Small Animal Surgical Emergencies. Группа авторов
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a To be considered as a general guideline. There are many variables that could alter the clinician's decision. The clinician is responsible for selecting the appropriate size.
Box 2.42 Instruments and Supplies for Arthrotomy
Orthopedic instrument set (Figure 2.42)
Gelpis (small, medium)
Rongeur (single action)
Senn retractors
Hohmann retractor
Freer periosteal elevator
Sayre periosteal elevator
Gross ear hook and spoon
Frazier suction tip (#10)
Bulb syringe
Suction
Sterile saline
Culturette
Figure 2.42 Routine orthopedic instrument set.
Source: Courtesy of H. Herb, School of Veterinary Medicine, Philadelphia, PA.
Box 2.43 Supplies for a Robert Jones Bandage
Bandage scissor
Tongue depressor
Adhesive tape (1 in)
Rolled cotton (2–4 in, 12 in)
Elastic adhesive bandage
Self‐adhering bandage (VetWrap™)
Standard Surgical Preparation Protocol
Adding sterile surgical lubricating jelly to a wound before clipping the hair is a prophylactic measure to deter hair from entering the wound and causing further contamination. The lubricated jelly also serves as a protective barrier for exposed soft tissue, as contact with antiseptic detergent can cause irritation, pain, and structure damage. After clipping, a syringe containing sterile 0.9% saline is used to flush out the remaining hair, jelly, and debris from the wound. Distal fractures (i.e., radius/ulna, tibia/fibula) require a full circumferential clip of the entire limb, including the paw, whereas proximal fractures (i.e., humerus/femur) warrant a more conservative circumferential clip extending 10–15 cm proximal and distal to the incision site. In these cases, the unshaved portion of the distal limb should be inserted into an exam glove and taped to avoid hair exposure. For distal fractures, soaking the foot in dilute chlorhexidine solution (0.05%) or wrapping the foot in chlorhexidine‐soaked gauze until the patient enters the operating room is advocated. The patient is ready for transfer to an operating room once a preliminary scrub has been performed. It is the surgeon’s preference to use chlorhexidine gluconate or povidone‐iodine to scrub the limb, however, the residual activity in chlorhexidine is greater than with povidone‐iodine. If the surgeon elects to drape the limb with a povidone‐iodine‐impregnated antimicrobial adhesive sterile drape, such as Ioban™ (3M, Maplewood, MN), a povidone‐iodine‐based final preparation solution must be used rather than chlorhexidine solution for Ioban to adhere to the limb.
Positioning is in lateral or dorsal recumbency with the limb suspended. The position should be confirmed with the surgeon prior to surgery.
Bone Plates and Screws
Types of plates are listed in Box 2.44 and other instruments and supplies for fracture repair are given in Box 2.45. Box 2.46 lists the String of Pearls™ (Orthomed, Palo Alto, CA) instrument set (Figure 2.43). The instruments and supplies needed to insert an interlocking nail are given in Box 2.47 (Figure 2.46). The instruments and supplies needed for the SK® external skeletal fixation system by IMEX® (Imex® Veterinary, Inc., Longview, TX) are listed in Box 2.48 and illustrated in Figures 2.44, 2.45.
Box 2.44 Types of Plates
Non‐locking:Dynamic compression plates (DCP)Limited contact dynamic compression plates (LC‐DCP)
Locking:Locking compression plates (LCP)String of PearlsAdvanced locking plate system (ALPS®, Kyon Veterinary Surgical Products, Boston, MA)
Specialty:CuttableReconstruction
Box 2.45 Instruments and Supplies for Fracture Repair
Orthopedic instrument set
Orthopedic fragment instrument/plate/screw setMini (1.5 mm, 2.0 mm, 2.4 mm)All instrumentation for implanting both locking and cortical mini‐fragment screws and platesLocking and cortical screws (1.5 mm, 2.0 mm, and 2.4 mm)Locking plates (LCP)Standard plates (DCP, straight plates, T‐plates, acetabular plate)Small (2.7 mm, 3.5 mm, 4.0 mm)All instrumentation for implanting both locking and cortical small‐fragment screws and plates2.7‐/3.5‐mm washersAcetabular plates, T‐plates, L‐plates, oblique L‐plates, 2.7 mm LC‐DCP plates, and 3.5 mm LC‐DCP plates (regular and broad)Screws: 2.7‐mm locking and cortical, 3.5‐mm cortical screws, 4.0‐mm cancellousLarge (4.5 mm)All instrumentation for implanting both locking and cortical large fragment screws and platesWashers: 10 mm (up to 4.5‐mm screws) and 13 mm (up to 6.5‐mm screws)4.5 mm narrow and broad LCP plates, and LCP T‐platesScrews: 4.5 mm locking and cortical screws, 4.5 mm shaft screws, 6.5 mm cancellous screws
Surgical power drill
± Impregnated antibiotic beads
± Bone graft
Box 2.46 String of Pearls Instruments and Supplies
Orthopedic instrument set
String of Pearls setAppropriate fragment instrument/screw set for plate size used
String of Pearls bending and twisting irons
Box 2.47 Instruments and Supplies to Insert an Interlocking Nail