Wound Examples and Considerations

Wound Examples and Considerations

Presenter: E. Little, DVM, MS, MBA, DACVS

Definitions & Anatomy

  • Extensor Muscle: Muscle responsible for extending the limb.

  • Tibia: Bone located in the distal hind limb.

  • Gastrocnemius: Calf muscle that aids in propulsion in horses.

  • SDFT (Superficial Digital Flexor Tendon): Connects to the flexor and helps bend the digits.

  • Point of Hock: The equivalent of the human ankle in horses, critical for locomotion.

Equine Distal Hind Limb Synovial Structures

  • Tibiotarsal Joint: Major joint located in the hock.

  • Proximal and Distal Intertarsal Joints: Joints located above the tibiotarsal joint.

  • Splint Bone: Small bones located between the cannon bone and carpus.

  • Extensor Tendon Deep Digital: Pulls the limb forward.

  • Flexor Tendon: Provides flexion; associated tendons include superficial and deep flexor tendons.

  • Cannon Bone: Primary weight-bearing bone in equine locomotion.

  • Check Apparatus: A structure that aids in maintaining the fetlock during locomotion.

  • Suspensory Ligament: Supports the leg and helps prevent overextension.

  • Flexor Tendon Sheath: A sheath that encloses the flexor tendons, allowing smooth movement.

  • Fetlock Joint: Joint crucial for bending motion.

  • Prefixed Bone Naming: Various bone segments include Proximal P1, Sesamoid Bones, P2, and P3.

  • Coffin Joint: The joint between the P2 and P3 bones.

  • Navicular Bursa: Fluid-filled sac associated with the navicular bone in the foot.

  • Navicular Bone: Carries significant load; located within the hoof.

Initial Wound Assessment

  • Question: Is the wound near a synovial structure?

    • Procedure: Collect a sample of synovial fluid and determine if the joint can be distended with a sterile isotonic solution.

    • Drainage Assessment: Check for drainage from the wound, indicating potential complications or infection.

Concerns with Specific Wounds

  • Identifying Concerns: Prompt assessment of the specific wounds presented and their anatomical context.

Treatment Plan Consideration

  • Evaluation: Develop a targeted plan for managing the wound based on location, type, and severity.

  • Questions Addressed: Address treatment options and concerns related to the injury.

Common Wound Types in Equine Veterinary Practice

  • Pastern Lacerations: Frequent injuries requiring proper evaluation.

  • Tendon Sheath Wounds: Risks affecting the mobility of the horse.

  • Pastern Joint Injuries: Affect joint functionality.

  • Heel Bulb Lacerations: Requires careful monitoring for complications.

  • Coffin Joint Puncture Wounds: High risk for septic synovitis.

  • Navicular Bursa Involvement: Critical in managing hoof and leg injuries.

Distal Limb Wound with Synovial Involvement

  • Implications: Immediate action is essential to prevent further complications.

Decision-Making in Wound Closure

  • Wound Closure Techniques: Selection based on the type of wound and involvement of underlying structures.

Specific Examples of Wound Types

  • Heel Bulb Laceration: Special considerations on treatment and healing process.

  • Immobilization Techniques:

    • Cast/Splint Application: Essential for stabilization after extensive soft tissue loss or disruption.

    • Kimzey Splint: Recommended for degloving injuries.

Healing Timeframes for Specific Wounds

  • Metatarsal Laceration: Healing rates documented as follows:

    • 4 days post-injury

    • 9 days post-injury

    • 2 months post-injury

Specific Wound Types and Management

  • Thoracic Wounds: Different wound considerations as compared to limb injuries.

  • Impaling Injury Considerations: Need for special attention during treatment.

  • Wounds of Lips and Eyes: Critical care required

    • Full Thickness Eyelid Lacerations: Must be repaired surgically.

Eyelid Repair Guidelines

  • Rules for Eyelid Repair:

    • If missing <1/3rd of margin: Use direct apposition technique.

    • If missing >1/3rd of margin: Must utilize grafting techniques for functional closure.

    • Advisable to avoid removing skin flaps from eyelid lacerations in horses.

    • Preferred Technique: 2-layer primary repair recommended for optimal outcome.

Objectives of Eyelid Repair

  • Tissue Alignment: Critical to align margins of the eyelid accurately.

  • Protection During Suturing: Essential to guard the eye from any trauma while suturing.

  • Post-Repair Consideration: Ensure no suture material rubs against the eye once the repair is complete.

Post-Repair Assessment

  • Critique of Repair Quality: Evaluating the effectiveness of the surgical intervention post-repair.

Lip Laceration Management

  • Full Thickness Lip Lacerations Requirement: Must always be surgically repaired to ensure complete healing.

  • Upper Lip Lacerations: Particular attention needed for meticulous alignment of the muco-cutaneous junction to promote functionality and aesthetic results.