Evaluation of a laparoscopic technique for collection of serial full-thickness small intestinal biopsy specimens in standing sedated horses

OBJECTIVE: To assess a technique for laparoscopic collection of serial full-thickness small intestinal biopsy specimens in horses. ANIMALS:13 healthy adult horses. PROCEDURES: In the ex vivo portion of the study, sections of duodenum and jejunum obtained from 6 horses immediately after euthanasia were divided into 3 segments. Each segment was randomly assigned to the control group, the double-layer hand-sewn closure group, or the endoscopic linear stapler (ELS) group. Bursting strength and bursting wall tension were measured and compared among groups; luminal diameter reduction at the biopsy site was compared between the biopsy groups. In the in vivo portion of the study, serial full-thickness small intestinal biopsy specimens were laparoscopically collected with an ELS from the descending duodenum and distal portion of the jejunum at monthly intervals in 7 sedated, standing horses. Biopsy specimens were evaluated for suitability for histologic examination. RESULTS: Mean bursting strength and bursting wall tension were significantly lower in the ELS group than in the hand-sewn and control groups in both the duodenal and jejunal segments. Use of the hand-sewn closure technique at the biopsy site reduced luminal diameter significantly more than use of the stapling technique. In the in vivo part of the study, all 52 biopsy specimens collected during 26 laparoscopic procedures were suitable for histologic examination and no clinically important perioperative complications developed. CONCLUSIONS AND CLINICAL RELEVANCE: Laparoscopic collection of serial full-thickness small intestinal biopsy specimens with a 45-mm ELS may be an effective and safe technique for use in healthy adult experimental horses.     

Bursting tension of medium and large canine arteries sealed with ultrasonic energy or suture ligation

OBJECTIVE: To compare bursting tension of arteries > or =3 mm in diameter sealed with ultrasonic energy (UE) with arteries ligated with suture. STUDY DESIGN: Experimental, nested factorial design. SAMPLE POPULATION: Vascular segments from canine cadavers. METHODS: Arterial segments (12) were collected from each of 16 canine cadavers and equally divided into 2 groups based on vessel diameter (medium, 3.0- < 4.5 mm; large, 4.5 - < or =6.0 mm). Arterial specimens (3) from each group were sealed with either UE (Harmonic Scalpel, HS, power level 3) or suture ligation. The mean bursting pressure and tension were determined and compared. RESULTS: Bursting tension was significantly higher (P< .0001) for sutured arteries than UE-occluded arteries, irrespective of size. Bursting tension was significantly higher (P=.0013) for medium than large UE-occluded arteries, whereas there was no difference associated with size for ligated arteries. UE energy failed to seal 1 medium artery and 7 large arteries. Compared with normal blood pressure, bursting pressures were 3.5 times greater for sutured arteries irrespective of size, 1.8 times greater for medium UE-occluded arteries, and approached normal blood pressure for large UE-occluded arteries. CONCLUSION: At the power level tested, UE should not be used to seal arteries > 4.5 mm in diameter. Suture provided an optimal seal for arteries < or =6.0 mm in diameter. CLINICAL RELEVANCE: Use of UE to occlude arteries during laparoscopic surgery is advantageous because only 1 instrument is required to simultaneously cut and coagulate tissue, but care should be exercised where large arteries might be encountered.     

Post-partum uterine rupture: Standing repair in three mares using a laparoscopic technique

Three mares underwent diagnostic laparoscopy because of suspicion of post-partum uterine ruptures. All three horses showed clinical signs of a uterine rupture between 1 and 3 days after parturition and underwent diagnostic laparoscopy. In all cases a full thickness uterine rupture could be detected and was sutured laparoscopically. Availability of suture material and surgeon experience were responsible for the surgical methods chosen for repair. In the first case, a hand-assisted laparoscopic approach was chosen for suturing the ruptured uterus, whereas in the other cases the approach was entirely laparoscopic. In the second case, extracorporeal knots were used for the repair and in the last case described a barbed loop suture was available for closure of the uterus. Two of three mares were alive for at least 12 months after surgery without any abdominal problems. One of these mares delivered a healthy foal 2 years after surgery. The remaining mare died 3 months after surgery but no necropsy was done. Laparoscopy should be considered for post-partum mares with signs of peritonitis to access the uterus and repair a rupture if it is accessible. A laparoscopic approach using intracorporeal knots or barbed sutures for the repair of the uterine rupture as well as a hand-assisted laparoscopic approach are feasible. The use of the barbed suture for intracorporeal closure makes the minimal invasive laparoscopic technique easier to perform.     

Ex vivo strength comparison of bioabsorbable tendon plates and bioabsorbable suture in a 3-loop pulley pattern for repair of transected flexor tendons from horse cadavers

OBJECTIVE: To test the failure strength and energy of 2 bioabsorbable implants applied to transected deep digital flexor tendons (DDFT) from adult horses. STUDY DESIGN: Ex vivo biomechanical experiment. SAMPLE POPULATION: Twelve pairs of deep digital flexor tendons harvested from the forelimbs of fresh equine cadavers. METHODS: Poly-L-lactic acid tendon plates were custom manufactured for application to the cylindrical surface of an adult equine deep digital flexor tendon. Twelve pairs of DDFTs were transected 2 cm distal to the insertion of the distal check ligament of the deep digital flexor tendon. One tendon of each pair was randomly selected for repair with a biodegradable plate or a 3-loop pulley method. Size 2 polydioxanone suture was used in both repairs. Repairs were tested in tension to failure, with peak force (PF) and total energy (TE) at repair failure recorded in Newtons (N) and Joules (J), respectively. A paired t-test was used for statistical evaluation with a significant level set at P< or = .05. RESULTS: Mean+/-SD PF for failure of plated tendons (1507.08+/-184.34 N) was significantly greater than for sutured tendons (460.86+/-60.93 N). TE was also significantly greater for failure of plated tendons versus sutured tendons. CONCLUSIONS: Plate fixation of transected cadaver DDFTs appear to have superior immediate failure strength than 3-loop pulley repairs. CLINICAL RELEVANCE: Whereas in vivo testing is required, a bioabsorbable tendon plate may provide initial increased strength to support tendon healing and decrease external coaptation requirements.     

In vitro evaluation of an inverted end-to-end equine jejunojejunal anastomosis using skin staples

OBJECTIVE: To compare functional indices of end-to-end (EEA) jejunojejunal anastomosis using skin staples in horses with a 2-layer inverting hand-sewn technique. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Jejunal segments from 8 fresh equine cadavers. METHODS: For each bowel segment, 2 EEA anastomoses were created: one 2-layer hand-sewn and one 1-layer using skin staples. Time for anastomosis creation was recorded and compared. Lumen diameter of each anastomosis was measured on digital radiographs after intraluminal instillation of contrast medium and inflation of the jejunal segments to 14 mm Hg. Anastomotic indices (a compensated measure of stoma diameter) and bursting pressure were determined. RESULTS: EEA jejunal anastomosis using skin staples was significantly faster than use of a 2-layer hand-sewn technique. Anastomotic index, a measure of lumen size, was significantly larger with the skin-staple technique; however, the bursting pressure of stapled anastomoses was significantly less than for the hand-sewn technique, but the values were well above those reported for other anastomotic techniques. CONCLUSIONS: An anastomotic technique using skin staples was easy to learn and perform, effective and faster, and mechanically comparable with a hand-sewn 2-layer technique. CLINICAL RELEVANCE: The staple technique could be beneficial in equine gastrointestinal surgery by reducing anastomosis time, although further in vivo studies are needed to establish clinical safety.     

Comparison of incisional bursting strength of simple continuous and inverted cruciate suture patterns in the equine linea alba

OBJECTIVE: To determine the bursting strength of ventral median abdominal incisions closed by either simple continuous or inverted cruciate suture patterns. STUDY DESIGN: Experimental. ANIMAL OR SAMPLE POPULATION: Twelve equine cadavers. METHODS: A 25 cm ventral median incision was made through the linea alba and a 200 L polyurethane bladder was placed within the abdomen. Either a simple continuous or an inverted cruciate pattern using 3 polyglactin 910 with a bite size and suture interval of 1.5 cm was used to close linea incisions. Closure time was recorded for each pattern. The bladder was inflated with air at 40 L/min, and the pressure at body wall failure recorded. The length of suture used for wound closure and the wound failure modes were recorded. Deviation from the linea (cm), total suture length (cm), suture length to wound length ratio (SL:WL), closure time (min), bursting pressure (mm Hg), and failure modes were compared between groups using Welch-Aspin t-tests. The effects of independent subject variables were assessed for possible effects on bursting strength using analysis of covariance. RESULTS: Mean bursting pressure was significantly greater for the simple continuous pattern than for the inverted cruciate pattern (P = .01). Significantly less suture material (P = .0002) was required with the continuous pattern than with the inverted cruciate pattern. Mean closure time, SL:WL, deviation from the linea, and failure modes were not significantly different between groups. No significant effects were noted for independent variables in both groups on bursting strength. CONCLUSIONS: In this model, a simple continuous closure pattern for ventral median abdominal incisions was stronger than an inverted cruciate pattern. A simple continuous pattern leaves less foreign material in the wound, which may be of benefit in reducing incisional complications. CLINICAL RELEVANCE: Use of a continuous closure pattern for the linea alba may offer greater wound security during episodes of increased intra-abdominal pressure in horses.     

Evaluation of four techniques for injecting the trochanteric bursa of horses

Objective: To describe the anatomic features of the equine trochanteric bursa and to evaluate 4 techniques for bursa centesis. Study Design: Prospective, randomized design. Animals: Equine cadavers (n=2) and 20 live horses. Methods: The trochanteric bursae of 2 equine cadavers were injected with latex to identify the boundaries of the bursae. Four techniques for centesis of the trochanteric bursa were evaluated by attempting to inject dye into both trochanteric bursae of 20 live horses. Techniques included injection of the bursa with the limb‐bearing weight and injection with the limb nonweight bearing and supported on a block, with or without ultrasonographic guidance of the needle. Ultrasonographic guidance of the needle was performed with or without the use of a guide channel attached to the ultrasound probe. Each of the 4 techniques was used to inject 10 bursae. The region of the bursa was dissected after horses were euthanatized to determine the location of the dye. Results: The trochanteric bursa was most successfully injected with the limb positioned caudally with the foot on a block, even though topographic landmarks for centesis were more difficult to identify when the limb was in this position. The highest incidence of success was achieved when the needle was inserted using ultrasonographic guidance with the foot in a Hickman block. Conclusion: Positioning the limb caudally with the foot nonweight bearing and on a block facilitated centesis of the trochanteric bursa.     

In vitro evaluation of a closed-bowel technique for one-layer hand-sewn inverting end-to-end jejunojejunosotomy in the horse

OBJECTIVE: To report a technique for closed-bowel 1-layer inverting end-to-end jejunojejunal anastomosis in horses. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Fresh cadaveric jejunal segments from 12 horses. METHODS: For each bowel segment a 1-layer closed and a 2-layer inverting end-to-end jejunojejunosotomy was created. Anastomosis construction time and anastomotic bursting pressure were measured and compared. RESULTS: Closed-bowel anastomosis was significantly faster to create than a 2-layer technique. Luminal narrowing (<30%) was similar with both techniques and comparable with other inverting techniques. Bursting pressure was significantly higher for the 2-layer technique, although all anastomoses resisted pressures higher than those reported for other jejunojejunal anastomosis techniques. CONCLUSIONS: A 1-layer hand-sewn, closed, inverting jejunojejunosotomy using a modified Doyen clamp was easy and faster to perform, and resulted in functional characteristics similar to, a 2-layer hand-sewn inverting technique. CLINICAL RELEVANCE: A closed, 1-layer inverting technique could be considered for equine jejunal anastomosis but requires in vivo evaluation before recommendation for clinical use.     

Comparison of three dorsal techniques for arthrocentesis of the distal interphalangeal joint in horses

OBJECTIVE: To compare 3 dorsal techniques for arthrocentesis of the distal interphalangeal joint in horses with regard to ease of performing the technique and to determine the role of operator experience in ease of performing these techniques. DESIGN: Observational study. Sample Population-Forelimbs from 17 equine cadavers and 12 horses (16 joints) undergoing arthrocentesis for therapeutic or diagnostic purposes. PROCEDURES: In both forelimbs from 7 of the equine cadavers, 3 arthrocentesis techniques (dorsal perpendicular, dorsolateral, and dorsal inclined) were performed in random order by a single experienced individual, and number of attempts needed to successfully insert the needle into the joint was recorded. For the forelimbs from the remaining 10 cadavers, veterinary students without experience in arthrocentesis performed each of the 3 arthrocentesis techniques (2 limbs/student) in random order, and number of attempts was recorded. In the clinical patients, arthrocentesis was performed by means of the dorsal inclined technique. RESULTS: For both the experienced individual and the veterinary students, number of attempts needed was significantly lower with the dorsal inclined technique than with the dorsal perpendicular or dorsolateral technique. Arthrocentesis was successful with the dorsal inclined technique in all 16 joints in the clinical patients; synovial fluid was recovered from 14 of the 16 joints. The procedure was well tolerated in all horses, except one that reacted to needle insertion. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that the dorsal inclined technique for arthrocentesis of the distal interphalangeal joint was easier to perform than was the dorsal perpendicular or dorsolateral technique, regardless of experience level of the operator.     

Comparison of two laparoscopic suture patterns for repair of experimentally ruptured urinary bladders in normal neonatal calves

OBJECTIVE: To compare 2 laparoscopic suture patterns for repair of experimentally ruptured urinary bladders in normal neonatal calves. STUDY DESIGN: Experimental surgical study. ANIMALS: Thirty male Holstein calves. METHODS: A bladder defect was created in 24 anesthetized calves (day 0). They were randomly divided into 4 groups (n=6/group). In groups 1 and 3, the defect was closed laparoscopically using a one layer full thickness simple continuous (FTSC) suture pattern (pattern A). In groups 2 and 4, the defect was closed laparoscopically in 2 layers using a FTSC suture pattern followed by Lembert continuous suture pattern (pattern B). Groups 1 and 2 calves were euthanatized at the end of the surgery and groups 3 and 4 at day 10. Six healthy calves were also euthanatized and used as a control group. The bladders were harvested and tested for bursting strength (BS). The surgical time (ST) data from the two groups for each pattern were pooled. A Student t-test was used to compare ST data. For the BS data, a 2-factor ANOVA test with post-hoc Student t-test was used to determine if treatment, time, or treatment-time interaction was significant. A Dunnett's test was used to compare BS of the 4 treatment groups to the control group. P<.05 was considered significant. RESULTS: Mean ST was significantly shorter for pattern A than for pattern B. In all treatment groups, the mean bladder BS (MBBS) was significantly lower than the MBBS for the control group. The MBBS was significantly lower for group 1 than for group 2. There was no significant difference in the MBBS between groups 3 and 4. CONCLUSION: In this study, a 1-layer laparoscopic closure technique had advantages compared with 2-layer laparoscopic closure technique. Further work is required before a 1-layer laparoscopic closure technique can be recommended clinically. CLINICAL RELEVANCE: One-layer bladder closure is fast and safe in clinically normal calves and permits additional research to evaluate its safety in foals and clinical ruptures.     

An in vitro comparison of two suture intervals using braided absorbable loop suture in the equine linea alba

OBJECTIVE: To compare bursting strength and failure modes of ventral median abdominal incisions closed with loop suture in a simple continuous pattern using two different suture-bite intervals. STUDY DESIGN: In vitro experiment. SAMPLE POPULATION: Equine cadavers (n=14; weighing >318 kg; postmortem interval <2 hours). METHODS: A template was used to make a 25 cm incision with suture interval and bite size of either 1.0 cm x 1.5 cm or 1.5 cm x 1.5 cm. A 200 L polyurethane bladder was inserted within the abdomen and insufflated to create abdominal wall tension. Celiotomies were closed with a #2 braided lactomer 9-1 continuous pattern with a loop suture. Deviation from the linea, closure time (minutes), total suture length (cm), suture length to wound ratio (SL:WL), bursting pressure (mm Hg), and failure modes (fascial or suture) were compared between groups using a Mann-Whitney U test. Significance was set at P<.05. RESULTS: No significant differences were identified between closing time, total suture length used, SL:WL, bursting pressure, or failure mode. Fascial failure was the main failure mode for both techniques; suture failure occurred rarely and knot failure did not occur. CONCLUSION: Based on the overall bursting pressure and failure mode, #2 braided lactomer loop suture placed in a continuous pattern should provide sufficient security for closure of the equine linea alba during recovery and the immediate postoperative period. CLINICAL RELEVANCE: Although there were no significant differences in the 2 patterns evaluated, the 1.5 cm x 1.5 cm pattern may have potential advantages for closure time, less total suture remaining in the wound, and strength.     

Partial Arytenoidectomy in the Horse with and without Mucosal Closure

Left-sided partial arytenoidectomy was performed in eight horses to evaluate healing. Four horses underwent conventional partial arytenoidectomy with suture apposition of the mucosa. In four horses, most of the arytenoid cartilage, including overlying mucosa, vocal fold, and laryngeal saccule, were excised en bloc without mucosal closure. The horses were monitored clinically by endoscopic examination. One horse from each group was euthanatized at weeks 2, 4, 8, and 16. Complete necropsies with gross and histologic examination of the arytenoidectomy sites were performed. Postoperative complications such as coughing, dysphagia, and aspiration pneumonia were not encountered and problems with wound healing were minimal in both groups. The defect created by partial arytenoidectomy without mucosal closure initially filled to the level of the luminal surface with granulation tissue, with a gradual transition to mature fibrous connective tissue. Grossly, the defect appeared to be healed and was completely epithelialized by week 16 without apparent narrowing of the laryngeal lumen. Partial arytenoidectomy sites with mucosal closure healed in a similar pattern by week 8. Partial dehiscence of the dorsal portion of the sutured mucosa occurred in three horses.     

Evaluation of a vessel-sealing device for small intestinal resection and anastomosis in normal horses

OBJECTIVES: To compare arterial bursting pressure after vessel closure using a vessel-sealing device (LigaSure Atlas Laparoscopic Sealer/Divider Instrument; Valleylab, Boulder, CO), a ligate-and-divide stapling device (LDS), and 2-0 polydioxanone suture. To evaluate the LigaSure Atlas as a method for ligation of the mesenteric vasculature during small intestinal resection in normal horses. STUDY DESIGN: Experimental study. ANIMALS: Part A: jejunal segments from 19 horses. Part B: 6 horses, aged 1 to 18 years, weighing 330 to 509 kg. METHODS: Part A: Jejunal segments with mesenteric vessels were collected from 19 horses. After closure by 1 of 3 methods (LigaSure Atlas, LDS, 2-0 polydioxanone) arteries were cannulated, and bursting pressure was measured by incrementally increasing intraluminal pressure until failure. Part B: Six horses had jejunal resection and anastomosis using a vessel-sealing device (LigaSure Atlas) to provide hemostasis of the mesenteric vasculature. Horses were monitored clinically for 4 weeks. RESULTS: Part A: Mean +/- SEM bursting pressure after 2-0 polydioxanone ligation (1,014.50 +/- 279.05 mm Hg) was significantly greater than mean bursting pressure after LigaSure (554.25 +/- 228.79 mm Hg), which was significantly greater than the mean bursting pressure after LDS (373.25 +/- 183.69). Part B: No major operative or postoperative hemorrhage occurred after application of the LigaSure Atlas for sealing and transecting mesenteric vasculature during small intestinal resection in normal horses. CONCLUSIONS: The LigaSure Atlas appears to be a safe method for hemostasis of the mesenteric vasculature during small intestinal resection in normal horses. CLINICAL RELEVANCE: Benefits of the LigaSure Atlas vessel-sealing device include reduced time required to provide hemostasis, acceptable arterial bursting pressure, no remaining foreign material, and no risk for ligature slippage. In our experience, use of the LigaSure Atlas during small intestinal resection and anastomosis in horses is safe for ligation of vessels less than or equal to 7-mm diameter.     

A Comparison of Repair Methods for Gap Healing in Equine Flexor Tendon

In nine horses (18 forelimbs), a 3 cm section of superficial digital flexor tendon was removed and the tendons were repaired with immobilization for 6 weeks and (1) no suture (n = 6); (2) a double locking loop tenorrhaphy with carbon fiber (n = 6); or (3) a double locking loop tenorrhaphy with size 2 nylon suture (n = 6). Clinical assessment, gross evaluation, morphometry, histology, and mechanical testing were performed on two limbs from each treatment group at weeks 6, 12, and 24. At weeks 6 and 12, the unsutured tissue was less mature than the tissue sutured with nylon. By week 24, the carbon fiber repair had breaking stress (mean, 12.5 M Pa) similar to the unsutured repair (mean, 10.6 M Pa). There was necrosis and a granulomatous foreign body reaction around the carbon fiber. The nylon suture repair had significantly greater strength per unit area (mean breaking stress, 20.4 M Pa) because of a smaller area of repair tissue in the gap (mean, 3.6 cm2). At week 24, the nylon suture repair tissue was the most mature with the least inflammation of the three repair methods. A nylon double locking loop suture was the preferred method for equine flexor tenorrhaphy of a tendon gap because of greater breaking stress, histologic maturity, biocompatibility, and the adequate functional and cosmetic outcome.     

Mechanical Properties of Four Suture Patterns for Transected Equine Tendon Repair

Thirty-six superficial digital flexor tendons from nine fresh equine cadavers were transected and sutured with size 2 monofilament nylon. Nine tendons were repaired with each of four suture patterns: single-locking loop, double-locking loop, triple-locking loop, or three-loop pulley. The times required for application, tensile strengths, resistance to distraction (gap), and modes of failure were analyzed. The mean times required were: single-locking loop, 3 mins, 15 secs; double-locking loop, 4 mins, 15 secs; triple-locking loop, 10 mins, 50 secs; and three-loop pulley, 4 mins. The double-locking loop, triple-locking loop, and three-loop pulley suture patterns were stronger than the single-locking loop. The triple-locking loop and three-loop pulley patterns were close in strength and only the triple-locking loop was stronger than the double-locking loop. The three-loop pulley had the greatest resistance to gap formation and its mode of failure was different from the others. The three-locking loop suture patterns failed by suture breakage but the three-loop pulley failed first by suture pull-out and then by suture breakage.     

Laparoscopic intestinal exploration and full-thickness intestinal biopsy in standing horses: a pilot study

OBJECTIVE: To assess a laparoscopic technique for equine intestinal biopsy. STUDY DESIGN: Experimental study. ANIMALS: Seven adult horses. METHODS: Food but not water was withheld for 36 hours before laparoscopy. In 3 horses (group A) standing, right laparoscopic access to different small intestinal segments was compared with ventral median celiotomy access. Inaccessible segments were identified at necropsy. In 4 horses (group B), the feasibility of obtaining full-thickness duodenal and cecal biopsies and any associated morbidity were evaluated. Biopsy specimens were collected during standing right laparoscopy using a 2-step procedure and intracorporeal suturing technique, and abdominal lavage was performed. Horses were monitored clinically and by abdominal fluid cytology and microbial culture, and repeat laparoscopy was performed on day 6. RESULTS: Standing right flank laparoscopy provided good observation of small intestinal segments and enabled manipulation of all but 15-20 cm of the duodenum and approximately 40 cm more ileum compared with ventral median celiotomy. Group B horses had no complications, no adhesions, and no bacterial growth from peritoneal fluid samples. None of the horses had signs of abdominal pain. CONCLUSION: A 2-stage intestinal biopsy technique performed during standing, right flank laparoscopy may be a safe alternative to exploratory celiotomy and biopsy in normal horses. CLINICAL RELEVANCE: Right flank laparoscopy allows biopsy of intestinal segments including duodenum and 50% more of the ileum than is accessible by ventral median celiotomy. This technique should be evaluated in clinical patients.     

Urinary incontinence and incoordination in three horses associated with equine protozoal myeloencephalitis

Urinary incontinence, weakness and ataxia associated with equine protozoal myeloencephalitis (EPM) was diagnosed in three horses. Rectal examination of all horses revealed distention of the urinary bladder. Urine was expressed when manual pressure was applied to the bladder of each horse during rectal examination. The anal reflex and tone of the anus and tail were normal in all horses. Two horses had bacterial cystitis associated with Enterococcus sp. All horses were treated with pyrimethamine and a sulfonamide for EPM, but there was a variable response to treatment.     

Management of facial injuries

Because of the excellent blood supply to the head region, superficial lacerations to the soft tissue structures of the head generally heal rapidly without treatment. Lacerations of the equine tongue frequently go unnoticed because difficulty in eating usually is not apparent. The majority of lacerations heal if left untreated, with no loss in function. Surgical repair is indicated to promote healing and prevent deformity, to amputate a severely compromised apex, and to alter a scar or defect that is unacceptable to the owner. Surgical principles to be adhered to include thorough debridement and copious lavage, multiple layer closure, and placement of tension sutures away from the primary suture line and tied on the dorsum of the tongue. Full-thickness lip lacerations should be repaired using multiple-layer closure and tension sutures tied on the skin surface away from the primary suture line. Reconstructive techniques have been described for extensive lip lacerations when primary repair was inadequate or tissue loss was severe. Thorough evaluation of the equine lid, adnexa, and orbit is essential in determining severity of injury and appropriate treatment methods as well as for establishment of a prognosis. The injury may be minor or more severe, leading to blindness, disfigurement, or loss of the eye itself. Depression fractures involving the frontal, maxillary, or nasal bones are frequently open fractures. Skin abrasions, epistaxis, facial deformity, crepitus, and pain are clinical signs seen with this type of injury. Bone and soft tissue reconstruction should be performed to minimize potential complications. Facial fractures left untreated can result in facial deformity, sequestration, sinusitis, and osteomyelitis.     

Surgical repair of coxofemoral luxation in a horse.

A 4-year-old castrated male Miniature Horse was evaluated because of severe right hind limb lameness of 5 days' duration. The diagnosis of craniodorsal luxation of the right coxofemoral joint was made by physical examination and radiographic imaging. Closed reduction was attempted but was unsuccessful. Surgical reduction was successfully performed, using toggle pin, synthetic capsular reconstruction, and trochanteric transposition techniques. No postoperative complications were observed. Follow-up 26 months after surgery revealed no recurrence of the luxation and no evidence of lameness. These surgical techniques are used successfully for repair of coxofemoral luxations in small animals. To our knowledge, there has been no report of these techniques attempted in horses. These surgical techniques may have merit for the treatment of coxofemoral luxations in small equine patients.     

Factors affecting outcome of extensor tendon lacerations in the distal limb of horses. A retrospective study of 156 cases (1994-2003)

Distal limb lacerations are common injuries in horses, with a better prognosis reported for extensor tendons lacerations compared to flexor tendons lacerations. The objective of the present study was to determine the influence of type and location of injury, modalities of treatment and post surgical complications on the outcome of extensor tendon lacerations. The medical records of 156 horses surgically treated for extensor tendon lacerations over a 10-year period were analysed retrospectively. Information was obtained for 124 horses with a minimum of 18 months follow-up. Statistical analysis was performed on 129 horses (five horses were euthanatized during hospitalization) in order to determine factors affecting outcome. Seventy-four percent of the horses returned to soundness, 17% had moderate gait impairment and 9% remained lame. Approximately 60% of the sports horses returned to an equal or higher level of performance, and 17.5% returned to a lower level. In the multivariate statistical analysis, the only significant factor that favourably influenced outcome was complete suture of the wound. A significant association could not be detected between outcome and absence of a functional extensor tendon, The most important post-surgical complication was extensive scarring of the wound. The present results report outcome of extensor tendon lacerations in a large number of horses and outline the importance of primary wound healing in order to avoid major scarring with potential functional consequences.