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254 Section IV: Postoperative Care and Rehabilitation

restriction, the use of warm packing and, if appropriate, a compres-
sive bandage can be used to reduce potential dead space. Aspiration
of the seroma is avoided unless infection is suspected, to limit the
potential for bacterial seeding and abscess formation. If aspiration
is performed, the area should be clipped and aseptically prepared
prior to aspirating the fluid for cytology, and bacterial culture and
sensitivity. Infected seromas typically require active drainage with
appropriate antibiotic administration. Surgical site infections are
uncommon in neurological surgery, but when they occur they need
to be aggressively treated to prevent development of ascending
infections into the CNS (Figure 28.7).

Laser Therapy
Laser therapy has been well described in both the human and
veterinary literature as a technique for improving healing of tissues
and wounds. For more information regarding the technique of laser
therapy for incision and wound management, readers are referred
to Chapter 29.

Antiepileptics
Seizures are often a presenting sign in patients with intracranial dis-
eases. In many cases antiepileptic medications such as phenobarbi-
tone, potassium bromide, levetiracetam, or pregabalin have been
administered preoperatively to reduce the frequency or severity of
seizures. Although not proven to be beneficial, antiepileptic medi-
cations have also been recommended for patients undergoing
intracranial surgery to remove mass lesions. When antiepileptics
have been administered prior to surgery, it is recommended to
continue in the postoperative period and gradually taper the medi-
cations over a 4–6 week period to prevent seizure development.
The doses, frequency, and specifications of the individual antie-
Figure 28.7 Postoperative incisional seroma/abscess noted 2 weeks follow- pileptic medications are beyond the scope of this chapter and read-
ing fixation of a lumbar fracture/luxation. ers are referred to a veterinary drug handbook [20] for more
information regarding available drugs.
In the immediate postoperative period, the use of hypothermia
in the form of cold packing can be employed to provide adjunctive Physiotherapy and Exercise Restriction
analgesia and reduce postoperative swelling and inflammation. Physiotherapy is an important component of rehabilitation
Hypothermia is recommended three to four times per day for following neurosurgery and should be initiated as soon as the
20 min for the first 3 days following surgery. After this period warm patient is comfortable. Although some concern for early rehernia-
compresses can be used to help reduce swelling. tion has been expressed when physiotherapy is initiated in the early
Complications that can be seen with incisions include dehiscence postoperative period [52], the benefits of early mobilization and
due to self‐trauma, seroma formation due to inadequate oblitera- controlled activity outweigh these concerns until there is further
tion of dead space or excessive motion, and incisional infections. evidence of adverse effects. In a recent study [52], the early recur-
Elizabethan collars can be used when appropriate to prevent self‐ rence rate was reported at 2%, which is similar to that reported in
trauma. In mild superficial incisional dehiscence with no evidence older studies, and although not mentioned it is assumed that all the
of infection, the incision can be treated conservatively with wound population of patients that underwent decompressive surgery dur-
cleaning using a 0.05% aqueous chlorhexidine solution twice daily ing the study period also underwent a similar postoperative reha-
and the use of a wound dressing to prevent further contamination. bilitation program without an increased incidence of recurrence.
If there is dehiscence of deeper tissue layers or evidence of infec- Physiotherapy exercises that should be initiated in the early post-
tion, the wound can be initially managed as an open wound until operative period include passive ROM exercises and muscle mas-
infection has resolved and then general anesthesia, surgical debride- sage. Flexion and extension of all joints should be performed 10
ment, and closure is recommended. This course of action is not times per joint, three to four times per day. For a complete discus-
acceptable when deep tissues are exposed, especially in patients sion on physical rehabilitation of the neurosurgery patient, see
with implants. In a large restrospective study the most common Chapter 29.
surgical wound complications were swelling and discharge in 7.5%
and 5.3% of cases, respectively [51]. Exercise Restriction Following Spinal Surgery
Seroma formation is common following dorsal approaches The duration of exercise restriction depends on the neurological
to the cervical spine and with excessive postoperative motion. status of the patient and the surgical procedure performed. Patients
Uncomplicated seromas are typically managed with exercise that have undergone decompressive surgery for IVD herniation are