Basic surgery

image of Basic surgery
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Surgery is an integral part of day-to-day veterinary practice. The popularity of pet birds means that more requests than ever are being made for advanced veterinary care. This chapter provides clinicians with information and guidance on selected soft tissue surgical procedures that may be encountered in pet avian practice.

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17.1 The pre-surgical avian patient should be carefully evaluated and prepared for surgery. This includes an assessment of appropriate anaesthesia and the requirement for perioperative fluid support, which may be intravenous (such as in this Blue and Gold Macaw), subcutaneous or intraosseous, antimicrobials and pain management.
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17.3 A self-induced mutilation wound on the medial crus of a Goffin’s Cockatoo. The wound is beginning to contract at the edges, suggesting the lesion is changing from the collagen to maturation phase.
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17.4 The foot of a young Golden Eagle damaged in a wildfire. A week after the initial injury, the foot was still in the healing process but did well with wet to dry bandages soaked in chlorhexidine solution and topical 1% silver sulfadiazine cream.
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17.5 Large open wounds, as seen in this Moluccan Cockatoo, may require surgically assisted closure.
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17.6 Foam pipe insulation material can be used to make a temporary neck collar. Primarily reserved for parrots, the pipe insulation material is placed on the bird’s neck and cut to the appropriate length to prevent the patient from self-mutilating. When properly placed, the patient can eat, drink and ambulate with no difficulties. These types of collars should be rarely used and only for short periods of time. Every effort to understand the underlying cause of mutilation should be determined and treatment instituted as soon as possible.
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17.7 A malunion distal tibiotarsal fracture (arrowed) in a Timneh Grey Parrot resulted from a poorly placed leg bandage. As a result, the leg had to be refractured, surgically reduced and set with an external fixator.
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17.8 A juvenile dove to have a tape splint applied. The leg is first wrapped with minimally adherent bandage material from the foot to just proximal to the stifle. Butterfly tape strips are applied up and down the leg to create a ‘tape cast’. The edges of the butterfly strips are crimped (with a haemostat or finger) and then cut. If the cast is too tight, the toes will become darkened. Simply loosen the cast and re-evaluate.
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17.9 Schroeder–Thomas splints are used to stabilize distal tibiotarsal and tarsometatarsal fractures. Each splint is custom made to match the leg dimensions of the bird with a ring that encircles the femur and two sides that run parallel to the length of the leg. The wire frame splint is padded by covering it with tape.
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17.10 A Schroeder–Thomas splint is used to stabilize a distal tibiotarsal fracture in a dove ( sp).
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17.11 Distraction tabs made of butterflied white tape are placed on the outer layer of this figure-of-eight wing bandage in a Palm Cockatoo. The bandage was placed simply to protect the intravenous catheter and line, while the distraction tabs give the patient something to groom or chew on without destroying the bandage. Distraction tabs are not a substitute for a poorly placed uncomfortable bandage. If the patient is chewing at the actual bandage, re-bandage the wing and consider analgesics to help manage pain.
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17.12 A figure-of-eight wing bandage demonstrated on a deceased Red-tailed Hawk. The bandage (in this case a first layer of roll gauze) is started high in the axilla and carried over the dorsal aspect of the wing to the leading edge of the carpus. Next, the bandage material is wrapped around the carpus from lateral (dorsal wing) to medial, circling the carpus to the medial side of the wing and ultimately being pulled high in the axilla to be brought around the dorsal side of the wing for a second pass. A second layer of flexible minimally adherent bandage material is placed following the same pattern as the first.
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17.13 A body wrap is demonstrated on a deceased Red-tailed Hawk. Start by placing tape over the central portion of the keel and wrap it around the body, keeping the tape relatively high in the axilla. 3M™ Durapore™ is used here because it is adherent but minimally damages the feathers when removed. Next, bring the tape around the dorsal side of the injured wing over the middle portions of the humerus, radius, ulna and phalanges, such that the wing lies in a normal resting position. After making one or two passes stabilizing the wing against the body, insert one or two fingers under the tape to ensure the bandage is not too tight.
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17.14 A Budgerigar with bumblefoot lesions on both feet. Such lesions can benefit from perch management, addressing underlying illness (especially arthritis and obesity), topical medications and a simple foot bandage.
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17.15 A simple foot bandage demonstrated on a deceased Red-tailed Hawk. Start by wrapping the distal tarsometatarsus with minimally adherent bandage material. Carry the bandage under the plantar surface of the foot, then over the dorsal foot, and back to and around the distal tarsometatarsus. Next, pass the bandage material between each toe, going from plantar to dorsal, until all interdigital spaces are covered. The bandage can be extended to one or more toes as needed. An excessively tight bandage may result in tissue necrosis and should be monitored.
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17.16 A ball bandage demonstrated on a deceased Red-tailed Hawk. Ball bandages are reserved for more serious foot injuries and also used as needed to prevent birds of prey from impaling handlers during procedures. Roll gauze or square gauze pads are placed into the central plantar surface of the foot and the bird is allowed to grab the material. Next, a layer of roll gauze is started at the distal tarsometatarsus and carried over and around the foot with the toes kept in a semi-perching position. This is followed by a layer of minimally adherent bandage material laid in the same fashion.
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17.17 As a result of chronic upper respiratory disease and accumulation of caseous debris, the right naris of this Green-cheeked Amazon is severely distorted. A Budgerigar with a swollen infraorbital sinus and discharge from the nares. This is more typical of the classic presentation of advanced sinusitis. Some sinus masses are solid and may manifest as a visible swelling only with no discharge, as in this Canary.
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17.18 Advanced diagnostics such as radiography, computed tomography and magnetic resonance imaging are often needed to better characterize sinus disease in birds. In this case, a large soft tissue dense mass is identified in the rostral diverticulum of the infraorbital sinus (in the base of the upper mandible, outlined by arrows) in a Blue and Gold Macaw.
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17.19 When performing an infraorbital sinusotomy, incise directly over the swollen area but away from the eye, as shown with this Green-winged Macaw (cadaver). By opening the beak, the potential space within the infraorbital sinus can be increased, thereby increasing exposure and working room. A cotton-tipped applicator is used to remove mucoid discharge. Microsurgical and miniaturized instruments, such as loop ear curettes, can all be used to help retrieve infectious and foreign material from the sinus.
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17.20 Trephination is sometimes required, especially when sinus masses are hidden behind bony structures. A trephine is drilled into the frontal sinus of a Blue and Gold Macaw with caseous sinusitis. After trephination, caseous debris is scooped out with an ear curette.
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17.21 The upper mandible was bitten off this Budgerigar by a larger parrot. Such severe beak injuries require supportive care until the bird can learn to eat on its own.
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17.22 The upper mandible of this Cockatiel is severely overgrown and related to an underlying liver disease. Simply trimming the beak without treating the underlying disease will not address the cause of the beak abnormality.
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17.23 A minor injury such as this beak tip damage in a Cooper’s Hawk can be patched with cyanoacrylate adhesive (super glue) and baking soda, providing temporary protection until the beak adequately heals. The bird will likely benefit from analgesia.
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17.24 A left lateral approach is used with this aracari. With the patient in right lateral recumbency, the wings are taped dorsally, the right leg is taped caudally and the left leg is taped cranially (for a more cranial approach to the coelom and in this case an endoscopic renal biopsy). The closed endoscopic entry site. With the bird in right lateral recumbency, the paralumbar fossa is bound cranially by the caudal thigh muscles (pink), dorsally by the synsacrum (white) and caudally by the pubis (green).
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17.25 A Cockatiel in dorsal recumbency with a ventral midline incision (arrowed). Note the cranial extent of the incision just caudal to the sternum.
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17.26 Ventral coeliotomy. A ventral midline coelomic incision is made on a Yellow-naped Amazon. The caudal extent of the sternum is highlighted by the white lines. The skin only has been incised, leaving the underlying ventral coelomic muscles visible, and the linea alba is barely visible along the midline (as indicated by the arrow). The linea has been incised and its margins are outlined by the arrows. Cotton-tipped applicators are used for blunt dissection. The ventral midline coelomic incision is closed in two or three layers. The linea alba has been closed with monofilament absorbable suture material in a simple interrupted pattern. The skin has been closed with a horizontal mattress pattern using monofilament absorbable suture material. Obese birds may require a middle subcutaneous layer closure.
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17.27 An Umbrella Cockatoo presented with a large ventral coelomic hernia. The initial incision is made as cranial as possible. The pendulous ventral coelom has an ulcer (arrowed) from contact with the ground. Inflamed intestines are carefully exteriorized through the incision.
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17.28 In preparation for an ingluviotomy, the skin over the ventral caudal neck (proximal to the thoracic inlet) is prepared. Bluntly separate the overlying skin from the crop, which is held in the forceps here. Excise any abnormal tissue for biopsy. When screening for proventricular dilatation disease, select a highly vascular area of the crop to collect neurovascular tissue. A large sample of crop tissue has been collected for proventricular dilatation disease screening. Note the seeds still in the now exposed crop lumen. Upon completion of the ingluviotomy, close the crop with a continuous inverting pattern using monofilament absorbable suture material. An initial simple interrupted layer may be placed first. The final skin closure for the ingluviotomy site can include the underlying crop wall or this may be closed separately.
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17.29 Penetrating ventricular foreign bodies, such as this bone outlined by arrows in a Harris’ Hawk, represent an emergency. Rare circumstances such as the one presented here require aggressive medical therapy and exploratory coeliotomy.
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17.30 When performing a proventriculotomy to ventriculotomy, look for other abnormalities that may be present, such as masses and diverticula. During removal of a ventricular foreign body, a large cystic mass (arrowed) was found on the dorsal surface of the proventriculus of a Yellow-naped Amazon. The cyst was aspirated to remove its fluid contents and collect samples for culture and sensitivity testing. The cyst was exteriorized, ultimately removed and submitted for histopathological analysis.
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17.31 The approach to the proventriculus, isthmus and ventriculus demonstrated on a Yellow-naped Amazon. The left leg is pulled cranially and is abducted from the body. The inguinal skin has been incised and forceps have been used to puncture through the lateral coelomic muscles (arrowed) just caudal to the ribs. The last two ribs have been cut (arrowed) to increase exposure. Thumb screw retractors (double-headed arrow) are used to expand the surgical entry into the left lateral coelom. The proventriculus (cranial dashed lines) and ventriculus (caudal dashed lines) are exteriorized with the aid of stay sutures (double-headed arrow). Ideally, two stay sutures should be placed in the tendinous portion of the ventriculus. If placing sutures in the proventriculus, as shown here, minimal tension should be applied. Most, if not all, of the tension should be on the ventricular stay sutures. Due to an unusual proventricular cyst in this parrot, a single stay suture was placed in the proventriculus to better examine the cyst. Using precise technique, incise into the isthmus (narrowed junction between the proventriculus and ventriculus, both outlined by dashed lines), being careful to cause as little damage as possible.
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17.32 Carefully probe orad (into the proventriculus) and aborad (into the ventriculus) for foreign material. Microfine mosquito haemostats are used to probe the proventricular lumen through the isthmus incision in this Red-fronted Macaw. This bird had a large foreign body (shown within the jaws of a microfine mosquito haemostats) obstructing the distal oesophagus. The arrow points to the large isthmus incision.
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17.33 Sucralfate is instilled into the proventricular–ventricular lumen via the isthmus incision after successful removal of a metal screw in this hornbill. By directly instilling the sucralfate, delivery to the affected area is ensured (incised proventricular, isthmus and/or ventricular mucosal surface). Sucralfate reacts with hydrochloric acid in the ‘stomach’ to form a cross-linking, viscous material capable of acting as an acid buffer and ultimately protecting ulcers or, in this case, a surgical incision. The isthmus incision is closed in a simple interrupted appositional pattern using fine monofilament absorbable suture material. The orad proventriculus, isthmus and aborad ventriculus are outlined by a green dotted line with the closed incision roughly in the centre. Due to the relatively large size of this bird, a continuous inverting suture pattern was sewn over the isthmus incision. Ventricular stay sutures are denoted by the arrows. The left lateral body wall is closed, taking care to re-appose ribs (if needed). The underlying muscle layer is closed such that no air leaks during positive pressure ventilation. The overlying skin can be closed separately or by incorporating the underlying muscle and subcutaneous (if identifiable) layer(s) as needed to prevent a potential space. The finished closure.
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17.34 Ventplasty is not recommended for acute cloacal prolapses, as seen with this Black-capped Caique.
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17.35 A male Umbrella Cockatoo with a chronic (>10 years) cloacal prolapse. A male Umbrella Cockatoo’s significantly dilated vent associated with chronic cloacal prolapse (the prolapsed tissue was easily replaced prior to photographing this patient).
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17.36 A grossly dilated and disfigured vent in an Umbrella Cockatoo due to chronic cloacal prolapse and multiple local surgeries. The goal of ventplasty is to reduce the vent opening to a normal size and thereby prevent further prolapse of cloacal or other tissue. This particular bird required intensive behaviour modification and lifestyle changes prior to surgery. Ventplasty in a male Umbrella Cockatoo. A triangular wedge has been resected from the left and right sides of the vent. The bird’s left side ventplasty has already been performed, leaving the right to finish. The ‘new’ vent diameter is outlined with dashed lines. The submucosal layer has been closed (area outlined by arrows) with monofilament absorbable suture material. The ventplasty procedure is continued and the dermis has been sutured closed. At this point only the overlying skin needs to be closed and the vent diameter (dashed lines) should be normal for the species and easily allow for waste material to pass.
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17.37 A ventral midline approach is used to access the liver in a Cockatiel. The sternum and keel are highlighted in green. Note the cranial extent of the ventral midline incision. The right liver lobe (L) is located behind a coelomic membrane (arrowed) and lateral to the ventriculus (V). The liver is enlarged with a rounded edge.
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17.38 Hepatomegaly in a Blue-headed Pionus. The liver (L) is readily distinguishable from the ventriculus (V) and intestines (I). The right liver lobe is enlarged with rounded edges. A mosquito haemostat is clamped on the medial aspect of the right liver lobe helping to expose a pale lesion in the centre edge of the hepatic lobe. Another mosquito haemostat is placed on the lateral aspect of the right hepatic lobe. Microsurgical scissors are used to excise the liver tissue distal to the clamps. The haemostats were left in place after the tissue sample was collected. The haemostats have been removed, revealing a minimally bleeding liver biopsy site.
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17.39 The ventral (pictured) and dorsal pancreatic lobes rest in between the ascending and descending duodenal loop, as in this Blue-headed Pionus. An atrophied pancreas is noted in this Monk Parakeet at post-mortem examination. Notice the lack of recognizable tissue in between the duodenal loop.
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17.40 A small section of the distal aspect of the ventral pancreatic lobe is simply cut off in a curassow. No haemostasis was required here; however, sutures, haemostatic agents or just direct pressure can all be used as needed to control bleeding.
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17.41 A kidney biopsy (endoscopic view) is the only means to accurately characterize renal pathology.
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17.42 A Budgerigar with a prolapsed oviduct. This represents a true reproductive tract emergency.
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17.43 A Yellow-naped Amazon Parrot with salpingitis and an impacted oviduct having a necrotic egg removed via salpingotomy. Ultimately the entire oviduct was removed.
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17.44 Dystocia in a Sun Conure. This conure presented depressed and anorexic for 2 days with a swollen ventral coelom and a palpable egg. The white colour of the egg is visible through the vent, supporting the hypothesis that it is located in the distal oviduct. The egg is aspirated by directing the needle through the shell without penetrating any other tissue. The egg is then manually collapsed by using two fingers on the outside body wall and pressing on the now empty egg. The cloaca is swabbed with sterile lubricant jelly and the shell is grasped with haemostats. The collapsed egg shell is carefully removed.
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17.45 A left lateral coeliotomy in a hybrid macaw. This hen was reproductively active at the time of surgery, as supported by the presence of a highly vascular oviduct (arrowed) exteriorized through the incision. The initial incision is made in the paralumbar fossa. The underlying lateral coelomic muscles are cut in the direction of the fibres. Thumb screw retractors are used to improve access to the left oviduct. The abdominal air sac is often incised to directly visualize the oviduct and ovary. The air sac is variable between species and does not always need to be transected. The proximal portion of the oviduct (infundibulum) is retracted out of the incision if possible.
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17.46 A left lateral coeliotomy in an Eclectus Parrot with the left leg pulled cranially. As more of the oviduct is exteriorized, large vessels should be occluded with haemoclips as needed to limit haemorrhage.
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17.47 A ventral midline coeliotomy is used to approach an impacted oviduct (arrowed) in this Yellow-naped Amazon. The margins of the keel and sternum are outlined in white.
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17.48 F1–F5 follicles removed from a domestic duck. The F1 follicle is fully developed and ready to be released by the ovary and caught by the oviductal infundibulum. Leaving such large follicles after salpingohysterectomy increases the risk of egg yolk coelomitis.
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17.49 A large F1 follicle is being ‘twirled’ such that it can be easily removed. Use a cotton-tipped applicator to rotate the follicle 20–40 times until the blood vessels are no longer visible. At that point, the follicle should simply come loose as its vascular supply is cut off and the pedicle literally twists off.
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17.50 An Eastern Rosella is placed in right lateral recumbency with the left leg pulled caudally. This exposes the cranial extent of the paralumbar fossa, which is the palpable depression just cranial to the thigh muscles. The area is plucked and surgically prepared for an air sac tube placement. A nick incision using a No. 15 blade is made over the cranial extent of the paralumbar fossa just enough to cut through the skin. A straight, curved or right-angled mosquito haemostat is used to ‘punch’ through the lateral body wall muscles and into the immediately underlying air sac (either caudal thoracic or abdominal depending on the exact position and species). Next, a red rubber feeding, endotracheal or similar sterile tube is guided by open haemostats into the air sac space. The internal diameter of the tube should approximate the patient’s tracheal lumen size. Do not place the tube too deep as vital structures can be speared and damaged. Next, the tube is trimmed to make its size more manageable and decrease the dead space. Prior to securing the tube, test the patency by placing a small feather over the opening and force ventilate the patient. If air is not adequately moving the test feather, reposition the air sac tube. Once the tube patency is determined, attach it to the body wall. This can be accomplished by directly suturing the tube to the body wall, via butterflied tape or a Roman sandal suture.
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