Get access to all handy features included in the IVIS website
- Get unlimited access to books, proceedings and journals.
- Get access to a global catalogue of meetings, on-site and online courses, webinars and educational videos.
- Bookmark your favorite articles in My Library for future reading.
- Save future meetings and courses in My Calendar and My e-Learning.
- Ask authors questions and read what others have to say.
Dealing with Postoperative Complications in the Field (Incisional Infection, Hernia, Thrombophlebitis, and Laminitis): The Importance of the Veterinarian-Specialist-Client Communication Triad
T. Mair
Get access to all handy features included in the IVIS website
- Get unlimited access to books, proceedings and journals.
- Get access to a global catalogue of meetings, on-site and online courses, webinars and educational videos.
- Bookmark your favorite articles in My Library for future reading.
- Save future meetings and courses in My Calendar and My e-Learning.
- Ask authors questions and read what others have to say.
Read
Take Home Message
Complications of colic surgery are common, and include postoperative ileus, incisional infection, incisional hernias, thrombophlebitis, diarrhoea, adhesions and laminitis. The management of these complications is highly dependant on a team approach involving the surgeon/specialist, the primary veterinarian and the client. In most cases these complications will resolve given time and appropriate treatment.
Communication
Good communication between the primary veterinarian, the owner and the surgeon/specialist is vitally important. Most owners faced with looking after a horse that has had colic surgery will have no previous experience of the care required or the problems that can occur. Likewise, many primary veterinarians will have limited experience of dealing with post-operative complications after colic surgery, and are therefore working outside of their “comfort zone”. It is the responsibility of the specialist/surgeon to ensure that the horse receives appropriate treatment after it has returned home – the recuperation period should be considered a continuation of the surgery and immediate postoperative care that was provided in the hospital. The specialist/surgeon will usually have experience and knowledge about the normal postoperative progress after colic surgery, as well as problems that can arise and how they should be dealt with. It is essential that this information is somehow communicated to the primary veterinarian and the owner. Three-way communication is difficult to achieve, and in most cases it is preferable for the primary veterinarian to be the point of contact for both the owner and the specialist/surgeon.
Acute Incisional Dehiscence
Acute incisional disruption generally occurs within 8 days of surgery and, fortunately, is very rare. Early clinical signs are a serosanguinous discharge with a progressive increase in drainage from the incision. Observation of omentum at the incision site is a sign of impending dehiscence. In most cases, physical examination identifies the diagnosis and extent of the problem. In some cases ultrasound examination will assist in defining the extent of the lesion.
Incisional Infection
The prevalence of incisional complications after gastrointestinal surgery in horses ranges from about 5 to 40%. Any incisional drainage at an incision is suggestive of abnormal wound healing.
Drainage delays wound healing and weakens abdominal fascia, and can predispose to hernia formation.
The use of abdominal bandages or “belly bands” has been associated with a reduced risk of incisional infections. However, once an infection has occurred, a decision needs to be made as to whether to maintain an abdominal bandage in place or whether it should be removed to promote drainage.
Any incisional drainage, except for mild bleeding for a few hours postoperatively, should be considered abnormal and may represent an impending incisional infection. The presence of serosanguinous fluid or purulent drainage should be evaluated carefully, and one should closely monitor the degree of peri-incisional swelling and tenderness. If a large quantity of fluid drips from the incision, the possibility of peritonitis and partial dehiscence of the incision should be considered. After sterile preparation at the drainage site, a sample should be obtained for cytological and/or bacteriological evaluation.
Incisional infections are treated with appropriate drainage, removal of selected skin sutures/staples, and topical cleaning and lavage of the incision. Systemic antibiotics usually have already been administered at the time infections occur but may need to be changed according to bacterial culture results. It is important to remember that incisional infections significantly increase the risk of incisional herniation, therefore, the period of restricted exercise after surgery should be increased to at least 8-10 weeks after the infection has resolved.
Incisional Hernia
Incisional hernias may be secondary to:
- suture or abdominal wall failure in the postoperative period
- incisional infection
- early return to exercise
The strength of the abdominal wall does not return to normal until many months after surgery. Therefore, horses should be restricted to a box stall for 6-8 weeks postoperatively, although daily hand walking should be allowed. The abdominal incision should be evaluated prior to turning the animal out to pasture for an additional 6 weeks. After 3 months the risk of incisional hernia is negligible.
Two types of incisional hernias may be seen postoperatively.
- A traditional hernia within the incision with a reducible hernial sac.
- Herniation due to a thinning of selected areas of the incision.
[...]
Get access to all handy features included in the IVIS website
- Get unlimited access to books, proceedings and journals.
- Get access to a global catalogue of meetings, on-site and online courses, webinars and educational videos.
- Bookmark your favorite articles in My Library for future reading.
- Save future meetings and courses in My Calendar and My e-Learning.
- Ask authors questions and read what others have to say.
Comments (0)
Ask the author
0 comments