Successful Surgical Excision and Management of Carpal Hygroma in a Buffalo
A.K. Bassan1
Veterinary Assistant Surgeon
State Veterinary Hospital Sai
Department of Animal Husbandry
Distt. Jammu. 181111(J&K)
Abstract
An unusually large, infected chronic hygroma of carpal joint in a buffalo was treated by surgical excision, compression bandage to immobilize the joint and routine post – operative care for 15 days resulted in complete recovery.
Key words: buffalo, hygroma, carpal joint, bursa.
Introduction
A hygroma is a false bursa, nonpainful, fluid-filled localized swelling of tissues surrounded by a thick, fibrous capsule that develops under the skin dorsal to the carpal joint. It result from repeated mild trauma to an area over a bony prominence caused by lying on hard surfaces, such as cement or hardwood floors, lack of bedding or poorly designed manger. A common cause of bursitis is direct trauma that leads to acute bursitis when it is sudden and severe and chronic bursitis when it is mild and repeated ( O’ Connors, 1950). Davis and Broughton ( 1996) reported prepatellar bursitis caused by Brucella abortus in cattle. The present paper reports successful surgical excision and management of carpal hygroma in a buffalo.
Case History and Observations
A Six year old 350 kg buffalo was presented at Veterinary Hospital Sai, Office of the Livestock Development Officer Block. R.S.Pura, District: Jammu, J&K, with the history that the animal had a non-painful soft fluctuating swelling of the size of a tennis ball in front of the right knee since six months. It was being treated by paravets who aspirated straw coloured fluid from the swelling at several occasions with the result that the swelling reocurred within few days after every treatment. Now the swelling had increased to about football size and was painful with the result animal was reluctant to sit while standing and vice-versa.
Clinical examination revealed a 25cm x 25cm ( Fig.1) round swelling in front of the right knee extending well above and below the knee. It was warm and doughy on palpation and evinced pain. Aspiration revealed thick creamy pus in the cavity of the swelling. The swelling was diagnosed as hygroma that had got infected due to repeated aspiration and medication probably using unsterlized needles and syringes resulting in abscessation. Hence it was decided to drain the pus and treat it like an abscess by passing a seton.
- Veterinary Assistant Surgeon in Animal Husbandry Department, J&K and corresponding author
E mail : drashwanivet87@gmail.com.
Treatment
The animal was cast and restrained in left lateral recumbency and a 2cm long incision was made on the lateral aspect of the swelling, under local infilteration of 2% lignocaine. About 3L thick creamy pus ( Fig. 2) was drained and exploration revealed a mass within the cavity. Therefore, it was decided to excise the excessive skin and the mass. A tourniquet was applied above the elbow joint and intravenous regional anaesthesia was achieved by injecting 30ml of 2% lignocaine intravenously in a superficial vein just above the knee. Sedation was achieved by injection of xylazine @ 0.05mg/kg b.wt. The limb including the skin of the swelling was clipped and scrubbed for aseptic excision. The cavity was packed with gauge for preventing contamination during surgery and also for its clear demarcation. An elliptical incision was made enclosing almost entire swelling with sufficient allowance for skin closure without any tension. The skin was reflected by blunt dissection and the entire cavity was separated from the knee joint without opening the knee joint. Entire exposed tissue was smeared with tincture iodine and subcutaneous tissue was apposed using No. 1 chromic catgut in simple continuous pattern to favour adhesion formation and to obliterate the dead space. The skin after trimming was sutured with nylon No. 1 using horizontal mattress sutures, so that the sutured incision was slightly on the lateral aspect of the limb. Wound at the distal most part was left unsutured to facilitate drainge. A compression bandage was applied to the limb ( Fig. 3). The excised swelling in addition to pus contained about 10cm x 12cm irregualr soft tissue mass at its base (Fig. 4).
Post –operative care and management
Animal was given antibiotic inj. Intamox 4.5 mg ( amoxicillin and cloxacillin @ 10mg/kg bw and NSAID inj. Maxxtol (Tolfenamic acid ) @ 2mg/kg bw for 7 days and the wound was dressed on alternate days after compressing and flusing the subcutaneous area with 5 % povidine iodine topical solution and applied pressure bandage for 15 days and animal was not allowed to move out of the stall. The skin sutures were removed after 15 days following uneventful first intention healing ( Fig. 5).
Discussion
A hygroma is the bursitis of acquired bursa of the knee, in which there is a cystic cavity filled with fluid and surrounded by a layer of fibrous tissue. Some hygromas are congenital while others are develop over time, usually in response to trauma. In cattle the constant rubbing with the rough flooring while the animal lie down and gets up is a common cause. In the horses , frequent falling during progression may cause it ( venegopalan, 2009). Another etiology for the condition relates to brucellosis in cattle ( Balbo et al.,1969). In the present case maintaince of the animal on hard floor resulting in constant rubbing of the skin over the knee while sitting down and getting was probably the cause of hygroma. Its improper treatment had resulted in infection and abscessation. In this case, the joint capsule was not involved just as found in horses ( veenendaal, spiers and Harrison,. 1981).
There is little information in the veterinary literature on the management of hygroma. Some of these need not be treated. The development of hygroma can be prevented by adequate protection of the bony prominence. ( Chhatpar et al., 2012). Treatment of hygroma include aspiration and drainge and insersion of seton or excision.Total and partial excision and injection of corticosteroids preparation have been advocated, however these procedures may be harmful ( Archibald, 1974, Johnston, 1975), or effective only in acute cases when cavity is filled with serous fluid.
Aspiration of the contents and injection of an irritant solution like iodine tincture or 3-5%carbolic acid leads to destruction of the bursal lining followed by granulation,cicatrisation and obliteration of the cavity (Stashak,1987 and Venugopal loc.cit.). Use of tincture iodine soaked gauge to destroy the capped knee has been recorded as a method of treatment for such cases. Use of copper sulphate into the capped knee has been done for treatment but it was observed to be having less success as compared to the surgical excision of the bursae ( Dilipkumar and Dhage, 2008).
Surgical removal of the bursa has been advocated only when all other methods of treatment have failed and the bursa is large and composed of primarily fibrous tissue ( Honnas et al., 1995). In the present case due to chronicity of the case, in addition to the pus their was fibrous mass inside the cavity. Thus excision was planned that resulted in uneventfull recovery.
Conclusion
Hygroma generally does not interfere with the gait of the animal as it is not painful. However , if not managed properly it may get infected and enlarge to interfere with gait of the animal. Aspiration of hygroma when acute should be performed under aseptic precaution followed by compression bandaging and rest to the animal. The surgical excision of the hygroma is recommended only in chronic bursitis causing inconvenience to the animal. The post operative care should be taken in consideration very cautiously and the animal should be provided maximum rest in order to avoid any post-operative complication.
References
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Fig 1: Large spherical shape swelling on right knee joint.
Fig 2: Thick creamy pus draining from the swelling.
Fig 3: compression bandage applied after surgical excision.
Fig 4: Irregular soft tissue mass removed from the swelling.
Fig 5: Complete uneventful recovery after 15 days.
