Abscess Management in Rabbits: an Illustrated Guide
Christine Macey and Esther van Praag, Ph.D.
Warning: this file contains pictures that may be distressing for
people.
|
An abscess is a pocket of fluid and pus, which results
from an attack by pyogenic organism (e.g.
bacterium) followed by the destruction of cells. The pocket usually contains
a collection of pus, dead phagocytic white blood cells, necrotic cells, and
live or dead bacteria. As the quantity of pus increases, the pocket grows
larger and starts to wall off from the surrounding tissues and blood
circulation. This renders treatment difficult. If the abscess is left
untreated, it continues to grow. Tissue will rupture either inside the body
or on the surface of the skin. This stage is particularly painful and
dangerous, with the liberation of bacteria and their toxins in the blood
circulation. In most cases of abscess, the rabbit has a history of
pasteurellosis, though other bacteria like Staphylococcus aureus, Streptococcus
sp, Pseudomonas sp. or Fusiformis sp.
are no exceptions. They often result from a nasolacrimal
or tooth problem, surgery, or a foreign body such as a hay splinter in the
gum. Options that are available to treat abscesses in rabbit
include: ·
Total surgical excision of the abscess cavity, necrotic tissue,
and the surrounding fibrous capsule. This treatment can, however, not be done
when several abscesses are present, or when the bone is affected (e.g.
osteomyelitis, jaw bone infection by a tooth root). When surgical excision is not
possible, the cavity should be packed with an antibiotic impregnated
dressing. Various types are available nowadays: ·
Permanent placement of antibiotic impregnated PMMA beads, ·
Temporary filling with antibiotic impregnated gelatin sponge
(e.g. GelFoam®, Surgicel®).
The dressing must be changed daily or every 2nd day, to avoid necrosis of
surrounding tissues.. ·
Temporary filling with wet-to-dry hygroscopic and bactericidal
sugar dressing (e.g. 50% dextrose, or manuka or clear sterilized (g-rayed) honey). The dressing must be
changed daily, to avoid necrosis of surrounding tissues. The later filling presents the
advantage to remove the malodorous smell of ammonium and sulfur compounds due
to bacterial breakdown of serum or cell proteins. Due to its richness in sugars, honey
has an hygroscopic effect on the wound, preventing
bacterial development. Honey will furthermore acidify the wound, accelerating
the healing process. The honey should not be boiled,
otherwise its bacteriostatic/bactericidal properties are lost. When used in
abscess treatment, success cannot be guaranteed by a 100%,
still we were able to treat successfully some intractable abscesses in horses.
Advantages in using honey are that the product is cheap, non-toxic and
treatment can be continued over a longer period of time. The goal for abscess treatment is to
cure the infection. Most people are afraid to hurt their rabbits, but they
tolerate a lot and it is necessary to do a good job on wound care or the
surgery will be for naught. Here we present daily care related to
management of the jaw abscess of Buh-Bunny. Background, by Christine MaceyBuh-Bunny had about 5 of jaw abscesses if I count correctly. He is my 4th jaw abscess rabbit and lived
the longest with them (3 years), and oddly enough a sarcoma and not the
abscesses did him in at 9 years old.
Buh-Bunny's first jaw abscess was 3 years earlier and ceftiofur beads were implanted. The next day he had another abscess removed
from another spot in his jaw found on closing the day before, ceftiofur beads placed too. He was on penicillin injections for a week. Three months later another jaw abscess, but the beads did
not stay suspended after surgery, falling down into his dewlap so I cannot
call this a true bead failure. The vet
who placed these beads assisted Kerin Tyrrell with
her rabbit mandibular and maxillary abscess study, so the choice of drugs for
the next bead placement was clindamycin. We both chose not to culture because
of the poor culture results Kerin had received from
this area's labs, knowing it would be a waste of time and money. Buh-Bunny stayed
abscess free for a year but required another facial surgery for a lump that
was reported as a benign fibroma on the histology. Buh-Bunny then
quit going out on the lawn where the cottontails roam as this was a probable
cause. Another jaw abscess a year later and I had read enough
testimonials from trusted individuals to know I wanted to try bicillin. My
initial vet did not want to go this route so I went to my local vet. I used bicillin
alone for maybe a few weeks but saw no decrease in abscess size so decided on
surgical removal and wound irrigations to let it heal inside to out along
with the bicillin.
This was also successful for a year. So, now we are on his 5th jaw abscess
and I went to my alternate vet (my local vet was not available), a 3rd vet I
use frequently when my local vet is not around, and she said it was
inoperable. I used bicillin
and Buh-Bunny began to have more and more trouble
eating.
I was not going to put him through more surgery but ended
up taking him to my local vet for a second opinion, and he said it was
certainly operable, that it would buy him time but in all likelihood this
would kill him in the end, but the end might be a ways off. I asked if he
would close it up and not leave me with a huge open wound and he said he
would if it wasn't too dirty but I ended up getting a smallish deep hole
which made observing the state of the wound hard. I believe he was on both bicillin and naxcel (ceftiofur) injections but that doesn't really matter, and
I cultured to which is another story, but did it more for academic reasons
and curiosity than for planning his drug therapy. Manuka honey is usually not the first choice dressing for
abscesses; it was the best selection given the circumstances: a wound tract
that exited through the cavity left by a lower incisor removal, the entrance
being on the outside of the left cheek. This meant that anything I irrigated
with would in part end up in my rabbit's mouth. Summary of the procedure used for dressing a wound with honey1. Do not leave it too late to start
using honey on a wound. 2. Use only honey that has been produced
especially for use in wound care. 3. Use dressings that will hold
sufficient honey in place on a wound to get a good therapeutic effect (i.e.
about 20 ml/25 g per 10 cm X 10 cm). 4. Ensure that honey is in full contact
with the wound bed (i.e. fill any cavities or depressions. 5. If a non-adherent dressing is used
between the honey dressing and the wound bed it must be sufficiently porous
to allow the active components of the honey to diffuse through. 6. Ensure that the honey dressings
extend to cover any area of inflammation surrounding wounds. 7. Use a suitable secondary dressing to
prevent leakage of honey. 8. Pressure bandaging can be used over
honey dressings. 9. Change the honey dressings frequently
enough to prevent the honey being washed away or excessively diluted by wound
exudate - if the honey gets washed away then the dressings can stick and
maceration of surrounding skin can occur. 10. When using honey to debride hard eschar, scoring
and softening the eschar by soaking with saline
will allow better penetration of the honey. Applying dressings soaked in
diluted honey (3 parts water or saline to honey) rather than straight honey
may give faster debriding of hard eschar. Procedure used for dressing a wound with honey in picturesEXTENT OF THE WOUND.This shows the wound tract that had
to be encouraged to stay open long enough for systemic antibiotics to do
their job and to clean out any recurring infection in the wound bed. This
also shows that a bunny will tolerate a lot of manipulation of their wounds.
I premedicate with something like torbugesic 30 minutes before the procedure.
GETTING ORGANIZED BEFORE STARTING.This is very important. Have
everything you will be using at the ready. I've found that having a thick
towel for the rabbit footing makes him feel much more secure, and I prefer to
do irrigations and wound cleanings over the sink. The squirt bottle is by far the best
tool in home care irrigating. I
started with a Water Pik (about $80.00 in the
States) and irrigating Froggie's jaw abscess in the
bathtub. The noise and weird location
probably added to her discomfort. That
was in 1997. By the time I was
irrigating Bupkiss' wound in '99, I used an
18-gauge catheter and 3 cc syringe. The squirt bottle is cheap and works
better; unfortunately it took me until 2002 to learn that.
SALINE IRRIGATIONS.After unpacking the wound I use a squirt bottle and
irrigate until I have a good flow from the entrance at the cheek to the exit
from the inside of his mouth, trying to keep him position over the sink so
the irrigant and debris does not get swallowed. This is when I would insert the Q Tip
and use it as a mechanical debridement and to open the wound back up. It is
constantly trying to close. This is
also a picture of a very clean wound.
Instilling honey with 1 cc syringe.I tried this method but learned right
away that it wouldn't work, this would not keep the
honey in contact with the wound bed. What I did was reread the directions
(it's easy to get overwhelmed in the face of having to do this) and cut up
the non-adherent pads into strips of gauze and soak them in honey/saline
solution per instructions. Then I packed the wound as best I could using hemostats or tweezers to push it in.
Cleaned up and packed wound.Picture of a wound needing attention. The white is not pus, much of it is dead tissue that needs to be cleaned
out as much as possible. Some is just debris that will wash away with the
irrigations. I learned a lot watching my vet clean a dirty wound. He taught
me that my rabbit would tolerate taking tweezers and pulling out dead tissue.
Dead tissue attracts bacteria. The purple is bruising that was
evident in those first post op days.
There is also a bit of dry gauze to seal the outside before the final
dressing (as the final dressing had a tendency to fall off a lot).
Happy to be all done.I used a product called Skin Prep which has a skin protectant and makes the outer dressing stick better.
Still, this was often the way I'd find it in the morning:
Wound the next day.He would never pull the gauze
out but the outside bandage would come off frequently. Still, this is
preferable to no packing at all and letting that wound close right up.
Keeping it open not only allows time for the systemic antibiotics to do their
job, but discourages anaerobic bacterial growth. I feel the honey method would
need to have more frequent dressing changes than our usual twice a day
cleanings and redressing with Buh-Bunny and for a
variety of reasons I didn't use honey to the end, but even so his wound was
closing up and I was at the stage where I'd let it win more and more until it
is finally closed. EVERYONE NEEDS A FRIEND AFTER TREATMENT !!!
I would have loved to end with a picture of a totally healed
wound, but shortly after this Buh-Bunny died after surgery
to remove a large abdominal sarcoma. He passed quietly at home with Keri by
his side. I believe a treat or
comforting of some kind is due after this procedure. !! REMINDER !!Always take your bunny back to
your vet when you are confused about the status of the wound. There were
times when I didn't know if I was looking at something that should stay put
or something that should come out. AcknowledgementThanks you oto
Buh-Bunny and Christine Macey (USA). . |
||||||||||||||
e-mail: info@medirabbit.com
