roper management of traumatic injuries inbirds significantly decreases complicationsand wound-healing time. Many of the prin-ciples and techniques for wound manage-

ment and bandaging in mammals apply to birds;however, anatomic differences require modificationsand adaptations. Treatments and bandaging tech-niques for soft tissue wounds and nonsurgical frac-tures in birds will be discussed.

An understanding of wound healing is important inorder to devise a treatment plan for optimal results.Wound healing is a complex interaction of host re-sponses to an injury leading to regeneration of con-nective tissue, vascular supply and epithelium.1 Thethree basic phases of wound healing are inflamma-tory (exudative), collagen and maturation.

Inflammatory Phase: The hemodynamic and cellu-lar responses of the acute inflammatory response inbirds have been studied in chickens and pi-geons2,6,10,19,22 (see Chapter 40). The response is simi-lar in both mammalian and chicken skin in the first12 hours. Immediate vasoconstriction to control hem-orrhage is followed by vasodilation within 30 min-utes.22 Polymorphonuclear leukocytes and monocytesinfiltrate the margins of the injured and necrotic tissuewithin the first 2 to 6 hours, causing active phagocy-tosis of necrotic cellular debris and bacteria.10,22

By 12 hours post-injury, the ratio of polymorphonu-clear to mononuclear cells shifts toward a predomi-nance of mononuclear cells.22 During the next 36hours, necrotic leukocytes that were active in phago-cytosis accumulate at the periphery of the necrotictissue and are phagocytized by macrophages andmultinucleated giant cells. Fibroblasts appear in thewound during this period and continue to proliferateduring the next few days, signaling the end of thefirst phase of the healing process.

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Collagen Phase: Beginning the third or fourth dayfollowing injury in chickens, fibroblasts synthesizecollagen in the form of microfibrils, which aggregateinto larger fibers over time.10 During this phase,which lasts approximately two weeks, capillaries de-velop from bud-like structures from nearby vesselsand penetrate the wound. Wound contraction occurs,and epithelial cells proliferate and migrate acrossthe wound surface.20,21

Maturation Phase: The final phase of wound heal-ing may take weeks to months, and is marked byremodeling of the collagen bed and a decrease in thenumber of fibroblasts.21 The weak, poorly developedcollagen is replaced by thicker, stronger collagen fi-bers, which become oriented relative to the normaltension on the wound margins (see Chapter 40).

Principles ofWound Management

Impediments to Wound Healing

There are many factors that can impair or preventnormal wound healing.8 Dehydration, starvation, se-vere protein deficiency and chronic anemia may haveadverse effects on wound healing (Figure 16.1). Ne-crotic tissue or blood clots may harbor bacteria andphysically impede epithelial cell migration. Infectionby pathogenic bacteria may significantly delaywound healing. Dirt, debris, dead bone and evensuture material6 may cause host reaction leading tothe development of fistulous tracts.

Tissue destruction resulting from desiccation, severetrauma (eg, crushing or projectile injuries) or poorsurgical technique will delay healing. Wounds of thedistal extremities (reduced vascular supply) and non-immobilized injuries over joints, the axilla and thepatagia tend to heal more slowly.

Initial Assessment

Preliminary assessment of the injured avian patientwill determine if immediate life-saving treatmentsare necessary.11 A complete history is taken to deter-mine the cause of injury, followed by a thoroughphysical exam. It is important to avoid overlookingless obvious injuries and unrelated problems. Trau-

matized birds often have multiple injuries and maybe further compromised by dehydration, malnutri-tion and other problems, especially if there has beena delay (hours to days) between injury and presenta-tion. Shock, fluid and nutritional therapy are criticalin the early management of traumatized birds. Over-zealous wound and fracture treatment before stabili-zation of the patient may result in the patient’sdeath. Anesthesia may be necessary with fractiousbirds or in birds with extensive soft tissue or ortho-pedic injuries. However, if the bird is not stable,partial wound management and bandaging mayhave to suffice until more thorough treatment can besafely completed.

When assessing a wound, one should note the loca-tion, extent and age of the injury. Associated orthope-dic injuries and the vascular and nerve supply to thearea should also be evaluated (Figure 16.2). It iscommon to have underlying fractures or luxationsassociated with soft tissue wounds of the limbs.Wounds can be located by parting or wetting thefeathers and viewing the normal translucent avian

FIG 16.1 A mature female Sulphur-crested Cockatoo was pre-sented for a unilateral non-weight-bearing lameness noted the daybefore presentation. The bird was reluctantly willing to use theaffected limb but when she did, she ambulated on the distaltibiotarsal area with the foot closed and held in extension. A largeblue-black wound was located on the caudal tarsometatarsus.Radiographic findings were limited to soft tissue swelling. Thewound was thoroughly cleaned with chlorhexidine scrub andflushed with copious quantities of warm lactated Ringer’s solution.A Gram’s stain of the wound after cleansing revealed a few gram-positive cocci. The wound was placed in a sterile bandage thatincorported a ball bandage to keep the foot open. The bandage waschanged every two to three days. By the fourth bandage change, ahealthy granulation bed had formed, and a primary skin closurewas performed. The bird was returned to the aviary with no furthercomplications.

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skin. Greenish discoloration of the skin is normal inbruised birds due to accumulation of biliverdin pig-ment following breakdown of hemoglobin. This dis-coloration develops two to three days post-injury andmay persist for a week or more.

The vascular integrity may be evaluated by palpat-ing the warmth of the limb, checking the capillaryrefill time of the skin, clipping a toe nail or prickingthe skin. Other diagnostic tests used to assess aninjured bird include microbiological cultures, hema-tology, radiology and ophthalmologic examination.Biopsies may be indicated in chronic, non-healing orself-inflicted wounds.

Surface Preparation and Wound Treatment

The initial goal in treating contaminants or infectedwounds is the removal of devitalized tissue, foreignmaterial and bacteria. The feathers surrounding thewound should be gently plucked or trimmed to allowmore thorough cleansing and to prevent feather mat-ting during the healing phases. Plucking featherswill allow for earlier regrowth of feathers, but cau-tion should be used to prevent additional trauma tofriable skin while plucking.

Wound lavage using a curved tip irrigating syringewill remove foreign material, reduce bacterial num-bers and rehydrate soft tissues. Sterile isotonic sa-line with or without 0.05% chlorhexidinea or 0.5-1.0%povidone iodineb solution is recommended for woundlavage.33 Cultures should be obtained after surface

contaminants have been removed and before anyantiseptics have been applied. Hydrogen peroxidehas been shown to be ineffective for bacterial infec-tions, but may be effective as a sporicide in cases ofsuspected clostridial infections, or for initial cleans-ing of dirty wounds.3 The volume of solution requiredwill depend upon the severity and location of thewound and the degree of contamination.

Wound debridement following lavage involves re-moval of as much of the devitalized and necrotictissue as possible until viable, vascularized tissue isrecognized. In complicated or older wounds, the de-bridement process may have to be repeated over aperiod of a few days.

Topical medications in certain wounds may be bene-ficial; however, use of non-water-soluble medicationsshould be avoided due to loss of insulation with soiledfeathers. Bacitracin, neomycin and polymyxin areeffective against a wide spectrum of bacteria.33 Onepercent silver sulfadiazinec is effective for thermalburns and other wounds.27 Topical use of hemorrhoidcreams containing live yeast cell derivativesd (LYCD)has been shown to stimulate epithelialization andcollagen synthesis in human23 and canine33 wounds.LYCD has been successfully used in raptors withgranulating wounds and pododermatitis (bumble-foot) lesions.12 A topical medication commonly usedfor pododermatitis in raptors and other birds is di-methyl sulfoxide (DMSO), used either alone or witha combination of dexamethasone and an antibiotic,such as carbenicillin or piperacillin.30

Products that have been shown to retard woundhealing in mammals include nitrofurazone, whichslows epithelialization,13 and gentamicin sulfate,which impairs wound contraction.24 Although similarstudies have not been conducted in birds, it is advis-able to avoid these products in avian wounds.

After lavage and debridement, the wound shouldeither be sutured, managed by second intention heal-ing or managed as an open wound with delayedclosure.8 Wounds less than eight hours old and notheavily contaminated, or wounds that were surgi-cally created under sterile conditions should be su-tured. Older, infected or more complicated woundsshould be managed as open wounds and allowed toheal by second intention.FIG16.2 An immature Red-tailed Hawk was found beside a high-

way, unable to fly. A severe wing droop was noted on physicalexamination. Radiographs indicated a fractured coracoid. The birdwas placed in a figure-of-eight bandage. Fracture repair was un-eventful, but when the bandage was removed, a severe wing droopwas still evident and muscle atrophy had occurred to the wingmusculature. EMG findings indicated denervation of all of themuscles in the wing. Necropsy indicated a brachial plexus avulsion.

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Bandaging Principles

Properly applied dressings and bandages will pro-vide an optimal environment for epithelializationand wound contraction with the fewest complica-tions.

The functions of bandages32 are to:Apply pressure to reduce dead space, swelling,edema and hemorrhageProtect the wound from pathologic microorgan-ismsImmobilize the wound and underlying fractures,if presentProtect the wound from desiccation and additionaltrauma from abrasions or self-mutilationAbsorb exudate and help debride the woundsurfaceProvide comfort for the patient.

The three layers of a bandage are the primary layer(or dressing that is in contact with the wound), thesecondary layer for absorption and the tertiary layer,which serves to hold the other layers in place.

Primary LayerThe primary layer is the most critical layer for opti-mal wound healing. This layer should be sterile,remain in place even with patient movement, providea moist wound environment and assist with the de-bridement process.32

The two basic groups of dressings include adherentand non-adherent dressings. Adherent dressingssuch as fine mesh or open weave gauze pads areindicated during the initial phase of wound treat-ment when there is a large amount of necrotic debristhat cannot be surgically debrided, or with excessiveexudate production. Wet-to-dry bandage techniquesinvolve the application of sterile saline-soaked, warmgauze pads over the wound surface.8,9 The exudateand necrotic debris will be mechanically removedwith daily dressing changes during the first few daysof treatment, at which time the type of dressing usedcan be changed to a non-adherent one. Disadvan-tages of wet-to-dry bandages may include tissue mac-eration and bacterial colonization with the moistenvironment, and disruption of the wound healingsurface with each dressing change.8

Non-adherent dressings, by definition, do not adhereto the healing wound surface,25 and include a varietyof products. Traditional non-adherent products com-

monly used in veterinary wound management in-clude cotton film dressingse and petrolatum-impreg-nated fine mesh gauze padsf. Advantages of theseproducts for use in avian medicine include availabil-ity and low cost. However, disadvantages includedisruption of the healing surface when the dressingis removed after being in place for more than two tothree days, soiling of feathers (petrolatum-impreg-nated products), slippage of dressings under the ban-dage and difficulty in bandaging certain anatomiclocations.11

Increased understanding of wound healing processeshas resulted in the development of many new syn-thetic adhesive, non-adherent dressings for use inhumans.4,5,14,15 These new dressings keep the woundsurface moist and prevent scab formation, whichsignificantly increases the rate of re-epithelializa-tion, compared to air-exposed and wet-to-dry gauzedressings.1 Adaptation of these products to avianwound management has resulted in elimination ofmany of the problems outlined earlier, and signifi-cant improvements in the rate and quality of woundhealing.11 The two product groups discussed includehydrocolloid dressings and moisture vapor perme-able (MVP) dressings.

Hydrocolloid dressings or hydroactive dressings(HAD)g,h are semi-flexible, opaque membranes thatare impermeable to moisture vapor and oxygen, andabsorb fluid and exudate to develop a moist, gelati-nous cover over the wound. These dressings adhereto normal skin and not wounds, but generally requireadditional bandaging material to be held in place.Hydrocolloid dressings have been used successfullyin a variety of avian species,9,11,12,17 and are mostuseful for extensive wounds with greater than nor-mal exudate production, wounds that require de-bridement or for slow healing wounds (Figure 16.3).

Moisture vapor permeable (MVP) dressingsi,j,k arethin, flexible, transparent polyurethane membranesthat are oxygen permeable, impermeable to waterand bacteria, allow accumulation of fluid andexudate under the dressing and are adhesive to nor-mal skin but not wounds.26 The maintenance of amoist, aerobic environment under the dressing pro-motes leukocyte debridement of the wound surface,prevents desiccation and scab formation and reducespain associated with desiccation of raw nerve end-ings.4 Epithelialization is more rapid when scabs arenot present to impede cell migration from the woundmargins.1,4,5

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FIG 16.3 In birds that weigh less than 150 g, hydrocolloid dressings can be used as a splint material for distal tibiotarsal fractures.This material is superior to tape because it is more rigid. a) Note the bruising associated with this distal tibiotarsal fracture. b,c) Ahydrocolloid dressing is wrapped around the leg incorporating the femur and the tarsometatarsus. d) The hydrocolloid dressing iscovered with self-adherent bandage materials.

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Both MVP and hydrocolloid dressings are indicatedfor a variety of avian wounds, but MVP dressings aremore suited to areas that are impossible to bandage(eg, head wounds) because of the superior adhesivequality and flexibility of the material. The dressingsare changed every two to three days initially, or moreoften if excessive exudate production results in fluidleakage from underneath the dressing. Once ahealthy granulation bed is established, dressings canbe changed weekly. Wounds treated with these dress-ings appear to heal more rapidly and with fewercomplications compared to conventional non-adher-ent dressings.11 Patient acceptance is usually verygood, even with psittacine species.

Secondary LayerThe functions of the secondary bandage layer are toabsorb fluids and wound exudate, pad the woundfrom trauma, and immobilize the wound and under-lying fracture during the healing phases.8 Conform-ing gauze materiall or cast padding is most commonlyused.

Tertiary LayerThe tertiary or outer layer serves to hold the otherlayers of the bandages in place. Most bandages con-sist of conforming stretch tapes with or without anadhesive. Self-adherent bandagesm are excellent forbirds because they are light-weight and breathable,are well tolerated by most birds, and the materialadheres to itself cohesively without problems associ-ated with tape residues on feathers. In cases where

patient acceptance is poor, white adhesive tape, ducttape, neck braces or Elizabethan collars may be re-quired for bandage protection.

Specific Traumatic Injuriesand Their Management

Lacerations and Abrasions

Lacerations and abrasions in companion birds arecommonly caused by enclosure wires, inappropriatetoys, collisions during flight, other birds or householdpets (Figure 16.4). Specific management of a lacera-tion is determined by the size, location and age of thewound. In birds with breast or wing tip lacerationsthat result from frequent falls, additional therapymay include pulling improperly clipped wing feath-ers to stimulate their replacement.

Band Injuries

As useful as leg bands are for individual identifica-tion, they are not totally innocuous. Open style steelquarantine bands may cause serious problems if theband gap is large enough to allow the bird to get hungup on the cage wire. Resulting injuries may include

soft tissue bruising, swelling orlacerations, leg fractures or luxa-tions and occasionally death. Evencaptive-raised birds with closedbands may get their bands caughton toys, clips or enclosure wire(Figure 16.5). Inappropriatelysized bands may cause soft tissueswelling and vascular compromiseto the distal leg and toes if youngbirds outgrow bands that are toosmall. Some birds on a marginaldiet will collect excessive quanti-ties of desquamated skin under aband, resulting in a constrictiveinjury. Soft tissue swelling of thetarsometatarsus associated withfractures or other injuries may befurther complicated by vascularconstriction caused by the band.Large psittacines may crimp alu-minum bands with their beaks,

FIG 16.4 A maxilla fracture occurred in this budgerigar when it was bitten by a larger bird.Placement of a wire suture in a mattress pattern was used to oppose the maxilla. Beak injuriesof this magnitude should be handled as emergencies. The sooner the damaged area isrepaired, the more likely the beak is to heal.

FIG 16.5 Necrosis of the metatarsal skin in a cockatiel that caught its band in an unsafe toy.If a bird hangs by the leg for prolonged periods, microvascular damage may occur that resultsin necrosis 10 to 14 days post-injury. In severe cases, amputation of the most proximal jointand application of a hydroactive dressing to the stump is necessary.

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causing a tight constriction of the distal limb, makingband removal difficult. Abrasions and swelling un-derneath the band may develop when the leg is ban-daged.

Band injuries should be prevented by anticipatingpotential problems, especially with open bands thathave large gaps and with inappropriately sizedbands (too small or too large). Prophylactic bandremoval or crimping to reduce the gap is preferableto treating a band injury (see Chapter 1). Once aninjury or associated problem with a band is recog-nized, extreme caution should be exercised with bandremoval to avoid additional injury to the bird. Theowner should always be warned of potential risks tothe bird whenever a band is removed, even when theprocedure is elective and not associated with trauma.Complications may include fractures, dislocationsand lacerations. If a wound is already present, avas-cular necrosis may complicate the band removal pro-cedure. Specific treatment options following bandremoval involve wound debridement and cleansing,surgical closure if indicated and coverage with appro-priate dressing and bandaging material as needed.

Feather, Toenail and Beak Injuries

Significant hemorrhage may occur with broken bloodfeathers, especially broken flight and tail feathers. Di-rect digital pressure over the bleeding feather shouldbe applied immediately to prevent excessive blood loss.A first-aid home procedure involves putting flour overthe bleeding feather stub. This conservative treatmentmay be adequate in some cases, but most broken bloodfeathers require timely removal. The feather should begrasped at the base with a hemostat (needle-nosedpliers can be used on large birds) or fingers and pulledfrom the follicle while applying counter pressure to thearea surrounding the follicle, to prevent tearing theskin (see Figure 15.12).

It is critical to remove the entire feather shaft fromthe follicle and continue to apply pressure over thefollicle until the hemorrhage stops. Products in-tended for hemorrhage control during nail and beaktrims, such as silver nitrate and ferric subsulfatepowdern should never be used in a feather follicle tostop bleeding, due to the irritation caused by theseproducts and the possible foreign body reaction thatmay occur (granuloma or feather cyst formation).Radiocautery should also not be used to blindly cau-terize the interior of a follicle.

Broken or torn toenails can be managed by trimmingthe exposed portion with a nail trimmer to make asmooth surface, and packing ferrous subsulfate orsilver nitrate into the exposed nail bed pulp cavity. Ifthe keratin sheath of the toe nail has been pulled offto expose the underlying bone, direct pressure shouldbe applied to control hemorrhage. The exposed bonecan be protected with liquid bandage products,o,p orlight bandaging.

Beak injuries occur most often from bites from otherpsittacines, or from collisions during flight. Cockatoomales often become extremely aggressive toward thefemales, sometimes inflicting lethal injuries (see Chap-ter 4). Head trauma is common with mate aggressionand may be associated with beak fractures, puncturesor avulsion of the maxillary or mandibular beak, inaddition to soft tissue trauma. Hemorrhage may becontrolled with direct digital pressure or by applyingclotting products such as silver nitrate or ferric subsul-fate. For specific beak repair see Chapter 42.

Self-mutilation

Many factors may induce self-mutilation behavior(see Chapters 4 and 24). A thorough diagnosticworkup to rule out predisposing factors should beconsidered. Appropriate antibiotic, antifungal or an-thelmintic treatment is combined with soft tissuewound management and protection of the woundsfrom further trauma. The wounds should be cleansedand debrided, and surrounding feathers carefullyplucked or trimmed to prevent them from becomingmatted in the wound. Aloe vera preparations mayhelp in soothing the pain and irritation caused bymassive self-trauma.

Application of moisture vapor permeable dressings isvery effective in promoting rapid wound healing, and iswell tolerated by most avian species including psittac-ines. The use of topical non-water-soluble wound medi-cations is discouraged due to feather soiling, and is notnecessary when MVP dressings are used. In severecases of self-mutilation, an Elizabethan collar or neckbrace collar may be indicated to protect the woundsfrom further trauma (Figure 16.6).

Burns

The most common thermal burns occur in the crop ofneonates fed improperly heated hand-feeding for-mula (microwaved without proper stirring). Furtherdiscussion of medical and surgical management ofcrop burns is covered in Chapter 30. Accidental burns

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may occur when pet birds come in contact with hotliquids, hot surfaces or electrical wires (Figure 16.7).The feathers provide some measure of insulation;however, the extent of the trauma depends upon thecause and the duration of exposure. Damage mayrange from singed feathers, ocular irritation or milderythema of the feet or other exposed skin, to severedestruction of the toes or feet, melted beaks or death(see Color 24). Treatment action to be taken includesimmediate cooling and rinsing of the affected areas,followed by supportive care, topical wound manage-ment and systemic antibiotic therapy. Topical medi-cations may include DMSO for acute inflammationand silver sulfadiazinec cream for antibacterial pro-tection.

Chemical burns secondary to contact with causticsolutions, acids or other irritants may be seen occa-sionally. The affected areas should be thoroughlywashed and the compound neutralized by either so-dium bicarbonate solution for acidic compounds, ordilute vinegar for alkaline compounds.27

Frostbite

Frostbite injuries are more common in cooler cli-mates, but may occur in warmer regions during un-expected cold snaps when birds are not acclimated ordo not have adequate shelter and supplemental heat.Injuries may range from mild redness, swelling andpain of the affected digit(s) or limbs, to gangrenousnecrosis and death (Figure 16.8). Treatment requires

supportive care including supplemental heat, fluidtherapy, anti-inflammatory agents or topical DMSO,bandaging and treatment of secondary complications(see Chapter 15). Loss of soft tissue viability may beassessed by discoloration of the skin, loss ofneuromuscular control, cooler skin temperature,odor, leakage of serosanguinous fluid and disruptionof blood flow to distal extremities. The prognosis forsaving a frozen digit or foot is extremely guarded,and amputation may be necessary if gangrenous ne-crosis develops.

Degenerative Joint Disease

Degenerative joint disease (DJD) is a chronic inflam-matory condition involving the joint and surroundingtissues. Bony changes and reduced function in thejoint may be secondary to trauma, bacterial infection,malnutrition or neoplasia. Radiographs, microbi-ologic cultures and biopsies are indicated to deter-mine the cause and severity of the problem. Theprognosis for successful treatment and return to nor-mal joint function is extremely guarded, even withlong-term antibiotic treatment.

FIG 16.6 A mature Quaker Parakeet was presented with a one-month history of feather picking that progressed to self-mutilation.Note the numerous emerging pin feathers that many bird ownersmistakenly identify as mites. The cause of this bird’s self-mutila-tion was undetermined.

FIG 16.7 An Amazon parrot was presented four days after flyinginto a pot of hot liquid on the stove. The bird had been treated athome with a topical burn ointment. On presentation, several pha-langes were missing, and the foot and leg distal to the mid-meta-tarsal region were cold, firm and black. Tissue fluids were oozingfrom the margin of the burned area. Because four days had passedsince the initial injury, the only effective therapy was amputationof the necrotic limb. The prognosis for burn wounds is best if theyare treated on an emergency basis.

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Bumblefoot

Bumblefoot or pododermatitis is a general term forany inflammatory or degenerative condition of theavian foot and may range from very mild redness orswelling to chronic, deep-seated abscesses and bonychanges.12,16,18,29,30 Considerations for prevention ofbumblefoot include proper perches (size, shape andtexture), flight pen or cage construction (wall compo-nents, substrate, perch arrangements), nutrition,general health of the bird and sanitation of facilities.

Classification and Causes of BumblefootWith the common occurrence of bumblefoot in com-panion and aviary birds, it seems appropriate toclassify bumblefoot in a new manner, combining theconcepts described by Halliwell18 with subtle clinicalchanges that alter the management and prognosis ofthe disease (Table 16.1). A classification scheme grad-ing from minor early clinical signs progressing tosevere lesions is proposed (Harrison GJ, unpub-lished). The clinical progression of the disease variesbased on the species of bird (eg, Psittaciformes, Pas-seriformes, raptors or Anseriformes) and the factorsthat contributed to the infection (Figure 16.9).

Grade I to III lesions may not be recognized in rap-tors that are commonly presented with Grade IV orV lesions. Older budgerigars and cockatiels (five toten years old) may have a Grade V to VI lesion ifprecipitating factors are not corrected early. Bony

changes and osteomyelitis may be present. Prognosisfor full recovery of Grades I to IV is usually morefavorable than Grade V to VI lesions.

Grade I to III lesions are common in Psittaciformesand Passeriformes that are on all-seed or over-sup-plemented fruit and vegetable diets, overweight,have no exposure to sunlight or are kept on improperperches (covered with sandpaper, too small or toolarge, no variance in size) (see Color 8).With properhusbandry and nutrition, most cases recover. Sub-strate perch size, shape and covering material mayall influence the bird’s weight distribution on the toesand metatarsal pad and the amount of skin wear onthe plantar surface.12,16,18,29 For example, a perch thatis too wide and flat may cause excessive weight-bear-ing on the toe pads, while one that is too small maycause excessive weight-bearing on the metatarsalpads.

Bruising and abrasions on the plantar surface of thefeet may develop when raptors persistently bate(jump) from a perch onto a hard surface or hang fromthe cage wire,18 or when they are forced to stand onperches or cement. Any soft tissue or orthopedic in-jury involving one leg or foot may cause excessiveweight bearing and secondary bumblefoot on thecontralateral foot. Overgrown talons cause improperweight distribution on the plantar surface of the foot(especially in falcons and finches) or self-inflictedpuncture wounds of the metatarsal pad.16 Other trau-matic injuries to the foot include bite wounds fromprey, punctures from thorns or quills and trap inju-

FIG 16.8 An adult toucanette hen was presented for a bilateralnon-weight-bearing lameness. The bird had not been seen forseveral days and was presumably incubating eggs. Dry gangrenesecondary to frostbite was evident in both legs distal to the tar-sometatarsal joint. Temperatures the week before presentationwere below freezing. The bird was euthanatized.

FIG 16.9 A 12-year-old cockatiel was presented with a non-weight-bearing lameness. Grade III bumblefoot is common in older inac-tive birds that are fed inadequate diets. Early lesions (smoothingof the plantar foot surface and hyperemia) are frequently missed,and the birds are not presented until they are lame.

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ries. Pathogenic bacteria introduced at these sitesmay lead to abscessation, osteomyelitis or jointchanges.31 Other causes of bumblefoot include severepoxvirus lesions with secondary bacterial infections,frostbite injuries and thermal burns.29,30

The precise pathogenesis of bumblefoot in variousavian species remains undetermined. It is theorizedthat dry, flaky hyperkeratotic skin on the feet (possi-bly precipitated by malnutrition, environmental de-ficiencies and systemic disease) changes the mechan-ics of weight bearing on the metatarsal pads, leadingto reduced circulation, micro-epithelial damage, lo-calized impairment of the immune system and inva-sion of opportunistic pathogens. A bird’s inactivity inan enclosure (inability to fly) may be a major precipi-tating factor. In one group of raptors, birds that werehoused outdoors and were able to exercise did notdevelop bumblefoot regardless of their perching sur-face. By comparison, a group of raptors maintainedindoors on the same diet developed bumblefoot irre-spective of the perching material (Redig PT, unpub-lished).

Prevention and TreatmentPrevention of bumblefoot involves constant vigilancefor early signs of hyperkeratosis, baldness, flaking of

the skin of feet and legs, redness or swelling andcorrection of the underlying causes. The walls of anenclosure should be designed with vertical bars orsolid barriers to minimize the tendency for hangingfrom the wire. Selection of proper perch size, shapeand cover for a particular species of bird is veryimportant.29 Perches wrapped with hemp rope orcovered with Astroturf work well for most raptors.Falcons do best on flat shelf or block perches coveredwith short Astroturf or cocoa mats. Strict sanitationof the facilities and feet is important to minimizebacterial infections. Feeding some formulated dietsand providing fresh water for bathing prevents orreverses early bumblefoot in Psittaciformes (Harri-son GJ, unpublished).

The goals of advanced bumblefoot treatment are toreduce inflammation and swelling, ensure an ade-quate diet, establish drainage if needed, begin an-tibacterial therapy to eliminate underlying patho-gens, manage the wound to promote rapid healingand address dietary deficiencies.29,31 Surgical exci-sion of the abscess or amputation of a severely trau-matized digit may be indicated. Treatment for GradeV to VI lesions must be vigorous, and the prognosisis guarded. Treatment for Grade IV should includedrainage, irrigation and closing the wound when theinfection has been resolved. The prognosis is fair.Grade I to III lesions generally respond to keepingthe foot clean and correcting underlying manage-ment or nutritional deficiencies. With Anseriformes,this frequently involves changing the dimension,shape and surface of the enclosure, including theaddition of adequate swimming areas.

Conservative treatment options may include chang-ing the diet and padding the perchs, applying topicalmedications and, if needed, bandaging. Many topicalproducts have been used, such as softening agents(udder balm or lanolin-based lotions) for dry, scalyfeet; topical dimethylsulfoxide (DMSO) for acute in-flammation and swelling;29 hemorrhoidal ointmentwith live yeast cell derivative for granulatingwounds;12,23 and liquid bandage products for minorskin cracks or torn talon sheaths.12

Moisture vapor permeable dressings or hydrocolloiddressings should be applied topically to enhancewound healing for open, granulating wounds or post-operative incisions.11 Bandaging of affected Psittaci-formes may go on for several months until the birdresponds to the new diet. Bandaging options includesimple toe bandages, interdigitating bandages andball bandages (Figures 16.10, 16.11).

TABLE 16.1 Clinical Grades of Bumblefoot

Grade I Desquamation of small areas of the plantar footsurfaces represented clinically by the appearanceof small, shiny pink areas - peeling or flaking of theskin on the legs and feet.

Grade II Smooth, thinly surfaced, circumscribed areas on theplantar metatarsal pads of one or both feet with thesubcutaneous tissue almost visible through thetranslucent skin. No distinct ulcers are recognized.

Grade III Ulceration of the plantar metatarsal pads. In somebirds a peripheral callus may form.

Grade IV Necrotic plug of tissue present in ulcer. Most specieswith ulcers and accumulation of necrotic debris ex-hibit pain or mild lameness.

Grade V Swelling and edema (cellulitis) of the tissues sur-rounding the necrotic debris. The digits or foot mayalso be edematous. Necrotic debris may start toaccumulate in the metatarsal area, suggesting in-fection of the tendon sheaths. Severe lameness iscommon. The entire metatarsal pad may be af-fected. This is generally a chronic lesion.

Grade VI Necrotic tendons recognized clinically as swelling inthe digits and ruptured flexor tendons. Ankelosis andnonfunctioning digits usually present in recovery.

Grade VII Osteomyelitis.

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In raptors, therapy for Grade IV to V lesions includea DMSO preparation that is made by combiningpiperacillin (1 g) with dexamethasone (4 mg) andDMSO to make a 10 ml mixture. This is refrigeratedand discarded after one week. Resolution of Grade IVto VI lesions is slow, and complete healing may takeseveral months. Initial treatment also includes sys-temic antibiotics for seven to ten days. The entire footshould be cleaned with surgical scrub and any scabsshould be soaked free without applying pressure tothe wound. A swab taken from deep within the ab-scess should be cultured for bacteria and fungus. E.coli, staphylococcus and candida are commonly iso-lated pathogens. The wound should be flushed withcopious quantities of one percent povidone iodinesolution and allowed to soak for five minutes. Thewound should then be flushed with large quantitiesof sterile saline, the defect packed with a sterilegauze 2 x 2 soaked in povidone iodine solution and alarge soft bandage applied. On the second day, theflushing of the wound, gauze pack and bandaging arerepeated. Most can be done without anesthesia.

On the third day, swelling may be reduced and muchof the exudate gone. Any fibrotic material is removedand the foot is prepared for sterile surgery. A wideexposure of the affected area is made and the abscesswall is dissected out. Any devitalized ligaments ortendons must be removed in their entirety. A tourni-quet may be required to control hemorrhage. Thewound should be vigorously irrigated with povidoneiodine followed by sterile saline. If hemorrhage re-turns after removing the tourniquet, pressure, epi-nephrine or selective radiocautery may be used forcontrol, and the wound should be flushed to removeall free blood. The wound is partially sutured shut to

allow for drainage, packed with a seton soaked insaline and rebandaged with a large soft wrap. Ifhemorrhage was poorly controlled, the bandageshould be changed in four to six hours.

The bandage should be removed daily and the footscrubbed and flushed with iodine solution and sterilesaline until a “dry socket” is obtained (see Color 24).This may take a week or more. Then the bandage canbe changed at two- to three-day intervals. Each timethe bandage is changed, the wound should be flushedand kept open as long as there is serum seepage.Mechanical debridement of the wound with a sterileswab will prevent premature closure. The woundmay be sutured closed when there is no apparentinfection or drainage. Appearance of granulating tis-sue around the edges of the wound indicates healingis occurring, which may take up to two to five weeks.A week after closure, bandaging can be reduced toonly a light wrap. After healing is complete, the footmay still be tender for several weeks. Prevention oftrauma and maintaining the patient on soft footingare important to prevent recurrence. Waterfowlshould be returned to water as soon as possible toprevent other problems. Modifications and compro-mises to this procedure may be necessary dependingon the species involved and the individual situation.

Nonsurgical Immobilization of Fractures

There are many indications for bandaging avianlimbs: nonsurgical immobilization of fractures, softtissue and joint injuries, and following orthopedicfracture repair. The following bandages and splintshave been developed and modified to meet special-ized anatomic requirements for avian limb immobi-

FIG 16.10 Ball bandages can be used to protect the foot whileplantar lesions are healing.

FIG16.11 Interdigitating foot bandages are used when a woundneeds to be protected or padding is needed for the bottom of thefoot, yet it is desirable for the bird to perch.

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lization.7,28 Specific indications, contraindicationsand application techniques will be discussed for eachtype of bandage or splint.

Bandaging MaterialsBandage materials used in birds should be soft, pli-able and not have adhesive materials that can adhereto or damage feathers. Cast padding is an ideal basefor slings, bandages and wraps. Self-adherent ban-dage materials are best for the outer layer. Whennecessary, wooden splints, aluminum rods or light-weight casting materials can be used to reinforcebandages. Some human orthopedic products havebeen excellent support materials for use in birds.Orthoplastr and Hexcelites are excellent support ma-terials for use in birds. At room temperature, thesematerials are firm, but when placed in hot water theybecome malleable and can be manipulated to con-form to the shape of a bird’s limb.

Fracture StabilizationTo be effective, an external coaptation device mustimmobilize the joint above and below a fracture.Once in place, bandages should be carefully moni-tored for tissue abrasions, slipping, seepage or swel-ling in the distal part of a limb, all of which wouldindicate that the bandage needs to be replaced.

Figure-of-Eight Wing BandageThe indications for figure-of-eight wing bandages in-clude wing fractures distal to the elbow, luxations ofthe elbow or carpal joint and soft tissue wounds inthese areas that require bandaging and immobi-lization.28 There are no rules to dictate which wingfractures can be adequately repaired with externalcoaptation, which fractures require surgical repairand which are simply not repairable. In general,external coaptation in the form of a figure-of-eightwing bandage can be considered for the followingfractures: most closed fractures of the ulna and ra-dius, when the fragments are relatively well-aligned(Figure 16.12); most fractures of the major and minormetacarpals; fractures that are too close to a joint ortoo comminuted to surgically repair; fractures inbirds that may not require full return to flight capa-bility; fractures in small or very young birds; andfollowing most orthopedic surgeries of the wing. It iscontraindicated to apply a figure-of-eight wing ban-dage for a humerus fracture without also immobi-lizing the shoulder with a wing-body wrap.

Application of a figure-of-eight wing bandage isshown in Figure 16.13. It is important to incorporatethe scapular or tertiary covert feathers in the ban-

dage and apply the bandage as high in the axillaryregion as possible to prevent the bandage from slip-ping below the elbow. The bandage should not extendmore than approximately one-half bandage widthbeyond the elbow joint and should not be applied tootightly. A bandage that is applied too tightly maycause vascular compromise of the wing distal to thecarpal joint and sloughing of flight feathers. If theprimary and secondary flight feathers have a criss-crossed appearance following bandaging (instead oflying parallel), the bandage is too tight. The bandageshould not be so bulky that it causes balance prob-lems in the patient. It may be advantageous to tapethe tips of the primaries to the tail feathers in birdswith long primary feathers.

The length of time a wing bandage is left on isdetermined by the underlying problem. Most frac-tures require three to five weeks of bandaging, andsoft tissue wounds may require a few days to twoweeks of immobilization. Complications of prolongedbandaging are joint stiffness, bony changes, disusemuscle atrophy and occasionally sloughed flightfeathers.28 Weekly bandage changes with physicaltherapy on the wing, proper bandage application andremoval of the bandage as soon as possible afterhealing will minimize these problems.

Wing-Body WrapFractures or luxations involving the humerus, cora-coid, furcula or scapula should be immobilized with awing-body wrap,28 as shown in Figure 16.13. Hu-merus fractures are often immobilized with both fig-ure-of-eight and wing-body wrap bandages, and mostof these fractures require orthopedic repair.7 The legsshould be extended to pull the stifle joints away from

FIG16.12 Wing fractures, in which either the radius or ulna re-main intact, can be successfullly managed with a figure-of-eightbandage.

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the keel, and the wing should befolded in a normal flexed positionand held to the body using a self-adherent bandagem or adhesivetape that does not harm feathers(masking tape or Duraporeq tape).The bandage should be positionedapproximately halfway betweenthe top and bottom of the keel toavoid interference with the legsand the vent. It is important toapply the body wrap tight enoughto prevent wing motion, but nottight enough to compromise respi-ration.

Schroeder-Thomas SplintThe use of a Schroeder-Thomassplint is limited to fractures of thetarsometatarsus and the distalone-third of the tibiotarsus26 (Fig-ure 16.14). Indications for thesesplints include fractures of thetarsometatarsus in psittacinebirds in which the bone is toosmall to apply any form of ortho-pedic repair, fractures too close tothe tibiotarsal-tarsometatarsal(hock) joint or foot, uncomplicatedfractures in small birds, and fol-lowing internal surgical fixation ofdistal tibiotarsal fractures. Con-traindications for Schroeder-Thomas splints include all frac-tures of the femur and proximaltwo-thirds of the tibiotarsus, be-cause the extreme flexion at theileal-femoral joint and the wide in-guinal skin web in birds results inthe proximal portion of the splintacting as a fulcrum and interfer-ing with immobilization.

The wire or rod material of thesplint should be made with tworight-angle bends next to the ringat the top so that the splint isparallel to the long axis of the leg(Figure 16.14). The leg should bepositioned with some flexion atthe hock joint, with the splint an-gles bent to conform to the anglesof the leg. The splint should beslightly longer than the partially

FIG16.13 a,b,c) Rolled cotton padding is used for the initial layer of a figure-of-eightbandage d,e) followed by the application of a self-adherent bandage material. f) If thebandage is properly applied, the carpus of the injured wing will be positioned neitherhigher nor lower than the unbandaged carpus. In addition, the primary and secondaryfeathers will be in a normal anatomic association. If the primary tips are medial to thesecondary feathers, the carpus is being excessively flexed and the bandage is too tight.

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flexed leg and extended toes. The leg is lightly ban-daged with gauze and tape and is suspended withinthe splint by alternating strips of tape placed crani-ally and caudally with the toes extended to the end ofthe splint. The splinted leg is then covered withbandaging material. Weekly or bimonthly bandagechanges with passive physical therapy should be con-ducted until the fracture heals in four to six weeks.The bird should be provided a low perch so that thesplinted leg can hang below or be propped on theperch. With all leg injuries, bumblefoot lesions in thecontralateral, weight-bearing foot should be pre-vented through the use of soft flooring materials,adequate nutrition and, in some cases, ball bandages.

Robert Jones BandageThe Robert Jones bandage (Figure 16.15) should belimited to simple fractures of the distal one-third ofthe tibiotarsus and tarsometatarsus, injuries involv-ing the hock joint, soft tissue wounds of the tibiotar-sus or tarsometatarsus, or following orthopedic re-pair of the distal two-thirds of the leg. These heavily

padded leg bandages can be used with or withoutadditional splinting material, such as tongue depres-sors, aluminum splints or orthopedic casting materi-alr,s (Figure 16.16). Fractures involving the tar-sometatarsus should be combined with a ballbandage to immobilize the foot. The Robert Jonesbandage is contraindicated for leg fractures of thefemur, proximal two-thirds of the tibiotarsus and inlarger birds (eg, over 500 g) because of inadequateimmobilization.

A thick layer of casting material is wrapped from thetop of the foot to the most proximal point of the leg.The leg is slightly flexed, conforming gauze materialis tightly wrapped around the cast padding, addi-tional splinting material is incorporated into the ban-dage and tape or self-adherent bandaging material isused to cover the bandage. The toes should be moni-tored for swelling and discoloration if they are notincorporated within the bandage.

FIG16.14 Craniocaudal and lateral views of a Schroeder-Thomassplint, which can be used to temporarily stabilize fractures of thetarsometatarsus and distal tibiotarsus.

FIG 16.15 Lateral view of a Robert Jones bandage, which can beused to temporarily stabilize fractures of the distal tibiotarsus andtarsometatarsus.

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Spica SplintSpica splints may be used for simple, aligned frac-tures of the femur in smaller birds, but generallyneed to be combined with orthopedic fracture repairin larger birds (eg, over 300 g).7,28 Splint material canbe molded from orthopedic casting materialr,s or pad-ded aluminum finger splints. This splint is a modifi-cation of the Robert Jones bandage, except that thepadded, molded splint extends from the tibiotarsusproximally and over the bird’s pelvis in an invertedU-shape to immobilize the femur against the body ofthe bird.

Ball BandageIndications for ball bandages (Figures 16.17) includemoderate to severe forms of pododermatitis (bumble-foot), toe fractures and other soft tissue injuries in-volving the toes or feet in perching birds.12,29

The toes should be conformed around a stack of gauzesponges, and wrapped snugly with conforming gauze

material to form a teardrop-shaped ban-dage. There should be adequate paddingand support around the distal tar-sometatarsus to allow the bird to be ableto stand upright on the bandaged foot. Itis also important to make sure that thebandage is not applied too tightly aroundthe tarsometatarsus at the top of thebandage, which can cause vascular com-promise of the foot. Birds with one orboth feet in ball bandages should beplaced in an enclosure with a paddedsurface.

Other Leg and Foot Bandages and SplintsVarious tape splints have been devisedfor immobilizing simple tibiotarsal andtarsometatarsal fractures in smallbirds.26 Additional splinting materialsuch as paper clip wire or toothpicks,balsa wood, pipe cleaners or wooden ap-plicator sticks can be used to providemore stabilization. Such support must beproperly padded over bony protuber-ances to avoid pressure ulcers. The jointabove and below the fracture should beimmobilized.

Toe fractures can be immobilized by tap-ing two toes together, by splinting with apadded tongue depressor or cardboard ina modified “snowshoe” splint using twoor more toes, or by using thermoplasticcoated casting materials to mold a “shoe

splint” to fit the entire foot (Figure 16.18). For smallbirds, hydrocolloid dressings can be used as splintmaterial for tibiotarsal and tarsometatarsal frac-tures (see Figure 16.3). The hydrocolloid dressingshould be covered by another bandage material toprevent chewing, and should be changed on a dailybasis if it becomes moist. When the wound is dry, thedressing can be left in place for up to ten days.

Soft tissue wounds involving the plantar surface ofthe foot can be effectively bandaged with an inter-digitating bandage that leaves the toes exposed forperching (Figure 16.19). It is important to avoid ap-plying the bandage too tightly, or using too muchbandaging material between cranial digits. Thelightest possible bandage would be used in finchesand other small birds to prevent loss of balance.

FIG 16.16 An adult male Amazon parrot was presented for an acute onset of anon-weight-bearing lameness. The bird’s wing had been improperly trimmed, and itfell from the top of its enclosure to a concrete floor. Radiographs indicated an obliquefracture of the mid-tibiotarsus. The owner chose a cast repair (right) over theapplication of an external fixator. In this case, with a calm bird and a minimallydisplaced fracture, casting was sufficient coaptation to allow bone repair.

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FIG16.17 Ball bandages can be used to protect foot injuries while they heal. A stack of gauze pads or a piece of cardboard cut to fit thebottom of the foot is covered with cotton padding and placed on the plantar surface of the foot. The foot is then wrapped with a layer ofrolled cotton padding and covered with a self-adherent bandage material.

FIG 16.19 An interdigitating bandage is applied by placing gauzeon the metatarsal pad and wrapping it in place with cotton pad-ding, which is then covered with a self-adherent bandage.

FIG 16.18 A snowshoe splint can be used to provide primary sup-port for phalangeal fractures. The bandage is applied by wrappingthe toes and foot in a protective layer of cotton padding. A “snow-shoe”-shaped splint is fashioned out of Hexcelite and placed ontothe plantar surface of the foot. The splint is held in place withcotton padding covered with a self-adherent bandage material.

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Products Mentioned in the Texta. Nolvasan, Fort Dodge Labs Inc, Fort Dodge, IAb. Betadine, The Purdue Frederick Co, Norwalk, CT c. Silvadene, Marion Labs Inc, Kansas City, MO d. Preparation H, Whitehall Labs Inc, New York, NY e. Telfa Pads, The Kendall Co Hospital Prod, Boston, MA f. Nu Gauze Sponges, Johnson & Johnson, New Brunswick, NJ g. Dermaheal or DuoDerm, Squibb, Princeton, NJ h. Epi-Lock, Virbac, Inc, Lenexa, KSi. Tegaderm, 3M Animal Care Products, St. Paul, MNj. Op-Site, TJ Smith and Nephew, Welwyn Garden City,

Herts, UKk. Bioclusive, Johnson & Johnson Prod, New Brunswick, NJ l. Kling, Johnson & Johnson Prod, New Brunswick, NJ m. Vetrap, 3M Animal Care Products, St. Paul, MNn. Kwik-Stop, Gimborn-Rich Health, Irvine, CAo. Collodium Flexible, Humco Lab, Texarkana, TXp. NuSkin, Medtech Labs Inc, Jackson, WYq. Durapore Tape, 3M Animal Care Products, St. Paul, MN, USAr. Orthoplast, Johnson & Johnson Prod, New Brunswick, NJs. Hexcelite, Hexcel Medical Co, Dublin, CAt. Elastikon, Johnson & Johnson, Arlington, TX

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2.Awadhiya RP, Vegad JL, Kolte GN:Studies on acute inflammation in thechicken using mesentery as a test sys-tem. Res Vet Sci 29:172-180, 1980.

3.Baldry MGC: The bactericidal, fungi-cidal, and sporicidal properties of hy-drogen peroxide and peracetic acid. JApp Bact 54:417-423, 1983.

4.Barnett A, et al: Comparison of syn-thetic adhesive moisture vapor per-meable and fine mesh gauze dress-ings for split-thickness skin graft do-nor sites. Amer J Surg 145:379-381,1983.

5.Barnett A, et al: Scalp as skin graftdonor site: rapid reuse with syntheticadhesive moisture vapor permeabledressings. J Trauma 23(2):148-151,1983.

6.Bennett RA: Tissue reaction to five su-ture materials in pigeons. Proc AssocAvian Vet, 1992, pp 212-218.

7.Bennett RA, Kuzma AB: Fracture man-agement in birds. J Zoo Wildl Med23(1):5-38, 1992.

8.Bojrab MJ: A handbook on Veteri-nary Wound Management. Boston,Kendall Co, 1981.

9.Cambre RC: Use of Duoderm hydroac-tive dressing (Convatec, Squibb) for

wound healing in zoo animals. ProcAm Assoc Zoo Vet, 1984, pp 27-28.

10.Carlson HC, Allen JR: The acute in-flammatory reaction in chicken skin:blood cellular response. Avian Dis13:817-833, 1969.

11.Degernes LA, Redig PT: Soft tissuewound management in avian pa-tients. Proc Assoc Avian Vet, 1990,pp 182-90.

12.Degernes LA, Talbot BJ, Mueller LR:Prevention and treatment of bumble-foot in raptors. Wildl Rehab 9:73-78,1991.

13.Eaglstein WH, Mertz PM: Effect of topi-cal medicaments on the rate of repairof superficial wounds. In Dineen P,Hildick-Smith G (eds): The SurgicalWound. Philadelphia, Lea & Febiger,1981, pp 150-167.

14.Eaglstein WH, Mertz PM: Effects of oc-clusive dressings on wound healing.Clin Derm 2:107-111, 1984.

15.Eaglstein WH, et al: Optimal use of anocclusive dressing to enhance heal-ing. Arch Derm 124:392-395, 1988.

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20.Johnston DE: Wound healing and re-constructive surgery. J Am AnimHosp Assoc Sci Proc 2:383-398, 1975.

21.Johnston DE: The processes in woundhealing. J Am Anim Hosp Assoc13:186-196, 1977.

22.Jortner BS, Adams WR: Turpentine-in-duced inflammation in the chicken. Alight- and electron-microscope study,with emphasis on the macrophage,epithelioid cell, and multinucleatedgiant cell reaction. Avian Dis 15:533-550, 1971.

23.Kaplan JZ: Acceleration of woundhealing by a live yeast cell derivative.Arch Surg 119:1005-1008, 1984.

24.Lee AH, et al: Effects of gentamicinsolution and cream on the healing ofopen wounds. Am J Vet Res 45:1487-1492, 1984.

25.Lee AH, et al: Effects of non-adherentdressing materials on the healing ofopen wounds in dogs. J Am Vet MedAssov 190(4):416-422, 1987.

26.Mertz PM, Marshall DA, Eaglstein WH:Occlusive wound dressings to preventbacterial invasion and wound infec-

tion. J Amer Acad Derm 12(4):662-668, 1985.

27.Perry RA: Avian dermatology. InBurr EW: Companion Bird Medicine.Ames, Iowa State University Press,1987, pp 40-50.

28.Redig PT: Evaluation and nonsurgi-cal management of fractures. In Har-rison GJ, Harrison LR (eds): ClinicalAvian Medicine and Surgery. Phila-delphia, WB Saunders Co, 1986, pp380-394.

29.Redig PT: Medical Management ofBirds of Prey. St. Paul, MN, The Rap-tor Center, University of Minnesota,pp 130-141. Date?

30.Redig PT: Treatment of bumblefootand the management of aspergillosisand various other problems com-monly seen in raptors. Proc 1st IntlConf Zool & Avian Med, 1987, pp 309-321.

31.Riddle KE: Surgical treatment ofbumblefoot in raptors. In Cooper JE,Greenwood AG (eds): Recent Ad-vances in the Study of Raptor Dis-eases. London, Chiron Press, 1981,pp 67-73.

32.Swaim SF, Wilhalf D: The physics,physiology, and chemistry of bandag-ing open wounds. Comp Cont Ed7(2):146-156, 1985.

33.Swaim SF, Lee AH: Topical woundmedications: A review. J Am VetMed Assoc 190(12):1588-1593, 1987.

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