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Postoperative management and rehabilitation

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Abstract

The postoperative period is as important as the surgery itself in terms of analgesia and rehabilitation and depends on a team approach involving the surgeon, registered veterinary nurses, animal care staff and owners. This chapter discusses analgesia, immediate postoperative nursing care, physiotherapy/rehabilitation, discharge and re-examination, and exercise management. : Application of a soft padded dressing.

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Figures

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17.1 Application of a protective non-adhesive dressing immediately postoperatively to protect the wound.
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17.2 A topical skin adhesive used in place of skin sutures or staples.
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17.3 A soft cloth Elizabethan collar used to prevent self-trauma of wounds or inadvertent removal of indwelling catheters/drains.
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17.4 A custom-made jacket used as a Velpeau sling to restrict motion and prevent weight-bearing on a thoracic limb.
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17.5 Use of an Ehmer sling to prevent weight-bearing on a pelvic limb.
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17.6 Correct amount of kennel bedding organized to prevent inadvertent soaking of the patient while allowing suitable padding for recumbent patients. Incontinence pads are placed in contact with the floor; on top of these is a waterproof padded mattress and on top of this is a soft padded layer, such as VetBed, on which the patient would lie.
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17.7 Indwelling urinary catheter used to manage urine soiling/scalding in recumbent patients until some degree of mobility has returned.
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17.8 Slings are particularly useful to help move paretic or non-ambulatory patients safely and without risking injuries to the animal.
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17.9 Use of an underwater treadmill in the rehabilitation of an orthopaedic patient; specifically, and as opposed to a hydrotherapy pool, this allows walking with a variable depth of water that alters the amount of weight-bearing/flotation of the patient. (Courtesy of Darryl L Millis)
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17.10 (a) Preparation of a cold pack by enclosing a frozen ice block within an incontinence sheet or towel. (b) Application of the cold pack to the affected area.
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17.11 An example of a discharge instruction template that is given to owners following surgical procedures at the authors’ practice.
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17.12 (a) Two strips of adhesive tape are placed on the distal limb on the medial and lateral surfaces (or dorsal and palmar/plantar surfaces) to the level of the carpus/tarsus. (b) Cotton wool is placed between the digits to prevent rubbing.
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17.13 (a) Starting distally, the cast padding or cotton wool roll is wrapped spirally up the limb, overlapping layers by 50% on each rotation. (b) The dressing is continued proximal to the pathology/wound, or proximal to the elbow/stifle.
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17.14 (a) Extra padding should be added to those areas with poor soft tissue coverage. This should be applied evenly and care should be taken that the extra padding does not bunch or cause uneven pressure on the underlying skin. (b) Any extra padding can be covered with a further even layer of cast padding/cotton wool.
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17.15 (a) The conforming bandage is applied next, following the same placement used for the cotton wool/cast padding. (b) This should be placed with a small amount of tension, but not so tight as to result in venous stasis and swelling of the digits.
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17.16 The tape stirrups are separated from each other, rotated 180 degrees and placed proximally on the bandage material to prevent it from slipping.
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17.17 (a) The outer layer is applied, ensuring adequate coverage of the underlying layers. (b) This layer should be pulled free from the roll, the tension released and the material simply placed over the underlying bandage.

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