Skin Got Ripped Off My Baby Duck How Long for It to Heal
Wound management in the avian wild animals prey
| Author(due south) Glen Cousquer | Contents
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Keywords: avian wildlife casualty; soft tissue injuries; wound management; hydrocolloid dressings; wet vapour permeable dressings.
Key Points
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Only those birds that are likely to make a rapid recovery and be successfully rehabilitated dorsum to the wild should exist treated.
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Euthansia should be considered for birds with complex wounds and for those birds that neglect to respond to aggressive therapy.
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The wound management program must be of a high standard in guild to improve the rate and quality of healing and the chances for successful rehabilitation.
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Hydrocolloids and moisture vapour permeable dressings have been found to greatly improve the quality of avian soft tissue wound management, decreasing wound healing times and complications.
Abstract
The 2d part of this two-part commodity discusses the direction of a number of soft tissue injuries unremarkably seen in the avian wild fauna casualty. This is not an exhaustive review of avian wound management techniques and problems but serves to illustrate the techniques that tin be used successfully to deal with and manage some of the more common presentations.
Introduction
The large number of avian species in the animal kingdom, together with the wide range of presenting problems, makes avian wound direction, of necessity, a large and very complex subject. The majority of avian wounds are older than eight hours and/or contaminated past the time they present for treatment. Most soft tissue healing is therefore by second intention. The flexible properties of certain mod dressings conform well to almost every function of the avian anatomy and the dressings themselves take been establish to greatly ameliorate the quality and speed of avian wound healing. This attribute is of particular importance in the wild avian casualty where rapid rehabilitation back to the wild is a fundamental objective. Topical utilize of a bland preparation containing yeast excerpt has been shown to stimulate epithelialisation and collagen synthesis for wounds in humans [1] and canines [2]. Such products are besides recommended for utilize in granulating avian wounds [3], [4] to further speed healing.
The principles of wound management in small animals have been well documented [5], [vi]. In the avian species, these principles must be adapted to take into account important differences in beefcake, physiology and pathology [3]. For the purposes of this article, a number of unproblematic techniques used to manage commonly seen avian wounds are discussed. These involve the following wound presentations: beak injuries, head and scalp injuries, barbed wire injuries, keel wounds, caught-past-cat (CBC) mankind wounds, canis familiaris bite wounds, carpal injuries, power cable injuries and bumblefoot.
Neb injuries
Many birds will suffer beak injuries during the course of their lives. The upper and lower mandible are vulnerable to trauma and will often fracture as a result. Such injuries are orthopaedic in nature and will not exist discussed further in this article.
Non-orthopaedic wounds are frequently seen in waterfowl. The horny beak or bill (rhamphotheca) is a difficult, tough, keratinised epidermal structure in birds of prey, too as seed and grass eaters. In waterfowl such as ducks, geese and swans (Anatidae) the beak is much thinner and softer [7]. The rhamphotheca is a modified horny layer consisting of layers of flattened keratin-filled cells, separated from the bones of the upper and lower jaws past a thin, fibrous dermis [viii]. The beak's strength is dependent on the detail arrangement conferred by a layer of keratin on a house bed of bone. In waterfowl, and swans in particular, the soft rhamphotheca is vulnerable to trauma and easily injured. Swans fly at speeds of thirty-fifty mph and have difficulty making sudden changes in direction. This is probably due to a number of factors including their size and weight, also every bit their relatively poor frontwards vision [9]. Collisions occur regularly and can issue in beak injuries [10].
The beak will heal by a process of granulation and epithelialisation, much every bit with any other epidermal tissue. Yet, there are applied issues in that the beak will be regularly immersed under water and into food bowls. The objective of any wound management plan should be to keep the wound clean and moist to facilitate the spread of granulation tissue over the exposed os and protect the bone from dessication. The use of a waterproof dressing is indicated. Products such as the protective paste (Orabase) are resistant to water and tin be used to pack the wound cavity. Hydrocolloid dressings can then be applied over the wound to provide further protection (Figure i to Figure 6). Wide-spectrum antibiotics are indicated until a salubrious bed of granulation tissue is established. In the example illustrated in Figures 1-half-dozen the granulation bed was established in 20 days. Post-obit this, epithelialisation progressed chop-chop and inside 6 days the wound was virtually healed. The rhamphotheca has a good blood supply and will heal well. This can exist relied upon when performing surgery on the upper mandible. Historically, homo has made use of the swan's ability to heal its rhamphotheca, though with what success remains unclear. To announce buying past a particular individual or group of individuals, notches and patterns were cut or branded into the neb [11], [12]. Today, this is viewed as inhumane and leg ringing has replaced bill mutilation equally the preferred and recommended method of identifying swans in Britain.
Figure i - An extensive wound to the tip of a mute swan's (Cygnus olor) bill has exposed a considerable amount of os.
Figure 2 - Close up of the wound in Figure i. Fresh bleeding from a pocket-sized bed of granulation tissue at the wound's proximal margin can exist seen.
Figure 3 - A protective paste (Orabase) was used to pack the wound depicted in Figures 1-2.
Figure 4 - Several strips of a hydrocolloid dressing (Duoderm Extra Thin) were used to provide a protective bulwark.
Figure 5 - Bed of granulation tissue was established xx days following admission.
Figure 6 - Epithelialisation of the wound is almost complete(day 26).
Caput injuries
Head injuries are difficult to care for every bit the avian head shape is not easy to bandage [3], [thirteen]. Head injuries may ascend following collision with a motor vehicle, window or asylum wall. They may also result from territorial disputes betwixt birds of the same species (conspecific fighting) or as a result of attacks between birds of dissimilar species (interspecific fighting). The wounds produced as a consequence of suspected interspecific fighting in buzzards (Buteo buteo) have been described [14], [xv]. The injuries can be quite severe and may involve damage to the eye, periocular tissues, oral and perioral tissues likewise as the sinuses (Effigy 7 and Figure 8).
Figure 7 - Penetrating injury below the right center of a buzzard (Buteo buteo). This injury extended into the infraorbital sinus.
Figure 8 - The buzzard shown in Figure 7 also had two lacerations to the back of its head. These injuries are easily missed if a thorough examination is not made. The wounds have been cleaned under anaesthesia and dressed with a hydrogel (Intrasite) and a thin vapour permeable adhesive dressing (Opsite).
The head wounds shown in Figures 7 and 8 were cleaned and so dressed with a hydrogel (Intrasite). A thin vapour permeable adhesive dressing (Opsite) was then placed over each wound. The caput wounds were suitable for delayed closure later a few days. The wound below the right eye was allowed to heal past secondary intention as at that place was concern that penetration of the infraorbital sinus might result in complications. A broad-spectrum antibiotic (cephalexin 100mg/kg orally twice daily) was administered until a healthy bed of granulation tissue was established. The most suitable dressing for such wounds is a semi-permeable hydrolloid (eg Duoderm Extra Sparse) [xiv]. It is easy to employ, is highly pliable and has expert agglutinative properties. If applied to awkward sites such every bit the supra-orbital ridge of a bird of prey it can be secured with sutures (Figure 9 to Figure 12). The use of wet vapour permeable (MVP) dressings has also been advocated for the handling of head wounds [3], [13] considering of their adhesive qualities and flexibility of the fabric. Whether hydrocolloid or MVP dressings are used, these should be changed every 2-four days initially, or more often if there is excessive exudate causing fluid to leak from underneath the dressing. Once a healthy bed of granulation tissue has been established, dressings tin be changed weekly [13].
Figure 9 - All-encompassing caput wound to a buzzard's head. A strip of hydrocolloid dressing (Duoderm) has been practical to the wound and secured with stitches. This is specially necessary over the supra-orbital ridge.
Figure 10 - Five days later the dressing is still keeping the wound moist and well protected.
Effigy 11 - Later removal of the dressing, a good bed of granulation tissue is present. The wound to the correct side of the head has almost healed.
Effigy 12 - Later 17 days the wound has almost completely healed. A small-scale pare deficit over the supra-orbital ridge is nevertheless evident. Five days afterward the wound had healed over completely.
Spinous wire injuries
Birds caught on barbed wire are likely to struggle violently in an attempt to free themselves. Considerable soft tissue trauma is likely to consequence from this struggling. The barb, of the barbed wire, may merely be caught in the skin, but it may too catch in and damage underlying tissues. The pare overlying the fly is thin and closely adhesed to the underlying tissues, and tin be hands damaged. Damage to the tendons of the propatagial membrane and fly are especially common and are likely to be very serious, normally warranting euthanasia. The skin overlying the neck is a little thicker and moves more freely. Barbed wire injuries to the neck (Figure xiii) may therefore accept a better prognosis, providing the oesophagus, trachea, cervical nerves and blood vessels accept not been damaged. The duck in Figure 13 was anaesthetised shortly after access as considerable soft tissue was exposed and vulnerable to dessication. The spinous wire was firmly embedded in the skin of the neck but the key structures had escaped damage. The twisted skin was resected, removing all the compromised tissue. The wound was so closed with uncomplicated interrupted absorbable sutures (3/0 Vicryl) and a protective blanket of aluminium powder applied over the wound (Aluspray). Wide-spectrum antibody cover was provided for vii days with clavulanate amoxycillin (Synulox) 150mg/kg orally twice daily. The wound healed uneventfully (Figure 14) and the bird was released soon afterwards. Anti-tetanus treatment is not unremarkably indicated, as birds are particularly resistant to tetanus toxin [16].
Figure 13 - Mallard duck (Anas platyrhynchos) caught on barbed wire. The barb is firmly stuck in the peel of the duck's neck. The skin has been badly torn and twisted as a result of the duck's attempts to free itself.
Effigy fourteen - Ten days afterward access the wound has healed following surgical resection of the damaged skin and primary closure.
Keel wounds
Keel wounds are usually seen in sick and debilitated birds. Such birds spend long periods sitting downwards and will fall heavily onto their keels through weakness. The evolution of a pressure ulcer is a progressive process that will somewhen result in os necrosis. Treatment will only be successful if the underlying problems are properly addressed. Procedures to deal with keel wounds and spread the weight away from the keel and onto the pectoral muscles using tubing stitched to the chest, have been described [17], but have met with limited success. It is recommended that treatment should merely exist attempted in the mildest of cases where the underlying problems are probable to ameliorate in a short infinite of time. The development of a life jacket for swans, which could be strapped to the swan and inflated, may exist very helpful in healing such wounds. An air filled pad downwards either side of the pectoral area would take pressure off the keel and distribute it more evenly over the swan'due south ventrum.
Caught-past-cat flesh wounds
Cat bites may range from tiny puncture wounds to lacerations. The musculus underneath a puncture wound may exist lacerated due to the action of the teeth in immobile musculus (relative to the skin). Many wounds cannot exist detected with the naked eye and the need for antibiotics may not be recognised in cases where in that location is no evidence of a puncture wound or scratch [18]. Septicaemia is a common sequel to a cat bite, while other routes of infection take also been suggested. Birds may ingest organisms from cat saliva-coated feathers during preening leading to gastrointestinal illness and septicaemia [18]. Cats conduct Pasteurella multocida on their gingival tissue and teeth and antibiotics are therefore ever indicated in whatever bird attacked by a cat [19], [20]. In addition to Pasteurella spp, a mixed aerobic/anaerobic population has been recovered from the majority of cat bite wounds [18]. Selecting the correct antibiotic (or antibiotic combination) is therefore of vital importance. Penicillins have been cited as the antibiotic of choice due to their efficacy against P. multocida [20] and their broad spectrum of action. Fluoroquinolones, such as the much-favoured enrofloxacin (Baytril) should not be used on their ain every bit they lack action confronting anaerobes and provide incomplete coverage against Streptococci spp. For infected bites clavulanate-amoxycillin or combination therapy with penicillin, or clindamycin, and a fluoroquinolone is recommended. Ideally culture and sensitivity testing should be performed, just this will often be incommunicable for time and cost reasons.
Seize with teeth wounds should be aggressively cleaned and flushed with saline or 0.05% chlorhexidine [20]. Flushing may demand to exist repeated. Puncture wounds can be left open up to drain simply lacerations should be dressed to protect the underlying tissues. Some puncture wounds may demand to be opened upward to facilitate access to the underlying traumatised tissues.
Where the pectoral muscles have been lacerated, aggressive cleaning and debridement is indicated nether general anaesthesia. Torn, necrotic muscle should be removed and the wound packed with a hydrogel. A hydrocolloid dressing (eg Duoderm Extra Thin) can exist applied over the wounds to provide boosted protection. The wounds should exist reassessed after 24 to 48 hours and a decision fabricated as to whether wound closure is appropriate (Effigy 15 to Effigy xviii).
Figure 15 - This adult male person blackbird (Turdus merula) had a seize with teeth wound to his left chest. The exposed muscle is nighttime, dessicated and necrotic.
Effigy 16 - Post-obit surgical autopsy and debridement of the wound, salubrious muscle is visible.
Effigy 17 - The wounds, including a puncture wound over the lower back, were packed with a hydrogel and dressed with a sparse hydrocolloid dressing.
Effigy eighteen - A delayed (two twenty-four hours) closure was performed on the wound. The superficial pectoral musculus was stitched and the skin closed. An aluminium wound dressing was applied over the surgical wound, which is shown healing 12 days subsequently.
Dog seize with teeth wounds
Whilst cats are skilful at catching small, ordinarily juvenile, passerines (eg sparrows), doves and pigeons, it is non unusual for dogs to attack waterfowl who are perhaps less mobile than passerines and easier to hunt. Female swans volition remain on the nest despite receiving injuries to the neck and legs, while male swans will go on to defend a nest despite incurring bite wounds to the leading border of the wing each time they strike out [10]. A swan poses a formidable antagonist and will rear upwardly and defend itself with its wings. Consequently dogs need to attack from backside and it is perhaps for this reason that the tail and rump area is about often targeted. Some of these injuries can be very astringent and vulnerable to fly strike. Infection tracks readily betwixt the fascial layers of the tail muscles and euthanasia may be the only option in many cases (Effigy 19).
Figure xix - Old, necrotic bite wounds to the tail and rump of a mute swan (Cygnus olor). Note the multiple puncture wounds and the associated lacerations.
A fresh wound is likely to warrant treatment. Figure 20 shows a large adult male swan, which presented with bite wounds to both the dorsal and ventral tail. Most of the wounds healed well following careful debridement, dressing and delayed closure. One of the wounds to the dorsal tail had, notwithstanding, penetrated the left preen gland. Damage to the gland capsule meant that the lipid and waxy sebum produced by the gland [8] was leaking into the surrounding tissues. The wound healed with a sinus (Figure xx), necessitating removal of the damaged half of the gland. Unfortunately the resulting surgical wound also bankrupt down, leaving a deep but essentially healthy cavity (Figure 21). This was left to heal past secondary intention. The cavity was packed with a protective paste (Orabase) and a small-scale piece of hydrocolloid (Granuflex) was applied over the wound and secured in place with staples. Wound dressings were performed with the swan conscious, thus reducing the need for repeat general anaesthetics. The wound healed uneventfully and the bird's waterproofing appears unaffected.
Figure 20 - Necrotic sinus over left preen gland in a mute swan (Cygnus olor) with a number of seize with teeth wounds to the tail.
Figure 21 - Post-obit removal of half the preen gland, the wound broke downwardly leaving this big cavity.
Figure 22 - The cavity was packed with a protective paste (Orabase) and dressed with a hydrocolloid dressing (Granuflex). This was secured in position with surgical staples.
Carpal injuries
Trauma to the skin and tissues overlying the carpal joint can hands lead to complications. Tendon sheath infections and joint infections are very serious and advisable wound management techniques are indicated to ensure that carpal injuries practice not lead to complications.
The anterior surface of the carpal articulation is subject to considerable motion every time the articulation is flexed and extended. Debridement of any wounds must be followed by handling with an appropriate dressing. A hydrocolloid dressing (eg Granuflex) can exist applied and stitched into identify [21]. It may exist possible to perform a delayed closure of the wound, tissue tension permitting. In such cases a hydrocolloid dressing (eg Granuflex) may be applied over the stitched wound to provide additional protection and back up. Use of absorbable suture materials can permit flighty birds to be placed in a tranquility aviary, or even released, and the dressing immune to fall off. This is only recommended in exceptional circumstances, however, as wound re-examinations are essential if complications, such equally wound breakdown, are to be identified. Initially, the wing may benefit from immobilisation with a effigy of eight dressing. The wing should non be strapped for more than five days, however, as tendon contracture is probable to occur and will seriously damage the bird's chances of a successful rehabilitation.
Power cable injuries
One of the obstacles that swans may crash into is the power cable [nine]. Collisions of this nature are likely to outcome in injuries to the neck and to other parts of the body. Injuries volition not only arise every bit a result of the initial impact on the line, only besides equally a result of the subsequent crash-landing [10]. Electrical burns will occur where contact has been fabricated between 2 wires. The manifestation of electric injuries can be insidious [x] and all birds establish adjacent to power lines should be thoroughly and repeatedly examined for signs of burns to the feathers, peel or musculature over a flow of up to v days. Devitalised tissue will become cold and oedematous to the impact, before sloughing in a compartmentalised mode, delineating the tract along which the electricity travelled [10]. The considerable associated tissue damage accompanying such electrical burns (Figure 23 to Figure 24) will dictate euthanasia in the bulk of cases.
Figure 23 - Astringent electrical burns to the left leg and abdomen of a mute swan (Cygnus olor) found near ability cables. Euthanasia is indicated in all such cases.
Figure 24 - Suspect electrical burns to the feet of this mute swan carry a poor prognosis due to the likely tendon and joint interest. Note the severe baking of the human foot webs.
Foot injuries and bumblefoot
Unproblematic foot injuries may be treated with some success. Trauma to the foot when hitting a wire, motor vehicle or other object in flight can produce wounds (and fractures) to the dorsal surface of the foot and lower leg. Knuckling over of the foot on impact, when hitting such objects, can produce astringent trauma to the integument over joints [ten]. Closure of these injuries can exist hampered by lack of tissue, but supporting the pes with a swan shoe, for example, tin help (Figure 25).
Figure 25 - Mute swan (Cygnus olor) wearing a 'swan shoe'. A triangular plastic board is strapped to the plantar surface of the swan'southward heavily padded pes. This keeps the toes spread out and splints the whole human foot. Information technology is indicated for fractures of the phalanges and injuries of the human foot.
Bumblefoot
Surgery for bumblefoot or pododermatitis in the bird of prey has been described in detail by a number of authors [22], [23]. The removal of a fibriscess (Figure 26) from the plantar attribute of the tarsometatarso-phalangeal joint of a mute swan is described here.
Effigy 26 - Mute swan (Cygnus olor) foot with a large fibriscess on the plantar surface of the tarsometatarso-phalangeal joint. The large fibriscess was impairing the movement of the swan. An old puncture wound can be seen.
Following induction of general anaesthesia and surgical preparation of the human foot, the line of least tension was identified and a linear incision made over the fibriscess. A tourniquet was used to minimise blood loss. The encapsulated mass was dissected away from the underlying tissues by blunt dissection and removed as an entire mass (Figure 27 and Effigy 28). This is important if the surgical site is non to be contaminated, but may be difficult where a thick gristly wall has non had fourth dimension to grade around a focus of infection. The skin was and then airtight with a series of monofilament absorbable (3/0 PDS) mattress sutures every bit these are less likely to pb to infection in the wound or produce tissue reaction. Monofilament sutures provide a greater duration of wound support, which can be useful in slow healing tissues such every bit the thick horny layer of pedal skin. Aluminium powder (Aluspray) was applied to the wound and dressed using a swan shoe. The sutures were removed after 12 days (Figure 29). Premature removal of the sutures should be avoided as the wound can easily break downward if loaded.
Effigy 27 - The excised fibriscess: the dorsal surface has been dissected from the underlying tissues without breaking the capsule.
Figure 28 - The excised fibriscess has been cut open up to show the necrotic middle, surrounded by a thick fibrous capsule.
Figure 29 - Fourteen days after the excision of the fibriscess, the surgical wound has healed, leaving a pink scar of young epithelial tissue.
Conclusions
Wound direction for the avian wildlife prey is complicated by the big number and diversity of species seen, together with the wide range of presenting issues. A number of avian wound problems, unremarkably seen in the wild avian prey, have been discussed. This is not an exhaustive list of wound issues simply serves to illustrate the techniques that can be used to successfully deal with and manage some of the more mutual presentations. The vast bulk of soft tissue injuries will crave healing by 2d intention. The utilize of hydrocolloid and moisture vapour permeable dressings has greatly improved the quality of avian soft tissue wound direction, decreasing wound healing times and complications.
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All materials copyright © 1992-Feb 2001 by SMTL, March 2001 et seq by SMTL unless otherwise stated.
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