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SURGICAL RESOLUTION of SOFT TISSUE DISORDERS 791 Espen Odberg Fig 35.11A | Xanthomas Often Occur at the Distal Wing, but Have Been Found in Other Locations

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SURGICAL RESOLUTION of SOFT TISSUE DISORDERS 791 Espen Odberg Fig 35.11A | Xanthomas Often Occur at the Distal Wing, but Have Been Found in Other Locations 35_Soft Tissue.qxd 8/24/2005 5:11 AM Page 790 790 Clinical Avian Medicine - Volume II Surgical correction is accomplished with the patient in Uropygial Gland dorsal recumbency. The feathers are removed in a 2-cm The uropygial gland is located dorsal to the tail. It is diameter around the circumference of the wound and absent in Amazon parrots (Amazona spp.) and the the area surgically prepped. The skin and subcutaneous hyacinth macaw (Anodorhynchus hyacinthinus) and may tissues are debrided until healthy tissue is encountered. be reduced in size in some cockatiels. Disease of this It may be necessary to debride devitalized pectoral mus- gland and/or its papillae is not uncommon and surgical cle and affected portions of the carina of the keel. correction may be necessary. Absence of papilla feathers Radiosurgery may be used for hemostasis. Tissue and may indicate a problem with glandular function. Left bone samples should be submitted for bacterial culture untreated, a gland may rupture, causing inflammation and histopathologic examination. The elevated origins of and significant scar tissue formation. Simple impaction of the pectoral muscles are sutured together over the keel the gland may respond to medical therapy and gentle or anchored to the cartilaginous portion of the keel in expression of the contents. If the impaction cannot be an interrupted horizontal mattress pattern with alleviated by conservative therapy, small incisions may be absorbable monofilament suture. The skin is closed in a made over the affected lobe(s) of the gland, the contents simple interrupted or continuous pattern with monofila- expressed, and the gland irrigated with saline. Antibiotics ment suture. There is often considerable tension on and analgesics may be indicated during recovery.9 Neo- these incision sites, therefore, it may be necessary to plastic conditions of the uropygial gland with secondary place tension-relieving sutures lateral to the incision. infection occur with some frequency (see Chapter 13, One method described involves placing interrupted hor- Integument). izontal mattress sutures through the skin and pectoral muscle tied over gauze sponges just lateral to the medial Chronic impaction and/or infection unresponsive to incision. The wings may be bandaged to the body to pre- medical therapy and neoplasia of the uropygial gland vent extension and movement that would place addi- may require surgical removal of the affected gland. The tional tension on the suture site, and a restraint collar or patient is placed in lateral or semi-ventral recumbency. body suit is usually necessary if auto-mutilation has Intermittent positive pressure ventilation and close mon- occurred. Defects that are too large to close surgically itoring of respiration is necessary when positioned ven- may heal by second intention. Gentle irrigation and fre- trally to ensure movement of the sternum is not reduced quent bandage changes with a sterile hydrophilic dress- and respiration not impaired. The head may be elevated ing will assist in healing.39 and a pad may be placed under the tail, with the tail rec- trices taped in place to elevate the sacrum and improve exposure and visualization of the uropygial gland. The Xanthoma surgical site is aseptically prepared. The gland is bilobed Xanthomatosis results from the accumulation of lipid- and each lobe receives its vascular supply from a vessel laden macrophages, giant cells, free cholesterol and vari- that branches at the cranial, middle and caudal portions able degrees of fibrosis. Xanthomas often occur at the of the gland. These vessels and other surrounding ves- distal wing, but have been found in other locations as sels require ligation or bipolar radiocoagulation. The well. These masses may be locally invasive and wide gland may extend deep to the synsacrum and caudally to margins may be necessary to completely excise and pre- the insertion of the tail feathers.9 vent recurrence. Some birds may mutilate these lesions, causing ulceration and secondary infection. Elevated A fusiform incision is made via unipolar or bipolar radio- serum cholesterol, trauma and genetic predisposition in surgery around the circumference of the gland. This is some species have been implicated in the formation of initiated caudal to the papilla and continued craniolater- xanthomas. Dietary correction may be curative in some ally along both sides of the gland. Dissection of the gland species and in some individuals. However, very large, is initiated at the caudal aspect of the gland and extended painful, hemorrhagic or infected xanthomas often circumferentially and cranially until the gland is removed. require surgical resection. Mosquito hemostats or thumb forceps may be used to apply gentle traction on the gland, facilitating removal. Masses may be removed with bipolar or monopolar The strongest attachments are associated with the muscle radiosurgery, taking care to avoid damage to remaining fibers at the cranial border of the gland. Hemorrhage feather follicles and their blood supply. The site may be must be strictly controlled by radiocoagulation, manual closed if there is enough remaining tissue or allowed to pressure and/or hemostatic products.9 The deeper fascia heal by second intention and bandaged with a hydroac- is closed with absorbable monofilament suture in a sim- tive dressing (Figs 35.11a-g). If extensive subcutaneous ple continuous or interrupted pattern, depending on the tissues and bone are involved, amputation of the amount of tension present. Subcutaneous and skin clo- affected area may be necessary.9 sure is routine. Extensive tissue trauma, neoplasia or 35_Soft Tissue.qxd 8/24/2005 5:12 AM Page 791 Chapter 35 | SURGICAL RESOLUTION OF SOFT TISSUE DISORDERS 791 Espen Odberg Fig 35.11a | Xanthomas often occur at the distal wing, but have been found in other locations. Note the balding plantar foot patterns and the discoloration of the feathers. These are indicative of malnutrition and related disorders. Espen Odberg Espen Odberg Espen Odberg Fig 35.11b | Xanthomas that are well Fig 35.11c | Xonthomas that are closely Fig 35.11d | Removal of such well- demarcated and/or pedunculated may associated with feather follicles may be defined distal wing xanthomas can be per- need to be excised. excised, being cautious not to cause follicle formed by making a small skin incision and damage. gently teasing the contents out with a ster- ile cotton swab. Espen Odberg Espen Odberg Espen Odberg Fig 35.11e | Hemorrhage can be con- Fig 35.11f | After using radiosurgical Fig 35.11g | The skin is closed in a trolled with a bipolar or monopolar radio- hemostasis allow a few moments to make simple interrupted suture pattern with a surgical unit. sure no oozing occurs. monofilament suture. rupture of the uropygial gland may require additional administered as appropriate to each patient. Dehiscence, dissection and debridement. An additional caudal inci- damage to the follicles of the rectrices and infection are sion perpendicular to the dorsal midline incision may be potential complications (Figs 35.12a-e).9 necessary. If the remaining defect is too large to allow full closure, staged closure or healing by second intention Pododermatitis may be necessary. Any open defects should be bandaged Treatment and surgical intervention in severe presenta- under a hydroactive dressing to promote granulation and tions of pododermatitis are outlined in Chapter 13, prevent exposure. Antibiotics and analgesics should be Integument. 35_Soft Tissue.qxd 8/24/2005 5:12 AM Page 792 792 Clinical Avian Medicine - Volume II Espen Odberg Espen Odberg Fig 35.12a | The feathers of the uropygial gland and the Fig 35.12b | The tissues underlying the skin are gently dis- feathers of the skin dorsally should be removed prior to surgical sected and the skin flap is gently reflected dorsally and cranially. removal of the gland. Care must be taken when removing these Hemorrhage is controlled by coagulation with a bipolar radio- feathers to prevent gland rupture or hemorrhage. Once the surgical unit. The difference in the appearance between the left feathers of the papilla are removed, material may drain from (impacted) and the right (non-impacted) side of the gland are the gland. This material will need to be cleaned and a gentle apparent in this picture. routine surgical scrub performed prior to surgery. A fusiform incision is made around the uropygial gland papilla, remaining dorsal to the tail feathers. Espen Odberg Espen Odberg Fig 35.12c | The largest vessels of the uropygial gland are Fig 35.12d | The skin is apposed using 5-0 monofilament located on the cranial aspect of the gland along the muscular nonabsorbable suture. Beginning the sutures in the middle of attachments. By utilizing the duct as a handle and working cau- the incision will allow for easier alignment of the skin flap. dal to cranial, the underlying vessels can be visualized and coagulated with the radiosurgical unit. Removing the gland requires careful dissection and thorough examination for bleed- ing vessels. Surgery of the Upper respiratory sounds, inflation of the associated infraorbital sinus, nasal discharge and picking at the affected nares Respiratory System with a toenail. The nares will appear impacted with mate- rial, but it is important to recognize the normal anatomy RHINOLITH REMOVAL and not mistake the operculum for abnormal material Birds may develop rhinoliths secondary to chronic rhini- (Figs 35.13a,b). A strong light source, magnification and tis and malnutrition. These
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