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Fig. S3J
Suction drains are inserted immediately postoperatively.
3.3 The day after surgery
Typically, perioperative prophylactic antibiotics are administered throughout the 24-hour post-surgical period, then discontinued. The horse's vital signs are monitored twice daily and recorded in the case record.
A report of the surgical procedure is generated and sent to the client, the referring veterinarian, and any other interested parties. The report should deal with any changes in diagnosis or prognosis made at the operating table and should detail the responsibilities of the animal's caretakers in the long and short terms postoperatively. In a practice or clinic with a heavy orthopedic load, it is probably best to develop certain standard aftercare programs that can be tailored to fit individual circumstances.
Physical therapy [13] and controlled exercise should begin as early as possible during the recovery phase and continue at home. This commitment to the animal's final well-being is extremely important to the successful outcome of any given surgical procedure. Many surgeries of the distal limb such as those considered later in this manual require little or no protection by external fixation in the postoperative period. This allows for early joint and tendon mobilization, and prevents the capsular fibrosis and stiffness that are otherwise almost inevitable. The use of non-steroidal anti-inflammatory agents in the early postoperative phase permits passive joint manipulation by limiting the development of capsular and subcutaneous edema. Movement reduces the formation of adhesions, improves the nutrition of articular tissues, and aborts progression of degenerative changes [14].
Plans for follow-up radiography are made and the dates calculated based upon the date of surgery. Computer programs with “datebook alarms” can be helpful in reminding the surgeon of these dates. The follow-up information is essential to an adequate documentation of results, and to developing improvements and modifications of technique for the future.
Generate the surgical report immediately postoperatively.
3.4 Summary—Checklist
Day before...
Completeness of medical record concerning biographical data and medical history checked.
Owner made aware of alternatives and risks.
Complete physical examination performed.
Preoperative plan developed, indicating needs for implants and instrumentation.
Patient bathed; operative site clipped, scrubbed, and protected with a sterile wrap.
Antibiotic therapy instituted.
Food withheld 12 hours preoperatively.
Begin physical therapy and controlled exercise as early as possible.
Day of...
Final check of patient, personnel, and equipment.
Positioning of patient determined based upon accessibility and ease of intraoperative radiographic monitoring.
Appropriate drainage of the surgical site provided (if necessary).
Day after...
Surgical report generated and distributed.
Physical therapy instituted, its continuance described in writing, and discussed with owner/trainer.
Dates set for follow-up radiographs and examinations.
3.5 References
1. Bramlage LR (1983) Current concepts of first aid and transportation of the equine fracture patient. Comp Cont Educ Pract Vet; 5(suppl):564.
2. Fackelman GE, Peutz IP, Norris JC, et al. (1993) The development of an equine fracture documentation system. Vet Comp Orthop Traumatol; 6:47.
3. Wilson JF (1992) Professional liability in equine surgery. In: Auer JA, editor. Equine Surgery. Philadelphia: W.B. Saunders Co, 13.
4. Stashak TS (1987) Diagnosis of lameness. In: Stashak TS, editor. Adams' Lameness in Horses. Philadelphia: Lea & Febiger, 103.
5. Peutz IP, Fackelman GE (1985) Fracture classification tables Pt I: Exercise induced fractures. Grafton MA, published by authors.
6. Taylor GJ, Bannister GC, Calder S (1990) Perioperative wound infection in elective orthopedic surgery [published erratum appears in (1991) J Hosp Infect; 17:155]. J Hosp Infect; 16:241–247.
7. Bodoky A, Neff U, Heberer M, Harder F (1993) Antibiotic prophylaxis with two doses of cephalosporin in patients managed with internal fixation for a fracture of the hip. J Bone Joint Surg [Am]; 75:61–65.
8. Moore RM, Schneider RK, Kowalski J, et al. (1992) Antimicrobial susceptibility of bacterial isolates from 233 horses with musculoskeletal infection during 1979–1989. Equine Vet J; 24:450.
9. Brown M (1990) Antibiotics and anesthesia. Semin Anesth; 10:153.
10. Cars O (1991) Pharmacokinetics of antibiotics in tissues and tissue fluids: a review. Scand J Infec Dis Suppl; 74:23.
11. Richardson JB, Roberts A, Robertson JF, et al. (1993) Timing of antibiotic administration in knee replacement under tourniquet. J Bone Joint Surg [Br]; 75:32–35.
12. Clem MF (1992) Preparation for surgery. In: Auer JA, editor. Equine Surgery. Philadelphia: W.B. Saunders Co, 111.
13. Kraus AE, Fackelman GE (1987) Immediate controlled mobilization (ICM) in the treatment of acute athletic injury. Proc Vet Orthop Soc; 14:123.
14. Zarnett R, Velazquez R, Salter RB (1991) The effect of continuous passive motion on knee ligament reconstruction with carbon fibre. An experimental investigation. J Bone Joint Surg [Br]; 73:47–52.
3.5.1 Online references
See online references on the PEOS internet home page for this chapter:
http://www.aopublishing.org/PEOS/03.htm
Jörg A. Auer
4.1 Mandible and maxilla fractures
