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Head wounds
Correct closure of individual tissue layers will stimulate stronger repair with less chance of surgical failure


Correct closure of individual tissue layers in wounds to the eyes, mouth, tongue, lips and nostrils will result in a better, stronger repair with less chance of surgical failure. While the vast majority of these injuries can be done in the standing horse with a combination of general tranquilization and local anesthetic blocks, some injuries may benefit from general anesthesia if this allows for more correct and complete closure. Insufficient attention to closure of the inner layer of these types of wounds is perhaps the most common reason for problems. Closure of the surface or skin layers initially will result in a nice-looking surgery, but the deeper layers and especially the inner layers of repairs to the mouth, eyes and nostrils will determine healing and post-repair tissue strength. Anatomic closure of these inner layers, often requiring the burying of sutures, is crucial to the success of these types of repairs.

Dr. Scott Taylor, a surgeon at the Arizona Equine Medical and Surgical Center, had seen many such repair attempts fail and has developed his own approach to these injuries.

"Though some may feel that this approach is overkill, it has worked well for me," Taylor says. He advocates repair under general anesthesia and separates the wound into three separate layers (mucosa, muscle and skin) for individual closure. Use large (1-2 nylon) tension sutures in the skin, placed in a vertical mattress pattern with large button stents placed 2 cm apart and 2-3 cm from the skin edge."

He then suggests Prolene or nylon interrupted sutures between the tension sutures to achieve good tissue apposition.

"In some cases, one can use medical-grade super glue or tissue adhesive along the mucosal and skin edges to prevent saliva from entering and disrupting the repair," he says.

Injuries to the eyes, mouth and nostrils often are not well tolerated by horses. As the skin begins to heal, these animals generally become itchy and will rub and abrade their sutures and/or staples. The use of a protective eye-cup halter or grazing muzzle sometimes can allow these injuries time to heal. Removing the protection too early is a common cause of repair failure.

"I recommend that these head wounds generally be protected from self trauma for a period of two weeks," Taylor says.

Not all face injuries need such an intense approach, but the principles of thorough debridement, accurate anatomical reconstruction and post-operative protection apply to head wounds of all types.

Editor's Note: In the first of a three-part series, Dr. Kenneth Marcella discusses wound care with leading practitioners. Subsequent stories will include body wounds, leg lacerations, heel and coronary band lacerations, puncture wounds involving tendons or ligaments, and rope burns and wire cuts to the caudal pastern and foot. Look for DVM Newsmagazine's Wound Care Quiz to follow the final installment of this series.

Dr. Marcella, a 1983 graduate of Cornell University's veterinary college, was a professor of comparative medicine at the University of Virginia. His interests include muscle problems in sport horses, rehabilitation and other performance issues.


Source: DVM360 MAGAZINE,
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