ini berfungsi untuk menghentikan pendarahan.

b. Melindungi Luka

 Memakaikan pasien (hewan) dengan Elizabeth Collar. Tujuan dari pemakaian

Elizabeth Collar agar menghindari pasien (hewan) tidak menggaruk luka
operasi.
 Membalut luka tersebut. Tujuan dari pembalutan luka agar luka tidak
terkontaminasi dari organisme luar.

c. Membatasi Pergerakan

 Dikandangkan
 Diikat ataupun di rantai. Dengan cara mengingat kaki belakangnya agar
pasca operasi tidak tergaruk.

d. Memberi nutrisi yang baik serta dipuasakan beberapa hari.

Pengobatan diindikasikan untuk pasien dengan tanda-tanda klinis yang

ringan dan binatang-binatang dengan kurang dari 50% runtuhnya (Stadium I).
Terapi medis untuk hewan pasca pembedahan merupakan gejala dan paliatif, tidak
kuratif.

Biasanya, pasien (hewan) diperlakukan dengan kombinasi dari antitusif,

bronkodilator, kortikosteroid antiinflammatories, antibiotik dan obat penenang.

11
Sangat jarang untuk pasien untuk menerima semua terapi yang tercantum di atas,
dan pengobatan disesuaikan dengan kebutuhan individu.

Mengontrol obesitas, meningkatkan ventilasi dan kualitas udara di

lingkungan pasien. Selain itu juga diberikan neurobion 0,5 mg/hari secara IM dan
antibiotik Nova 0,05 ml per dua hari selama tiga kali. Pemberian neurobion
dilakukan untuk memperkuat kerja syaraf sedangkan pemberian antibiotic
dilakukan untuk mencegah infeksi sekunder.

Pengobatan antibiotik pasca operasi diteruskan dan untuk mempercepat

pertumbuhan kulit baru serta otot yang mengalami lisis dipergunakan Unguentum
Balsamum Peruvianum 20 % yang dicampur dalam jumlah yang sama dengan
Unguentum Jecores Ascelli IO %.

Dalam masa persembuhan, kurang lebih dua bulan pasca operasi, pemah
dicoba dilakukan penutupan kulit dengan penjahitan, tetapi tidak bcrhasil baik
karena kulit yang terbentuk masih rapuh dan belum cukup kuat untuk menahan otot-
otot di bawahnya.

Pcngobatan antibiotika sistemik diperpanjang dan dilakukan bervariasi

(Gentamycin 50 dan Penstrep 200), serta diberikan salep perangsang epithelisasi
yang bervariasi pula (Bephanten TM dan Unguentum Balsamum Perivianum 20 %,
Unguentum Jecores Ascelli I0 %) dengan pertimbangan kemunculan infeksi
sekunder di daerah luka sayatan dan lemahnya pertautan kulit baru yang terbentuk.

12
 BAB IV

PENUTUP

4.1 Kesimpulan

Oesophagotomy adalah tindakan operasi yang dilakukan dengan mengincisi

pada dinding esophagus untuk membuka lumen esophagus. Indikasi terjadi bila
terdapat obstruksi esophagus atau untuk mengeluarkan benda asing. Pada dasarnya
oesophagostomy memiliki kesamaan dengan esophagotomy, yang membedakan di
antara keduanya adalah hasil akhir dari proses pembedahan tersebut.

4.1 Saran

Hewan dapat sembuh secara sempurna dalam beberapa minggu sehingga

sangat penting untuk terus memonitor hewan pasca operasi. Dan sangat disarankan
pada pemilik hewan untuk menjaga hewannya agar tidak memakan benda asing
yang dapat tersangkut di esophagus sehingga membuat hewan menderita.

13
 DAFTAR PUSTAKA

Fossum T.W. 2009. Surgery Of The Esophagus And Stomach. World Small Animal Veterinary
Association World Congress Proceedings. USA.
Kachwaha, K. et all. 2017. Diagnosis of Surgical Management of Eshophageal Foreign Body in
a Dog. College of Veterinary and Animal Science: Intas Polivet Vol. 19(I): 124-125

Moghaddam, A.J. et all. 2016. Evaluating the Feasibility of Esophagotomy Suture Line
Reinforcement Using Platelet Rich Fibrin Membrane and Its Effect on Wound Healing.
Irian Journa Of Veterinary Surgery (IJVS): IJVS 11 (1) Serial No. 24

Sudisma, IGN. 2016. Ilmu Bedah Veteriner dan Teknik Operasi. Universitas Udayana

Semieka M.A. 2015. Standing Position Esophagotomy in Cattle and Buffaloes. Journal of
Advanced Veterinary Research
Tobias, K.M. 2014. Esophagotomy Feeding Tubes. Clinicianbrief
 Journal of Advanced Veterinary Research Volume 5, Issue 4 (2015) 176-178

Journal of Advanced Veterinary Research

http://advetresearch.com/index.php/avr/index

Standing Position Esophagotomy in Cattle and Buffaloes

M.A. Semieka

Department of Animal Surgery, Faculty of Veterinary Medicine Assiut University 71526, Assiut, Egypt.

ARTICLE INFO ABSTRACT

Original Research The present study was carried out on 16 animals (12 cattle and 4 buffaloes) suffering from
complete cervical esophageal obstruction. The animals were presented to the Veterinary
Accepted: Teaching Hospital at Assiut University, Egypt. Diagnosis of the cases was achieved through
18 October 2015
clinical signs, external palpation of the foreign body and survey radiography. Standing po-
Keywords:
sition esophagotomy was performed for treatment of the cases. Follow up revealed recov-
ery of all cases without any postoperative complications.
Cattle
Bufaloes
Esophagotomy

Introduction struction in cattle and buffaloes.

The primary indication for esophageal surgery Materials and methods

in large animals is to relieve esophageal obstruc-
tions (choke) which have not respond to conserva-
tive treatment (Meagher and Mayhew, 1978).
Esophageal obstruction is a common occurrence in
cattle and is attributable to their feeding habits
(Smith, 2008). Obstructions are often caused by in-
gestion of foreign objects or feed stuff (Patel and
Brace, 1995). Diagnosis of esophageal obstruction
was obtained by external palpation, manual oral ex-
amination, passing a stomach tube, esophageal en-
doscopy as well as radiography of the esophagus
(Haven, 1990). Surgical treatment of esophageal
obstruction is indicated when conservative therapy
fails, however many surgeons were going directly
to surgical treatment as a sole solution (Misk et al.,
2004). The aim of the present study was to estab-
lish standing position esophagotomy as a safe
method for treatment of cervical esophageal ob-
*
Corresponding author: M.A. Semieka
E-mail address: semiekam@yahoo.com
The present study was carried out on 16 animals
(12 cattle and 4 buffaloes) suffering from complete
cervical esophageal obstruction. The animals were
presented to Assiut veterinary teaching hospital.
They were females and of 1 – 7 years old. Diagno-
sis of the cases was obtained depending on case
history, clinical signs and survey radiography.
Esophagotomy in standing position was performed
in all cases.
For survey radiographic examination, the ani-
mals were tranquilized using Xylazine Hcl in a
dose rate of 0.05 mg/kg b.w. I.M. Lateral radi-
ographic projection to the neck of the animal in
standing position was performed using 35-45 MAs
and 65-75 k.v. Standard speed film and intensifying
screens were used.
Preoperatively, the animal was given dextrose
and Ringers solutions 3000 ml intravenously. The
animal was in standing position with fixation of the

ISSN: 2090-6277/2090-6269/ © 2015 JAVR. All rights reserved.

 M.A. Semieka /Journal of Advanced Veterinary Research 5 (4) (2015) 176-178
neck extended. The surgical site was prepared asep-
tically. Linear infiltration analgesia at the site of
operation was performed using Lidocaine Hcl 2%.
A longitudinal incision was made in the skin
over the obstructing foreign body. The esophagus
was exposed and incised, and then the foreign body
was removed. The esophagus was thoroughly
cleaned with normal saline and then closed with a
two layer suture pattern.
In the first layer, the mucosa was closed with
the continuous suture pattern. In the second layer,
the submucosa and muscularis were closed with
simple continuous suture pattern using chromic
catgut. The skin apposed with simple interrupted
suture pattern using silk.
Postoperatively, oral feeding was with held and
the animal was maintained with dextrose and nor-
mal saline for 3 days. The owners and local veteri-
narians were instructed regarding the medication
and postoperative cure.
Follow up of the cases was determined and skin
stitches were removed 10 days postoperatively.
Results
All cases of the present study were suffering
from complete cervical esophageal obstruction.
The animals were presented to our hospital with a
history of acute onset of severe bloat, respiratory
distress and inability to swallow. Clinical exami-
nation revealed that, the animal had severe abdom-
inal distention, extension of the neck and copious
amounts of saliva were expelled. By palpation
there is hard swelling at left ventrolateral aspect of
the middle cervical region in 11 cases and at the
thoracic inlet in 5 cases. Attempts to pass a stomach
tube were unsuccessful. Survey radiography re-
vealed presence of radiopaque structure at the level
of the esophagus which confirms esophageal ob-
struction.
The foreign bodies which cause complete
esophageal obstruction in the present study were
root of cabbage, corn, pieces of rubber, leather
mass and plastic bag filled with food materials.
Follow up of the cases revealed complete recovery
of all animals within 12 days without any postop-
erative complications.
Discussion
Esophageal obstruction is the most important
177
surgical problem involving esophagus in cattle and
buffaloes (Smith, 1996; Tyagi and Singh, 1996;
Misk et al., 2004).
Esophageal obstruction commonly occurs at the
cranial aspect of the cervical esophagus, at the tho-
racic inlet or at the base of the heart (Haas, 2010).
In the present study, esophageal obstruction was at
the middle cervical region in 11 cases and at the
thoracic inlet in 5 cases.
Double contrast radiography with barium and
air helped to better identify the location and nature
of the foreign body (Haven, 1990; Niehaus 2008).
In the present study, clear diagnosis of esophageal
obstruction was achieved through external palpa-
tion of the foreign body, clinical signs and survey
radiography.
The prognosis is good for animals suffering
from esophageal obstruction if they were treated
within 2 to 12 hours from the onset of clinical signs
(Smith, 2008). In the present studym all cases were
exposed to surgical interference (esophagotomy)
within 10 hours from the onset of obstruction.
Fatality associated with complete esophageal
obstruction in adult ruminants results from the in-
ability of fermentative gases to escape the ru-
menoreticulum. Signs might be attributable to
ruminal tympany, respiratory distress, and meta-
bolic acidosis, which can be severe enough that
they mask the primary underlying esophageal dis-
turbance (Smith, 2008).
Due to complete esophageal obstruction, the
cases suffering from severe abdominal destination
and respiratory distress, which may leads to death
of the animal during operation if it performed in re-
cumbent position, so that esophagotomy was per-
formed in standing position in all animals included
in the present study.
Post-operative complications associated with
esophagotomy are incisional dehiscence and fistula
formation (Ruben 1997). All cases of the present
study were recovered without any post-operative
complications.
Conclusion
From our point of view, esophagotomy in stand-
ing position is considered to be an easy, safe, rapid
and successful treatment in cases of complete cer-
vical esophageal obstruction in cattle and buffaloes.
 M.A. Semieka /Journal of Advanced Veterinary Research 5 (4) (2015) 176-178

References Ruben, J.M., 1997. surgical removal of a foreign body from

the bovine oesophagus. Veterinary Record 100, 220.
Haas, J., 2010. Esophageal foreign body in a 2 days old calf. Smith, B.P., 1996. Large Animal Internal Medicine 2nd Ed.
Can. Vet. J. 51, 406-408. Mosby.
Haven, M.L., 1990. Bovine esophageal surgery. Vet. Clin. Smith, B.P., 2008. Large Animal Internal Medicine. 4th Ed.
North Am. Food Anim. Pract. 6, 359-369. St. Louis Missouri: Mosby. pp. 804-805.
Meagher, D.M., Mayhew, I.G., 1978. The surgical treatment Tyagi, R.P.S., Singh, J., 1996. Ruminant Surgery. CBS pub-
of upper esophageal obstruction in the Bovine. Can. lishers and distributors.
Vet. J. 19,128–132.
Misk, N.A.; Ahmed, F.H., Semieka, M.A., 2004. A clinical
study on esophageal obstruction in cattle and buf-
faloes. J. Egypt. Vet. Med. Assoc. 64, 83-94.
Niehaus, A.J., 2008. Rumenotomy. Vet. Clin North Am Food
Anim Pract 24, 341-347.
Patel, J.H., Brace, D.M., 1995. esophageal obstruction due
to a trichobezoar in a caw. Can. Vet. J. 36, 774-775.

178
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Diagnosis of Surgical Management of Esophageal Foreign Body in a Dog

Article · June 2017

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Intas Polivet (2017) Vol. 18 (I): 124-125
Diagnosis of Surgical Management of Esophageal Foreign Body in a Dog
K. Kachwaha1, S.M. Qureshi and T.K. Gahlot
Department of Veterinary Surgery and Radiology
College of Veterinary and Animal Science
Rajasthan University of Veterinary and Animal Sciences (RAJUVAS)
Bikaner - 334001 (Rajasthan)
Abstract
A Boxer dog was presented with history of frequent vomiting, inappetance, lethargy and depression for last four days.
Lateral radiograph revealed a round radiopaque foreign body in the esophagus. The foreign body within the esophagus
was recovered through gastrotomy operation under fluoroscopic guidance and general anesthesia.
Keywords: Dog, esophageal; foreign body; surgical management
Introduction
Esophageal foreign bodies are a common clinical
disorder which can become life threatening in dogs
(Sale and Williams, 2006). The frequently encountered
esophageal foreign bodies are bones, balls, fish
hooks, raw hide, wooden sticks, toys, pieces of plastic
or metal and other varied objects have been also
reported (Thompson et al., 2012). Mostly seen clinical
symptom in dogs having esophageal foreign body is
regurgitation, gagging and retching following feeding
(Leib and Sartor, 2008). The aim of our paper is to
present diagnosis and removal of foreign body from
the esophagus in a dog.
History
A two year old male boxer dog was presented with
history of accidental intake of rubber ball four days
back. The dog was showing regurgitation,
dysphagia, hypersalivation, abdominal respiration
and depression. Thoracic radiography showed
presence of foreign body which localized between
heart base and diaphragm (Fig. 1). The dog bought
under fluoroscopic unit to retrieve foreign body
through oral cavity by a welded long handle
instrument (Fig. 2) but it was unable to recover. The
surgeon’s team decided to go for an emergency
gastrotomy operation.
Treatment
The surgery was carried out under general
anesthesia with combination of Atropine Sulphate,
Xylazine and Ketamine with the dose rate of 0.04
mg/kg, 0.5-1 mg/kg and 10 mg/kg b. wt. respectively
(Kolata and Rawlings, 1982). The stomach was
approached by right flank region. After given incision
1. Corresponding author.
E-mail: kapilsingh814@gmail.com
a - Brand of Intas Animal Health, Ahmedabad
124
Short Communication
on gastric mucosa, the foreign body was pushed
towards cardiac sphincter by welded long handle
instrument. A vulsellum forcep was inserted and
approached to caudal part of esophagus via cardiac
sphincter under fluoroscopic guidance. The foreign
body that was a rubber ball removed with the help of
vulsellum forcep (Fig. 3). Gastric mucosa sutured by
inverted sutures i.e. lambert and cushing by
absorbable suture material vicryl no 1. The
peritoneum and muscle layers sutured by simple
continuous suture pattern by absorbable suture
material vicryl no 2. Skin was sutured by simple
interrupted suture pattern by using silk no 1.
Post-operatively Inj Ceftriaxonea (20 mg/kg b.wt, i.v.)
and Inj Meloxicam a (0.2 mg/kg b.wt, i.m.) were
administered for 5 and 3 days respectively. The
wound dressing was done daily with 0.1% Povidone
iodine solution till complete healing. Dog kept off-
feed and off-water for next 5 consecutive days. The
dog was given blended diet for next 5 days. The
sutures were removed on 10th post-operative day.
The dog was recovered uneventfully.
Discussion
It has been reported that localization of esophageal
foreign bodies in dogs is mostly thorax entrance or
thoracic area (Moore, 2001) and common observed
esophageal foreign bodies are bone, chew treats,
balls, toys, fish pole and metal, plastic or wood pieces
have been noted in dogs (Thompson et al., 2012). In
this case, foreign body that was removed from
esophagus was a rubber ball which was located
between heart and diaphragm in accordance with
previous reports (Sale and Williams, 2006). Mostly
seen clinical symptom in dogs having esophageal
foreign body is regurgitation following feeding (Leib
and Sartor, 2008). In the present case, primer clinical
 Kachwaha et al.
Fig. 1: Presence of foreign body localized
between heart base and diaphragm
Fig. 3: Rubber ball removed with the help of
vulsellum forcep through gastrotomy
symptom was regurgitation. However vomiting,
gagging and coughing were observed. It has been
well documented that direct and indirect radiography
should be applied, if the regurgitation is evident. In
the presented case, the thoracic radiography
showed the presence of foreign body which localized
between heart base and diaphragm. The process of
diagnosis was consistent with Willard and Weyrauch
(1999) and suggested that direct and indirect thorax
radiography is a basic tool to diagnose esophageal
foreign bodies following the clinical symptoms such
as regurgitation, vomiting, retching and gagging.
Pushing esophageal foreign bodies localized at
thoracic area towards stomach by using rigid catheter
or removing foreign body with gastrostomy are
possible treatment options (Gianella et al., 2009).
Moore (2001) has reported that esophageal foreign
bodies could be removed orally with guidance of
fluoroscopy and help of forceps. In the presented
case, the foreign body was tried to remove orally
with the help of a welded long handle instrument
125
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Fig. 2: The fluoroscopic image of an attempt
for retrieving foreign body through oral cavity
by a welded long handle instrument
under fluoroscopic guidance but ball was recovered
through gastrotomy.
In conclusion, this unique case describes the
successful treatment of esophageal foreign body
existed for four days. It is suggested that gastrotomy
can be applied successfully for removing
esophageal foreign bodies which is not possible to
remove by using fluoroscopic method at thoracic
area in dogs.
References
Gianella, P., Pfammatter, N.S. and Burgener, I.A. (2009).
Oesophageal and gastric endoscopic foreign body
removal: complications and follow–up of 102 dogs. J Small
Anim Pract. 50: 649-54.
Kolata R.J. and Rawlings C.A. (1982). Cardiopulmonary
effects of intravenous xylazine, ketamine, and atropine in
the dog. Amer. J. Vet. Res. 43:2196-98.
Leib, M.S. and Sartor L.L. (2008). Esophageal foreign body
obstruction caused by a dental chew treat in 31 dogs (2000–
2006). J Am Vet Med Assoc 232: 1021-25.
Moore, A.H. (2001). Removal of esophageal foreign bodies
in dogs: use of the fluoroscopic method and outcome. J
Small Anim Pract 42: 227-30.
Sale, C.S.H. and Williams, J.M. (2006). Results of
transthoracic esophagostomy retrieval of esophageal
foreign body obstruction in dogs: 14 cases (2000–2004).
J Am Anim Hosp Assoc, 42: 450-56.
Thompson, H.C., Cortes, Y., Gannon, K., Bailey, D.
and Feer, S. (2012). Esophageal foreign bodies in dogs:
34 cases (2004–2009). Journal of Vet Emerg and Crit
Care 22: 253-61.
Willard, M.D. and Weyrauch E.A. (1999). Esophagitis, In:
Kirk, R.W. and Banoguno, J. (editör), 13th edition, Kirk’s
Current Veterinary Therapy–Small Animal Practice, WB
Saunders, Philadelphia, pp: 607-10.
 Procedures Pro Surgery / Critical Care Peer Reviewed

Esophagostomy Feeding Tubes

Becca Hodshon, DVM, DACVS Karen M. Tobias, DVM, MS, DACVS

BluePearl Veterinary Partners University of Tennessee
Louisville, Kentucky

E
nteral nutrition is indi- Compared with nasoesophageal and jejunostomy feeding tubes,
cated for conditions that esophagostomy tubes can be large enough to permit feeding a
prevent oral food intake blenderized commercial canned diet. Unlike pharyngostomy
or result in chronic caloric tubes, esophagostomy tubes do not cause pharyngeal or laryn-
insufficiency and is useful geal irritation or blockage. Unlike gastrostomy or jejunostomy
for fluid supplementation or tubes, esophagostomy tubes can be removed any time after
administration of medications placement.
in intractable animals. When
the esophagus and stomach are Placement
functional, enteral feeding can General anesthesia with endotracheal intubation is recom-
be provided via an esophagos- mended. Animals should be fully anesthetized to minimize risk
tomy tube. Benefits include minimal cost; limited equipment for gag reflex when the tube or instruments are passed through
requirements; and rapid, easy placement, especially in cats and the pharynx. Pharyngeal stimulation can cause the patient to
smaller dogs (see Benefits & Disad-
vantages of Esophagostomy Tubes).
Esophagostomy tubes are well toler-
Benefits & Disadvantages of Esophagostomy Tubes
ated and do not interfere with eating
or drinking.
Benefits Disadvantages
The main disadvantage is the neces- ■ Minimal cost ■ General anesthesia necessary
sity for general anesthesia. When
■ Limited equipment needed ■ Possibly challenging to place in giant
placing an esophagostomy tube in a
Rapid, easy placement breed or obese patients
giant breed or obese patient, which ■

can be challenging, specialized per- ■ Well tolerated

cutaneous feeding tube applicators
(ELD Tube Applicator, jorvet.com)
may help. Esophagostomy tube feed-
ing is contraindicated in patients
with persistent vomiting and is not
usually recommended in animals
that have undergone esophageal sur-
gery or have esophageal disorders
(eg, megaesophagus, esophageal
strictures or neoplasia, esophagitis,
esophageal stenosis from vascular
ring anomalies).
■ Contraindicated in patients with persist-
ent vomiting
■ No interference with eating
■ Usually not recommended in patients
or drinking
that have:
■ Allows feeding of a blender-
ized commercial canned diet – Undergone esophageal surgery
– Esophageal disorders (eg, megaesopha-
■ No pharyngeal or laryngeal
gus, esophageal strictures or neoplasia,
irritation or blockage
esophagitis, vascular ring anomalies
■ Can be removed any time causing esophageal stenosis)
after placement

66 cliniciansbrief.com • February 2014

vomit, awaken, or bite reflexively. Large-bore tube selection
should be based on the size of the patient; a 14- to 20-French
red rubber, silicone elastomer, or polyurethane tube can be
used. Esophagostomy tubes can be placed in either side of the
neck, depending on proximity of the esophagus, which can be
evaluated during tube placement.
Feeding
Blenderized commercial canned food is recommended for
esophagostomy tube feeding. Canned recovery diets are less
likely to clog the tube and have the highest caloric density but
may cause diarrhea. Food can be administered as bolus meal
feedings several times a day or, with liquid diets, as continuous
infusion. The resting energy requirement (RER) of the patient
should be calculated:
RER = 70 ¥ (body weight[kg]0.75)
Alternatively, RER for animals weighing more than 2 kg can be
calculated:
RER = 30 ¥ (body weight[kg]) + 70
The patient should be fed approximately 25% to 30% of its
caloric requirement on the first day of feeding, with subsequent
gradual increases of 25% to 30% of its caloric requirement per
day.1-3 This may not always be necessary but is recommended
to reduce risk for refeeding syndrome in patients with anorexia
or hyporexia for more than 3 to 5 days’ duration.1,3 Refeeding
syndrome manifests as dramatic decreases in phosphate, mag-
nesium, and potassium and can result in potentially fatal pul-
monary, cardiovascular, neurologic, and neuromuscular
abnormalities.
Gastric capacities for cats and dogs are 5 to 10 mL/kg during
food reintroduction, but capacities as high as 45 to 90 mL/kg
have been measured after complete realimentation.2,3 With
bolus feeding, the daily volume of food is divided into 4 to 6
feedings according to estimated stomach capacity. Daily fluid
requirements should be calculated based on amount of water in
or added to the canned diet and used to flush the tube.
Complications
Complications, usually minor, may include tube obstruction,
swelling of head and neck from an overly tight bandage, peri-
stomal dermatitis or cellulitis, inflammation, and stomal infec-
tion and abscessation.4,5
Tube obstruction with food or medications (common) can usu-
ally be remedied by flushing warm water in and out of the tube
using alternating gentle pressure and suction. If unsuccessful,
carbonated water or a pancreatic enzyme slurry can be instilled
into the tube and allowed to sit for an hour before reapplying
pressure and suction. Obstructions rarely require a guide wire to
unclog the tube, which is more common if the tube has a blind
end, a nonblenderized diet is fed, or administration of solid
medications (eg, crushed tablets) has been attempted. To pre-
vent clogs, tubes should be flushed with 10 to 20 mL of warm
water before and after each feeding, depending on patient and
tube size. Straining blenderized food can help prevent tube
obstructions, especially when small tubes are used.
The risk for cellulitis and peristomal inflammation is increased
if a purse-string suture is placed around the stoma. Inflamma-
tion and infection around the stoma site generally resolve with
tube removal and local wound therapy; stomas should always be
left to heal by second intention. Hemorrhage during tube place-
ment (uncommon) may occur if a skin incision is made before
the forceps tips are pushed through the esophageal wall and
subcutaneous tissue.
Esophageal leakage through esophageal wall tears (also uncom-
mon) can occur in very young patients with friable tissue, if
multiple attempts have been made to pass the tube or an exces-
sively large stoma is in the esophageal wall. Esophagitis and
vomiting may occur if the tube passes through the lower
esophageal sphincter.
Patients rarely vomit and dislodge the tube, allowing the end to
protrude from the mouth (more common with smaller, soft
tubes). The patient can then bite through the tube, resulting in a
gastric foreign body. Tube dislodgement requires replacement
under general anesthesia; immediate replacement through the
existing stoma is possible if the tube has been in place long
enough for fibrous tissue formation.
Aspiration pneumonia is a potential complication of enteral tube
feeding. Risk factors include absence of a gag or cough reflex,
impaired mental status, neurologic injury, mechanical ventila-
tion, presence of laryngeal disease (especially after arytenoid
lateralization surgery), and previous aspiration pneumonia. In
patients at high risk for aspiration pneumonia, gastrostomy or
jejunostomy tubes should be considered over esophagostomy
tubes. To reduce aspiration risk, feeding should not start until the
patient has fully recovered from anesthesia and can be kept in a
sternal position.
MORE
February 2014 • Clinician’s Brief 67
 Procedures Pro

What You Will Need

■ Clippers, 4% chlorhexidine scrub, gauze or roll cotton (for aseptic prep)
■ Sterile gloves
■ Sterile Huck towels and towel clamps (optional)
■ Sterile needle holders
■ Mayo suture scissors
■ Curved Carmalt (medium and large dogs) or Kelly (cats and small dogs) forceps
with long jaws and fine tips
■ Scalpel blade
■ 14- to 20-French red rubber, silicone elastomer, or polyurethane tube
■ Tubing adapter and injection cap (to permit capping of tube)
■ 0 or 2-0 nylon suture
■ Nonionic iodinated radiographic contrast (eg, iohexol)
■ Triple antibiotic ointment
■ Nonadherent dressing and bandage material
■ Fabric, washable esophageal feeding-tube collar (eg, Kitty Kollar, kittykollar.com;
optional)

Step-by-Step ■ Esophageal Tube Placement

Step 1 Step 2

Place the anes- Premeasure the

thetized patient tube from the
in lateral recum- midcervical
bency and clip esophagus to
and aseptically the level of the
prepare the 5th–8th inter-
lateral cervical costal space.
region.

Step 3
Author Insight To
ensure appropriate place-
Cut the tip of the tube to remove any ment, use a permanent
blind end and to ensure appropriate marker to indicate where
length. Alternatively, if the tube does the tube will be level with
not need to be shortened, elongate the skin when properly
the side-hole opening to help prevent positioned. Alternatively,
clogging. The tube should be long have a second tube of the
enough so that the proximal end same length available.
exiting the neck can be gently curved
away from the head.

68 cliniciansbrief.com • February 2014

 Step 4

Insert Carmalt (medium and large dogs)

or Kelly (cats and small dogs) forceps
through the oral cavity and into the cervi-
cal esophagus with the tips facing outward.
Choose forceps that are long and narrow
enough to pass caudal to the hyoid
apparatus.

Step 5

Tilt the forceps (ie, lower the handle

toward the table) so the tips (arrow) are
pressing the esophagus outward and dorsal
to the jugular vein, and palpate the neck to
determine where the esophagus is most
superficial. Placing a sandbag or towel
under the neck may facilitate passing and
tilting the forceps and aid in isolation of
the esophagus against the skin.

Step 6

Using the palm of the dominant hand, apply steady pressure to
the forceps rings (A), making sure not to insert fingers into the
rings. With the nondominant hand, make a fist and apply
downward pressure over the tips of the forceps to force them
through the esophageal wall and musculature of the neck. This
pushes the jugular vein (B), carotid artery (arrow; note proxim-
ity of carotid artery and vagosympathetic trunk to the esopha-
gostomy tube), and other neurovascular structures aside to pre-
vent trauma. On palpation, the forceps tips are indistinct until
pushed through the esophageal wall and cervical musculature.

Author Insight The

esophageal wall can be
inadvertently caught and
torn if the box locks of
the forceps open and the
tips separate before they
penetrate the skin. The
clamps must remain
firmly closed until the
tips protrude through the
skin incision.

A B
MORE

February 2014 • Clinician’s Brief 69

 Procedures Pro

Step 7
Author Insight If the
tube end is large, it can
With a scalpel blade, incise the skin over
be cut at an angle to more
the forceps tips. Place a palm on the han-
easily clamp the forceps
dle rings and push the forceps tips through
to pull the tube end back
the incision. Open the tips just enough to
through the skin and
grasp then clamp the tube end.
esophageal wall.

Step 8

Pull the tube end rostrally through the

neck and out through the oral cavity. Leave
several centimeters of the proximal tube
end protruding from the incision. At this
point, the distal tip of tube will be facing
rostrally and the proximal end will be
facing caudally.

Step 9

Redirect the distal tip of the tube through

the oropharynx (A) and gently advance
the tube as far as possible into the esoph-
agus using fingers or forceps tips. Avoid
encircling the endotracheal tube or its
gauze tie with the esophagostomy tube.
Once the tube has been advanced as dis-
tally as possible, retract the proximal
end through the skin incision several cen-
timeters until the tube is redirected in a A
rostrocaudal position (B). Adjust the tube
to the premeasured appropriate length
and cap the end.

70 cliniciansbrief.com • February 2014

 Step 10
Author Insight Esophagostomy tubes frequently fold as
they are advanced through the oropharynx and into the esoph-
Secure the tube to the
agus. If the proximal end of the tube is retracted from the neck
skin with 0 or 2-0
while the folded section is pushed down toward the esophagus,
nylon in a finger trap
the folded section is gradually pulled out of the esophageal per-
pattern. A purse-string
foration and will palpably unfold, allowing the tube to reorient
suture should not be
itself with the proximal end facing rostrally. The proximal end
used. In cats, include a
of the tube can then be redirected and the tube advanced far-
bite of deep muscle or
ther down the esophagus.
the periosteum of the
atlas wing to prevent
tube migration from
neck movement.

Step 11 Ensure the tube is properly positioned via lateral radiography (A). If placement is uncertain, infuse a small
amount of nonionic contrast material to differentiate the esophagostomy tube from the endotracheal tube or
jugular catheter (B). If the tube is in the trachea, the portion running in the proximal cervical region will be
visibly ventral to the esophagus on radiography (C).

A B

Inadvertent tube insertion

into the trachea; note the
position of the proximal
esophagus (arrow)
compared with the
esophagostomy tube
(arrowhead). The jugular
catheter is in the ventral
neck.

MORE

February 2014 • Clinician’s Brief 71

 Procedures Pro

Step 12

Once tube position is verified,

bandage the neck to cover the
stoma site. The bandage
should be changed daily for
the first week and as needed
thereafter.

Step 13

The tube can be left in as long as it is needed (eg, months); sutures may need to be replaced
monthly to keep the tube secure. The tube can be replaced if a blockage or degradation
occurs or if the end connected to the adapter splits. If the tube has been in place long
enough for formation of a fibrous stoma (ie, 7 days or more), it can be replaced as needed
through the stoma. The patient should be anesthetized for tube replacement, and tube
position should be confirmed with radiographs.

Once the esophagostomy tube is no longer needed, anchoring sutures should be removed
and the tube clamped and removed. The site should be bandaged and left to heal by second
intention, which usually occurs within a week of tube removal. ■ cb

Replacement of a blocked esophagostomy tube attempted with an awake patient resulted in collapse
of the stoma, inadvertent placement of the tube (arrow) into the mediastinum, and subsequent mild
pneumothorax.

See Aids & Resources, back page, for references & suggested reading.

72 cliniciansbrief.com • February 2014

 IJVS 2016; 11(1); Serial No:24

IRANIAN JOURNAL OF
VETERINARY SURGERY
(IJVS)
WWW.IVSA.IR

Evaluating the Feasibility of Esophagotomy Suture Line Reinforcement Using

Platelet Rich Fibrin Membrane and Its Effect on Wound Healing

Amidreza Jeyrani Moghaddam1, Davoud Kazemi*2

Abstract
Objective- This study aimed to evaluate the feasibility of using platelet rich fibrin membrane as a novel
on-lay patching biomaterial in canine esophagotomy and its effects on esophageal wound healing.
Design- Experimental study.
Animals- Eight adult mixed breed dogs of both sexes equally allocated to control and treatment groups.
Procedures- Longitudinal incisions measuring 3 cm were made in the cervical esophagus of all dogs (2
incisions in each dog). All incisions were sutured and on-lay patching was performed in four dogs using
platelet rich fibrin. After 28 days, wound healing was assessed by macroscopic, histological and
biochemical methods
Results- Patching resulted in less adhesion formation (18.24 vs. 61.67 mm, p<0.05) and increase in tissue
hydroxyproline content (91.31 vs. 74.31 mg, p>0.05). Histologically, platelet rich fibrin membrane
mostly influenced wound healing in the outer layers of the esophagus particularly the muscular layer
although a slightly better wound healing was observed overall.
Conclusion and Clinical Relevance- Platelet rich fibrin membrane could be used as an alternative
patching biomaterial in esophageal surgery although further investigations needs to be carried out
particularly in clinical cases.
Key words- Platelet rich fibrin membrane, Onlay patching, Esophagus, Dog, Wound healing.

Introduction The resultant product is a true biomaterial containing

Esophagotomy is commonly performed to remove
foreign bodies and treat esophageal perforations or
diverticula.1,2 Dehiscence and leakage are the two most
important complications of esophagotomy with
catastrophic results.3,4 Patching of the suture line with
various tissues has been used to prevent leakage and
improve wound healing.1,2,5,6 Despite their success,
these patching techniques are technically demanding to
perform and invasive leading to prolonged operative
times and increased postoperative complications.
Platelet rich fibrin (PRF) is a second generation platelet
concentrate developed by Choukroun et al.7 Venous
blood from the patient is collected into glass tubes
without anticoagulants and immediately centrifuged.
platelets, leukocytes and growth factors trapped inside a
dense network of fibrin clot. It can be used either as a
clot or membrane and the latter form can easily be
sutured in place during surgical procedures. PRF has
been used in oral, maxillofacial, ENT (ear, nose and
throat), plastic and orthopaedic surgery.7-13
The purpose of the present study was to evaluate the
feasibility of using PRF membrane as an autologous
biomaterial to reinforce esophageal incisions in an
experimental animal model. It was hypothesized that
PRF membrane could prevent dehiscence and leakage
and improve wound healing through the release of
growth factors.
Materials and Methods

1Graduate of the Department of Veterinary Clinical Sciences, Tabriz Branch,

Animals & Study design
Islamic Azad University, Tabriz, Iran.
2Department of Veterinary Clinical Sciences, Tabriz Branch, Islamic Azad
This study was approved by the experimentation ethics
University, Tabriz, Iran.
Address all correspondence to Davoud Kazemi (DVM, DVSc),
committee and research council of the Faculty of
E-mail: dkazemi@iaut.ac.ir Veterinary Medicine, Islamic Azad University, Tabriz
Received 30 Aug 2015 ; accepted 17 Dec 2015 branch. It was carried out on 8 adult mixed breed dogs
of both sexes with the body weight of 20.34 ± 5.23 kg

9
 IJVS 2016; 11(1); Serial No:24
(mean ± SD). They were housed individually with
adherence to institutional guidelines for the care and use
of laboratory animals in research. Their health status at
the time of experimentation was determined based on
findings from physical examination and laboratory tests
(complete blood cell count, blood biochemistry profiles,
and urinalysis).
The dogs were randomly allocated to two identical
groups consisting of 4 animals per group. Cervical
esophagotomy was performed on all animals and the
esophageal suture line was reinforced with platelet rich
fibrin membrane in the treatment group. The animals
were kept for 28 days and then euthanized to evaluate
the esophageal wound healing using macroscopic,
histological and biochemical parameters.
PRF preparation method
Autologous PRF was prepared according to the method
described by Dohan et al.14 Prior to induction of
anesthesia, 20 ml of whole blood was collected from the
jugular vein of each treatment animal into two sterile
glass test tubes without any anticoagulants. The blood
samples were immediately centrifuged at 3000 rpm (400
g) for 10 minutes using a laboratory centrifuge (Hermle
Z 206 A, Germany). The PRF clot located in the middle
section of the sample was removed from the test tube
during surgery and the red blood cells at the bottom and
acellular plasma at the top of the sample were discarded.
The clots were pressed gently between sterile gauze
sponges in order to obtain the PRF membrane which
was sutured over the esophagotomy incision (Fig.1).
Figure 1. PRF produced in the middle layer of blood
sample (arrow) immediately following centrifugation (a)
and its clot (b) and membrane (c) forms
Surgical Procedure
The animals were fasted for 12 hours before surgery. A
combination of ketamine (Ketamine 10%, alfasan,
woerden, Holland) 5 mg/kg and acepromazine
(Neurotranque 1%, alfasan, woerden, Holland) 0.05
mg/kg plus atropine (Atropine sulphate 0.5,
Daroupakhsh Co., Iran) 0.03 mg/kg was injected
intramuscularly as pre-medication. Anesthesia was
10
induced by injecting 2.5% solution of thiopental 10
mg/kg (Thiopental sodium 1 gr, Sandoz GmbH, Kundl,
Austria) through an IV catheter placed in the cephalic
vein and maintained by 1-1.5% halothane (Fluothane
250 ml, Nicholas Piramal India Ltd.) in oxygen after
endotracheal intubation. Cefazolin (Cefazolin 1 gr,
Loghman Pharmaceuticals, Iran) 20 mg/kg was given as
preoperative antibiotic immediately after induction and
lactated ringer’s solution (Lactated Ringer 500 ml,
Shahid Ghazi Pharmaceutical Co., Tabriz, Iran) 10
ml/kg/hr was infused during the surgery.
The dogs were placed in dorsal recumbency on the
operating table and the ventral neck region was
aseptically prepared. A ventral midline cervical incision
was made on the skin beginning from the larynx and
extending to the manubrium. The platysma muscle and
subcutaneous tissues were incised and retracted. After
separation of the sternohyoid and sternocephalicus
muscles and retraction of the underlying trachea to the
right, access was gained to the cervical esophagus.
Moistened gauze sponges were used to pack off the
esophagus from the remainder of the surgical field. Stay
sutures were placed and two longitudinal full thickness
incisions measuring 3 cm were made in the cranial and
caudal cervical esophagus of each dog therefore a total
of 8 incisions /group were created. The esophageal
lumen was flushed with warm saline solution and the
incisions were sutured with single layer simple
interrupted pattern using 3/0 nylon (Supalon, Supa
Medical Devices, Tehran, Iran). The sutures were
placed 2 mm from the wound edge and 2 mm apart. The
integrity of suture line was checked by occluding the
lumen, injecting saline and observing for any leakage
between sutures after applying gentle pressure. In the
treatment group, PRF membrane was sutured over the
incision using simple interrupted pattern to reinforce the
esophagotomy suture line (Fig.2). The incised muscles,
subcutaneous tissues and skin were sutured routinely to
complete the procedure.
Postoperatively, antibiotic therapy with cefazolin 20
mg/kg IV was continued for 5 days and the animals
were given ketoprofen (Vetofen, Aburaihan
Pharmaceuticals Co., Tehran, Iran) 2 mg/kg IM for 3
days as analgesic. Oral food was withheld for 24 hours
and blenderized diet was offered for the next 3 days
until the animals were gradually returned to their normal
diet.
Figure 2. Completed patching of esophagotomy suture
line using PRF clots sutured over the incisions
 IJVS 2016; 11(1); Serial No:24
Macroscopic and histological examination
The dogs were first anesthetized with thiopental 10
mg/kg IV and subsequently euthanized with an
overdose of the same drug on the 28th postoperative day.
Access was gained to the cervical esophagus via the
same approach used during the surgery. The
esophagotomy incisions were indentified and digital
photographs were taken to measure the adhesion length.
The adhesions were bluntly and carefully dissected and
the cervical esophagus was totally removed. Each
incision was then sectioned into two halves and the
sections were used for histological and biochemical
evaluations.
For histological analysis, the samples were fixed in 10%
buffered neutral formalin and embedded in paraffin for
routine sectioning. The 5 µm thick sections were stained
with hematoxylin-eosin and Masson’s trichrome and
examined blindly under the light microscope to evaluate
the healing of different layers of the esophagus. Digital
photographs of the healed incision area were taken and
the following histomorphometric measurements were
made: thickness of the newly formed mucosal
epithelium, thickness of the healing reaction defined as
the thickness of the healed esophageal wall at the
incision site without the mucosal layer and length of the
healed area devoid of submucosal glands and muscular
layer. The former two measurements were made at the
center of the healed area and at the edges of the incision
with normal esophageal tissue and the mean of the three
measurements were used for each sample. All
macroscopic and histological measurements were made
using the ImageJ software (ImageJ 1.45s, National
Institutes of Health, USA).
Hydroxyproline measurement
Tissue specimens harvested for biochemical analysis
were preserved at -70 °C. The amount of tissue
hydroxyproline was measured by modified
spectrophotometric method described by Podenphant et
al.15
Statistical analysis
One sample or unpaired t-test was used to compare the
mean values of the quantitative data between the two
experimental groups. The significance level was defined
as P<0.05. GraphPad Prism 5 software package
(GraphPad Software Inc., La Jolla, CA) was used for
data analysis.
Results
All animals survived the surgical procedure and no
mortalities were recorded during the experimental
period. Postoperative complications such as
regurgitation, vomiting, dysphagia or infection were not
11
observed. Incisional swelling was observed to some
extent in all dogs after the surgery which resolved in a
few days.
At macroscopic examination, adherence of the incision
site to the surrounding soft tissues was observed in all
dogs. Although permanent adhesions were not seen and
they were broken down by gentle blunt dissection, but
stronger adhesions were observed in the control group
(Fig.3). Also the extent of the adhesions in the treatment
group was significantly lower in comparison with the
control group (Fig.4). Wound dehiscence, leakage,
stricture and fistula formation was not observed in any
of the dogs. PRF membrane used in the treatment group
was indistinguishable from the surrounding tissues.
Figure 3. Adhesion of the esophagus to the surrounding
tissues in control (a) and treatment (b) groups indicating
stronger and lengthier adhesions in the control group.
Figure 4. Mean adhesion length in the two treatment
groups, error bars indicate standard deviation (SD) and
the P value represents the statistical difference between
the two groups
The incision site was readily identifiable in histological
sections from the surrounding normal tissue due to
alterations observed in the structure of the esophagus.
Complete epithelial regeneration was observed in all 8
samples of the treatment group and 7 samples from the
control group. The newly formed mucosal epithelium
was thinner than the surrounding normal epithelium in
both groups. The submucosal and muscular layers of the
esophagus had lost their normal structure and were
mainly replaced by a newly formed fibrous or
collagenous reparative tissue in both experimental
groups. The submucosal glands and muscles were
confined to the edges of the incision (Fig.5). Results of
histomorphometric measurements indicated better
wound healing in the treatment group. Mean thickness
 IJVS 2016; 11(1); Serial No:24
of the newly formed epithelial layer along with the
healing reaction in the treatment group was more than
the control group although the difference was not
statistically significant. Mean length of the esophagus
devoid of submucosal glands in the treatment group was
insignificantly less than the control group whereas the
mean length of the esophagus lacking any muscular
layer was significantly less in the treatment group in
comparison to controls (Fig.6).
Figure 5. Representative histological sections of the
healed esophageal tissue at the site of the incision.
Incomplete mucosal re-epithelialisation (arrow) can be
seen in the control group (a) while complete re-
epithelialisation is observed in the treatment group (b)
(Hematoxylin-eosin staining, bars= 2.04 µm).
Figure 6. Mean values of the histomorphometric
measurements in the two treatment groups, error bars
indicate standard deviation (SD) and the P value
represents the statistical difference between the two
groups.
12
Mean tissue hydroxyproline content of the treatment
group was more than the control group but there was no
statistically significant difference between the two
groups (Fig.7).
Figure 7. Mean tissue hydroxyproline content in the two
treatment groups, error bars indicate standard deviation
(SD) and the P value represents the statistical difference
between the two groups
Discussion
Esophagotomy or esophageal surgery in general has
always been associated with higher postoperative
complication rates in comparison with other parts of the
gastrointestinal tract. Several factors have been held
responsible including the presence of adventitia instead
of serosal layer leading to ineffective fibrin production
and sealing of the incision site, segmental blood supply,
lack of omentum, constant motion and distension
resulting from deglutition and respiration and the
inability of the esophagus to tolerate tension.1, 2, 5 It has
also been suggested that suture placement in the mucosa
is made more difficult due to its considerable retraction
from the cut margin of the esophagus which has been
attributed to the unusual mobility of the mucosa
resulting from the fat content of the submucosal layer.16
Low vascularity and excess tension at the suture line
appear to be the major reasons for delayed wound
healing and problems encountered in esophageal
surgery.17 Apart from that, collagen metabolism is the
most important influential factor in esophageal wound
healing. The polymerized collagen present in normal
esophageal tissue is replaced by immmature and
mechanically weaker newly formed collagen hence the
probability of dehiscence and leakage increases at days
4 to 7 following surgery.18 To minimize the incidence of
wound dehiscence and esophageal leakage, patching of
the suture line with various tissues has been
recommended. Apart from the periesophageal muscles,
greater omentum has been used for this purpose by
several investigators.17,19,20 Omental patching prevents
leakage and reduces adhesion of the incision to the
surrounding tissues. But it appears that the most
important benefit of using omentum lies in its ability to
increase revascularization and neovascularization of the
healing esophageal tissue through the release of its lipid
 IJVS 2016; 11(1); Serial No:24
angiogenic factors particularly vascular endothelial
growth factor (VEGF).19 Omentum must be harvested
from the abdominal cavity via celiotomy which
increases tissue destruction leading to increased patient
morbidity therefore its use outside the abdominal cavity
is infrequent.
PRF is a true biomaterial which can be prepared easily
and inexpensively from the patient’s own blood before
or during the surgical procedure. It is a rich source of
several growth factors including platelet derived growth
factor (PDGF), VEGF, transforming growth factor β
(TGFβ) and thrombospondin-1 which promote wound
healing mainly by stimulation of collagen production
and increase in wound strength.21 Due to the absence of
any anticoagulants in the preparation of PRF, platelet
activation is triggered resulting in the release of growth
factors and cytokines slowly over an extended period of
time in the site of PRF use.22-24 Apart from the growth
factors, large amounts of fibrin present in PRF also
promotes wound healing by allowing recruitment,
migration, adhesion and proliferation of cells needed for
wound repair.25
PRF is not the same as plasma and there are differences
between these two blood products. Plasma is the
supernatant obtained following centrifugation of a
whole blood sample which is taken with an
anticoagulant and contains only acellular components of
blood including hemostatic proteins. The addition of
calcium chloride and thrombin to plasma results in the
formation of diffuse fibrin clot and entrapment of all the
cellular components of blood in the clot. As previously
mentioned, PRF is produced by immediate
centrifugation of whole blood without any
anticoagulant. The absence of anticoagulant results in
the activation of platelets and release of fibrinogen
which is concentrated as a result of centrifugation in the
middle part of the test tube. Therefore, PRF or fibrin
clot is formed naturally during centrifugation in the
middle part of the sample and platelets plus leukocytes
are trapped inside the fibrin network. The red blood
cells at the bottom and the supernatant acellular plasma
or correctly termed serum can easily be separated from
the PRF clot.14,22,23
Dogs were chosen as the animal model to carry out this
study based on the recommendations of Dohan
Ehrenfest and colleagues. They argue that studies
involving the use of PRF should be carried out on large
animal species like dogs. True PRF clots which can be
used in various surgical procedures can be obtained in
these species as opposed to poor quality PRF like fibrin
which is produced in laboratory animals.26 The reason
for making two esophageal incisions in the cervical
region of each animal in this study was to limit the
13
number of animals used while creating acceptable
number of samples for analysis. Regarding the choice of
suture pattern for closure of esophageal incisions, we
opted for single layer instead of double layer simple
interrupted sutures to rapidly complete the operations
and decrease anesthesia time. Although it has been
accepted that traditional double layer single interrupted
pattern results in greater immediate wound strength,
better tissue apposition and improved esophageal wound
healing, but it takes longer to perform and single layer
closure can be a rapid, safe and effective alternative
which has been used successfully in clinical cases.1,2,5
Non absorbable suture materials were used to readily
identify the incision site during sampling.
The results of the present study indicated the positive
influence of PRF use on esophageal wound healing. The
PRF patch had reinforced the suture line and increased
its strength similar to omental graft but its preparation
was much faster and easier than obtaining omentum
from the abdominal cavity. Also the use of this
autologous biomaterial significantly reduced the amount
of adhesion formation. Collagen production assessed by
measuring the amount of tissue hydroxyproline was also
increased due to PRF use. Although angiogenesis and
neovascularisation was not quantified in the present
study by employing specific techniques like
immunohistochemistry, but due to the release of VEGF
from PRF patch, these features of wound healing could
also be expected to be increased by using PRF patches
to support esophagus.
Based on the results of the histological evaluations of
the present study, it seems that the growth factors
released from the PRF membrane mostly influenced the
wound healing process in the external layers of the
esophageal wall particularly the muscular layer. This
seems logical due to the fact that the PRF membrane
was sutured to the most external layer of the esophagus
i.e. the adventitia.
To the authors’ knowledge, this is the first study
describing the use of PRF membrane as an onlay patch
in esophageal surgery therefore the results could not be
compared with similar studies. Guinot et al27 have
successfully used autologous PRF membrane for
urethroplasty coverage in distal hypospadias surgery of
human patients. They concluded that PRF patch is a safe
and efficient coverage technique helping to reduce
postoperative complications in circumstances where
healthy tissue is unavailable for coverage.
Based on the results of the present study, it seems that
PRF membrane can be used as an alternative to other
methods of esophageal suture line reinforcement
techniques safely and effectively although further
studies should be carried out in clinical surgical cases.
 IJVS 2016; 11(1); Serial No:24
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‫‪IJVS 2016; 11(1); Serial No:24‬‬

‫ﻧﺸﺮﻳﻪ ﺟﺮﺍﺣﻲ ﺩﺍﻣﭙﺰﺷﻜﻲ ﺍﻳﺮﺍﻥ‬

‫ﺳﺎﻝ ‪ ،2016‬ﺟﻠﺪ ‪) 11‬ﺷﻤﺎﺭﻩ ‪ ،(1‬ﺷﻤﺎﺭﻩ ﭘﻴﺎﭘﻲ ‪24‬‬

‫ﭼﻜﻴﺪﻩ‬

‫ﺍﺭﺯﻳﺎﺑﻲ ﺍﻣﻜﺎﻥ ﺑﻜﺎﺭﮔﻴﺮﻱ ﻏﺸﺎء ﻓﻴﺒﺮﻳﻦ ﻏﻨﻲ ﺍﺯ ﭘﻼﻛﺖ ﺟﻬﺖ ﺍﺳﺘﺤﻜﺎﻡ ﻣﺤﻞ ﺑﺨﻴﻪ ﺩﺭ ﻋﻤﻞ ﺑﺮﺵ ﻣﺮﻱ ﻭ‬
‫ﺗﺎﺛﻴﺮ ﺁﻥ ﺑﺮ ﺍﻟﺘﻴﺎﻡ ﺯﺧﻢ‬

‫‪2‬‬
‫ﻋﻤﻴﺪﺭﺿﺎ ﺟﻴﺮﺍﻧﻲ ﻣﻘﺪﻡ‪ 1‬ﻭ ﺩﺍﻭﺩ ﻛﺎﻇﻤﻲ٭‬
‫‪P‬‬ ‫‪P‬‬ ‫‪P‬‬

‫‪1‬ﺩﺍﻧﺶ ﺁﻣﻮﺧﺘﻪ ﮔﺮﻭﻩ ﻋﻠﻮﻡ ﺩﺭﻣﺎﻧﮕﺎﻫﻲ‪ ،‬ﺩﺍﻧﺸﻜﺪﻩ ﺩﺍﻣﭙﺰﺷﻜﻲ‪ ،‬ﻭﺍﺣﺪ ﺗﺒﺮﻳﺰ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﺁﺯﺍﺩ ﺍﺳﻼﻣﻲ‪ ،‬ﺗﺒﺮﻳﺰ‪ ،‬ﺍﻳﺮﺍﻥ‪.‬‬‫‪P‬‬ ‫‪P‬‬

‫‪2‬ﮔﺮﻭﻩ ﻋﻠﻮﻡ ﺩﺭﻣﺎﻧﮕﺎﻫﻲ‪ ،‬ﺩﺍﻧﺸﻜﺪﻩ ﺩﺍﻣﭙﺰﺷﻜﻲ‪ ،‬ﻭﺍﺣﺪ ﺗﺒﺮﻳﺰ‪ ،‬ﺩﺍﻧﺸﮕﺎﻩ ﺁﺯﺍﺩ ﺍﺳﻼﻣﻲ‪ ،‬ﺗﺒﺮﻳﺰ‪ ،‬ﺍﻳﺮﺍﻥ‪.‬‬
‫‪P‬‬ ‫‪P‬‬

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‫ﺍﻓﺰﺍﻳﺶ ﺍﺳﺘﺤﻜﺎﻡ ﻣﺤﻞ ﺑﺨﻴﻪ ﺑﻪ ﻋﻨﻮﺍﻥ ﺭﻭﺷﻲ ﺟﺪﻳﺪ ﺩﺭ ﻋﻤﻞ ﺑﺮﺵ ﻣﺮﻱ ﺑﻮﺩ‪.‬‬
‫ﻃﺮﺡ‪ -‬ﻣﻄﺎﻟﻌﻪ ﺗﺠﺮﺑﻲ‬
‫ﺣﻴﻮﺍﻧﺎﺕ‪ -‬ﻫﺸﺖ ﻗﻼﺩﻩ ﺳﮓ ﺑﺎﻟﻎ ﻧﺮ ﻭ ﻣﺎﺩﻩ ﺍﺯ ﻧﮋﺍﺩ ﻣﺨﻠﻮﻁ‬
‫ﺭﻭﺵ ﻛﺎﺭ‪ -‬ﺣﻴﻮﺍﻧﺎﺕ ﺑﻄﻮﺭ ﺗﺼﺎﺩﻓﻲ ﺑﻪ ﺩﻭ ﮔﺮﻭﻩ ﻣﺴﺎﻭﻱ ﺷﺎﻫﺪ ﻭ ﺗﻴﻤﺎﺭ ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ‪ .‬ﺩﺭ ﻗﺴﻤﺖ ﻣﺮﻱ ﮔﺮﺩﻧﻲ ﻫﺮ ﺣﻴﻮﺍﻥ ﺩﻭ ﺑﺮﺵ ﺑﻪ ﻃﻮﻝ ‪3‬‬
‫ﺳﺎﻧﺘﻴﻤﺘﺮ ﺍﻳﺠﺎﺩ ﺷﺪ‪ .‬ﺗﻤﺎﻣﻲ ﺑﺮﺷﻬﺎﻱ ﺍﻳﺠﺎﺩ ﺷﺪﻩ ﺑﺨﻴﻪ ﺯﺩﻩ ﺷﺪ ﻭ ﺩﺭ ﮔﺮﻭﻩ ﺗﻴﻤﺎﺭ ﺍﺯ ﻏﺸﺎ ء ﻓﻴﺒﺮﻳﻦ ﻏﻨﻲ ﺍﺯ ﭘﻼﻛﺖ ﺑﻪ ﻋﻨﻮﺍﻥ ﻭﺻﻠﻪ ﺑﺮ ﺭﻭﻱ ﺧﻂ‬
‫ﺑﺮﺵ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪ‪ .‬ﭘﺲ ﺍﺯ ﺳﭙﺮﻱ ﺷﺪﻥ ﻣﺪﺕ ﺯﻣﺎﻥ ‪ 28‬ﺭﻭﺯ ﺍﻟﺘﻴﺎﻡ ﺯﺧﻢ ﺩﺭ ﻣﺤﻞ ﺑﺮﺵ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺭﻭﺵ ﻫﺎﻱ ﻣﺎﻛﺮﻭﺳﻜﻮﭘﻲ‪ ،‬ﻣﻴﻜﺮﻭﺳﻜﻮﭘﻲ ﻭ‬
‫ﺑﻴﻮﺷﻴﻤﻴﺎﻳﻲ ﻣﻮﺭﺩ ﺍﺭﺯﻳﺎﺑﻲ ﻭ ﻣﻘﺎﻳﺴﻪ ﻗﺮﺍﺭ ﮔﺮﻓﺖ‪.‬‬
‫ﻧﺘﺎﻳﺞ‪ -‬ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻏﺸﺎ ء ﻓﻴﺒﺮﻳﻦ ﻏﻨﻲ ﺍﺯ ﭘﻼﻛﺖ ﻣﻨﺠﺮ ﺑﻪ ﻛﺎﻫﺶ ﻣﻌﻨﻴﺪﺍﺭ ﻣﻴﺰﺍﻥ ﭼﺴﺒﻨﺪﮔﻲ ) ‪ 18/24‬ﻣﻴﻠﻴﻤﺘﺮ ﺩﺭ ﻣﻘﺎﻳﺴﻪ ﺑﺎ ‪ 61/67‬ﻣﻴﻠﻲ ‪-‬‬
‫ﻣﺘﺮ( ﻭ ﺍﻓﺰﺍﻳﺶ ﻏﻴﺮ ﻣﻌﻨﻴﺪﺍﺭ ﻣﻴﺰﺍﻥ ﻫﻴﺪﺭﻭﻛﺴﻲ ﭘﺮﻭﻟﻴﻦ ﺑﺎﻓﺖ ﺍﻟﺘﻴﺎﻣﻲ ) ‪ 91/31‬ﻣﻴﻠﻴﮕﺮﻡ ﺩﺭ ﻫﺮ ﮔﺮﻡ ﺑﺎﻓﺖ ﺩﺭ ﻣﻘﺎﻳﺴﻪ ﺑﺎ ‪ 74/31‬ﻣﻴﻠﻴﮕﺮﻡ ﺩﺭ‬
‫ﻫﺮ ﮔﺮﻡ ﺑﺎﻓﺖ( ﺷﺪ‪ .‬ﻫﻤﭽﻨﻴﻦ ﻏﺸﺎء ﻓﻴﺒﺮﻳﻦ ﻏﻨﻲ ﺍﺯ ﭘﻼﻛﺖ ﺗﺎﺛﻴﺮ ﺑﻴﺸﺘﺮﻱ ﺩﺭ ﺍﻟﺘﻴﺎﻡ ﻻﻳﻪ ﻫﺎﻱ ﺧﺎﺭﺟﻲ ﺟﺪﺍﺭﻩ ﻣﺮﻱ ﺑﺨﺼﻮﺹ ﻻﻳﻪ ﻋﻀﻼﻧﻲ ﺍﻳﺠﺎﺩ‬
‫ﻛﺮﺩﻩ ﺑﻮﺩ ﻫﺮﭼﻨﺪ ﺍﻟﺘﻴﺎﻡ ﻛﻠﻲ ﺯﺧﻢ ﺩﺭ ﮔﺮﻭﻩ ﺗﻴﻤﺎﺭ ﺑﻬﺘﺮ ﺍﺯ ﮔﺮﻭﻩ ﺷﺎﻫﺪ ﺑﻮﺩ‪.‬‬
‫ﻧﺘﻴﺠﻬﮕﻴﺮﻱ ﻭ ﻛﺎﺭﺑﺮﺩ ﺑﺎﻟﻴﻨﻲ‪ -‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻧﺘﺎﻳﺞ ﺣﺎﺻﻠﻪ ﺑﻪ ﻧﻈﺮ ﻣﻴﺮﺳﺪ ﻛﻪ ﻏﺸﺎ ء ﻓﻴﺒﺮﻳﻦ ﻏﻨﻲ ﺍﺯ ﭘﻼﻛﺖ ﻣﻴﺘﻮﺍﻧﺪ ﺟﺎﻳﮕﺰﻳﻦ ﻣﻨﺎﺳﺒﻲ ﺟﻬﺖ‬
‫ﺑﻜﺎﺭﮔﻴﺮﻱ ﺑﻪ ﻋﻨﻮﺍﻥ ﻭﺻﻠﻪ ﺭﻭﻱ ﺧﻂ ﺑﺮﺵ ﺩﺭ ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﺳﺎﻳﺮ ﺭﻭﺵ ﻫﺎ ﺑﺎﺷﺪ ﻫﺮ ﭼﻨﺪ ﻣﻄﺎﻟﻌﺎﺕ ﺑﺎﻟﻴﻨﻲ ﺑﻴﺸﺘﺮﻱ ﻣﻮﺭﺩ ﻧﻴﺎﺯ ﻣﻴﺒﺎﺷﺪ‪.‬‬
‫ﻛﻠﻤﺎﺕ ﻛﻠﻴﺪﻱ‪ -‬ﻏﺸﺎء ﻓﻴﺒﺮﻳﻦ ﻏﻨﻲ ﺍﺯ ﭘﻼﻛﺖ‪ ،‬ﻭﺻﻠﻪ ﺧﻂ ﺑﺮﺵ‪ ،‬ﻣﺮﻱ‪ ،‬ﺳﮓ‪ ،‬ﺍﻟﺘﻴﺎﻡ ﺯﺧﻢ‪.‬‬

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