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.

Intra-abdominal adhesions in horses: a retrospective evaluation of repeat laparotomy in 99 horses with acute gastrointestinal disease.

The objectives of this study were (1) to determine the prevalence of pathological abdominal adhesion formation following exploratory laparotomy; (2) to establish the site of adhesion formation and its relationship to the initial lesion; (3) to ascertain whether the development of intra-abdominal adhesions decreases long-term survival and (4) to identify risk factors for adhesion formation. Of 1014 horses treated surgically for acute gastrointestinal disease, 113 (10.1%) were subjected to repeat laparotomy, with surgical records available for 99 of these cases. Pathological adhesions were the most common diagnosis at repeat laparotomy (28%), followed by complications associated with the anastomosis (16%). Adhesions were not associated with the site of the primary lesion, resection, or endotoxaemia, consistent with the hypothesis that surgical trauma is the most important stimulus in adhesion formation. Together these findings strongly support the need for pan-abdominal, rather than site-specific adhesion prevention measures in all horses undergoing exploratory laparotomy.

Hyaluronic acid fluid agents for the prevention of adhesions after fertility-preserving gynecological surgery: a meta-analysis of randomized controlled trials.

OBJECTIVE: To investigate the role of hyaluronic acid-based fluid agents in the prevention of adhesions after fertility-preserving gynecological surgery. DESIGN: Meta-analysis. SETTING: The authors searched the Cochrane Menstrual Disorders and Subfertility Group Specialized Register of Controlled Trials, The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE for randomized controlled trials of hyaluronic acid fluid agents compared with no treatment or placebo. PATIENT(S): Women undergoing fertility-preserving gynecological surgery. INTERVENTION(S): Hyaluronic acid fluid agents. MAIN OUTCOME MEASURE(S): [1] Prevalence and change in adhesion severity at second-look laparoscopy and [2] live birth rate. RESULT(S): Four studies were included in the meta-analysis. The use of hyaluronic acid agents was associated with a decrease in the prevalence of adhesions at second-look laparoscopy (odds ratio, 0.31; 95% confidence interval, 0.19 to 0.51) and a lesser chance of deterioration of preexisting adhesions (odds ratio, 0.28; 95% confidence interval, 0.12 to 0.66). There was, however, no evidence for improvement in the prevalence of adhesions (odds ratio, 1.55; 95% confidence interval, 0.82 to 2.92). CONCLUSION(S): There is evidence that hyaluronic acid agents may decrease the prevalence of adhesions and prevent the deterioration of preexisting adhesions. However, because of the limited number of studies available, this evidence should still be interpreted with caution.

Experimental manipulation of transforming growth factor-beta isoforms significantly affects adhesion formation in a murine surgical model.

Transforming growth factor-beta (TGF-beta), a multifunctional growth factor, represents three mammalian isoforms, TGF-beta1, TGF-beta2, and TGF-beta3. In cutaneous wound healing, combined neutralization of TGF-beta1 and -beta2 or addition of TGF-beta3 reduces scar formation. Here, we investigated whether experimental manipulation of TGF-beta isoforms reduced adhesion formation after injury to the peritoneum. Adhesions were produced in mice by surgical abrasion of adjacent serosa followed by close apposition. In the first part of this study, a detailed analysis of TGF-beta isoform distribution was performed through immunolocalization. TGF-beta isoforms clearly showed a unique temporal and spatial pattern of expression after peritoneal wounding. Based on this pharmacokinetic data, we next administered neutralizing antibodies to TGF-beta1 and -beta2 or exogenous TGF-beta3 peptide by local application and intraperitoneal injection at various times before and after surgery. At day 7 after surgery, addition of neutralizing antibodies to both TGF-beta1 and -beta2 significantly reduced the number and size of adhesions (P < 0.05) compared with the vehicle control. By contrast, exogenous addition of TGF-beta3 either had no effect or increased adhesion formation compared to the vehicle control. In conclusion, these results show that by blocking both TGF-beta1 and TGF-beta2 using neutralizing antibodies, it is possible to prevent abdominal adhesion formation.