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Comeback: The art and science of equine rehabilitation
New studies show rehab can get horses back to health even more quickly than previously thought.


DVM360 MAGAZINE


Case study: Colic surgery

A colic surgery repair is often largely determined by the condition and healing of the ventral midline incision. There's some confusion and disagreement as to an abdominal incision's healing strength and the time needed to arrive at a safe point for physical activity. Surgeons generally cite the weakness of the abdominal incision as the main reason for disallowing turnout or even a return to controlled athletic activity. Excessive motion or stretching of the abdominal incision, goes the standard thought on the issue, will result in damage to the abdominal repair, the horse's body wall or both, with infection, herniation or failure of wound closure as possible complications.

Some surgeons take this concern for the ventral midline incision to the extreme. Postoperative colic rehabilitation recommendations from the Philip Leverhulme Equine Hospital at the University of Liverpool in Great Britain advocate a conservative return to athletic function of well more than three months, stating, "All equine abdominal incisions are very slow to heal. Research shows that even one year after such an incision, the body wall has regained only 80% of its original strength."3

Discharge instructions from that institution further explain that "any exercise that prematurely increases strain on the incision (e.g., bucking, rearing, galloping across a field) increases the risk of a hernia forming at the surgical site."3

More recent studies, however, directly oppose this extended healing idea. These studies don't support a conservative healing time frame and actually suggest horses may in fact be able to return to athletic work much sooner. For example, a recent study on the tissue strength of the linea alba showed that "an uncomplicated abdominal incision regained tissue strength comparable with preoperative strength in as early as eight weeks after a ventral midline celiotomy."4

This study showed that surgeons could greatly influence the postoperative healing of colic surgery by their choice of suture material, suture pattern and surgical technique.

Peroni agrees and further suggests, "The amount of trauma and handling the abdominal wall undergoes during the actual surgery is probably correlative to the healing process of the incision as well."

If the surgeon must stretch and handle the edges of the incision excessively by taking intestines out and then repacking them in the belly, or by prolonged deep palpation through the incisional opening, then that incision may experience more swelling and will therefore take longer to heal. Such a horse may not return to work in eight weeks. However, a horse with uncomplicated colic surgery and a minimally traumatized incision may be fully repaired in six to eight weeks.

The linea alba study discussed above states, "Based on our observations, there is a valid scientific argument for returning horses to controlled exercise at 60 days postoperatively."4

To achieve this more aggressive return to athletic function after colic surgery, without placing the equine athlete at risk, most veterinary surgeons agree that improved communications and crucial rechecks are imperative.

Says Blikslager, "Close communication between the surgeon and the owner or trainer at the time of discharge can be very helpful in structuring the lay-up period and the time wframe for a return to exercise."

Adds Peroni, "A conversation with the surgeon focusing on an assessment of the relative stress the abdominal incision underwent during surgery and recovery would be crucial to the development of a more rapid but successful rehab program."

The most important time would be at the six-to-eight-week period, as incisions have healed but the horse still can benefit from a slow return to exercise to put some light strain on the incision and increase its strength. Good healing in an uncomplicated case, on the other hand, would be a signal to a trainer to step up rehabilitation. Such a horse may be doing light work at six weeks and be back in a regular program at eight weeks.

The last few weeks of the rehabilitation program can essentially be looked at as the first few weeks of a conditioning program, thereby shortening the overall time for comeback and making a well-healed horse ready for competition sooner.

Dr. Marcella is an equine practitioner in Canton, Ga.

References

1. Christophersen MT, Tnibar A, Pihl TH, et al. Sporting activity following colic surgery in horses: a retrospective study. Equine Vet J 2011;43(Suppl 40):3-6.

2. American College of Veterinary Surgeons. Colic. Available at: http://www.acvs.org/AnimalOwners/HealthConditions/LargeAnimalEquineTopics/Colic/.

3. Equine colic: Philip Leverhulme Equine Hospital discharge instructions. Available at: http://www.liv.ac.uk/equinecolic/post_operative_care/discharge/.

4. Chism PM, Latimer FG, Patton CS, et al. Tissue strength and wound morphology of the equine linea alba after ventral median celiotomy. Vet Surg 2000;29(2):145-151.


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Source: DVM360 MAGAZINE,
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