Vet Clin Exot Anim 7 (2004) 19–36

Wound management in nonpsittacine birds

Shannon M. Riggs, DVMa,*, Thomas N. Tully, Jr.,
DVM, MS, Dipl. ABVP (avian), ECAMSb
a
University of California–Davis, Medicine & Epidemiology, Tupper Hall,
Davis, CA 95616, USA
b
LSU-School of Veterinary Medicine, Department of VCS, Skip Bertman Dr.,
Baton Rouge, LA 70803, USA

The veterinary clinician that treats avian species will see many different
anatomical presentations. There are close to 9000 different avian species,
with the majority being nonpsittacine birds. The veterinarian may have the
opportunity to treat birds maintained in zoologic collections, private
waterfowl collections, falconry mews, wildlife rehabilitation facilities,
agribusiness, or other ventures.

Examination and wound assessment

The skin of birds differs from mammals. The avian skin is comprised of
an epidermal, dermal, and subcutaneous layer. The epidermal layer of avian
skin is extremely thin in comparison to mammals, being only three to five
cell layers, except on the thicker cornified areas, such as the feet [1]. The
epidermis itself consists of three layers: (1) a deep stratum basale, which is
comprised of dividing cells; (2) an intermediate layer; and (3) a superficial,
cornified layer of dead cells [2,3].
The dermis is comprised of superficial and deep layers. The superficial
layer contains dense connective tissue, while feather follicles, smooth
muscles, nerves, blood vessels and fat reside in the deeper layer. Smooth
muscle from the deep layer controls the movement of the feathers.
Mechanoreceptors, termed Herbst’s corpuscles, are also located in the deep
dermis [2]. The subcutaneous layer of the avian integument is made of loose
connective tissue with a minor distribution of fat.

* Corresponding author.
E-mail address: [email protected] (S.H. Riggs).

1094-9194/04/$ - see front matter Ó 2004 Elsevier Inc. All rights reserved.
doi:10.1016/j.cvex.2003.08.005
20 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36

Although the skin lacks glands (with the exception of the uropygial gland
and external ear canal), the individual keratinocytes act as holocrine glands,
producing oils [2]. Avian skin is dry and inelastic over much of the body.
Knowledge of the differences between avian and mammalian skin will help
the clinician determine the best course of action to manage skin wounds.
When examining injuries to evaluate the severity, treatment options, and
prognosis in vastly different animals, one must remember to follow basic
veterinary medical procedure. By following basic medical guidelines, mul-
tiple species can be treated and examined, even if the veterinarian has no
experience with that type of bird. Wound management always starts with
assessment of the patient. The patient’s general disposition and condition is
a determining factor on diagnostic protocol and treatment. This is a difficult
concept for zoo personnel, owners, and veterinarians to grasp, especially
when an avian patient presents in critical condition. Inherently, the bird’s
owner and veterinarian feel like all measures should be taken to save the
bird and treat the presenting condition. Unfortunately, when avian patients
are presented in critical condition, stress and handling may result in death if
the animal is handled in an excessive manner for treatment, diagnostic
sample collection, or both. There is a simple guideline to follow called, ‘‘put
it down.’’ In cases where the bird is too weak for examination, diagnostic
sample collection or treatment, the best chance for that animal’s survival is
placement in an incubator after swift empiracal supportive care (eg, fluids,
gavaging with critical care formula) until the patient is more stable [4].
Injuries occur for many reasons in nonpsittacine species. These groups of
birds are usually housed outside in flock or multispecies collections. When
housed outdoors, predation is a problem from both wild and domesticated
animals. Severe trauma from bite or puncture wounds from talons or teeth
are not uncommon. The unnatural environments of manmade ponds, inten-
sive agriculture/wildlife propagation, and raptor enclosures, lead to foot,
wing and general trauma due to unnatural habitat, population dynamics,
and the establishment of territories within that particular enclosure. The
ever increasing environmental concerns affect these birds more than caged
species housed indoors. Discarded trash (eg, plastic soda rings) and
petroleum spills are two other avenues in which injuries occur that need
veterinarian intervention for successful resolution.
When examining a bird for external wounds, the physical assessment
should commence at the tip of the beak and in a methodic manner progress,
to the tip of the tail. Feather coverage may make it difficult for the examiner
to detect small wounds, common in predator injuries, even if they are life
threatening. Wounds that affect nonpsittacine species range from minor
lacerations, to severe multiple bite injuries, and oil spill trauma. As
mentioned previously, a general assessment of the patient’s condition is
critical in determining further examination, diagnostic sample collection,
and testing and treatment. If the patient is in serious to grave condition,
stabilization is important before diagnostic testing is initiated. The bird
 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36 21

should have respiratory, fluid, and thermal support, and any wounds
quickly disinfected and dressed to control hemorrhage. Consideration for
corticosteroid administration and antimicrobial therapy should be given at
this time. If antibiotic therapy is warranted, a general broad spectrum
antibiotic should be administered. Once the patient is stabilized, further
assessment of the wound can and should take place. The bird should be
examined starting at the beak and looking at all extremities and body
surface. The body surface is examined by slowly rubbing the feathers against
the direction of growth. This examination will not only allow the examiner
to observe the body surface, but also to feel for any moisture resulting from
the bleeding of a small puncture wound or laceration.

Products needed for wound management

If one is to treat avian species, especially in potentially critical condition,
it is important to have the proper equipment and products to improve the
veterinarian’s chances for treatment success. Equipment starts out with
a digital gram scale (Veterinary Specialty Products, Boca Raton, Florida)
that can measure up to 6 kg. For smaller birds, a separate digital gram scale
measures up to 2 kg will be appropriate. The primary difference between the
scales is that the 6 kg scale will likely weigh in 5-g increments while the 2-kg
scale will have measurements in 1-g increments. For larger birds, dog and
cat scales are used, while ratites need scales manufactured for large animals.
It is not only important to weigh the patient upon presentation to determine
the proper therapeutic dosages, but to weigh the bird on a daily basis for
patient response to treatment. A temperature-controlled critical care unit
(Lyon Electric, Co., Inc., Chula Vista, California) is also important. This
unit should be fitted for access to supplemental oxygen when needed for
patients with respiratory distress. It is desirable to have a unit with humidity
control, as dry heat alone may result in dehydration of smaller patients,
especially those with extensive wounds that contribute to fluid loss. Many of
the newer intensive care units have digital controls that are easy to adjust for
precise environmental parameters. Isofluorane anesthesia is a must for any
avian practice. Sevoflurane (SevoFlo, Abbott Labs, North Chicago, Illinois)
is an anesthetic agent that has gained popularity in the last few years, but the
clinical benefit is negligible and the cost significantly more compared with
isofluorane [5].
A pair of binocular loops (Surgitel, General Scientific Corp., Ann Arbor,
Michican) and microsurgical instruments should be part of the avian
practice. Binocular loops and microsurgical instruments will be beneficial
for any number of animal species undergoing surgical procedures at
a veterinary hospital, including all avian patients. The benefits of using
binocular loops are numerous and only through their use will one truly
appreciate the elevation of their surgical skills, especially with smaller
22 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36

patients. Radiosurgical capabilities will allow the avian practitioner to use

this state of the art technology from incision to closure. Pathology is similar
to the cold steel of a scalpel, and the dual frequency technology and digital
programming of the radiosurgery (Ellman International Inc., Hewlett, New
York) unit allows for cutting and coagulation, hemostasis, and bipolar
forcep application. There are many applications for the radiosurgery unit
in wound management, at a fraction of the cost of LASERs, without com-
promising surgical quality. Adequate cage space is important for larger
birds (eg, cranes, egrets, ratites, and raptors), while hydrotherapy tubs are
required for waterfowl.
Therapeutic agents for the critical patient are often available in most
hospitals and include catheters (1.5-inch, 22-gauge spinal needle for
intraosseous catheters), crystalloid and colloidal fluids, iron dextran
(Watson Labs. Inc., Corona, California), oxygen-carrying hemoglobin
solution (Oxyglobin, Biopure, Cambridge, Massachusetts), and a nutritional
critical care formula (Lafeber Co., Cornell, Illinois). Analgesic compounds
have been a beneficial addition to most veterinary hospitals, and for the
avian patient, this has been no exception. Carprofen (Rimadyl, Pfizer Inc.,
New York, New York) and butorphenol tartrate (Torbugesic, Fort Dodge
Animal Health, Fort Dodge, Iowa) are two of the most commonly used
analgesic compounds for avian patients. A recent addition to available
nonsteroidal antiinflammatory drugs that may be used in avian species is
meloxicam (Metacam, Merial Limited, Duluth, Georgia). It comes in an
oral suspension that is easy to administer to most avian species, and has
been used successfully at a dose of 0.1 – 0.3 mg/kg, by mouth, every 12 or 24
hours. The antibiotic, antifungal, and antiparasitic agents used to treat both
systemic and topical wounds are similar to those found in most veterinary
hospitals. Avian patients often tolerate oral fluid medications better than
pill or tablet forms. If a veterinary hospital does not have common
antibiotic agents formulated in an oral suspension form, then a compound-
ing pharmacy should be contacted. Metronidazole hydrochloride (Watson
Laboratories, Inc.) can be difficult to administer orally because of its poor
taste. Metronidazole benzoate is considered more palatable than the more
common form manufactured in the United States.
Topical therapeutic products, including antibiotic ointment, may be
applied depending on the nature of the injury and advantages of using the
product for that particular case. When prescribing a topical ointment for
avian use caution must always be taken into account. Owners need to be
educated on the application process, using only a small amount to treat
the lesion to reduce the possibility of feather matting. Topical ointments
containing corticosteroids are not recommended for avian species due the
high potential for severe side effects. Preparation-H (Wyeth Laboratories,
Marietta, Pennsylvania) has been advocated for dermal wounds to decrease
the healing time. An active ingredient in the Preparation-H ointment is live
yeast cell derivative that increases the respiratory component of the
 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36 23

epithelium surrounding the wound, thereby increasing the healing capacity

of the tissue. There has been a recent advance in wound management with
the advent of Tricide (Molecular Therapeutics, LLC, Athens, Georgia). This
product is an antimicrobial potentiator used to flush the wound bed and
control infection. Some topical antibiotic preparations that have been used
with success by the authors are triple antibiotic ointments (eg, Neosporin,
Pfizer Inc.) and silver sulfadiazine cream (SSD) (Smith & Nephew Heath
Care, London).
Appropriate bandage material is extremely important in wound
management. Nonstick surface bandaging material (Adaptic, Ethicon Inc.,
Arlington, Texas) will protect the tissue bed and prevent leakage of serum
into the contact layer and thereby prevent adhesion of the bandage to the
wound. Semiocclusive dressings (Tegaderm) also aid in the healing of skin
lesions but may be difficult to apply because of poor adhesive qualities.
Tissue glue (Nexaband, Veterinary Products Laboratories, Phoenix, AZ) or
cyanoacrylic bandages have been used to repair minor skin lacerations or
incision sites. Although tissue glue is convenient to use for the appropriate
injury, it can be expensive, and the shelf life has been disappointingly short.
Cyanoacrylic bandages have been advocated to cover larger tissue defects in
the past, but there is a newer product that is more tissue friendly allowing
for reepithelization and tissue respiration. VET BIOSIST (VBS) (Cook
Veterinary Products, Spencer, Indiana) is an extracellular matrix derived
from the submucosal layer of the porcine small intestine. The protein matrix
bandage, which consists of mainly of Type I collagen with some Type III
and V present, is freeze dried to preserve the structural integrity of the
product. VET BIOSIST can be used on large skin wounds that cannot be
closed by primary intension. The affected area should be prepared for
bandaging using standard techniques before the application of VBS. Aseptic
handling techniques should be employed when preparing the protein matrix
bandage for tissue application. The VBS sheet should be cut to overlap the
affected area by approximately 3 mm. This allows for tissue overlap when
the bandage is placed over the wound for suture placement. The VBS
bandage should be rehydrated in a sterile dish containing 50 mL of sterile
saline or water. This process takes approximately 3 minutes. Once applied to
the wound, the VBS should be sutured in place using 4.0 or smaller diameter
monofilament resorbable suture material. It is very important to remember
that VBS needs to have an aqueous dermal gel applied, so the matrix sheet
remains moist during the healing process. If the bandage is maintained
properly and not rejected by the patient, then the protein matrix should
serve as an epithelial framework in which the bandage material is
incorporated into the host tissue. Nonadhesive bandage material should
cover the VBS before applying an appropriate outer dressing. The outer
dressing should be changed daily when reapplying the aqueous dermal gel to
maintain the VBS hydration status. CARRASORB (Veterinary Products
Laboratories) is another product that protects dermal lesions and speeds the
24 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36

healing process. CARRASORB is a freeze-dried gel that is manufactured

for application on medium exudating wounds. It contains the ingredient
acemannen, which is a complex carbohydrate product derived from the aloe
vera plant, and can be applied topically to a dermal lesion that has been
prepared similar to the manner described for VBS. If the lesion is dry, then
the freeze-dried gel product may be moistened with a wound cleanser to
provide a moist wound environment.
Items needed to complete bandages include cast padding, gauze sponges,
VetWrap (3M Company Animal Care Products, St. Paul, Minnesota),
Elasticon (Johnson & Johnson Medical Inc., Arlington, Texas), and white
cloth tape (waterproof and nonwaterproof). Fiberglas cast material,
temperature sensitive cast material (Vet-lite, Runlite S.A., Micheroux,
Belgium), and UV light-sensitive dental acrylic (Triad, Henry Schein, Port
Arthur, New York) are used to make splints and wound bandages for the
nonpsitticine avian species. Ethylcyanoacrylates (Cyanovanear, Ellman
International Inc., Hewlett, New York) using a catalyst is available for
beak repair and UV light-sensitive dental acrylic may be used for the same
purpose. Pins, wire, and aluminum rods are used for beak structure
foundations before the application of prosthesis and for foot braces,
respectively.

Bandaging techniques
When a bird is injured, bandaging will allow protection of the injury
before treatment and after the affected area has been attended to. There are
simple bandages that require little knowledge or ability to apply, and there
are more complicated bandages that need to be applied in a manner to
prevent secondary trauma. How the bandage is applied is an important
consideration. If the bandage is around the body, a constrictive bandage
may interfere with the mechanics of the patient’s respiration. If the bandage
is placed too tightly around an extremity, then vascular constriction of the
distal tissue may occur and the tissue will begin to swell if circulation is
compromised. It is recommended to leave a small amount of the distal tissue
exposed to allow the veterinarian and client an opportunity for observation
of tissue swelling. When bandaging birds, it is always recommended to
bandage the extremity from the bottom up and wrap the affected area with
bandage material already removed from the roll to prevent the dispensing
process from tightening the dressing.
For lacerations and abrasions, a nonadhesive bandage material (eg,
Adaptic) should be placed over the injury, followed by either cast padding
or gauze sponges. The underlying material is held in place with cloth tape,
which may be waterproof. VetWrap is used to secure the bandage, and
a small piece of cloth tape is placed around the bandage to prevent the
bandage from unraveling. This same simple bandage can be used in
 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36 25

conjunction with other support devices depending on the need and injury.
For raptor and waterfowl pododermitis, foot support devices that have been
padded may be used to lend structure to the bandage for the bird to perch,
stand, or walk. The support devices can be made out of aluminum rods used
for small animal splints or heat sensitive material (eg, Vet-lite). For wing
injuries, the figure-of-eight bandage has been used with great success for
injuries distal to the humerus. A body wrap is added to the figure-of-eight
bandage for wing injuries at the level of the humerus (Fig. 1). It is very
important to apply this bandage properly, because avian wing anatomy
encourages improper application. The injured area should be cleaned and
prepped with the same techniques described for the simple bandage before
placing the figure-of-eight bandage.
Any of the above bandages can be used with a wet-to-dry technique [6].
The wet-to-dry technique has been very successful in closing large dermal

Fig. 1. An adult ring-billed gull (Larus delawarensis) is shown with a properly applied figure-of-
eight bandage for a distal wing injury. Care must be taken to incorporate the humerus and
upper wing into the wraps as the bandage is applied.
26 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36

defects that are not amenable to primary closure. The defect is cleansed and
prepared for bandaging in the standard manner. A dilute chlorhexadine
(Nolvasan, Fort Dodge Inc., Fort Dodge, IA) solution, Tricide, or sterile
saline may be used for the wet portion of the bandage. Appropriate-sized
gauze sponges are soaked in the desired solution then placed on the lesion.
Large quantities of similarly sized gauze sponges are laid on top of the wet
sponges and a routine bandage wrap keeps the sponges in place. The desired
effect is for the wet sponges to wick fluid discharge from the wound bed
toward the dry sponges. The wet-to-dry bandages need to be changed
frequently, often on a daily basis. Removal of the adhered contact layer will
debride the wound, thereby stimulating the formation of a granulation bed.
The granulation bed should not be allowed to dry out. Once a healthy
granulation bed is established, then a nonadherent bandage should be used.
Over time the wound margins will start to contract, eventually closing the
large surface defect. Foot injuries to passerine species and raptors are often
‘‘ball’’ bandaged. This type of bandage works for raptors that have
pododermitis lesions, not only treating and protecting the injured area but
reducing the pressure to the lesion.

Common presentations and treatment methods

Wound healing begins with clot formation followed by an inflammatory
response. The inflammatory response in birds is initially characterized by
a heterophil and monocyte response, and subsequently, the lymphocyte cell
line. Inflammation is followed by the proliferation of fibroblasts at the
edges of a wound. Capillaries begin to proliferate and enter the wound site
during this time [7]. The next step is remodeling, which is characterized by
conversion of poorly organized collagen with stronger collagen fibers [8].
Collagen fibers orient themselves in relation to the tension placed on the
edges of the wound [7].

Beak injuries
A common presentation for nonpsittacine species is beak injuries, where
the beak is fractured or completely removed. A prosthesis may be applied,
but will likely provide only temporary resolution, and may need to be
reapplied. The temporary nature of the prosthesis must be taken into con-
sideration, especially if a bird on a zoo exhibit or a releasable wild bird is
affected. Treatment of beak injury cases generally require a wire and pin
structure foundation with a dental acrylic overlay (Fig. 2) [9,10]. There have
been a number of prosthetic materials used to reconstruct beak structures,
but all have been a temporary solution. If the prosthesis is needed to
assist with the prehension of food, and thus survival, it can be reattached
(Fig. 3). Many birds survive with minor beak injuries without permanent
complications.
 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36 27

Fig. 2. A wire or pin framework is required for prosthetic stability. An extensive framework
was required for this injured goose before attaching and molding the prosthetic material.

Lacerations
The first step in determining the best therapy for a skin wound is
a thorough examination. With wildlife patients, it is often surprising to
determine the magnitude of the injury through the use of full body survey
radiographs. An initial assessment of a few small lacerations may give way
to a large number of shotgun pellets when radiographic images are obtained.
Nervous and vascular viability must be evaluated, as well as the integrity of

Fig. 3. Different avian species require different beak prosthetic material. This ibis received
a molded plastic polymer mandibular prosthesis.
28 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36

underlying soft tissues (eg, tendons and ligaments). Examination should be

followed by careful debridement of devitalized tissue and lavage of
remaining tissue. The area surrounding the wound should be free of
feathers to decrease contamination and keep the feathers out of the injury,
which could impede healing. A 2 to 3-cm ‘‘feather-free’’ zone should be
prepared around the wound by either plucking or trimming the surrounding
feathers [7]. Debridement of all necrotic debris is important; however, care
should be taken when debriding soft tissues such as tendons and ligaments if
function is to be maintained [8]. In conjunction with debridement, lavage is
used to cleanse a wound. Sterile water, isotonic crystalloid solutions,
cholorhexidine (0.05%), povidone iodine (1% or less), or hydrogen peroxide
(3%) may be used [8]. Hydrogen peroxide has minimal effect against most
bacterial organisms, but is sporacidal, and is therefore useful for wounds
that may be contaminated with clostridial organisms [7].

Primary closure
The method of wound closure is dependent on several factors; (1) wound
location, (2) degree of contamination, (3) amount of soft tissue loss, and (4)
the patient’s clinical status [8]. Primary closure is an option for simple, clean
wounds usually less than 24 hours old.
Because avian skin is extremely thin, choosing the correct suture material
and pattern for primary closure is crucial. In general, absorbable suture
material should be used, particularly for wild species, to eliminate the stress
of suture removal at a later date. A study on the inflammatory response of
suture material in avian skin has shown that polydioxanon suture (PDS,
Ethicon Inc., Arlington, Texas) is superior in long-term structural integrity,
and produced minimal inflammation to the surrounding tissue when
compared with other commonly used material [11]. A simple continuous
pattern is acceptable for closure of avian skin, which also reduces the time
required for surgery [12]. Mattress patterns may be used to reduce tension at
a closure site or to evert the skin [8]. In general, suture material on a taper
needle is preferred to a cutting needle, as the cutting needle may cause the
delicate skin to tear [12]. This is especially true in smaller birds when closing
highly keratinized tissue (eg, plantar surface of the foot). In highly
keratinized tissue, especially the foot, we recommend suture material of
the size 5-0 or smaller because the smaller needle that is attached to the
suture reduces skin tearing that is encountered with a larger needle. Chromic
gut (Ethicon Inc.) and Vicryl (Ethicon Inc.) should not be used because
a considerable inflammatory response may be elicited with these suture
types [9,11].
Wing web lacerations are common presentations in nonpsittacine species.
For birds that must be returned to flight, such as raptors, proper closure to
minimize contracture of the healing skin is essential. To achieve adequate
closure, both the ventral and dorsal skin layers must be closed individually
 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36 29

in full thickness wounds. Careful examination of a wing web injury should

be performed to ensure that the tendons of the propatagium are intact [12].
Following repair, physical therapy should be performed to stretch the skin
in the affected area; however, adequate time must be allowed for the skin to
heal before the initiation of physical therapy.

Secondary closure/skin flaps and grafts

There are certain areas on the bird’s body where primary closure may not
be possible. These wounds may be allowed to heal by second intention, skin
flaps, or grafts. If a wound is allowed to heal by second intention, selection
of the appropriate topical antimicrobial therapeutic agent and bandages are
directly correlated to the speed of recovery [8]. Moisture-permeable wound
dressings, such as Tegaderm, are excellent choices to cover large dermal
defects in avian species. These dressings help maintain an aerobic, moist
environment and allow phagocytosis by leukocytes and migration of
epithelial cells [13]. Products such as Tegaderm are especially useful in avian
patients because they can be easily applied to irregularly shaped areas [13].
Free skin grafts work better on avian patients than on other species
because the dermis is very thin, which allows for rapid revascularization of
the graft [12]. The best area for harvesting skin for grafting is the inguinal
area, at the attachment of the leg to the body [12].
Skin flaps are commonly used to manage large dermal defects that are
difficult to close through primary intention. A skin flap differs from a free skin
graft in that it remains attached to the donor site by a pedicle. The pedicle is
maintained as the primary blood supply to the skin flap. The full-thickness
skin flaps also contain feather follicles, providing coverage at the graft site, so
feather orientation must be taken into consideration when applying the graft
[14]. Sites that have been reportedly used for harvesting skin flaps include the
dorsal cervical region [14] and the dorsal antebrachium [15].
Failure of skin grafts and flaps is often due to infection; therefore, proper
site preparation and aseptic technique is critical for the healing process [12].
Nonadherent bandage material (Tegaderm, Adaptic) should be applied
directly to the graft sites to avoid disturbing new granulation tissue when
changing bandages. The flap and nonadherent bandage should be covered
by a conforming bandage to keep the site clean and protect it from damage.

Pododermatitis
Pododermatitis or ‘‘bumblefoot’’ is a frequent presentation in captive
raptor and waterfowl species. Suspected etiologies of pododermatitis include
improper substrate, heavy body condition, decreased vascularity to the foot
(specifically the middle plantar surface), poor diet (hypovitaminosis A or E),
and captivity [16–18]. Pododermatitis may also be secondary to an
infectious or parasitic disease processes such as avian poxvirus or
Knemidokoptes spp. mite infestations in smaller avian species [12].
30 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36

To a lesser degree, penetrating foot wounds (self-inflicted bites from prey

items, thorns) or frostbite may also initiate the debilitating cascade of
pododermatitis. Avascular necrosis of the middle plantar area caused by
abnormal weight bearing, heavy body condition (Fig. 4), captivity, or poor
training techniques appears to the inciting cause of the majority of raptor
bumblefoot cases [17–19]. In waterfowl, the majority of cases appear to be
associated with heavy body condition, improper substrate in captivity, or
previous leg injuries affecting normal gait and weight distribution. Once the
protective barrier of the plantar surface has been compromised, invasion of
the underlying tissue by opportunistic organisms often occurs. Staphylo-
coccus aureus is the most common isolate from pododermatitis lesions of
captive raptors, although other bacterial and fungal organisms have been
identified, including Escherichia coli, Proteus spp., Pasteurella spp.,
Streptococcus spp., Pseudomonas spp., Klebsiella spp., Clostridium spp.,
Corynebacterium spp., Bacillus spp., Diplococcus spp., Nocardia spp., Actino-
bacillus spp., and Aeromonas spp, [16]. S aureus is not commonly isolated
from pododermatitis lesions in wild raptors. It has been speculated that
the Staphylococcus spp. organisms may be transferred into the captive
raptors environment by their human handlers [16]. In one study, female
raptors were more commonly affected by pododermatitis (91.4%) than male
raptors, presumably due to the larger body size of the females [19]. In the
same study, larger raptor species were more commonly affected than small
species, because weight is a predisposing factor for the development of
pododermatitis [19].

Fig. 4. Increased pressure to the center of a bird’s foot will lead to vascular compromise, which
culminates in pododermatitis. This Florida sandhill crane (Grus canadensis pratensis) had
prosthesis on the opposite leg causing increased pressure on the foot shown in the figure, which
resulted in pododermatitis.
 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36 31

There are several recommended classification systems published to grade

pododermatitis lesions on severity of presenting signs. The recommended
classification schemes have as few as three and as many as seven categories
[8,17,18]. The severity of pododermatitis lesions can range from a smoothing
of the epithelium on the plantar aspect of the foot to involvement of tendons
and bone [18]. For the more severe lesions radiographic images of the foot
are important in determining classification, treatment, and prognosis for
recovery.
Pododermatitis usually begins as a thinning and smoothing of the
cornified skin on the plantar aspects of the digital or metatarsal pads. This
thinning of the cornified skin has been associated with the loss of focal
vascularity primarily to the center of the plantar surface [17,18]. Careful
assessment of husbandry practices should be made, and appropriate changes
recommended. Perching surfaces should be kept clean and be of varied
textures and diameters. Astro-turf and hemp rope are ideal for covering
perches because they provide varying textures, cushion, and allow for weight
bearing on different areas of the plantar surface. Diet related issues and
training methodology must also be addressed [17].
Mild forms of pododermatitis may be treated successfully by addressing
husbandy problems. Placing the affected foot in a wrap (eg, ball bandage) is
often recommended in an attempt to protect the affected tissue and reduce
weight bearing on that foot. In instances where one foot is wrapped, the
other foot must be monitored closely for signs of developing pododermatitis
due to increased weight bearing on that foot. Interdigitating bandages may
also be applied. These differ from ball bandages in that while the metatarsal
pad is protected, the digits are left exposed for support and perching.
Topical therapy can also be used to treat milder forms of pododermatitis. A
case of pododermatitis associated with poxvirus lesions on the feet was
successfully treated topically with a combination of antibiotics, steroids,
and dimethyl sulfoxide (DMSO) (American Marketing, Inc., Rising Sun,
Indiana) [20]. A therapeutic ‘‘cocktail’’ for topical treatment of bumblefoot
lesions comprised of DMSO, dexamethasone (The Butler Co., Columbus,
Ohio) and piperacillin sodium (Pipracil, Wyeth Pharmaceuticals, Philadel-
phia, Pennsylvania) has been described and used with success [21].
More advanced forms of pododermatitis require surgical debridement
followed by bandaging techniques aimed at reducing weight bearing on the
affected areas of the feet. Surgery usually centers on the removal of com-
promised skin on the plantar aspect of the foot, including the scab, if
present. A culture of the deep underlying tissues is important to ensure the
proper antibiotic regimen is being employed [19]. Following debridement of
contaminated and necrotic tissue; the site can be closed with absorbable
suture in a simple interrupted or mattress pattern. Irrigation with sterile
saline or a dilute chlorhexidine solution will help extract necrotic and
inflammatory material from the wound. Lavage with an antibiotic
preparation, such as ticarcillin disodium (Timentin, GlaxoSmithKline,
32 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36

Research Triangle Park, North Carolina) or piperacillin has also been

described [19]. Remple has developed and described techniques for casting
of raptor feet following surgical debridement using thermoplastic orthope-
dic tape and styrene plastic polymer to keep the surgical site stable and
reduce weight bearing on the affected surfaces [19].

Thermal burns and dermal chemical irritants

Wounds associated with thermal burns are not a common presentation
with nonpsittacine species. Wildfire and electric power lines are conditions
or sites where birds may be burned. If a patient presents with a possible
thermal injury a complete assessment of the dermis is required. Because of
a bird’s thin skin, the amount of heat needed to achieve serious damage to
the epidermis is less than that of mammals. Supportive treatment for
stabilization of the patient is initiated with the addition of antibiotic and
pain medication. Once it is determined that the patient is stable enough
for examination, the dermis should be examined. As with thermal burns
associated with hot formula in young psittacine patients, the initial extent of
the injury cannot be determined until tissue necrosis delineates viable from
nonviable tissue. The delineation of tissue usually occurs in 3 to 7 days
postinjury. During the healing phase treatment should consist of supportive
therapy, topical treatment of the affected area with an aqueous based topical
antibiotic medication, a bandage for protection, systemic antibiotic therapy,
and analgesics. Once the affected area has been delineated, the burned tissue
should be removed and a skin flap used to close the defect or a wet–dry
bandage placed over the injury to encourage secondary intension healing.
For dermal chemical irritants, the first step in treatment is dilution or
removal of the caustic agent by copious lavage with water [8]. Burns
resulting form acidic compounds may be neutralized with sodium
bicarbonate, while alkaline compounds may be neutralized with a dilute
vinegar solution [7]. One of the most common dermal chemical irritants in
which nonpsittacine avian species are treated is crude oil. It is not only
important to clean the feathers and skin to prevent topical injury, but to
remove the oil to discourage ingestion (Fig. 5). The birds that present with
oil exposure have to be stabilized before the cleaning process can take place,
which includes regulation of normal body temperature, rehydration, oral
activated charcoal administration, prophylactic antibiotic and antifungal
administration, and diagnostic testing to determine and monitor health
status [22]. Once stabilized the cleaning process takes place using detergent
(Dawn, Proctor and Gamble Inc., Cincinnati, Ohio) and water solution
warmed to 40 to 45 C [22]. The wash-and-rinse cycle continues until the
water beads on the clean feathers. After the oil has been removed the birds
are placed in a warm room with drying fans until dry. The next day the birds
are introduced to a pool for grooming and feather conditioning, which may
take 4 to 5 days [22]. There are many factors that determine the survivability
 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36 33

Fig. 5. Crude oil and other topical irritants should be removed as soon as the patient is
stabilized after rescue.

of birds after exposure to crude oil but the overall survival rates regularly
reach 60%[22].

Predator bites and wounds

One of the more common presentations in for waterfowl are predator
bites and wounds. Common predators include the dog, cat, coyote, raccoon,
weasel, or other wild animal (Fig. 6). The identity of the predator makes
little difference, because all trauma cases identified as bite wounds should be
considered life-threatening injuries. Although the traumatic incident may
be damaging, it is the secondary bacterial infections associated with the
puncture wounds that are of the most concern. Aggressive antibiotic therapy
should be initiated as the patient is being stabilized upon presentation.
Without antibiotic treatment the bird is susceptible to bacterial sepsis within
24 to 72 hours, often resulting in death [23]. Fifty percent of bite wounds in
humans inflicted by dogs and cats contained Pasteurella spp. [24]. Of the
human cat bite injuries in which bacteria were isolated, 75% were
Pasteruella spp. with 80% of those being Pasteruella multocida [24]. Of
the human dog bite injuries in which bacteria were isolated, 50% were
Pasteurella spp. with 25% being P multocida [24]. In 56% of the bite
wounds, a mixed population of aerobic (eg, Streptococcus spp., Staphylo-
coccus spp., Moraxella spp., and Neisseria spp.) and anaerobic (eg,
Fusobacterium spp., Bacterioides spp., Porphyromonas spp., and Prevotella
spp) bacteria were isolated [23]. Septicemia associated with certain isolates
of P multocida will cause pathology in major organ systems and the
endotoxins will affect the vascular system.
To cover the wide spectrum of bacteria isolated from predator bites and
wounds, the synergistic use of an antibiotic combination is the treatment of
34 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36

Fig. 6. Predator bites can cause serious injuries to many avian species. This Chinese goose
(Anser cygnoides) was injured when fighting with a great dane dog.

choice. Treatment of bite wounds should begin with penicillin in

combination with a first-generation cephalosporin or clindamycin hydro-
chloride (Antirobe, Pfizer Animal Health, Exton, Pennsylvania) combined
with a fluoroquinolone. During the recovery and treatment period, it is
recommended to observe the patient for depression or other signs of
infection through serial complete blood counts.

Tendon repair
Bite wounds are one of the many causes of tendon injury in raptor
species. Other causes of raptor tendon injury include infection, damage from
anklets or identification rings, damage from leather jesses, fractures, or
scarring from bony developmental abnormalities [25]. A technique has been
developed to repair a vascularized major flexor tendon by using a flexor
sheath pedicle [25]. If a diagnosis of a severed digit II major flexor tendon
has been made, an incision to expose the affected structure is made over the
main area of swelling [25]. The tendon sheath is incised, exposing the
attached vascular segment and the nonvascular distal segment [25]. A strip
of tendon sheath is selected to serve as a vascular pedicle with the tendon
ends sutured using a modified Kessler pattern [25]. A simple interrupted
suture pattern is used to close the tendon sheath, taking care to maintain
blood flow to the pedicle, after which the skin is closed [25]. A ball bandage
is recommended to protect the healing surgery site.
Wound management in nonpsittacine avian species is difficult because of
the species variability and stress often involved with capture, hospitalization,
and treatment. Birds that comprise this group do respond well to proper
handling and veterinary care when provided. It is imperative that the
 S.H. Riggs, T.N. Tully Jr / Vet Clin Exot Anim 7 (2004) 19–36 35

veterinarian assess and stabilize the patient before collecting diagnostic

samples and performing stressful procedures. Once stabilized, the general
care of the avian patient should follow basic parameters using the correct
equipment, treatment protocol, procedures, and bandage material. Follow-
ing basic medical protocol and adjusting to each patient presented for proper
diagnostic testing, treatment and therapy will be the determining factor
between success and failure in nonpsittacine wound-management cases.

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