Surgical preparation, post-operative care important considerations for avian patients - DVM
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Surgical preparation, post-operative care important considerations for avian patients


DVM360 MAGAZINE


Following removal of feathers standard aseptic technique should be used to prepare the skin for surgery. The goal of surgical preparation of the skin is to reduce the numbers of bacteria without damaging the skin, thereby reducing postoperative infections.

Surgical prep solutions should contain chlorhexidine diacetate (0.5%) (Nolvasan Solution, Fort Dodge Laboratories, Fort Dodge, IA) or Chlorhexidine gluconate (4.0%) (Hibiclens, Stuart Pharmaceuticals Division, ICI America, Wilmongton, DE). In most instances, veterinarians use alcohol as a surgical rinse. The use of saline is preferable because it doesn't contribute to as much heat loss as alcohol.

Instrumentation Most techniques and instruments used in companion species (dogs and cats) can be used in exotic species. In many instances, a surgical pack with ophthalmic instruments can be used, but for delicate surgical procedures, microsurgical instruments are required. Microsurgical instruments are available from a variety of sources (ASSI, Accurate Surgical & Scientific Instruments Corporation, Westbury, NY; Sontec Instruments, Inc., Englewood, CO; Pilling Co., Ft. Washington, PA) and are preferred for several reasons; their length allows the surgeon's wrists to rest comfortably on the table while the tips are within the body cavity, the handles are rounded so that they can be rolled between the thumb and first finger which reduces tremors, and they are counter balanced which reduces fatigue.

Tissue retractors Tissue retractors are of great benefit during surgical procedures as the small patient size may limit the number of surgeons that can actively participate in the procedure. The Lone Star Veterinary Retractor System (Jorgensen Laboratories, Inc., Loveland, CO) consists of a notched, autoclavable frame and a set of tissue hooks on elastic bands. However, the stays are not autoclavable. The hooks are placed in the tissue and the appropriate amount of tension is placed on the band to allow visualization of the surgical field. The band is then inserted into one of the notches. The first two hooks must be placed on opposite sides of the surgical site to allow stabilization of the frame.

Radiosurgical units I consider radiosurgical units an absolute necessity for all procedures. Electrosurgical units employ a high-frequency alternating current to generate energy that creates molecular heat within each cell causing water to vaporize and the cell to rupture while the electrode remains cool. Coagulation of tissues occurs when the current density is sufficient to dehydrate the cell(s) and their contents. Electrosurgical units use two electrodes, an active electrode and an indifferent electrode (ground plate). This results in concentration of the current at the tip of the active electrode. For most electrosurgery units, the ground plate is placed as close to the surgical area as possible, with contact improved by the use of a gel or paste. In contrast, the Surgitron (Ellman International, Inc., Helwett, N.Y.) produces radiofrequency wavelength energy that allows the ground plate to act as an antenna rather than as a ground plate. Thus, the ground plate does not need to be in contact with the patient. This is important when considering the small patient size of many exotic patients. Burns can occur when the ground plate contacts only a small area because the current exiting the patient is concentrated at this location. The radiosurgical units also have a bipolar forceps which eliminate the need for the groundplate altogether.

Laser surgical units Lasers (light amplification by stimulated emission of radiation) are also viable options for surgical procedures in exotic patients. Since the operator can control the laser's output and focus the beam there is less collateral heat damage to surrounding tissues that leads to better healing.

The most commonly used lasers in the veterinary medical field are the carbon dioxide laser and the diode laser. CO2 lasers (Accuvet CO2, ESC/Sharplan) produce a beam of light energy at a wavelength of 10,600 nm. This wavelength is highly absorbed by water making it ideal for cutting (with a focused beam) and vaporizing (with a defocused beam). Incisions with the CO2 laser are essentially bloodless as it seals vessels with a diameter of 0.6 mm or less. CO2 lasers also seal lymphatic vessels that may reduce postoperative edema. Smaller nerves are also sealed which may reduce postoperative pain. It is thought that the thermal insult resulting from the use of the CO2 laser is superficial (approximately 50-100m deep); however, when used incorrectly, lasers can cause significant thermal injury.


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Source: DVM360 MAGAZINE,
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