Dog found with severe facial injuries receives reconstructive surgery
Written by Meghan Lepisto
Gemma’s journey begins in Doha, Qatar, found in the stairwell of an industrial area with ghastly injuries to her face.
It ends in Beloit, Wisconsin, where together with the Hasse family, she has found her happy home.
In between, her story has many chapters: transport from the Middle East to American Midwest, multiple medical procedures, reconstructive surgery, and generosity from around the world. Thought to be a former stray, today the sweet but shy pup enjoys a life of comfy couches, frequent snuggles, and adoration from her human and canine family. She’s come a long way.
“She’s an absolute sweetheart,” says Bryan Hasse, who with his wife Brandi, their three daughters, and two dogs welcomed Gemma first as a foster and then through adoption. “We can’t imagine our family without her.”
Exactly what caused Gemma’s severe injuries is unknown, but clinicians at UW Veterinary Care suspect she sustained chemical burns from contact with corrosive materials. The injuries extended across Gemma’s snout, jaw, and down both sides of her face. Large scabs encompassed her muzzle, and her teeth, nasal bones, and upper jaw were visible through the wounds.
A Promise of Love Animal Rescue, based in Wisconsin, was determined to help. After learning of Gemma’s situation from PAWS Rescue Qatar and other partners, Paula Copper, the group’s president and co-founder, helped coordinate Gemma’s travel to America, arrange for a foster family, investigate treatment options, and fundraise to help cover costs. In total, donors from across the globe gave more than $8,000 through GoFundMe to support Gemma’s specialized care.
Gemma made her first visit to UW Veterinary Care in March 2019 for an initial exam with the Dentistry and Oral Surgery Service. Immediately, doctors realized her recovery would require a creative, multi-pronged approach.
“I hadn’t seen anything exactly like this,” says Graham Thatcher, a clinical assistant professor of dentistry and oral surgery who played a lead role in Gemma’s treatment along with section head Jason Soukup and resident Alexander Geddes.
At a follow-up visit, the team conducted X-rays and a computed tomography (CT) scan of Gemma’s head for a more detailed look at her injuries. She was diagnosed with rhinitis (inflammation of tissue in the nose); chronic infection and inflammation in her jaw, cheek, and nasal bones; and extensive loss of skin tissue, including her upper left lip. Gemma’s burns had also caused severe gum disease and bone death along her left jaw, which required the removal of four teeth. In addition, her top two canine teeth showed signs of infection and inflammation, so root canal treatments were performed.
As doctors next shifted to preparing for Gemma’s facial reconstruction, they uploaded her CT data into computer image processing and design software to create a three-dimensional model of her skull. This allowed Thatcher and colleagues to view the fine details of Gemma’s head in 3D and conduct virtual surgical planning. Through virtual simulations, they rehearsed removing the dead and damaged segments of bone. Then, they planned and practiced how to repair the remaining bone, down to intricate details like where to place surgical screws.
March 15, 2019: Gemma boards a 15-hour flight from Qatar to O’Hare International Airport. She then travels by car to her foster family’s house in Beloit and begins to acclimate to her new home and life.
March 18: Gemma makes her first visit to UW Veterinary Care’s Dentistry and Oral Surgery Service for an evaluation.
March 27: Gemma receives a comprehensive oral examination and computed tomography (CT) scan to provide clinicians the information they need to plan and prepare for her facial reconstruction.
April 10: Four tooth extractions and two root canal treatments are performed on teeth damaged by the burns Gemma experienced to allow time for healing before reconstructive surgery.
May 8: Doctors perform a six-hour facial reconstructive surgery, tightly rehearsed through virtual surgical planning.
October 21: Gemma returns to UW Veterinary Care for spay surgery and a follow-up CT scan to evaluate the facial reconstruction. Successful bone remodeling can be seen in her nose, jaw, and cheek.
As a final step, they printed in 3D at the School of Veterinary Medicine an exact model of Gemma’s skull with changes incorporated from the virtual surgery. Using this model, they then cut and shaped a portion of contourable titanium mesh to help recreate Gemma’s snout. During reconstructive surgery, the titanium mesh would provide a strong base over the missing bone, and serve as a support bed for surrounding soft tissues.
Orthopedic surgeon Jason Bleedorn, who leads innovative efforts in the School of Veterinary Medicine to virtually design and plan surgical models and launched a 3D-printing lab at the school, provided a crucial assist in this area and was an important part of Gemma’s surgical team.
Eventually, it was showtime. One month after Gemma’s initial CT scan and dental extractions, she returned for facial reconstruction. To begin the operation, surgeons removed the decaying bone fragments, then placed a fascia transplant (a thin layer of connective tissue) inside Gemma’s nose.
Thatcher says this fascia transplant was critical and, though common in human reconstructive surgery, is a relatively novel application in veterinary medicine. The tissue recreated Gemma’s nasal lining and repaired a hole caused by burns. “Probably the most important thing was to cover the hole from the outside of Gemma’s nose to the inside of the nose,” Thatcher notes. “Without lining the nasal component, we might not have had the same success.”
For the next step in surgery, the piece of titanium mesh — pre-contoured to Gemma’s 3D skull model to create a perfect fit — was screwed into place atop Gemma’s snout. Following this, surgeons cut a flap of skin from Gemma’s cheek and neck, then carefully rotated and sutured it over her muzzle to recreate the necessary skin covering. This skin flap extends from Gemma’s left lip over her snout down the right side of her mouth. In total, the surgery took six hours.
While the team had implemented similar individual components of the operation with previous patients, Thatcher says Gemma’s procedure was novel in its combination of techniques. The ability to conduct 3D virtual planning was of immense benefit, and he believes UW Veterinary Care is one of only a few veterinary medical teams internationally to use 3D modeling and virtual planning for oral and maxillofacial surgery.
“It takes out of the equation a lot of the questions that come up in the middle of a surgery and takes into account the anticipated challenges that you might foresee,” he says. “We didn’t have any surprises. I felt like I had done the surgery before, even though for me, it was, from start to finish, the first time I’d done a surgery quite like this. We were really well prepared.”
In the days and months following, Gemma healed tremendously. Follow-up CT scans have shown that new, healthy bone tissue has formed in her jaw, cheek, and skull, just as the doctors hoped.
Without the surgery, Thatcher says Gemma would have experienced chronic infections, as well as additional inflammation and deterioration inside her nose. “Rather than heal and close over as they did with surgery, the tissues would have likely continued to get worse,” he says.
Because the skin flap that was grafted across Gemma’s muzzle originated from her neck, the fur is longer than the surrounding muzzle hair and grows in a different direction. This gives the pup her signature look, like a snout combover. Occasionally, when the hair grows too long, her family gives it a trim.
“But that’s what makes her who she is,” says Hasse. “She’s very, very quirky.”
While it’s gratifying to have completed the innovative surgery, Thatcher says the ultimate reward is seeing Gemma, now approximately four years old, enjoy an exceptional quality of life. “I’m so thankful she found a family that took good care of her and made her feel comfortable and confident,” he says. “It’s heartwarming to see how happy she is, snuggling with her dog siblings and human companions. She’s so full of life and it really solidifies my desire to help these animals.”
For the Hasse family, caring for Gemma has been a labor of love. “If you ask my wife and kids, they’ll say from the day she got home that they knew she was going to be part of our family forever,” says Bryan. “She’s had nothing but love since she’s been here.”
A lieutenant with the Town of Beloit Police Department, Hasse’s work schedule requires that he’s early to bed and early to rise. But in the evenings, he often settles in to watch a bit of TV with his wife and their dogs — a routine that has become “cuddle time” for Gemma. Once the couple sits down, “almost immediately she’ll jump right up on Brandi, lay down on her chest, and she’ll be completely sound asleep,” he says.
“I’m so thankful (Gemma) found a family that took good care of her and made her feel comfortable and confident. It’s heartwarming to see how happy she is, snuggling with her dog siblings and human companions. She’s so full of life and it really solidifies my desire to help these animals.”
The family’s two other dogs have also helped Gemma feel content. She is especially smitten with Koda, the youngest of the pack. “Gemma and Koda are best buddies,” he says. “They’re always lying next to each other.”
Looking back on Gemma’s entire journey, it feels like “things just fell into place,” he notes. “Her entire journey from the start to where we’re at now … we didn’t have any major setbacks or anything we had to be concerned with. It was a very positive experience for the doctors, for us, and for Gemma.”
“It’s definitely been a success story,” he adds. “We’re happy that she’s healthy, safe, and happy here. And thankful for the people that found her and then took the steps to get her whatever they could and find the love that she needed.”