A novel tension relief technique to aid the primary closure of traumatic equine wounds under excessive tension.

BACKGROUND: To achieve an excellent functional and cosmetic result, primary closure is preferred over leaving wounds to heal by secondary intention. However, traumatic wounds are often under excessive tension during wound closure and incorrect suture technique can compromise microcirculation, leading to skin necrosis and impaired wound healing. OBJECTIVE: To describe an inexpensive and effective tension relief technique that helps the successful primary closure of a variety of equine wounds at high risk of dehiscence. STUDY DESIGN: Retrospective case series. METHODS: All wounds that were managed with the Tension Tile System (TTS) at four Equine Hospitals between March 2017 and May 2021 were evaluated. The wounds were classified according to various criteria including anatomical location, time elapsed prior to surgery, depth of wound and post-surgical use of immobilisation. Outcome criteria were based on the success of primary intention healing. The duration of convalescence (weeks) after surgery was also recorded. RESULTS: During the study period, the TTS was used in 191/860 (22%) wounds repaired under general anaesthesia or standing sedation. Overall, primary intention healing (Group A) was achieved in 132 of 191 cases (69%, CI 62%-75%), with partial dehiscence (Group B) in a further 30/191 cases (16%, CI 11%-22%). Severe dehiscence (Group C) was recorded in 29/191 cases (15%, CI 11%-21%). The median convalescence time was 4 weeks (Range 3-15, interquartile range 4-6) in Group A. MAIN LIMITATIONS: Retrospective nature of the study and subjective outcome assessment. The technique was applied to wounds under significant tension; however, this was based on a subjective assessment by the surgeons involved. CONCLUSIONS: The Tension Tile System is an economical and effective technique for challenging equine wounds under tension, in a variety of anatomical locations.

Standing laparoscopy combined with a conventional inguinal approach to treat extended septic funiculitis in 12 horses.

OBJECTIVE: To describe a 2-step surgical procedure combining standing laparoscopy with a conventional inguinal approach to treat deep intra-abdominal funiculitis (extended septic funiculitis) after castration. STUDY DESIGN: Retrospective case series. SAMPLE POPULATION: Twelve client-owned horses. METHODS: Medical records of horses treated for extended septic funiculitis with the 2-step surgical procedure were reviewed. Data collected included the initial castration technique, number of surgical interventions for septic funiculitis prior to presentation, clinical signs, diagnostic and surgical procedure, and short-term and long-term survival. RESULTS: Complete resection of the infected spermatic cord was achieved without intraoperative complications. Intra-abdominal adhesions were documented in 6 horses, involving the ascending colon (4 cases) and descending colon (2 cases). Postoperatively, minor incisional swelling (2/12) and emphysema (3/12) at the laparoscopic portals were observed. All horses survived to discharge. At 3 months, wounds had completely healed without complications. No recurrence of signs was recorded at long-term follow up (4-36 months after discharge). CONCLUSION: In cases of extended septic funiculitis, complete resection of the infected spermatic cord can be safely performed using a laparoscopic-assisted surgical approach, reducing postoperative complications and risk of recurrence of infection.

Evaluation of three ligatures in simulated equine open castration.

OBJECTIVE: To compare three surgical knots for preventing leakage from the vascular bundle during ligation in simulated equine open castrations. STUDY DESIGN: Randomized, case-control, in vitro study. SAMPLE POPULATION: Testes (N = 60) collected from 30 horses. METHODS: Testes were collected from 30 horses and randomly assigned to one of three groups: group G (friction, giant knot), group T (modified transfixing knot), or group S (sliding, strangle knot; n = 20/group). The assigned knot was used to ligate the vascular bundle during open castration. The length of suture material used and the leak pressure of the testicular artery were measured and compared between groups. RESULTS: Strangle knots consistently leaked at higher pressures (median, 735.5 mm Hg; interquartile range [IQR], 735.5-735.5) compared with giant (median, 441.3 mm Hg; IQR, 367.8-643.6) and transfixing (median, 419.2 mm Hg; IQR, 323.6-643.6; P < .0001) knots. Both the strangle (median, 5 cm; IQR, 4.5-5.5) and giant (median, 6 cm; IQR, 5.35-6.075) knots required less suture material compared with the transfixing (median, 9.2 cm; IQR, 8.425-10.38; P < .0001) knot. CONCLUSION: The three surgical knots tested withstood pressure well above physiological levels in simulated open castrations. The strangle knot withstood higher pressure and required similar (giant) or less (transfixing) suture material than the other two knots. CLINICAL SIGNIFICANCE: This study provides evidence to support the use of a strangle knot to ligate the vascular bundle during simulated open castrations in horses.

Ex vivo comparison of barbed and unbarbed sutures for the closure of caecal and pelvic flexure enterotomies in horses.

In this study the caecum and large colon were harvested from 24 slaughtered horses. On each sample, an 8­cm long enterotomy was performed. Enterotomies were closed using either barbed or unbarbed glycomer­631. We compared the time to close, appearance, length of suture material, bursting pressure, and costs associated with each type of material. Our findings demonstrated that time to close was significantly shorter (caecum, P = 0.034; pelvic flexure, P = 0.039) using barbed sutures (caecum 610.4 seconds; pelvic flexure 699.3 seconds) than unbarbed sutures (caecum 661.0 seconds, pelvic flexure 743.1 seconds). The length of suture material used was significantly less (caecum, P < 0.0001; pelvic flexure, P < 0.0001) with barbed (caecum 28.1 cm, pelvic flexure 32.0 cm,) compared with unbarbed sutures (caecum 41.6 cm; pelvic flexure 46.6 cm). There were no significant differences in bursting pressure (caecum, P = 0.294; pelvic flexure, P = 0.430) between barbed (caecum, 172.5 mmHg, pelvic flexure, 188.9 mmHg) and unbarbed sutures (caecum 178.3 mmHg, pelvic flexure 183.3 mmHg). The cost was higher using barbed sutures. However, the use of barbed sutures was faster, left less suture material in the tissue, and sustained comparable bursting pressure to unbarbed sutures. We therefore conclude that barbed sutures are a valid alternative to unbarbed sutures for closing large intestine enterotomy in horses.

Laparoscopic nephrosplenic space ablation with barbed suture in eight horses.

CASE DESCRIPTION 8 horses (5 geldings and 3 mares) were evaluated for laparoscopic closure of the nephrosplenic space following a history of recurrent left dorsal displacement of the large colon. CLINICAL FINDINGS All horses underwent a physical examination and routine clinicopathologic testing. Transrectal palpation and transabdominal ultrasonography were performed to exclude the presence of organs in the left paralumbar region. TREATMENT AND OUTCOME A left flank laparoscopic approach with the horses standing was used. A continuous suture was placed in a craniocaudal direction between the renal and splenic capsules with unidirectional barbed suture material. This allowed obliteration of the nephrosplenic space without the need for knots to secure the leading and terminal ends of the suture line. In all horses, transrectal palpation was performed 2 months after surgery; at this time, closure of the caudal part of the nephrosplenic space was evident. In 2 horses, follow-up laparoscopy was performed, and complete closure of the nephrosplenic space was confirmed. Telephone follow-up revealed that none of the horses had any signs of recurrent left dorsal displacement of the large colon. CLINICAL RELEVANCE Results suggested that laparoscopic nephrosplenic space closure with unidirectional barbed suture material could be considered as an option for prevention of left dorsal displacement of the large colon in horses. In the horses of this report, barbed suture material allowed secure ablation of the nephrosplenic space and eliminated the need for intracorporeal knot tying.

Ex Vivo Evaluation of Skin Staples for Typhlotomy Closure in Cattle.

OBJECTIVE: To compare 2 sutured techniques with a skin stapled technique for typhlotomy closure in bovines. STUDY DESIGN: Ex-vivo study. SAMPLE POPULATION: Bovine fresh cadaveric ceca (n = 27). METHODS: Typhlotomies (4 cm in length) were made on the cecal apex and closed with 1 of the following techniques: hand-sewn, 2-layer suture consisting of a continuous, full-thickness layer oversewn with a Cushing layer (Group FC); hand-sewn, double inverting suture consisting of a 1st Cushing layer oversewn with an additional Cushing layer (Group CC); skin staples (Group S). Closure time, bursting pressure, and related costs of each technique were calculated and compared. RESULTS: Median (range) construction time for group S was 1.12 (0.49-1.3) min and was significantly shorter than for group FC 5.14 min (3.45-7.44), and for group CC 4.26 min (2.3-5.52) (95% CI 3.342-4.851), (P = .007). There was no significant difference between bursting pressures of group S (91.67 ± 15.41 mmHg, 95% CI 79.82-103.5) compared with group FC (119.4 ± 40.03 mmHg, 95% CI 88.67-150.2) (P = .160) and compared with group CC (103.3 ± 32.31 mmHg, 95% CI 78.5-128.2) (P = .707) CONCLUSION: Hand-sewn techniques are effective but fairly demanding in terms of time. Skin staples are less time-consuming, and resist pressures comparable to those resisted by handsewn techniques. For this reason, an SKS technique may be a valid option for typhlotomy closure in cattle.

The Surgeon's View: Comparison of Two Digital Video Recording Systems in Veterinary Surgery.

Video recording and photography during surgical procedures are useful in veterinary medicine for several reasons, including legal, educational, and archival purposes. Many systems are available, such as hand cameras, light-mounted cameras, and head cameras. We chose a reasonably priced head camera that is among the smallest video cameras available. To best describe its possible uses and advantages, we recorded video and images of eight different surgical cases and procedures, both in hospital and field settings. All procedures were recorded both with a head-mounted camera and a commercial hand-held photo camera. Then sixteen volunteers (eight senior clinicians and eight final-year students) completed an evaluation questionnaire. Both cameras produced high-quality photographs and videos, but observers rated the head camera significantly better regarding point of view and their understanding of the surgical operation. The head camera was considered significantly more useful in teaching surgical procedures. Interestingly, senior clinicians tended to assign generally lower scores compared to students. The head camera we tested is an effective, easy-to-use tool for recording surgeries and various veterinary procedures in all situations, with no need for assistance from a dedicated operator. It can be a valuable aid for veterinarians working in all fields of the profession and a useful tool for veterinary surgical education.

Validation of an effective, easy-to-make hemostasis simulator.

The purpose of this study is to describe the construction method of a cost-effective, easy-to-make hemostasis simulator and to compare its effectiveness as a training tool to cadaver training. The simulator is made of materials commonly found in hospitals and clinics. These include a column manometer, a 500-ml saline bag, two intravenous fluid lines, a three-way stopcock, and a 6-mm-diameter Penrose drain. The device was tested on 10 final-year veterinary students. All participants tied 40 knots on the simulator and 40 knots on equine jejunal arteries sourced from a local abattoir. They were then asked to fill out a questionnaire comparing both methods. Participants assigned an overall assessment median score of 8.5/10 to the simulator and of 6.2/10 to cadaver practice. The simulator provided reliable haptic feedback, giving trainees a lifelike feel very close to that experienced when actually closing a blood vessel. In addition, it was effective in objectively evaluating students' ability to place ligatures on vessels. After adequate training, students' skills had significantly improved, alongside their confidence in placing hemostatic sutures. This proves our model is also useful in teaching basic open-surgery skills. Finally, its low production cost makes it ideally suited for self-practice.