Inside the Advanced Surgical Services at BEVS
When your patients require advanced surgery – emergency or not – look no further than BEVS. Our Surgery department, led by board-certified veterinary surgeon Jacob Helmick, DVM, DACVS-SA, and staffed by a team of experienced licensed technicians, is here to provide a broad range of surgical services for your patients and to ensure the best possible outcome. The types of surgical procedures we perform include:

  • 24/7 emergency and trauma
  • Cardiothoracic/cardiopulmonary
  • Gastrointestinal/hepatobiliary
  • Neurosurgery
  • Orthopedic
  • Reconstructive
  • Soft tissue
  • Urinary tract
  • And much more

Beyond the procedures themselves, BEVS also provides:

  • Sophisticated diagnostic imaging equipment to provide the most accurate pre-surgical planning available. Our modalities utilize CT, MRI, digital radiograph, endoscopy, fluoroscopy, and ultrasonography. 

  • Leading-edge pain management techniques using peri-incisional liposome-encapsulated bupivacaine, combined with a multimodal approach to pain management that includes NSAIDs, NMDA receptor antagonists, and GABAergic drugs. This allows for a reduction in the need for opioids, reducing the risk of side effects and helping us ensure patient comfort, safety, and surgical success. 

  • Access to our Rehabilitation team, who aim to reduce pain, improve muscle mass, and enhance range of motion, while focusing on patient comfort and quality of life, post-surgery. Patients that benefit the most include those with osteoarthritis of the hips, stifles, elbows, and other joints – and patients with ligamentous or tendinous injuries, fractures, and spinal cord injuries.
Surgical Case Study: Tibial Fracture Repair Using Fluoroscopic Guidance & External Fixation
Patient: Oakley, a 2-year-old spayed female Treeing Walker Coon Hound who is a regular patient of Enosburg Veterinary Care in Enosburg Falls, VT.
Presentation: Oakley presented to BEVS Emergency Service after being hit by a tractor. She presented with right pelvic limb lameness. 

Diagnostics: Thoracic radiographs revealed mild pneumothorax and pulmonary contusions of the left caudal lung fields. Radiographs of the right pelvic limb revealed a closed, severely comminuted, mid-diaphyseal right tibial fracture. (Fig. 1)

Treatment: A splint was placed for temporary fracture stabilization to improve patient comfort and reduce ongoing bone and soft tissue damage. Her respiratory rate and effort, as well as pulse oximetry, were monitored overnight. Thoracocentesis was not required due to a lack of respiratory signs. Oakley was discharged the following day to allow her pneumothorax and pulmonary contusions to resolve before surgery on her tibial fracture. 

Oakley returned to BEVS a few days later for surgical consultation. Recheck thoracic radiographs revealed resolution of her pneumothorax and pulmonary contusions and closed reduction with external fixation recommended for fracture repair. Oakley underwent general anesthesia for placement of a modified type 2 external fixator under fluoroscopic guidance. (Fig. 2) Oakley recovered well and was discharged the following day. She then presented weekly to BEVS for bandage changes with BEVS lead surgery technician, Melissa Daley, CVT.

At her 4-week recheck radiographs, significant healing of the tibia was noted with no complications. Staged disassembly was begun by cutting the lateral pins, resulting in a type 1a external fixator. Oakley continued weekly bandage changes with Melissa until her 8-week recheck radiographs. (Fig. 3) These revealed complete healing of the tibial fracture, allowing removal of the remainder of the external fixator. (Fig. 4) Oakley has since returned to normal activity.  
Fig. 1 Pre-op
Fig. 2 Post-op
Fig. 3 Post-op
Takeaway: The use of fluoroscopic guidance allowed a closed approach to reduction and alignment of the tibial fracture. Open fracture repair involves invasive approaches to the bone that disrupt blood supply to the fracture site and increase patient morbidity. This, in turn, affects the biological response to fracture healing, slowing the bone healing process and increasing the risk of fracture non-union. Our approach allowed early comfortable return to function, as well as early removal of the external fixator. 

The most important aspect of post-operative external fixator maintenance is pin tract wound management. Melissa’s skills in bandage management allowed for the maintenance of healthy pin tracts that prevented pin loosening. Staged disassembly of an external fixator involves removal of a portion of the frame after some healing has started. This weakens the construct and allows progressive loading of the bone to strengthen the callus prior to the complete removal of the fixator. 

This case exemplifies how the use of fluoroscopy to allow closed reduction and external fixation, along with proper pin tract management and staged disassembly, combine to allow early return to comfortable function, prevention of pin tract loosening, and rapid healing of complex fractures resulting in a positive patient outcome.  
Meet Jacob Helmick, DVM, DACVS-SA
Dr. Helmick joined the BEVS team in June 2020. Before joining us, he enjoyed an eclectic background in veterinary surgical opportunities including as a clinical instructor at The University of Georgia College of Veterinary Medicine, working at large and small general practices in Maryland and an emergency practice in West Virginia, and volunteering at People United for Rescue and Rehabilitation (P.U.R.R.), a nonprofit cat rescue organization, as a veterinarian and a board member.

He has a special interest in orthopedic surgery, including TPLO and long bone fractures.
Outside of BEVS, Dr. Helmick enjoys mountain biking and hiking. He and his wife share their home with two rescued mixed breed dogs, Millie and Bernie, and two cats, Karma and Hubert. 

DVM: Mississippi State University College of Veterinary Medicine
Internship: Small Animal Medicine and Surgery, Mississippi State University College of Veterinary Medicine
Residency: Small Animal Surgery, The University of Georgia College of Veterinary Medicine
Board Certified: American College of Veterinary Surgeons (2020)
A Truly Collaborative Approach

The best relationships successfully serve the interests of both partners. Our goal is to support you, your practice, and your patients in a manner that works well for all parties.

Each month, we will be sending you information about our services and other items we hope you find helpful. If you have any questions about our Surgery department or would like to discuss a patient, please call us at 802.863.BEVS (2387). To help expedite the referral process, you can fill out our Patient Referral Form online, or visit our Referring Veterinary Portal. We’re here to help in whatever way we can.
COVID-19 Safety Protocols: Curbside Service 

For the health and safety of our clients and staff, we are providing exclusively curbside care until further notice. Please visit our COVID-19 web page for updates, including details on all of our safety protocols related to specialty appointments, visitation, discharge, medication refills, end-of-life options, and more. We are still experiencing a high demand for emergency veterinary services and continue to triage emergency cases to care for the most critically injured or ill pets first.
Burlington Emergency and Veterinary Specialists
1417 Marshall Avenue, Williston, VT 05495 | 802.863.2387 |
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