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Life-Saving Facial Surgery

A team from Pride Veterinary Centre in Derby have performed a life-saving operation – a first at Scarsdale Vets - on a puppy who suffered severe head injuries following a collision with a motorbike.

The facial reconstruction surgery, which was performed at Pride Veterinary Centre (Scarsdale’s state-of-the-art referral hospital) has been a success and now, seven-months on, Bella the 9-month old German Shepherd puppy has bounced back.

Bella was involved in a collision with a motorbike in Belper, Derbyshire, last October, where she suffered severe head injuries as a result of the accident. She was rushed to Pride Veterinary Centre, where she referred for investigations and emergency surgery.

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 maxillofacial (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.”

The CT scan also showed how the small pieces of bone from Bella’s nose and skull were loose, which needed to be removed before they could cause further problems such as infection or nasal obstruction. Bella was monitored in ICU for two days before being taken into emergency surgery, where Rosario worked with Ines Gordo, Surgical Resident, to begin reconstructing Bella’s head – something made slightly easier by having the 3D CT scan to refer to during the reconstruction.

An image of Bella's skull before and after surgery.

As Bella’s teeth had been knocked out of place, Rosario and Ines had to firstly stabilise her jaw and palate using an interdental wire frame (like a human brace) and dental resin, making sure that her teeth would line up again post-surgery.

Titanium mesh was then 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.

A Multi-Disciplinary Approach To Save Bella's Life
The operation took two hours and was a huge team effort: Caroline Fina, European Specialist in Veterinary Diagnostic Imaging, performed both the pre and post-surgery CT scans; Rosario Vallefuoco and Ines Gordo performed the operation; Ana del Alamo Foster, American Specialist in Anaesthesia, managed Bella’s general anaesthetic and post-surgery pain management; Veterinary Nurse Louise Stokes assisted Rosario and Ines in the management of this challenging case and a team of vet nurses and kennel assistants looked after Bella following the operation.

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.”

Due to how quickly the teams acted, and because Bella was comfortable post-surgery, amazingly within two days Bella was able to eat [wet foods only] by herself. She did not need extra pain relief, so her owners were able to manage her pain at home and she was discharged.

Rosario kept in regular contact with Bella’s owners to make sure everything was going well and two weeks later her stitches were removed and her wounds checked. Six weeks post-surgery Bella’s dental frame was removed under a general anaesthetic, where 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.

Watch Rosario Speaking To ITV News About The Case