Sea Turtle Surgery

If you know Dr. Grafinger at all, you probably know that he really enjoys working with exotics; the staff here at TVRH enjoys that he enjoys them.  We see hawks and owls and beavers and otters from the wildlife rehabilitator group CLAWS. We work on tigers and lions and caracals and Geoffrey’s cats from the rescue organization The Conservators’ Center (some of their photos are on the wall in his exam room).  And recently, some of us got to help out with surgery on a Kemp’s Ridley sea turtle and a green moray eel.

Dr Grafinger has performed surgery on several sea turtles (the previous one from the Karen Beasley Sea Turtle Rescue and Rehabilitation Center, seen here in a previous blog post), so when the North Carolina Aquarium on Roanoke Island  needed help with an injured turtle, they gave him a call.

In November of 2014, the Sea Turtle Assistance and Rehabilitation (STAR) Center at the Aquarium obtained a sub-adult Kemp’s Ridley turtle that they nicknamed Finn.  Finn had partially healed wounds on his carapace (shell), a puncture wound to the head, and a swollen left front flipper (all possibly inflicted by a boat propeller).  The doctor and staff at the aquarium observed that Finn was lethargic, usually kept both eyes closed, and he was not eating. 

The wound on the carapace was healing well and required no further treatment.  Finn received extensive care for the wound on his head, and bits of bone and necrotic tissue were removed at each cleaning; he was treated with antibiotics, pain medications, and force feedings.

Radiographs and a CT indicated that Finn’s head tilt was probably due to trauma and pain (not brain damage) and that the humerus (the upper “arm” bone of his flipper) was fractured into three pieces, with evidence of bone lysis (the bone was dissolving) as well as possible infection of the bone.  This flipper issue was what Dr Grafinger was there to try to fix.  Oy!

By the time our TVRH team made the road trip to Manteo, Finn had been undergoing minor procedures and receiving wound care for five months.  He was doing some eating on his own and gaining weight, but his neck and flipper wounds were still producing smelly, necrotic material.  Dr Grafinger and the aquarium team agreed on a plan of attack, and then it was time to try to repair this amazing animal.

After the experienced aquarium team sedated, intubated, and anesthetized Finn, Dr Grafinger’s surgery assistants (Samantha and Rafe) prepared the site.  Dr Grafinger then made the initial incision that would allow him to access the affected area of the humerus without damaging vital nerves or blood flow.  What he found added an extra degree of complication to Finn’s surgery – the center piece of bone that had broken loose was dead (the source of the odor and infection).

That dead piece of bone was nearly a third of the length of the humerus, so Dr Grafinger had to find a way to stabilize the remaining bone and reduce that open space.  Pins and plates (hardware that’s often used in orthopedic surgeries) just weren’t going to work, so he had to come up with a new plan.

What he used was external fixation.  External fixation is a method of stabilizing bone and soft tissue at a distance from the original injury;  Dr Grafinger would drill into healthy bone, pass metal pins through those drilled holes, and then pass them back out of the body. 

Once the pins were placed to his satisfaction, a fast-hardening epoxy putty was used on the outside of the incision to keep those pins from moving, allowing the bone to heal.  Then the entire putty arrangement was protected by using pipe insulation in case Finn managed to bump it in his tank. 

Dr Grafinger managed to get those distant bone edges closer together, but Finn will still need to do some significant remodeling (new bone formation) to close that open space.  Luckily, the aquarium’s staff veterinarian has found that sea turtles are very good at that sort of repair, so we have high hopes for Finn’s ultimate outcome.

We don’t know yet if Finn will thrive, or even survive; he suffered a lot of damage.  But with the support and knowledge of the aquarium team and Dr Grafinger’s best effort to repair that flipper, we’re all hoping that Finn can go back into the wild at some point in the future.  You can bet that when that day comes, the TVRH team will be there to see it, cheering him on.


Meet Rocky the Raccoon

Triangle Veterinary Referral hospital is not able to take wildlife cases from the public because we don't have any licensed rehabilitators on staff; it's safer for the animals to go directly to a rehabber that can take care of them properly.  But that doesn't mean that we don't do what we can to help out!  Dr Grafinger, our surgeon, has an interest and experience in exotics and so he volunteers his expertise to several organizations that work with any number of fascinating animals.

One of those groups is CLAWS, Inc., a nonprofit organization that is dedicated to helping wild and exotic animals.  They rehabilitate animals with the goal of being able to release them back into the wild, and use non-releasable animals to educate the public about how to safely live in harmony with native wildlife.

Recently one of their resident animals, a charming raccoon by the name of Rocky, stopped eating and became suspiciously lethargic.  When we sedated Rocky and took some radiographs, Dr Grafinger identified a probable foreign body in Rocky's intestines. 

Rocky was immediately prepped for surgery; he was intubated and placed on inhalant anesthesia.  We then placed an intravenous catheter, started fluids, and his belly was shaved and cleaned.  Once in the operating room, Rocky was placed on a heated surgery table, hooked up to a monitor that tracked his heart rate, blood pressure, temperature, oxygen saturation, and pulse rate; once he underwent a surgical scrub, Dr Grafinger went to work.  After making an incision and exposing the abdominal cavity, Dr Grafinger gently palpated Rocky's stomach and the length of his intestines and quickly located the suspicious object.  After making an incision into the intestine, he was able to remove a glass pebble, the cause of all of Rocky's problems.  Dr Grafinger then sutured the intestine closed and injected sterile saline into the affected area of the bowel, gently squeezing to each side of the incision to create pressure with the saline, checking for any leakage.  The test was successful, so Rocky's incision was carefully sutured closed.  Wild animals don't tend to tolerate e-collars, so Dr Grafinger took extra care with Rocky's sutures, leaving no external sutures to irritate Rocky.

We're very happy to report that Rocky recovered well from his surgery and quickly bounced back to his happy, active self.  If you'd like to see some of the animals that CLAWS uses in programs, check out their website and FaceBook page for event announcements.  And if you'd like to help them out during this busy baby season, it's super easy to check out their wish list.

Meet Nichols

Here you can see the scar on Nichols' carapace and on her right flipper

Here you can see the scar on Nichols' carapace and on her right flipper

Meet Nichols, the loggerhead turtle.  Loggerheads are just one of the endangered species of turtles treated at the Karen Beasley Sea Turtle Rescue and Rehabilitation Center in Topsail Island.  Nichols suffered a boat propeller injury to her carapace and had a crab pot line wrapped around her right front flipper.

In 2012, Nichols was transported to the North Carolina State University School of Veterinary Medicine where a team of surgeons worked to repair her injuries. (See previous blog/link)  The debris from her shell was cleaned out, allowing her collapsed lung to reinflate.  Dr Grafinger focused on her flipper, stabilizing the broken bones and repairing the massive laceration.

We're happy to announce that yesterday Dr Grafinger attended the release of Nichols back into the wild!  How rewarding to see the end result of all the time and work that was showered on Nichols and the other turtles, freedom and a chance to live out their lives where they belong, in the vast ocean.