ecallenSeries 3: Managing Bleeding & Preventing Enucleation Surgery Complications
In Parts 1 and 2, we covered Dr. Broadwater’s revolutionary positioning and surgical techniques. This final installment focuses on the challenge that intimidates many veterinarians most: controlling orbital bleeding and preventing complications that bring patients back to surgery.
The Orbital Bleeding Challenge
Orbital bleeding presents unique challenges during enucleation surgery that traditional hemostatic methods struggle to address effectively.
Why Traditional Hemostatic Methods Fall Short
Electrocautery limitations:
- Can’t reach deep bleeding sites effectively
- Risk of thermal damage to surrounding tissues
- Difficult to maneuver in confined orbital space
Standard hemostatic sponges:
- Don’t conform to irregular orbital anatomy
- Often too large for precise placement
- May not maintain contact with bleeding sites
Multiple bleeding sites:
- Require repeated intervention attempts
- Delay surgery while addressing each location
- Can obscure visualization when multiple sites bleed simultaneously
Advanced Hemostatic Control with Vetigel ® Hemostatic Gel
Dr. Broadwater describes Vetigel Hemostatic Gel as particularly valuable for orbital bleeding control, addressing the specific challenges that traditional methods can’t handle effectively.
Superior Conformability for Orbital Anatomy
Plant-based gel design:
- Conforms to irregular bleeding sites deep in orbit
- Reaches locations traditional methods cannot access effectively
- Flows into crevices and around irregular surfaces
- Maintains contact even in difficult-to-reach areas
Clinical advantage: The gel’s ability to conform means you can treat bleeding sites that would otherwise require extensive dissection to access with other methods.
Mechanical Barrier Formation
Advanced hemostatic mechanism:
- Cross-linked structure creates immediate mechanical barrier
- Enhanced viscosity and cohesive strength adhere to bleeding tissues
- Doesn’t disturb natural fibrin clot formation – works with body’s natural processes
- Maintains barrier integrity even in wet surgical environment
Dr. Broadwater’s observation: “The gel creates an immediate seal that stays in place, unlike other hemostatic agents that can wash away or lose effectiveness in a bloody field.”
Bioabsorbable Design Eliminates Concerns
Complete dissolution:
- Completely dissolves within two weeks
- Eliminates long-term foreign body concerns
- No removal procedure required
- Reduces risk of chronic inflammatory reactions
Clinical Application of Vetigel Hemostatic Gel
Application technique:
- Apply directly to deep orbital bleeding sites using included sterile cannula
- Use only amount needed – product is effective in small quantities
- Can be applied to multiple sites simultaneously
- Works immediately upon contact with bleeding tissue
Strategic timing: Dr. Broadwater applies Vetigel hemostatic gel as soon as significant orbital bleeding is encountered, rather than struggling with traditional methods first.
Hemostatic Management Strategy
First-line approaches include:
Electrocautery for accessible sites:
- Effective for surface bleeding that can be directly visualized
- Use lower settings to minimize thermal damage
- Most effective for single, discrete bleeding points
Pressure and time for minor bleeding:
- Often effective for smaller vessels
- Combined with patient positioning allows gravity assistance
- Requires patience but avoids unnecessary intervention
When to Advance to Vetigel Hemostatic Gel
Indicators for Vetigel hemostatic gel use:
- Persistent deep orbital bleeding uncontrolled by electrocautery
- Multiple bleeding sites requiring simultaneous treatment
- Bleeding in locations difficult to access with traditional methods
- Cases where continued bleeding significantly impairs visualization
Application protocol:
- Identify bleeding source as precisely as possible
- Apply Vetigel hemostatic gel directly to bleeding site using sterile cannula
- Allow 30-60 seconds for gel to take effect
- Resume surgery once hemostasis achieved
- No need to remove gel – it will dissolve naturally
Alternative Hemostatic Options
Absorbable gelatin sponges:
- Less effective for deep orbital bleeding
- May be useful for surface bleeding
- Require precise placement and often multiple pieces
Orbital implants:
- Dr. Broadwater discourages due to 2-3% rejection/infection risk
- Adds unnecessary complexity and potential complications
- Not recommended for routine enucleation
Preventing Common Complications
Orbital cysts are a common side effect of eye removal. Primary causes of post-surgical cysts include:
- Retained conjunctival tissue with goblet cells – most common cause
- Incomplete third eyelid removal – must include gland
- Retained medial canthal caruncle – often overlooked during surgery
Dr. Broadwater’s prevention strategy: “If it’s pigmented tissue, remove it.” This simple rule provides clear guidance for complete conjunctival removal and prevents the majority of cyst complications.
Systematic approach:
- Remove all visible conjunctival tissue
- Pay special attention to medial canthal area
- Ensure complete third eyelid and gland removal
- Double-check for any remaining pigmented tissue before closure
Chronic Draining Tracts
Common misconception: Many veterinarians treat draining tracts appearing months post-surgery with repeated antibiotic courses.
Dr. Broadwater’s approach: These typically indicate retained material requiring surgical exploration rather than infection. Antibiotics rarely resolve the underlying problem.
Typical causes of draining tracts:
- Retained conjunctival tissue creating continued secretion
- Foreign material (suture, debris) causing chronic irritation
- Incomplete medial canthal caruncle removal
- Retained glandular tissue from incomplete third eyelid removal
Management strategy: Surgical exploration and removal of retained material is usually required for definitive treatment.
Excessive Post-Operative Bleeding Control
Normal expectations:
- Most orbital swelling resolves within 24-48 hours
- Conservative management usually sufficient
- Cold compresses and patient sedation for active animals
Dr. Broadwater’s experience: “I rarely need to return to surgery for bleeding control when using proper hemostatic technique during the initial procedure.”
Prevention through proper technique:
- Proactive hemostatic management during surgery
- Use of Vetigel hemostatic gel for persistent orbital bleeding
- Careful attention to complete muscle and tissue removal
- Proper closure technique
Quick Reference: Complication Prevention Checklist
✓ Remove all pigmented conjunctival tissue systematically
✓ Complete third eyelid removal including gland
✓ Address medial canthal caruncle completely
✓ Use Vetigel hemostatic gel for persistent orbital bleeding
✓ Test 360-degree globe rotation before optic nerve transection
✓ Inspect surgical site for retained tissue before closure
✓ Apply appropriate closure technique for tissue layers
Implementation Guidelines for Your Practice
Hemostatic Protocol Changes
Stock Vetigel hemostatic gel for orbital bleeding management:
- Keep readily available during enucleation procedures
- Train staff on proper application technique
- Include in standard enucleation surgical pack
Modify surgical approach:
- Address bleeding proactively rather than reactively
- Use systematic tissue removal to prevent complications
- Apply “remove all pigmented tissue” rule consistently
Training Staff on New Protocols
Key points for surgical team:
- Recognition of when to use advanced hemostatic control
- Proper application technique for Vetigel hemostatic gel
- Understanding of complication prevention strategies
- Post-operative monitoring expectations
Complete Transformation: 15-Minute Enucleation Surgery
By combining all three parts of Dr. Broadwater’s approach, you can achieve consistent 15-20 minute enucleation procedures:
Part 1: Dorsal positioning provides optimal surgical access and visualization
Part 2: Specialized instruments and technique ensure efficient, safe surgery
Part 3: Advanced hemostatic control and complication prevention eliminate the most common problems
“The path forward is straightforward: acquire the essential equipment, practice the positioning technique, and stock Vetigel hemostatic gel for orbital bleeding management. These modifications will not only improve your surgical confidence but also deliver better outcomes for your patients.” – Dr. Josh Broadwater, DVM, DACVO
Dr. Broadwater’s refined approach proves that enucleation surgery doesn’t have to be intimidating. The three key changes—dorsal positioning, specialized instruments, and Vetigel hemostatic gel for reliable hemostatic control—transform challenging hour-long procedures into confident, efficient surgeries.
Ready to implement these game-changing techniques? Learn more about Vetigel Hemostatic Gel and discover how Zomedica’s innovative solutions are helping veterinarians deliver better patient outcomes.
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*Dr. Broadwater was paid by Zomedica, Inc. for his webinar presentation, which you can watch here.
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