Head wounds

Head wounds

Correct closure of individual tissue layers will stimulate stronger repair with less chance of surgical failure
Apr 01, 2005

Horses often suffer wounds to the head and face due to many situations. Loading and trailering often contribute to these types of injuries as horses can rear when entering a trailer and cause a flap-like scalping injury to the top of the head. Because of the close quarters in trailers, horses can bump and injure their heads during travel, too. Protective headgear is recommended to prevent these problems.

Inaccurate closure of the eyelids can result in excessive tear loss from the eye and marking of the side of the face as well as possible corneal irritation and visual difficulties.
Horses often suffer head injuries that include sinus bone fractures and fractures of the zygomatic arch above the eye because of direct trauma from kicks, mallet strikes (in polo ponies), from falls while on a cross-country course or in a jumping arena, as well as from becoming cast and struggling in a stall. Lacerations to the nostrils, eyelids, and corners of the mouth, lips and tongue are all commonly seen. These injuries are most often due to interaction with environmental objects such as wire, other fence material, nails, bucket hooks and similar protruding obstructions or from bite trauma.

Head wounds are relatively easy for owners and barn managers to notice, so they usually are brought to a veterinarian's attention quickly. Exceptionally good blood supply and pliable tissue that is not generally under much tension, except for the midline of the forehead, generally allows for effective surgical repair. Because of the potential for underlying bone damage, all injuries to the head and face should be carefully evaluated, and radiographs should be taken if needed. Thorough debridement and flushing of head wounds sometimes will identify small bone fragments or bits of foreign material that must be cleared from the wound before closure is attempted.

Wounds that penetrate into a sinus usually can be closed because serum and blood forming below the wound will drain to the sinus and be resolved there. These horses often will show significant nasal discharge for a few days following trauma, and owners should be advised of this complication. Antibiotic therapy and occasionally even flushing of the sinuses will reduce the potential for post surgical complications in these types of injuries.

Lacerations to the eyelids, lips, tongue, mouth and nostrils require precise anatomical closure for both functional and cosmetic reasons. Inaccurate closure of the eyelids can result in excessive tear loss from the eye and marking of the side of the face as well as possible corneal irritation and visual difficulties. Problems with correct closure of injuries to the nostrils are more likely to result in a poor repair that can be cosmetically unacceptable to the owner and can reduce the value of that horse in the future. In extreme cases, poor nostril closure may affect airflow in conditions of maximal exercise. Problems with closure of injuries to the mouth, tongue and lips can result in eating difficulties or problems with the bit but usually fall into the category of poor cosmetics. Often these failed first surgical attempts can be repaired at a later date, but good accurate closure of a primary injury is still the best approach when possible.

In order to achieve this good anatomical closure, the wounds should be cleaned and evaluated to ensure that the surgeon is attempting to reposition tissue correctly and that healthy tissue is being used for the repair. Injuries to the nostrils, mouth and lips often include thin strips of tissue or pieces of skin that have undergone blunt trauma. This can damage blood supply to this tissue resulting in devitalized material that will die and subsequently slough. Utilization of this damaged tissue in wound repair will doom that repair to failure.

Occasionally, a surgeon will use such damaged tissue knowingly because there are no other alternatives for closure, and even partial repair for a short time will allow for the beginning of a granulation response in tissue below the injury. This is a situation where a second reconstructive surgery will be planned from the start, and this probable progression should be communicated to the owner.