Postoperative management of external fixators in dogs and cats - Veterinary Medicine
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Postoperative management of external fixators in dogs and cats
Despite the widespread use of external skeletal fixation in small-animal practice, little information is available regarding postoperative care. Here are some tips to promote optimal healing, keep patients comfortable, and avoid complications.


VETERINARY MEDICINE


INITIAL POSTOPERATIVE BANDAGING

Immediately after surgery, place a compressive bandage, similar to a Robert-Jones bandage, on the operated limb.


4. A sterile nonadherent dressing is placed directly on the skin. Slits have been cut into the dressing to facilitate placement of the dressing adjacent to the fixation pins, thus protecting the fixation element-skin interfaces.
First, apply topical antibiotic (e.g. bacitracin, neomycin, and polymyxin B) ointment at the fixation element-skin interfaces to decrease microbial contamination and migration from the skin surface to the fixation element tract.2-4 Then place sterile nonadherent dressings or gauze over any incision and around each fixation element-skin interface to prevent adherence of other bandage layers. Cut slits in the dressing to facilitate placement around individual fixation elements (Figure 4).


5. Foam sponges are packed between the limb and fixator. Slits have been cut in the foam sponges, similar to those made in the nonadherent dressings, allowing for easier placement.
Next, place padding, consisting of either sheet cotton or the detached foam portion of rinsed and dried surgical scrub brushes, between the stabilized limb segment and the fixation elements.5,6 If foam is used, again cut slits in the material to facilitate placement around the fixation elements (Figure 5). If sheet cotton is used, layer the cotton sufficiently to compress the underlying soft tissues when packed between the frame and the stabilized limb segment.


6. A compression bandage has been applied over the tibial fixator. The remainder of the limb distal to the fixator has also been bandaged to prevent swelling of the hock and paw.
Then wrap the limb and fixator in cast padding or sheet cotton, beginning at the digits and extending just proximal to the fixator. Wrapping only the stabilized limb segment can cause edema and congestion in the extremity distal to the bandage.5 Apply a compressive layer of conforming self-adherent gauze over the cast padding, followed by a tertiary layer of cohesive bandage material (Figure 6).

This bandage absorbs exudate from the release incisions and decreases postoperative swelling that could lead to contact between fixator components and soft tissues, which has the potential to cause soft tissue necrosis.2,3 The compression also decreases motion of the soft tissues around the fixation elements. Excessive motion can cause tissue strain, which leads to increased drainage and potential loosening of the fixation elements.2,3

Keep a compressive bandage in place until postoperative swelling has subsided and release incisions begin to heal by second intention.1 The frequency of bandage changes is determined by the necessity to treat open wounds (if present), the volume of drainage from the fixation element tracts, the amount of soft tissue swelling, and the condition of the bandage (e.g. if the bandage becomes wet or soiled).1 The initial compressive bandage is usually removed 12 to 48 hours after surgery, before the animal is discharged, and another compressive bandage is placed. Administration of sedatives and analgesics during this initial bandage change is recommended.

SECONDARY BANDAGING

Two forms of secondary protective bandaging techniques have been described for use once a compression bandage is no longer warranted—bumper bandages and shrouds. Both are aimed at protecting the construct, animal, and owners from damage or injury due to accidental impact or entrapment of the frame on objects. The protective bandage needs to allow for exposure, monitoring, and care of the fixation element-skin interfaces.

Bumper bandages


7. A secondary bumper bandage has been placed over the humeral hybrid fixator in a cat. The fixation element-skin interfaces are visible and accessible for cleaning.
A bumper bandage is composed of a layer of cohesive bandage material covering only the frame components and exposed ends of the fixation elements (Figure 7).7,8 The fixation element-skin interfaces remain visible for monitoring and accessible for care. Sometimes a primary layer of gauze or cast padding may be placed before the cohesive material to provide extra padding and protection. Fixators placed on proximal limb segments are often only amenable to the bumper bandage form of protective bandaging.

Shrouds


8. A secondary shroud has been placed over the fixator on a dog. The fixation element-skin interfaces are protected from environmental contamination, yet the covering can be removed for daily treatment of the interfaces.
A shroud consists of a fabric sleeve with a length and diameter that loosely conforms to the stabilized limb segment and fixator, secured at each end with a drawstring or elastic band (Figure 8).4,6 We recommend that the owner have several shrouds so that a clean shroud can be placed over the fixator after daily fixation element-skin interface care. The shroud is advantageous in that it protects the fixation element-skin interfaces from environmental contaminants, while still allowing simple access for care of fixation element tracts. Shrouds can be purchased from commercial sources ( http://DogLeggs.com/) or can be self-fabricated. For example, the elastic portion of a tube sock is a simple and economical substitute that can be used for smaller constructs.


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Source: VETERINARY MEDICINE,
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