Limb amputation
Introduction
- Complete or partial surgical removal of a limb which is too diseased or damaged for treatment by other means.
Print off the Owner Factsheets Caring for your rabbit following limb amputation and Caring for your rabbit before and after surgery to give to your clients.
Uses
- Amputation of a limb may be necessary in severely comminuted fracture Limb fracture, extensive soft tissue damage, chronic osteomyelitis Osteomyelitis, joint infection after failed fracture repair, or where the cost of repairing the leg and aftercare is prohibitive for the owner.
- The most common presentation is long-standing neglected fractures, which are severely contaminated. Usually this will be a distal tibial fracture and the leg will be 'swinging' with gross soft tissue contamination. There is often underlying osteoporosis, which can complicate fracture repair.
Advantages
- Amputation is a good salvage option where the owner is considering euthanasia due to prohibitive cost.
- Rabbits readily adapt to the three-legged state so this is definitely an option where money is a concern and the owner is considering euthanasia, especially in young rabbits.
- Amputation is a relatively quick procedure and there is little surgical risk provided the animal is well stabilized prior to surgery.
- Amputation is a cheaper alternative to limb repair because it reduces surgery time and removes the need for repeated check-ups, radiographs and dressing changes.
- Even hindlimb amputation is well tolerated by many rabbits.
Disadvantages
- Surgery time is generally shorter than complex fracture repair.
- The main surgical risk involved is hemorrhage from the femoral artery.
- Ensure there is no arthritis, trauma or disease, eg pododermatitis, in the contralateral limb such that the rabbit is unable to tolerate the additional weight load.
- If amputating a hindlimb, the ear on the side of the amputation must be routinely cleaned as the rabbit will be unable to clean/groom on that side without the foot.
- Possibility of wound infection, trauma and/or abrasion at the site of amputation.
- Post-surgical contamination of single remaining hindlimb by urine/feces.
Technical problems
- The main problem is to convince the owner that a three-legged rabbit will look cosmetic once the fur has grown back, and that the animal will have good quality of life.
Alternative techniques
- Conservative treatment.
- External coaptation Limb fracture repair: external coaptation.
- Internal fixation Limb fracture repair: internal fixation.
- External fixation Limb fracture repair: external fixation.
- Euthanasia Euthanasia.
Time required
Preparation
- Routine sterile surgical preparation.
Procedure
- Performed as in dog/cat amputation.
- It is important that forelimb amputation is performed proximal to the elbow, and hindlimb amputation is performed proximal to the stifle. In ALL cases, amputation should be proximal to the lesion/injury such that the remaining limb is not in constant contact with the ground.
Decision taking
Criteria for choosing test
- Rabbits often present with long-standing limb injuries as unlike the cat or dog they are less well observed by their owners.
- Being prey animals, they also have a strong 'preservation reflex' causing them to mask pain so owners can be unaware of the extent of the injury.
- The most common cause of non-viable limb fractures is owner ignorance and neglect.
- Rough handling leading to the rabbit being dropped and/or poor caging facilities are common underlying causes.
- Many owners do not seek prompt veterinary attention so often the limb is beyond salvage by the time it presents to the veterinarian.
- Attacks, eg by a fox, causing severely contaminated and crushed soft tissue damage can also necessitate amputation.
- Most rabbit limb fractures can be repaired as for cats and dogs if presented early post-trauma.
- Severe crepitus indicating comminution, and open fractures of the distal limb with tearing of the thin skin and contamination by debris will usually require amputation.
- In summer, maggot infestation can occur in long-standing cases Fly strike.
- Radiography Radiography: antebrachium Radiography: tibia / fibula should be performed to further assess injuries and consider whether fracture repair is viable.
- Examination under sedation Sedation is essential, as often the soft fur of the rabbit will disguise serious damage to the limb.
Risk assessment
- Assess the patient fully, particularly to ascertain severity of a recent traumatic injury, and stabilize before performing surgery.
- Consider the patient’s signalment carefully. Outcome of hindlimb amputation can be much worse for old, overweight or arthritic animals.
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Garcia-Pertierra S, Ryan J, Richardson J et al (2020) Presentation, treatment and outcome of long-bone fractures in pet rabbits (Oryctolagus cuniculus). J Small Anim Pract 61 (1), 46-50 PubMed.
Other sources of information
- Harcourt-Brown F & Chitty J (2013) BSAVA Manual of Rabbit Surgery, Dentistry and Imaging. BSAVA, UK.
- Slatter D H (2003) Textbook of Small Animal Surgery. 3rd edn. W B Saunders, USA
- Bojrab J, Waldron D R & Toombs J P (1998) Eds. Current Techniques in Small Animal Surgery. 5th edn. Teton NewMedia, USA.
- Hillyer E V & Queensberry K E (1997) Eds. Ferrets, Rabbits and Rodents - Clinical Medicine and Surgery. Saunders, USA.