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EQUINE WOUND MANAGEMENT

Under general anesthesia the tongue is exteriorized by traction with a towel clamp placed in the dorsum of the
tongue or by a gauze loop placed around the tongue caudal to the laceration. The exposed portions of the tongue
can be isolated by draping (Figure 6.8a).

Debridement of a thin margin of the wound edges with a scalpel is usually all that is required to produce

viable wound edges; however, this must be done without excessive removal of tissue to prevent a dorsal or
lateral deviation. Because of the constant movement of the tongue and the presence of saliva, bacteria, and feed
at the sutured site postoperatively, it is important to close as much dead space as possible and accurately
approximate the tongue’s surface to reduce the risk of dehiscence.

The dorsal surface of the tongue has the greatest strength and will hold tension sutures well, but the tissue

edges on all sides must be accurately sutured. The lacerations normally run transversally across the tongue and
extend from the dorsal surface down into the depths of the tissue. Absorbable suture material is preferred
because it prevents the necessity for suture removal. Vertical mattress tension sutures of #0 monofi lament syn-
thetic absorbable sutures that penetrate the laceration in the muscle to at least half the depth of the wound are
placed, with the knots tied on the external surface (Figure 6.8b). This layer gives greater strength to the repair.
Above this, synthetic absorbable monofi lament sutures (0 or 2-0) that are buried are used to appose the lacer-
ated muscles and eliminate dead space. The mucous membrane is apposed with a similar suture placed in a
vertical mattress pattern (Figures 6.8c,d) or a combination of vertical mattress and simple interrupted sutures.

If the laceration is severe and the blood supply is lost, amputation followed by oversewing the remaining

stump with mattress sutures is indicated. Incision of a transverse wedge-shaped piece of tissue from the viable
tip facilitates suturing of the dorsal and ventral aspects of the tongue.

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Postoperatively, antibiotics are continued for 24 hours and NSAIDs for 2 to 3 days; however, if the tongue’s

blood supply is marginal, these medications can be continued longer. Eating does not appear to be affected
after repair or amputation; however, food that is soft is recommended. A good functional end result is expected
in most cases (Figure 6.8e)

Nostril

Lacerations of the nostril are usually caused by a protruding object. The object may be blunt or sharp and

lacerate the nostril from within or from the outside. A common offender is an angled bolt protruding from a
gate or a horse trailer.

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Horses predisposed to these lacerations are often “head shy.”

If the laceration is extensive and full-thickness, the soft tissues will collapse during inspiration and fl utter

during expiration. The collapse is due to an inability to properly dilate the nostril and the negative inspiratory
pressure. As with other regions of the head, the nostrils benefi t from a good blood supply which ensures that
repair will be successful even when carried out days after injury.

Laceration at the lateral margin (base) of the nostril can be problematic following repair, however, because

of tension/shearing forces applied to the surgical site and a tendency to rub the area. Tension/shearing forces
result from muscle contractions associated with movement of the lips and those associated with movement of
the alar cartilages when the nostrils dilate. Rubbing the site can be discouraged by administering NSAIDs,
cross-tying, and/or the application of a half-muzzle. Repair of a full-thickness laceration to the arch of the nostril
is fairly straightforward and rarely problematic. In both cases, however, the horse may attempt to rub the repair
site postoperatively; therefore, it must be closely observed during this period or cross-tied. Administration of
penicillin G, (22,000 units/Kg [10,000 IU/lb] IM) and NSAIDs is recommended.

Occasionally, a horse will present with a history of trauma to a nostril that has been allowed to heal by

second intention (Figure 6.9a) or it was sutured and the end result is a stenotic nostril. If the stenosis occurs
following second intention healing, and only the most rostral aspect (external orifi ce) of the nostril is involved,
two Z plasties may be used to increase the diameter of the opening (Figure 6.9b).

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However, if the stenosis occurs

following closure of a full-thickness laceration that extended caudal for at least two-thirds the length of the false
nostril, the sutured site will have to be incised and re-apposed in such a fashion so that the normal arch of the
nostril is restored.

Treatment

Acute lacerations of the dorsal arch of the nostril (Figure 6.10a) are best managed by suturing the defect

with #2-0 monofi lament nylon in an interrupted pattern placed in a modifi ed fi gure-8 fashion (Figure 6.10b).

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