Page 61 - Manual of Equine Field Surgery
P. 61
Distal Limb Perfusion 57
interstitial fluid into the lymphatic system.7 In are then glued and taped into place. The selected
these cases, a tourniquet is applied to the distal antibiotic diluted in 60 mL of saline is injected
metacarpus without prior Esmarch bandage ap- slowly using a small syringe. Because of the pres-
plication. sure needed to deliver the antibiotic, we com-
monly use a three-way stop-cock to allow the
diluted antibiotic to be conveniently delivered
Intravenous Perfusion with a small syringe (Figure 8-5). The tourniquet
A 20- to 26-gauge I-inch catheter is placed in the is left iI1 place for 30 minutes. After release of the
palmar vein at the level of or just distal to the tourniquet, the catheter is removed and pressure
sesamoid bones. The catheter and extension set is applied to the puncture site for several minutes.
lntraosseous Perfusion
\ \ A stab incision is made in the proximal portion of
I ,
the pastern midway between the lateral and dorsal
I ' ~~
1 aspect. An appropriately sized drill bit is used
to create a pilot hole for the cannulated screw
' \' Ql,-1.
l '
\ °' (Figure 8-6). The hole is tapped and the cannu-
\ '
\ oJ;
lated screw is placed (Figure 8- 7). The selected
\
antibiotic diluted in 60 mL of normal saline is
then slowly injected using a three-way stop-cock
and small syringe. The tourniquet is left in place
for 30 minutes. After release of the tourniquet, the
screw is removed and the skin is closed with an
interrupted suture.
POSTOPERATIVE CARE
!m. -·
Postoperative Cc,re ,. " .
Bandaging: A sterile dressing is placed over the
incision or catheter site and a half limb bandage
is applied.
Exercise Restridions: Stall rest with limited
activity is advised until the sepsis is resolved.
Medications: Systemic antibiotic therapy is con-
tinued as indicated by the underlying condition.
When the same antibiotic is given systemically as
is used in the perfusion, we omit one systemic
dose of the antibiotic. on the day the perfusion is
performed. Tetanus prophylaxis is provided if nec-
essary.
Suture Removal: Skin sutures are removed 12
days postoperatively.
Figure 8-5 A 20- to 26-gauge I-inch catheter is
placed iI1 the palmar digital vein at the level of or just
distal to the sesamoid bones. The catheter and exten- EXPECTED OUTCOME
sion set are then glued and taped into place. The
selected antibiotic diluted in 60 1nL of saline is injected
slowly using a small syringe. Because of the pressure Synovial structure and bone infections are diffi-
needed to deliver the antibiotic, a three-way stop-cock cult to treat and can have a poor outcome despite
is used to allow the diluted antibiotic to be delivered aggressive treatment. Regional antibiotic perfu-
with a small syringe. sion is an adjunctive therapy in the treatment of
