DAVIS, Calif. -- Classical music played in the background as a team of surgeons leaned over Mischa, who lay anesthetized on the table, mouth wide open, tongue lolling to the side, all four legs in the air. The owners of the 7-year-old German shepherd had rushed her to the veterinary hospital at the University of California, Davis, after she ran in front of a small private plane and was clipped in the jaw by a propeller.
She was lucky. She had only a nicked lip and a few broken teeth, relatively minor wounds compared with many others that the veterinary surgeons Boaz Arzi and Frank Verstraete treat here. As experts on maxillofacial reconstruction, they have patched up pets with split heads, mashed-in faces, disfiguring tumors, dislocated jaws and, in a recent high-profile case, a dog whose entire snout and upper jaw were sheared off by a speeding motorcycle.
"In the past many of these animals would have been euthanized," Verstraete said. Now, "we can fix them."
A few months later, Mischa was back to playing with the family's cats and gnawing on bones. "To look at her, you'd never know she was hit," said her grateful owner, Christy Taylor. The only lingering consequence of her accident: Mischa won't go near planes.
Pets like her are undergoing reconstructive surgeries as sophisticated as anything in human medicine: joint replacements, skin and bone grafts, ligament repairs, even therapeutic eyelifts for ingrown lashes and, yes, nose jobs - the last resort for snuffling, short-nosed breeds like pugs and Persian cats.
That more and more pets are going under the knife stems partly from technological advances and the increasing presence of specialists in general practices. It is also a consequence of the fact that pets are living longer. Reaching 70, even in dog years, raises the odds of cancer and other ailments that call for surgical treatment.
But veterinarians say the biggest driver is demand by pet owners. Most now view their furry charges as members of the family - and are willing to spend accordingly.
"More people are willing to, let's face it, pay more for specialized people like myself to fix their pets," said Kevin McAbee, a veterinary surgeon in Auburn Hills, Mich. Those treatments can bring four- and even five-figure tabs, depending on the complexity of the problem and whether complications arise.
Since just 1 percent of Americans have pet insurance, most end up covering the expenses themselves. Christi Voelker, a Philadelphia-based consultant, and her husband spent $15,000 on a series of surgeries to treat a facial cancer afflicting Ace, their 7-year-old rescue dog.
"Ace is basically our child," said Voelker, 29. "We decided instead of buying a new car, we'd put it into Ace."
Nearly 50 reconstructive techniques for animals were pioneered by Michael M. Pavletic, director of surgical services at Angell Animal Medical Center in Jamaica Plain, Mass. Many of them are outlined in his seminal text, "The Atlas of Small Animal Wound Management & Reconstructive Surgery." It's a compendium of ways an animal's life can go wrong, full of advice on how to reattach severed paw pads, apply grafts to a burn, or repair a bullet wound.
These days, reconstructive surgery on pets often involves procedures that would be difficult in humans. For one thing, it's relatively easy to move around pieces of skin on dogs and cats. To treat a greyhound whose thigh was shredded in an attack by other dogs, Kat Ham, a veterinary surgeon at Ohio State University, once stretched a flap of skin from the dog's chest over the wounded area and then stitched up the area from which she had cut the flap.
It was successful, though, she said, "he now has nipples on his thigh."
Reconstructive techniques also have expanded the options for cancer treatments, allowing surgeons to be much more aggressive. Ace, the Voelkers' dog, had a tumor below his eye. Because these tend to be invasive, John R. Lewis, a veterinary surgeon at the University of Pennsylvania, removed tissue from much of Ace's cheek and jaw in order to ensure he got all of the cancerous cells.
He then cut free a skin flap from Ace's neck, and rotated it to cover the hole he'd created. A second skin-flap surgery was needed to close a large wound in the roof of Ace's mouth. Now, 17 months later, the only sign of Ace's ordeal is that the fur on his cheek grows up toward his eyes rather than down.
Despite the increasing complexity, animals that undergo reconstructive procedures often come out looking surprisingly good. "The fur covers a lot," said Daniel Degner, a veterinarian in Burton, Mich.
Arzi and Verstraete are testing a variety of innovative techniques in facial reconstruction for animals. Working with the school's bioengineers, they've developed a method to print 3-D plastic models of patients' skulls from two-dimensional CT scans. They use the models to plan surgeries, which allows them to plot their moves with "micron-level accuracy," said Kyriacos Athanasiou, a professor of biomedical engineering at California-Davis.
They are also testing an experimental compound to stimulate bone growth, called bone morphogenetic protein, to treat animals with oral cancers or broken jaws. While excising a lower-jaw tumor from Whiskey, a 10-year-old Munsterlander from San Francisco, the surgeons removed 7 centimeters of bone, installed titanium plates to recreate the contour of the jaw, and then filled the gap with a spongy scaffold infused with the BMP.
The protein "grows bone really quickly," Arzi said. "Within two weeks you could feel hard tissue, and within three months we saw on the CT scan that it almost matched the density and porosity" of the remaining jaw bone. To date, they have treated 17 dogs - and one bearded dragon lizard missing part of its lower jaw because of an old fracture - with the compound.
It turned out to be a much simpler matter to treat the astonishing injury suffered by a dog in a Philippine village who threw herself at a motorcycle that was about to hit her owner's niece and daughter. Kabang saved the girls, but the bike tore off her upper snout, leaving a fist-size hole across the center of her face. Her heroism made headlines worldwide, and she was brought to California-Davis for reconstructive surgery, with the help of a fundraising campaign that brought in than $20,000.
In a complicated five-hour operation in late March, surgeons pulled skin flaps from the top and sides of her head together to close the wound and fashioned two holes to serve as nostrils. She looks strange, but "dogs don't look in the mirror," Verstraete said.
On her return to the Philippines, Kabang was welcomed with a motorcade through her hometown.
The technology may have advanced, but many veterinary surgeons are reluctant to put animals through such arduous procedures unless there is a strong chance of success. Although some vets leave it up to the pet owner, Lewis, who operated on Ace, says he sometimes turns owners away if an operation will buy their pets only a few more months of life.
"I'm looking for years rather than months of quality time," he said.
Even devoted owners hesitate to subject pets to such intensive treatment.
"We had to think about whether this was going to help him or whether it was just for us," said Brad Voelker, owner of Ace. Though it would mean months of pain and aftercare, the Voelkers decided it was in the dog's best interest "because this gave him a strong chance of living another five years or so."
By SUSAN FREINKEL
The New York Times