Page 56 - Manual of Equine Field Surgery
P. 56
52 LIMB SURGERIES
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The screws are tightened with a screwdriver until Postoperative Care I
the heads are flush with the soft tissues, taking
care not to tighten the screws excessively as this Bandaging: The surgical site is maintained un-
will cause the wires to become dislodged over the der a bandage until skin sutures are removed at
1 O to 14 days.
screw heads. Tightening the screws places addi- Exercise Restridions: Postoperatively, the foal
tional tension on the figure of eight wires as the should be strictly confined to a stall. Exercise
bevel of the screw head engages the wires. The restriction is instituted postoperatively to reduce
subcutaneous tissues are sutured with absorbable trauma to the asymmetrically loaded physis and
material in a simple continuous pattern, taking cuboidal bones and is considered an essential
care to cover as much of the implant as possible. component of the therapeutic plan during post-
The skin is sutured with simple iI1terrupted sutures operative convalescence. The duration and degree
of No. 3-0 nonabsorbable monofilament suture of exercise restriction are dependent on the age
material. The wound is bandaged routinely, and a of the foal and the severity of the angular limb
thin cotton padded outer wrap is placed to reduce deformity; however, strenuous exercise should not
external trauma to the surgical sites. be allowed until the angular limb deformity has
been corrected.
Suture Removal: Skin sutures are removed at
1 O to 14 days.
Other: The hooves should be trimmed to achieve
balance and the foal maintained on a nutritionally
POSTOPERATIVE CARE balanced diet.
An essential component of the postoperative care
is the timely removal of the transphyseal bridge
implants. Client education is a key component of
successful case management. Clients should be
instructed that the implants must be removed EXPECTED OUTCOME
when the deformity has corrected or just prior
to complete correction. In contrast to periosteal The expected amount and rate of axial correction
transection and elevation, overcorrection of the are proportional to the growth potential of the
angular limb deformity occurs if timely removal affected physis and are dependent on the age of
of implants is neglected. In cases where bilateral the patient and the physis affected. Typically, rapid
transphyseal bridging is performed, the removal correction of the angular limb deformity occurs
of implants may need to be performed on sepa- in young foals, while slower, but steady, correction
rate occasions to allow adequate correction for is anticipated for the older patient.
each limb. Although implant removal may be
achieved in some foals using sedation and local
anesthesia, general anesthesia greatly facilitates
the procedure and is indicated for most cases. COMPLICATIONS
Following routine aseptic preparation, the
position of the screw heads is identified by Swelling, inflammation, and scar tissue formation
probing with a hypodermic needle and a stab inci- at the surgical site of the implants are common
sion is made down to each screw head. A mos- but typically become less apparent once the limb
quito hemostatic forceps is used to retract the soft has straightened and resolve once the implants
tissues while a screwdriver is manipulated and have been removed. The development of infection
firmly seated into the screw head and used to may result in subcutaneous abscess or skin inci-
remove each screw. A sturdy curved hemostatic sion dehiscence and in some cases necessitates
forceps placed through the stab incision over the premature removal of the surgical implants. The
metaphyseal screw is used to hook the loops of the most serious potential complication is overcor-
figure of eight wires for extraction by firm trac- rection of the angular limb deformity. The gravity
tion. The skin incisions are sutured and the sur- of this complication should not be underempha-
gical site bandaged for 10 to 14 days until the sized; for example, a mild carpal valgus is typically
sutures are removed. only a cosmetic impairment compared with the
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