The Impact of Needle-Tip Monopolar Electrocautery on Surgical Outcomes in Dogs Undergoing Folded Flap Palatoplasty: a retrospective cohort study of 66 brachycephalic dogs undergoing multilevel surgery for airway obstruction

Brachycephalic obstructive airway syndrome (BOAS) is a well-known cause of respiratory distress in brachycephalic breeds, with an elongated soft palate being the primary trigger, followed by stenotic nostrils. Treating soft-palate abnormalities is a key component of surgical management for this condition, along with nostril-widening procedures. Because the thickness of the soft palate also significantly contributes to increased airflow resistance, Folded Flap Palatoplasty (FFP) is believed to address both thickness and length simultaneously, resulting in better outcomes than traditional staphylectomy. Various dissection methods for staphylectomy have been reported, but data on FFP are limited in the literature. This PhD thesis aims to investigate the outcomes, surgical efficiency, and postoperative complications of needle-tip monopolar electrocautery (NTME) used in FFP performed by a single experienced Dipl.ECVS surgeon on brachycephalic dogs. The study involved a retrospective cohort of 66 dogs. All dogs underwent a standardized multilevel surgical approach, including FFP, trader (suture-less) rhinoplasty (TR), ala-vestibuloplasty (AV), and tonsillectomy, as indicated. When available, surgical and anesthetic times, along with 14-day postoperative examinations, were documented. Short-term follow-up was conducted six weeks after surgery using an objective functional grading system, and long-term follow-up was obtained via a telephone owner questionnaire. Significant improvement in BOAS functional grades was observed at the six-week mark. The average FFP surgical time was 14.29 ± 1.41 minutes, with an average anesthetic time of 84 ± 17.59 minutes. The overall complication rate was 25.7%, including 19.7% minor complications, no surgical wound issues, and a 6% mortality rate. At a median follow-up of 19 months, 94.3% of owners reported high satisfaction, and 86.4–92.8% of dogs exhibited excellent improvements in respiratory and gastrointestinal health. Short anesthetic and surgical times were achieved through careful handling of NTME during FFP, while maintaining an acceptable overall complication rate and no significant surgical wound dehiscence in all dogs treated with a multi-level approach for BOAS.