Management of apposing,full‐thickness tracheal perforations in two horses

Two horses, one 15‐year‐old Arabian gelding and one 10‐year‐old Quarter Horse gelding, presented with a history of marked subcutaneous emphysema. The first case exhibited no external wound, although there was a depression noted on the ventral neck. The second case had a laceration on the ventral aspect of the neck over the trachea. Endoscopic examination revealed both horses to have concurrent dorsal and ventral perforations of the trachea. The horses were managed by placing a short, cuffed, J‐shaped tracheostomy tube in the ventral perforation, while the dorsal perforation healed. The dorsal perforation in the first horse was allowed to heal by second intention, whereas sutures were placed in the dorsal perforation in the second case to reduce the healing time. Both horses were maintained on oral antimicrobial and nonsteroidal anti‐inflammatory medications throughout treatment. The dorsal perforation healed after 13 days in the first horse, and 22 days in the second horse. The ventral perforation healed in both horses by second intention following tracheostomy removal, giving a cosmetically acceptable result. In addition to facilitating tracheal healing, the tracheostomy tubes prevented the progression of subcutaneous emphysema, and promoted its resolution.     

Bacterial meningitis after dental extraction in a 17-year-old horse

Dental extractions in horses may result in bacteremia, which can lead to systemic complications. Bacterial meningitis following oral cheek tooth extractions in a 17-year-old Thoroughbred gelding is described in this report. The bacterial meningitis was confirmed by histopathology. The gelding was presented for evaluation of intermittent fever, loose feces, and mild colic signs which started 5 days after cheek tooth extraction. This case illustrates a rare complication associated with oral tooth extraction in a horse and highlights the unusual presenting features of meningitis.Key clinical message:Bacterial meningitis secondary to oral cheek tooth extraction should be considered as differential diagnosis; particularly in cases with the development of pyrexia a few days after the procedure.     

Angularis oris axial pattern buccal flap for reconstruction of recurrent fistulae of the palate

OBJECTIVE: To describe the use of an axial pattern flap based on the angularis oris artery and vein for reconstruction of palate defects. STUDY DESIGN: Clinical case report ANIMALS: Two dogs with recurrent oronasal fistulae. METHODS: Oronasal fistulae previously treated by buccal mucosal random pattern flaps that subsequently dehisced were repaired using an angularis oris-based buccal tissue axial pattern flap. This flap was developed by full thickness incision of the cheek tissue, excluding the skin, about the angularis oris vascular pedicle resulting in a vascularized flap covered by oral mucosa on one side. RESULTS: In one dog, the repair was intact and healed 6 months after surgery. In the second dog with a fistula that resulted because of radiation necrosis, approximately 95% of the defect healed with a small (<1.0 cm(2)) area of dehiscence. Repair of this persistent fistula with a random pattern buccal flap failed and this small fistula remained with minimal clinical signs. CONCLUSION: An axial pattern flap based on the angularis oris artery and vein can be used to repair difficult or recurrent palate defects. CLINICAL RELEVANCE: Angularis oris axial pattern flaps provide an additional effective option for repair of defects in the hard and soft palate to the distal gingival margin of the canine tooth or beyond, depending on skull conformation. Advantages of this flap include its highly vascular and robust character, high degree of mobility and a surface of tough buccal mucosa.     

Iatrogenic fracture of the premaxilla during standing exodontia

This case report describes a 17‐year‐old horse that presented with a history of oral dysphagia secondary to buccal slab fractures and apical infection in two cheek teeth. During standing surgery to remove the diseased cheek teeth, the horse sustained a bilateral comminuted fracture of the premaxilla. An audible crack was followed by bilateral epistaxis. Subsequent radiography revealed minimal displacement at the fracture sites and the horse responded well to conservative management without the need for additional fixation techniques. One year later, the fracture appeared completely healed on repeat radiography. This is an uncommon complication of standing dental procedures necessitating the use of a speculum but is noteworthy and may be important to consider and inform owners in such aged cases.     

Treatment of septic common digital extensor tenosynovitis by complete resection in seven horses

OBJECTIVE: To describe and evaluate a technique for radical resection of the entire intrathecal component of the common digital extensor tendon (CDET) in horses. STUDY DESIGN: Prospective clinical study. ANIMALS OR SAMPLE POPULATION: Seven client-owned horses. METHODS: Seven horses with wounds that resulted in septic tenosynovitis of the CDET sheath were treated by complete surgical resection of the affected tendon and ablation of the tendon sheath; 5 had previous surgery that was unsuccessful. Time from initial injury to complete resection was 1-22 weeks. In 6 horses, the wound was closed primarily using a closed suction (4 horses), penrose (1), or passive open drainage system (1). In 1 horse, the surgical wound healed by second intention. All horses had postoperative bandaging, antibiotic administration, and physiotherapy. RESULTS: Surgical wounds healed primarily in 6 horses and by second intention in 1 horse. Follow-up (mean, 26.4 months; range, 18-38 months) was available for 6 horses; all returned to their athletic performance level without lameness or gait abnormality. CONCLUSIONS: Complete resection of the CDET was an effective surgical technique for management of chronic septic tenosynovitis. CLINICAL RELEVANCE: Horses with infection of the CDET and its sheath may be returned to long-term soundness without gait abnormality after radical resection.     

Myofibroblastic fibrosarcoma with multifocal osseous metaplasia at the site of equine influenza vaccination

We describe a fibrosarcoma in a 12-year-old Quarterhorse × Arabian gelding as a sequela to equine influenza vaccination. Shortly after the second vaccination, swelling at the site was noticed by the owner and it continued to increase in size over the following 6 months. Biopsy of the mass indicated a fibrosarcoma had developed at the vaccination site. It was approximately 20 cm in diameter and elevated well above the level of the skin. There was no clinical evidence of metastases to the lungs or local lymph nodes. Surgical resection of the mass was performed and the wound healed by first and second intention. Histopathological examination and immunohistochemical staining confirmed a myofibroblastic fibrosarcoma with multifocal osseous metaplasia. To the authors' knowledge, this is the first equine case of a vaccine-associated fibrosarcoma.     

Healing of multiple fractured thoracic dorsal spinous processes in a Quarter horse

A Quarter horse gelding sustained fracture and displacement of spinous processes T2-T10. Radiographic evidence of healing was seen 3 mo following injury, and at 2 years post-injury all spinous processes had healed and undergone partial re-alignment. This re-alignment has not been reported before.     

An unusual location of foreign body in the horse

A seven year old Arabian gelding was presented because of a draining tract cranial to the scapula that developed following puncture with a wooden rail four months previously and drained continuously despite antibiotic treatment.

The full extent of the tract could not be determined with the horse standing but a polyethylene catheter was passed 25 cm down the tract and passed medial to the scapula. With the horse under a general anaesthetic, further probing revealed the tract was much longer. The direction, length and contents of the tract were determined by fistulograph. The tract continued medial to the scapula and terminated with two radiolucent filling defects adjacent the spinous processes of the 5th-11th thoracic vertebrae. The filling defects were located more accurately in a cranial-caudal direction by the use of radiopaque markers, and in a medial-lateral direction by deep needle probing during surgery. Following surgical removal of the foreign bodies the tract healed and the horse returned to his original use. Foreign bodies and the use of fistulography are discussed.

     

Differentiation of Chronic Lymphocytic Leukemia in the Horse: A Report of Two Cases

Chronic lymphocytic leukemia (CLL) was diagnosed in two horses: an 18-year-old Quarter Horse gelding that was examined because of edema of the prepuce and ventral abdomen; and a 20-year-old mixed breed gelding that was referred because of lymphocytosis, ventral edema, and weight loss. The first horse had enlarged peripheral lymph nodes and cool nonpainful pitting edema of the ventral abdomen and prepuce. The second horse had enlarged peripheral lymph nodes, cool nonpainful pitting edema of the ventral thorax and cranial ventral abdomen, and a 3/5 holosystolic heart murmur. The diagnosis of CLL was based on increased blood lymphocyte counts and infiltration of marrow and other tissues by lymphocytes. In horse 1, the lymphocytosis persisted for 2 months between initial examination and death. The results of flow cytometric analysis on blood lymphocytes using anti-lymphocyte antibodies suggested that horse 1 had T-cell CLL, and horse 2 had B-cell CLL. In addition, the second horse had a monoclonal gammopathy (IgG), with light-chain proteinuria.     

Tracheal perforation managed by temporary tracheostomy in a horse

Tracheal trauma with resultant rupture is uncommonly reported in veterinary literature. We report the case of a 16-year-old Thoroughbred gelding that sustained a 1 cm longitudinal perforation of the dorsal tracheal membrane in the proximal cervical region. The horse subsequently developed dyspnoea due to acute upper respiratory obstruction secondary to severe emphysema of the guttural pouches. A temporary tracheostomy caudal to the site of tracheal perforation was performed under local anaesthesia. This procedure helped relieve the upper airway obstruction and aided resolution of the injury by diverting air away from the site of tracheal perforation. After conservative management, the gelding recovered completely.     

Use of the scrotum as a transposition flap for closure of surgical wounds in three dogs

OBJECTIVE: To describe use of the scrotum as a pedicle flap to cover defects created by tumor excision in the perineum or caudal and medial aspect of the thigh. STUDY DESIGN: Clinical study. ANIMALS: Three dogs. METHODS: After tumor excision and prescrotal castration, an incision was made around the base of the scrotum, leaving a pedicle on the side opposite the skin defect. After removal of the tunica dartos and abdominal fascia, the scrotal skin was stretched and shaped to the defect, then sutured in position with a simple interrupted pattern. Bandages that were changed every 48 hours compressed the flaps, and healing was observed until sutures were removed. RESULTS: Two dogs had first intention healing in 15 days, whereas 1 dog developed necrosis of 10% of the flap, and this area healed by second intention. CONCLUSION: In male dogs, the scrotal skin can be used as a pedicle flap for reconstructive surgery of wounds in the perineum and the proximomedial and caudal aspect of the thigh. CLINICAL RELEVANCE: The perineal region remains a surgical challenge because of the lack of the available skin for reconstruction of surgical wounds. The scrotal skin should be considered for use as a transposition flap to cover skin defects in this region.     

Application of Platelet-Rich Gel to Enhance Wound Healing in the Horse: A Case Report

A large torn wound of the dorsal elbow region was observed in a 17-year-old Arabian mare. Surgical reconstruction was performed with the horse in standing sedation, but suture dehiscence occurred 2 days later. Autologous platelet-rich gel (PRG) was then applied to the wound every 3 weeks for a total of 3 administrations to accelerate good-quality healing. The wound had healed rapidly and completely within 5 months of the first PRG treatment, without chronic effects or formation of exuberant tissue granulation and with minimum scarring. This case report suggests that topical treatment with autologous PRG, as additional therapy, might be considered beneficial in the management of large-wound healing in horses, and it can be regarded as safe and inexpensive treatment that can be used in field.     

Articular sagittal and medial parasagittal patellar fracture repair using lag screws in two mature horses

This report describes the clinical experience with internal fixation of a sagittal and a medial parasagittal patellar fracture using lag screws. Severely displaced sagittal and medial parasagittal fractures of the patella were diagnosed in 2 horses (a 10‐year‐old Thoroughbred gelding and a 5‐year‐old Thoroughbred mare) and were repaired using internal fixation. A direct approach through the fascia latae was used. In both cases, the leg was placed in full extension and the fracture was corrected by a combination of digital manipulation and application of bone reduction forceps. Articular congruency was assured by arthrotomy and digital assessment, and radiographic skyline projection. Then, the leg was placed in flexion and two 5.5 mm cortical screws with washers were inserted in lag fashion, under radiographic guidance (skyline projection). In one case, an additional 6.5 mm cancellous screw was used. Both fractures healed without evidence of degenerative joint disease. However, the first horse's wound dehisced, then healed by second intention uneventfully. The second horse was put in a sling in order to prevent lying down. Both horses were able to be used for their intended purpose. In these clinical cases, sagittal and medial parasagittal patellar fractures were treated successfully by open reduction and internal fixation. Post‐operative management in a sling was used successfully in the second case to prevent wound dehiscence.     

Severe gastric impaction secondary to a gastric polyp in a horse

A 13-year-old Percheron gelding was presented for refractory gastric impaction. At necropsy a pedunculated 10 cm × 11 cm × 14 cm mass, histologically identified as an inflammatory polyp, was suspected to have been partly obstructing the pylorus. This is the first report of a polyp resulting in gastric outflow obstruction in a horse.     

Effects of 25% propylene glycol hydrogel (Solugel) on second intention wound healing in horses

OBJECTIVE: To evaluate the effect of a commercially available 25% propylene glycol hydrogel preparation (Solugel; Johnson and Johnson Medical, North Ryde, Australia) on healing of full-thickness skin wounds on the distal aspect of the limb in horses. STUDY DESIGN: Experimental. ANIMALS: Eight Standardbred horses. METHODS: Standardized (2.5 x 2.5 cm) full-thickness skin wounds were created over the mid-dorsomedial aspect of both metacarpi in 8 horses. One wound in each horse was dressed with saline solution (0.9% NaCl) soaked gauze, and one was treated with Solugel under dry regular gauze; wounds were then bandaged with gauze-coated cotton wool and elastic adhesive bandages. Wounds were videorecorded and rebandaged twice weekly until healed. Wound healing variables were measured from the videorecordings using a computer software package and analyzed as a randomized complete block design with repeated measures. Where necessary variables were made positive for analysis; significance was set at P <.05. RESULTS: The area of the wound at the first bandage change did not vary between treated and untreated wounds. Treatment had no effect on the total rate of healing, rate of healing during the retraction phase of healing, rate of healing after the retraction phase was complete, or the amount the wounds retracted. CONCLUSIONS: Using this model of wound healing, Solugel had no effect on second intention healing of distal limb wounds in horses. CLINICAL RELEVANCE: Solugel does not appear to have any beneficial effect on healing of small full-thickness skin wounds to the distal limb of horses.     

Complications and outcome after thoracodorsal axial pattern flap reconstruction of forelimb skin defects in 10 dogs, 1989-2001

OBJECTIVE: To determine (1) the frequency and extent of complications associated with thoracodorsal axial pattern flap reconstruction of forelimb skin defects in dogs and (2) outcome after treatment of such complications. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: Ten dogs. METHODS: Medical records for 10 dogs that had a thoracodorsal axial pattern skin flap reconstruction of a forelimb skin defect were reviewed. RESULTS: Three dogs had complete flap survival. Partial necrosis of the distal flap, ranging from an estimated 2% to 53% (mean, 21%) of the flap surface area, occurred in 7 dogs. Six dogs required surgical management of the skin necrosis, resulting in successful resolution in 5 dogs, whereas, in 2 dogs, the wound healed by second intention. Positive bacterial cultures were obtained from 3 dogs with distal flap necrosis. Seroma formation was noted in 2 dogs; the entire flap survived in 1 dog, whereas the second dog developed distal flap necrosis. Edema and bruising of the distal portion of the flap were noted in 8 dogs; distal flap necrosis subsequently developed in 7 dogs. Partial incisional dehiscence, which healed by second intention, occurred in 2 dogs. Of 6 owners available for follow-up, all were satisfied with the functional outcome, but 1 owner was not satisfied with the cosmetic appearance. CONCLUSIONS: Partial flap necrosis was a frequent complication of thoracodorsal axial pattern flap reconstruction of forelimb skin defects and required additional wound care or surgical intervention to achieve healing. CLINICAL RELEVANCE: Thoracodorsal axial pattern flaps can provide full-thickness skin coverage of extensive skin defects of the forelimb, but owners should be aware of the likelihood of local wound complications.     

Adjuvant Electrochemotherapy Increases Local Control in a Recurring Equine Anal Melanoma

A 25-year-old gelding sport horse was referred for the treatment of recurring bilateral anal amelanotic melanoma. On physical examination, the horse presented bilateral poorly delimited perianal masses that recurred 2 months after surgical excision. The owner elected the lesions to be treated with surgery combined with electrochemotherapy using the drug cisplatin. The two masses were removed, and the surgical bed was treated with electrochemotherapy. A second session was performed 3 weeks later. The horse remained disease-free for 5 months and then experienced a marginal recurrence in one side. The nodule was re-treated, and the horse remained disease-free for 2 additional months, when it died of abdominal metastases. Electrochemotherapy can be added to the current strategies to palliate recurrent melanomas in horses.     

Carotenodermia in a Horse

This case report describes an 11-year-old Appaloosa gelding that was examined because of yellow–orange tinting of the skin of the muzzle, eyelids, sheath, anus, and perianal region without discoloration of the sclera or mucus membranes. The horse was reported to preferentially eat dandelions which were plentiful in the pasture. Physical examination was normal, except for the discolored skin. A serum chemistry panel was normal. Carotenodermia was suspected. Serum carotenoid concentrations were higher in the affected horse as compared with concentrations in two horses with depigmented skin of normal color that were on grass pasture in the same geographic area. The horse remained systemically healthy and the abnormal skin color had almost disappeared when he was examined 7 weeks later. Carotenodermia can occur in horses and can be differentiated from jaundice because the sclera remains unaffected. Veterinarians should be aware that the condition is benign and spontaneously resolves after stopping carotenoid intake.     

Neodymium:yttrium-aluminum-garnet laser ablation of a urethral web to relieve urinary outflow obstruction in a horse.

An 8-year-old Hanoverian gelding was examined because of urine dribbling and urethral obstruction. Mild proprioceptive deficits of the left hind limb were evident during neurologic examination. Ultrasonography per rectum revealed dilatation of the pelvic portion of the urethra. Endoscopy of the urethra revealed 2 webs of tissue: 1 was located 10 cm proximal to the external urethral opening; the other was located 65 cm proximal to the external urethral opening and prevented passage of the endoscope into the urinary bladder. The mass was ablated with a neodymium:yttrium-aluminum-garnet laser, using a transendoscopic noncontact technique. On follow-up examination 6 months after laser surgery, an endoscope could easily be passed into the bladder, and no urethral web was seen. The horse was able to void a stream of urine but continued to dribble urine intermittently. The proximal location of the urethral lesion in this horse would have made use of traditional surgical methods problematic, whereas transendoscopic laser photoablation was easy and effective.     

Pleuroscopic diagnosis of gastroesophageal squamous cell carcinoma in a horse

A 15-year-old Quarter Horse gelding was examined because of chronic intermittent colic of 40 days' duration. The clinical signs included acute onset of depression, ptyalism, abdominal splinting, and rolling within an hour of eating. An intramural mass of the esophagus was identified during esophagoscopy. A large soft-tissue density surrounding the distal portion of the esophagus, creating a stricture, was identified on an esophagogram. With the horse slightly sedated, pleuroscopy was performed, allowing direct visualization and biopsy of the mass. The histopathologic diagnosis was squamous cell carcinoma.