Simple avian surgical procedures (Proceedings)
Treating dermal injuries, fracture stabilization, stabilization of fracture sites after internal orthopedic repair, joint injuries and prevention of self trauma are common reasons bandages are used on avian patients. Bandages function to apply pressure to reduce dead space, swelling edema and hemorrhage; protect the wound from pathologic microorganisms; immobilize the wound and underlying fractures; protect the wound from desiccation and additional trauma from abrasions or self-mutilation; absorb exudates and help debride the wound surface; and provide comfort for the patient.1 Although bandages may be less stressful to apply than internal fixation of a fracture it is imperative that the proper application technique be used to prevent increased trauma to the affected area. Bandages that are applied incorrectly may not help the condition of the patient, if applied too tight, this will restrict blood flow to the distal extremity, if immobilization of the joints above and below the fracture is not achieved, the possibility of a nonunion significantly increases. Often what first appears to be a simple technique to apply is not that simple but requires skill, the proper materials, patience, a properly restrained patient and an understanding of the forces to be controlled by the bandage.
Common bandage materials used on avian patients include Vet-Wrap (3M Animal Care Products, St. Paul, MN), adaptic (Johnson & Johnson, New Brunswick, NJ), 4 X 4 and 2 X 2 gauze sponges, white cloth tape, cast padding, Hexcelite (Hexcel Medical Co., Dublin, CA), syringe cases, aluminum rods and roll gauze. One of the most important aspects of bandaging avian patients is that most of the bandage materials listed above do not come in sizes applicable to patients that weigh less than 300 grams, especially passerines that weigh less than 30 grams. Modification and manipulation of the smallest size of the bandage material mentioned above will be sufficient for proper application on the small avian patients. Vendors do not manufacture and sell specific splints for the different avian species or for animals the size of most pet birds. Therefore veterinarians are required to use their skills at manufacturing splints out of Hexcelite, syringe cases, aluminum rods or some other ridged material. To fabricate a syringe case splint, a dremel tool is required to cut and shape the splint to the size of the patient's anatomy that needs to be immobilized. Hexalite, a thermal sensitive material that becomes malleable when placed in hot water then hardens at room temperature in the shape of the injured anatomical area. Ultraviolet (UV) dental acrylic can be used in a similar manner as Hexalite, but cures hard when exposed to the UV light generated by a UV gun. Eye protection must be worn by veterinarians and hospital staff when using UV dental acrylic curing instrument.
The owner of bandaged avian patients must understand the importance of monitoring the bandage and affected area and to make sure they make the required follow up visits for reevaluation. Veterinarians, veterinary technical staff and owners should monitor the bandage site for slippage of the bandage/splint, swelling distal to the bandage, non-use of the limb or a regression of ability to use a limb, irritation or picking at the bandage site, and tissue abrasions at contact surface sites with the bandage. If any of the above listed conditions is occurring then the bandage needs to be removed, area below and around the bandage evaluated and the bandage reapplied if necessary.Figure-of-Eight Wing Bandage
One of the most commonly used external coaptation bandages and in my experience one of the most incorrectly applied bandages. The figure-of-eight bandage is a bandage that is applied to the wing and can be used to immobilize fractures distal to the elbow, maintain the wing in position when an intraosseous catheter is in place within the distal ulna or maintain bandages in place when treating dermal lesions. The supporting bandage material used is dependent on the condition of the underlying tissue and/or bones. If there is a closed fracture involving the ulna or radius underlying cast padding may be used to support the outer layer of non-stick wrap (Vet-wrap). If there is an incision, open wound or abrasion, the area is cleaned, treated and a non-stick gauze pad (Adaptic) is placed over the affected area then supported with 2X2 or 4X4 gauze sponges and held in place with an elastic gauze wrap (Kling®, Johnson & Johnson, New Brunswick, NJ) and an outer layer of non-stick wrap. These bandages may be changed daily or weekly depending on the injury and patient condition.
The difficulty in placing this wrap on the wing is keeping the bandage in place and incorporating the humerus in the bandage. Placement of the wrap should start at the axillary area where the wing attaches to the body. The bandage material is then brought over the dorsal surface of the wing toward the flexed carpal area. The wrap is then maneuvered under and around the ventral surface of the flexed carpal area ending up on the top of the wing. As the bandage material is brought back, caudally over the dorsal surface of the wing, the top part of the 8 is formed. Continue bringing the bandage material caudally and wrap under the primary feathers going back to the initiation point, completing the figure-of-8. By wrapping the bandage in this manner one can be assured of incorporating the humerus into this wrap. The figure-of-eight bandage is complete when the above instructions are repeated 3 or 4 times securing the wing. If the humerus is to be stabilized a body wrap can be incorporated into bandage. Care must me taken, if a body wrap is used, not to make the bandage too tight which may hinder the patient's ability to breath. If the body wrap is placed too far caudal on the body the patient's feet may have a tendency of getting caught in the bandage or they may not be able to extend their legs. When finished the non-stick bandage should be held in place with a small piece of adhesive tape.