Bovine digital amputation

Re: Bovine digital amputation

Wren — Fri, 08 Jul 2011 23:45:42 GMT

What briliant replies! From our practice records the last one I did was >10yrs ago so lots of reminders here and some tips that I hadn't thought of. Thanks!

Re: Bovine digital amputation

Julian Earl — Fri, 08 Jul 2011 22:36:46 GMT

Shame about the crush, it is easiest to have a foot raised up tight with the cow in a WOPA box. Anyway, either go for intravenous regional as long as you have a tight tourniquet or local infiltration with 50 to 100ml local. Whichever you do, I think it is good practice to scrub the foot well to remove the faecal contamination from the skin, the sole and the hoof wall and it demonstrates cleanliness to the farmer for when the stump inevitably shows signs of infection.

Also, pre-operatively I would advise giving NSAID and antibiotic, and xylazine if you think necessary.

If doing infiltration, inject a good couple of cm above the coronary band because if you are too low there is no subcutaneous space to inject into; likewise if the foot is very swollen then the inject is harder to do. If there is cellultitis above the coronary band to any significant degree, then they are a poorer prospect for amputation anyway.The best technique for infiltration is to use a 20ml syringe with 18g 1 .5inch needle and inject laterally first. Get a numb spot and then use the numb spots to work your way around the whole claw. Don't worry too much if you don't get much of a dose in at any one point, it seems to spread around easily. Injecting between the claws can be done from cranial or caudal side, or both just to be sure.

After anaesthetising, clean your own hands and then use a 22 scalpel handle on the appropriate handle to cut deeply and firmly through the skin down to the bone on all sides. A) Be careful that the foot is numb, but it is not usually a problem. B) Although you have to cut firmly be careful to position the cut at 1/2cm or so just above the coronary band, and aim to meet the start of the incision with the end - this is easy to get wrong! C) Make the cut horizontal or slightly angled from more distal externally to more proximal internally. What you do not want is the skin being higher than the stump of bone and fascia of the toe. The cut should end halfway along P1.

When you have this deep cut down to the bone, you will have your embryotomy wire of about 50cm long between two handles (bits of wood will do) and place the wire as deep into the cut as you can, and as high as you can. Then cut with smooth, firm and reasonably fast pulls. If the wire is too short, you won't cut effectively, nor if the wire is too long. The wire should cut through the bone easily and the bone should not protrude out from the fascial tissue.

If you have infiltrated local, then there may well be swollen gelatinous fascia bulging from the wound - trim this tissue away.

Then, finally, spray if you must, cover with Allevyn or similar absorbent dressing, just enough cotton wool for absorption and padding and pain relief, a couple of 10cm conforming bandages and one or two Vetraps. The conforming and Vetrap bandages must be tight, really tight. There should have been negligible haemorrhage during the procedure but if blood does come through at any stage after releasing the tourniquet, just keep adding tight bandaging until it stops. However, the bandages become less effective the more you apply, i..e. the first conforming is the most important and so on.

Rebandage every few days for a week, then weekly for a fortnight. Continue antibiotics and NSAIDs.

Job done.

Re: Bovine digital amputation

Michael Woodhouse — Fri, 08 Jul 2011 22:09:10 GMT

Front or back digit? Some feet are easier to do that others especially in a roll over crush. I'm sure you remember but the large vessel you will inject into is on the lateral aspect of the hind feet and the medial aspect of the front. Depending which way your crush rolls over the lower hind leg is very difficult to do an IVRA, but the upper hind easy (other way round with front feet).

The intra venous regional anaesthetic is easy unless the leg is very swollen. I use an old bicycle inner tube as the tourniquet tied around the leg two or three times (if you wet it you can pull it tighter). I just use a 18G 1" needle thrust into the vein not attached to the syringe. Give 30ml local anaesthetic as fast as possible. If it has gone in correctly the pressure increases with the injection and once you stop pushing the plunger the syringe will start to refill by the increased pressure. I tried the butterfly needles but found them fiddly and slower to inject - often 2/3 of the way through the injection the cow will give a kick as her foot goes to sleep.

If the IVRA has worked the foot relaxes almost immediately. If you can't get it for any reason a 4 point block works just as well, but takes a little longer to work (I inject below dew claws as you would in a horse and midline front and midline back, 15ml at each site). The last place for the cow to lose sensitivity is between the claws so I just test there with my needle now.

I make a decent effort of cleaning the foot, but it will never be perfect. The blunt side of a single edged hoof knife is good for scraping muck off before you start scrubbing.

Once you have checked anaesthetic has worked, and cleaned foot I use a scalpel and cut around the outside of the claw down to bone, through the tendons front and back and through the interdigital space. I never used to but it saves you a LOT of sawing and you can plan where you want to cut the claw off. Long slow strokes work just as well as daft fast ones. Don't cut your wire too short. If your scalpel work is adequate all you are cutting through is bone and half a dozen strokes and you are done.

If there is fat protruding near the remaining claw it is important to cut that away with your scalpel. I spray stump with oxytet spray. Dress with Melonin, then an soffban/orthoban, cotton wool, cohesive bandage, second layer of cotton wool, second cohesive bandage and then an elastic adhesive over the top. Building pressure with the force pushing up on the stump. Leave the remaining claw unbandaged. Change bandage after 7-10 days for a lighter version for another 7-10 days. I like to do 1st bandage change but instruct farmer to remove 2nd bandage themselves. Occasionally you will get one that bleeds through the bandage, this happens less the more you do. I just put another layer of elastic adhesive bandage TIGHTLY over the top and change the bandage sooner (after a few days).

I don't routinely give any antibiotic so long as infection confined to foot (if it's spread up the leg I would give Naxcel). Single shot of Carprofen.

I warn farmer that when you let her out the crush she will be sound from the local (so often they say 'she's less lame already') but for the next few days you will wish you hadn't done it as they can be very sore. By the time you change the bandage 90% are walking on it happily. They do better turned out or in cubicles - farmers who think they are been kind and keeping them in a deep straw yard actually put a lot of pressure on the stump and they do less well.

If the foot trimmer goes by the name of Richard Anderson he's a roving cattle foot trimmer from round our way, say hello from me. He gets about with his roll over crush!

Good luck - I find these strangely satisfying!

Re: Bovine digital amputation

Becky Filby — Fri, 08 Jul 2011 21:06:53 GMT

I usually go for placing a tourniquet above the fetlock then iv local in one of the digital veins (butterfly catheter and approx 20-30ml local seems to work quite well). The tourniquet seems to control most of the bleeding but useful to have a disbudding iron on hand. Usually cover the stump with topical antibiotics ( I generally soak swabs in lincocin or similar) then bandage over before removing the tourniquet. Generally advise the farmer to change the dressing every couple of days until the wound scabs over fully (normally needs 1 or 2 changes) plus meloxicam and systemic antibiotics in most cases