TECHNIQUE

Limb Amputation in Rabbits (Disease Investigation & Management - Treatment and Care)

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Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords --
Description Editor's Note: 
  • Information on this page is to be used together with information given in the "Treatment" section of the page Fractures in Rabbits and with information given in the page Treatment and Care.
  • This page is intended to provide the reader with information of particular importance for the treatment of lagomorphs. It does not provide details of the approach to different sites for limb amputation.
  • The reader should use the information in this text alongside their own experience in orthopaedic surgery and should consult relevant texts on small animal orthopaedic surgery as required.
Pre-operative preparation
  • Assess the rabbit's physiological status, including haematological and biochemical parameters. (B536.141.w141)
  • Give pre-operative analgesia 1-2 hours before surgery. (J213.5.w3)
  • Give pre-operative antibiotics 1-2 hours before surgery. (J213.5.w3)
  • Anaesthetise the rabbit.
  • Place an intravenous catheter and administer fluids during the operation. (B536.141.w141)
  • Prepare the limb for surgery.
Choice of amputation site
  • The amputation site should always be well proximal to the diseased area, and sufficiently high to avoid leaving a useless stump dangling. (B536.141.w141)
  • In general, amputation through a bone rather than through a joint is recommended. (B536.141.w141)
    • If amputation takes place through a bone, the bone end can atrophy. If through a joint, the articular epiphysis does not atrophy, while soft tissue around the joint does atrophy; this may result in insufficient coverage of the bone. (B536.141.w141)

Fore limb amputation

  • Surgery is simpler and faster, and a more cosmetic result is obtained if the scapula is removed; (B536.141.w141, B601.17.w17, B602.35.w35)
  • Some surgeons prefer to leave the scapula, amputating at the scapular-humeral joint, to retain the protective effect of the scapular for the chest wall. (B536.141.w141, B602.35.w35)
  • For digital, metacarpal or carpal lesions (fracture/osteomyelitis/neoplasia), carpal amputation can be used; this retains a "crutch-like" use of the remaining portion of the leg. (J213.5.w3)
Hind limb amputation
  • A midfemoral amputation is faster, easier, and gives a more cosmetic result than a coxofemoral removal. (B536.141.w141, B601.17.w17, B602.35.w35)
  • Disarticulation at the coxofemoral joint may be required if there is injury, infection or neoplasia reaching very near to the joint. (B601.17.w17, B602.35.w35)
  • For hind limb digital, metatarsal or tarsal lesions, amputation can take place at the tibial or tarsal joint. (J213.5.w3)
Amputation
  • Note: Use gentle tissue handling throughout the procedure to reduce the risk of development of a seroma. (B536.141.w141)
  • Incise through skin, subcutaneous tissues and muscle at a point distal to the intended amputation point.
    • Avoid extensive subcutaneous dissection as this leaves dead space which is difficult to close. (B536.141.w141)
    • Cut muscle at origins, insertions or through the belly of the muscle, as required. (B536.141.w141)
      • Use of electroincision controls haemorrhage. (B536.141.w141)
    • Make sure sufficient soft tissue, both muscle and skin, will remain to cover the bone with a tension-free closure. (B601.17.w17, B602.35.w35)
  • Control bleeding as required.
    • Double ligate major arteries using an inert nonabsorbable suture material. (B536.141.w141)
    • Ligate veins separately from arteries. (B536.141.w141)
    • Ligating veins after ligating arteries allows drainage of blood from the limb back to the body. (B536.141.w141)
    • Not ligating the artery and vein together avoids the risk of development of arteriovenous fistulas. (B536.141.w141)
  • Gently elevate soft tissues from the incision site to the point of the intended bone amputation.
  • Disarticulate the joint or saw through the bone, as required.
    • Note: Use a Gigli saw or power saw, not a bone cutter, to cut bones; the thin cortices tend to shatter if a bone cutter is used. (B602.35.w35)
  • Cover the end of the bone, or the joint, with muscle and suture the muscle (actually the fascial covering of the muscle) to maintain the muscle over the bone. (B536.141.w141)
  • Close the subcutaneous tissues and suture the skin over the stump in a tension-free closure.
    • For carpal and tarsal amputations it is important to provide a flap to sew over the bony stump. (J213.5.w3)
Post-operative care
  • Monitor for shock in the immediate post-operative period. (B536.141.w141)
  • Post-operatively, soft flooring is recommended, and bedding such as hay, wood chips or recycled paper. Note: if soft bedding and floor padding are not provided, development of pressure sores or arthritis is more likely. (J213.5.w3)
  • Analgesia should be continued post-operatively as necessary. (B606.10.w10)
    • NSAIDs are appropriate following fracture repair. (B600.5.w5)
  • Antibiotics as necessary. (P112.1993.w1)
    • Give antibiotics for 3-5 days post-surgery. (J213.5.w3)
  • Environment: clean and stress-free. (B606.10.w10)
    • Minimise the time in a hospital environment, which rabbits generally find stressful. (P112.1993.w1)
    • Provide a warm, quite environment. (P112.1993.w1)
  • Diet: nutritional support is important. (N12.38.w1)
    • Syringe feed with a herbivore recovery diet. (N12.38.w1)
    • Force feeding may be necessary if there is anorexia (make sure the rabbit is receiving appropriate analgesia, because pain is often manifested as anorexia). (B606.10.w10)
  • Fluids: oral or intravenous fluid therapy may be needed. (N12.38.w1)
  • Bedding: thick towels, torn-up paper or newspaper is recommended post-operatively. (J213.5.w3)
  • Monitoring (general):
    • Assess for pain.
    • Check food consumption. (J213.5.w3)
    • Check faecal output. (J213.5.w3)
Appropriate Use (?)
  • This is used for severe limb fractures which cannot be managed by other means. (B601.17.w17, B602.35.w35), 
  • For the treatment of osteomyelitis where other treatment is unsuccessful. (B601.17.w17, B602.35.w35, J213.5.w3)
  • Treatment of choice for bone tumours. (B601.17.w17, B602.35.w35, J213.5.w3)
  • As a salvage procedure. (B601.17.w17)
  • Amputation is used when severe financial constraints are relevant (i.e. the owner cannot afford follow-up such as repeated radiographs and bandage changes). (B602.35.w35)
  • Note: Rabbits adapt well to the loss of a leg, particularly a hind leg. (B601.17.w17, B602.35.w35)
  • Suitable e.g. for "shattered" bones particularly fractures of the hind leg. (V.w65)
Notes
  • Note: Use a Gigli saw or power saw, not a bone cutter, to cut bones; the thin cortices tend to shatter if a bone cutter is used. (B602.35.w35)
  • Make sure you leave enough soft tissue, both muscle and skin, to cover the bone with a tension-free closure. (B601.17.w17, B602.35.w35) and to give a flap sewn over the bony stump for carpal o r tarsal amputations. (J213.5.w3)
Complications/ Limitations / Risk
  • If a bone cutter is used, rabbit limb bones will tend to shatter. (B602.35.w35)
  • Development of pressure sores or arthritis is more likely. (J213.5.w3)
  • If a hind leg is amputated, there is an increased risk of ear disease if the rabbit cannot groom properly on that side. (V.w125)
Equipment / Chemicals required and Suppliers
  • Anaesthetic equipment.

  • General surgical equipment, including sutures etc.

  • Gigli saw or power saw for amputation through bone. (B602.35.w35)

Expertise level / Ease of Use
  • This procedure should only be carried out by an individual with appropriate clinical training and practical experience; this would usually be someone with a veterinary degree.
  • Amputation is simpler and requires less specialised equipment and training than pinning, bone plating or applying an external fixator. 
Cost/ Availability

The costs of a surgical operation include those associated with: (J15.30.w1)

  • Pre-operative diagnostics (e.g. radiography, ultrasonography, blood tests)
  • Anaesthesia.
  • Perioperative medication (e.g. analgesics, antibiotics, fluids).
  • Surgical preparation (of the operating theatre and the patient, including staff time).
  • Consumables and equipment.
  • Time of the surgeon and assistant(s).
  • Post-operative hospitalisation.

Amputation is generally faster and less expensive than other surgical forms of fracture treatment. (B601.17.w17, B602.35.w35)

Legal and Ethical Considerations In some countries there may be legislation restricting the use of this type of technique to licensed veterinarians. For example in the UK: "The Veterinary Surgeons Act 1966 (Section 19) provides, subject to a number of exceptions, that only registered members of the Royal College of Veterinary Surgeons may practice veterinary surgery." (See: LCofC1 - RCVS Guide to Professional Conduct 2000 - Treatment of Animals by Non-Veterinary Surgeons).
Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referee John Chitty BVetMed CertZooMed MRCVS (V.w65); Molly Varga BVetMed DZooMed MRCVS (V.w125)
References B536.141.w141, B601.17.w17, B602.35.w35, B536.141.w141, B606.10.w10, J15.30.w1, J213.5.w3, N12.38.w1, P112.1993.w1, V.w65

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