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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.

Thankfully the 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 horses movement. 

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!

 

The 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 repair.

 

 

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 Month!

 

 

 

 

 

 


Denise Bickel DVM
Whole Horse Veterinary Services
Phone # 517-474-4050
Fax # 517-764-7710
3906 Seymour Rd
Jackson, MI 49201
EMAIL US



 

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