This case may be a little gory for
some, but we are very happy with the outcome!
This case involves
“Alex” a 1 yr old Quarter Horse gelding. He was found
following some turnout time with a large laceration into
the muscle over the front of the shoulder. Although we
could not find the cause, it is suspected he may have
cut himself on a gate latch. The owner had plans to show
him extensively, so although sometimes wounds of this
type are left open due to issues with healing, it was
decided to close this one.
wound was fresh and quite clean of debris. This is
particularly important with wounds like this involving
large muscle groups. If the wound is old, swelling of
the muscles may make closure impossible.
However, the area
where this wound occurs is one of the more difficult
areas to suture on a horse. The number one problem we
have with wounds is called “wound tension”. This
basically means there is too much pressure on the suture
line and it gives way, breaking opening ( and upsetting
the owner who paid to have their horse stitched up!).
The suture line is a weak point in the horse’s skin.
Like a worn out area in a piece of cloth, if you pull
too much on it, it will tear. Two things are primarily
responsible for “pull” on the suture line. One is
swelling. This is often created by the muscle layers
underneath the wound that have been bruised and
traumatized. The other is movement, especially over a
joint or an area that moves a lot when the horse walks
or runs. The area then where we have the most issues
with suture lines not holding are areas with a lot of
muscle underneath AND a lot of movement . The chest,
shoulders, the butt, and the back of the hind legs are
all areas that can be difficult to keep closed and get
good healing when sutured.
As can be seen in
the photo, the edges of this wound were already gaping
apart due to underlying swelling and the effect of the
There are multiple
methods to reduce tension on wounds. In this repair Dr.
Bickel used three of them.
The first method used was called “undermining”. This is
when you separate the skin beyond the wound edges from
the underlying muscle. This loosens the skin, and also
reduces the pull on the skin when the horse moves. In
most wound repairs in horses you will undermine the skin
slightly. In this case, Dr. Bickel undermined the skin
for nearly 3 inches beyond the wound edges. This drastic
undermining was needed to allow effective wound closure.
The second thing
Dr. Bickel did was begin what is called a “modified z-plasty”.
This involves making additional incisions. Instead of
the wound having two edges, it now has six edges (before
we just had a straight line but now we have a wound
resembling the letter “Z”) which minimizes the tension
on the edges of the wound. You can see in the picture
that at this point in the repair everything looks a lot
worse than when it started!
third technique we used was called “tension relieving
sutures”. This involves suturing the skin in specific
patterns designed to minimize stress on the wound edges.
It also involves suturing the wound in a staggered
pattern. Dr. Bickel would place one suture on the left
end of the wound, one on the right end of the wound, and
then one in the middle, rather than just sewing from one
end to the other. This staggered pattern was repeated
over and over until the wound was fully closed, ensuring
that no one section of the wound had excessive tension
on it. When a wound is simply closed from side to side,
there is often one area of the wound that will be under
more tension and more likely to tear back open.
This photo shows the completed
The following photo
was taken only 2 weeks later when the sutures were
removed. As you can see, it healed very well. Thanks to
tension-relieving wound repair techniques, this yearling
has a promising show career ahead of him!
Check back for other Cases of the
Denise Bickel DVM
Whole Horse Veterinary Services
Phone # 517-474-4050
Fax # 517-764-7710
3906 Seymour Rd
Jackson, MI 49201