Monday, May 16, 2011

Cleaning the Circular External Skeletal Fixator Pins

The fixator is an external device which means unlike bone plating it is not screwed directly into the bones. It is used to stabilize the leg so that pressure is removed from the fracture site to allow it to heal. Fixators are strong devices; however, you have to make sure that your dog does not  get it snagged on anything. This could cause your dog to become alarmed and to move in an unsafe manner, possibly further harming their injured leg. Stainless steel transfixion pins (quite thin in Taj's case) are placed through healthy in-tact pieces of bone to help transfer weight over the fracture. In addition, sometimes pins are placed through pieces of the fracture to help properly align and stabilize the bone. These pins are then anchored to the external fixator which consists of concentric aluminum rings held together with long steel supports.

Because the screws, nuts, and supports can stick out and catch on things, the long support screws are padded with foam and then wrapped with vet wrap to cushion them. I found that I also had to apply a small piece of foam padding and vet warp to one of the nuts on the top ring because it would cut into Taj's shoulder if he moved the leg at certain angles. 

The areas where the pins breach the skin have to be kept as clean as possible. This means that you cannot let your dog lick the pin sites. Currently, we use the large plastic e-collar (aka lamp shade head) that the vet has given us to prevent this. There are some alternatives to the plastic e-collar that I will discuss on future posts!
Pin Sites Before Cleaning
When you clean the pin sites, your dog may be sensitive (especially for the first 1-2 post surgery). I would recommend giving a painkiller (e.g. Tramadol) approximately an hour before cleaning. Because Taj had 16 pin sites for me to clean daily, this would take me approximately one-hour a day initially; however, with time at 4-weeks post surgery it only takes me about 20-30 minutes (both because the pins ooze less and I am a more efficient cleaner)! The pin sites have to be cleaned once daily the ENTIRE time the fixator is on your dog's leg. If you neglect to do this, you put your dog at risk for infection - which will cause your dog much pain and possibly cause the fixator to fail - depending on the severity of the infection.

Cleaning with Diluted Chlorhexidine Solution
I used to be a veterinary technician during my undergraduate years, so the cleaning process did not bother me at all; however, if blood makes you queasy, then you may want a friend/partner/family to help you initially with this process. To clean the pins, first put chlorhexidine solution (an antiseptic / topical disinfectant used to kill bacteria and help wounds heal) into a small container. Then you can use q-tips or gauze sponges to clean around each of the pin sites. I prefer q-tips because it is easier to control the pressure and maneuver; however, some individuals like to use gauze to "shimmy" around the pins as though you were polishing them. You dip the q-tips into the solution and then gently clean around the pin sites by dabbing with mild pressure removing all blood, dried blood or scabs, and general discharge products. It can take several q-tips per pin and I will usually keep dabbing until there is no more discharge. The pins may discharge some blood (this is normal). In addition, the pins may discharge clear fluid or clear fluid tinged with blood. Generally the pins that go through more muscle mass and that are closer to flexion sites will have more discharge. Taj had about 4 pins (of 16) that would discharge more regularly than the other sites (two on the back of the leg and two on the top concentric ring near flex sites). If you notice any discharge that has a pus-like quality or that is yellow, green, or brown can be a sign of an infection and you should alert your veterinarian immediately.

Using Gentle Dabbing to Clean around the Pin Sites and Remove Discharge and Dried Blood
Discharge (Blood and or Clear Fluid or a Mix) is Normal
Make sure when cleaning that you do not double dip your q-tips into the chlorhexadine solution. You do not want to cross-contaminate pin sites, nor the bottle of solution itself. I also used the q-tips to clean generally around the leg, from pins that dripped discharge, and to remove the scabs from the superficial trauma to the leg when it was broken. I noticed that as the weeks went on, the discharge grew significantly less. By two weeks, there was fairly minimal discharge and many sites had healed around the pin (though these still needed cleaned daily). By 4-weeks post-surgery there was barely any discharge from any of the pins. Cleaning became a regular routine and Taj would often fall asleep while we were cleaning (I think he loved the extra attention)! My friend Roberta helped clean Taj's pins quite frequently - thank you Roberta! Also, while you are cleaning the pins, it is important to monitor the fixator for any loosening of bolts and pins. If you do notice a pin or bolt is loosening, you should let your vet know asap.

Applying Antibiotic Ointment to the Cleaned Pin Sites

The last step after cleaning is to apply a thin layer of triple antibiotic ointment around all the pin sites. Again, I would use q-tips although it is tricky to navigate and only get a small amount on! Most importantly, do not let your dog lick especially after cleaning the sites!

Make sure to get around the Entire Pin
Successfully Cleaned Pin with Ointment Applied

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