Equine Wound Management

576 Pages·2009·45.502 MB·English

by  Ted S. Stashak, Christine L. Theoret

EQUINE WOUND MANAGEMENT
Second Edition

EQUINE WOUND MANAGEMENT
Second Edition
Ted S. Stashak, DVM, MS, Diplomate ACVS, Professor Emeritus Equine Surgery
Department of Clinical Sciences
College of Veterinary Medicine and Biomedical Sciences
Colorado State University
Fort Collins, Colorado
Christine Theoret, DMV, PhD, Diplomate ACVS
Director, Comparative Tissue Healing Laboratory
Associate Professor
Département de biomédecine vétérinaire
Faculté de médecine vétérinaire
Université de Montréal
Saint-Hyacinthe, Québec
A John Wiley & Sons, Inc., Publication
First edition fi rst published 1991
Second edition fi rst published 2008
© 1991 Lea & Febiger
© 2008 Wiley-Blackwell
Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing program has been merged with
Wiley’s global Scientifi c, Technical, and Medical business to form Wiley-Blackwell.
Editorial Offi ce
2121 State Avenue, Ames, Iowa 50014-8300, USA
For details of our global editorial offi ces, for customer services, and for information about how to apply for permission to reuse the
copyright material in this book, please see our website at www.wiley.com/wiley-blackwell.
Authorization to photocopy items for internal or personal use, or the internal or personal use of specifi c clients, is granted by Blackwell
Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923. For
those organizations that have been granted a photocopy license by CCC, a separate system of payments has been arranged. The fee
codes for users of the Transactional Reporting Service are ISBN-13: 978-0-8138-1223-6/2008.
Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names
used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not
associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative
information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering
professional services. If professional advice or other expert assistance is required, the services of a competent professional should
be sought.
Library of Congress Cataloguing-in-Publication Data
Equine wound management / [edited by] Ted S. Stashak, Christine Theoret. – 2nd ed.
p. ; cm.
Rev. ed. of: Equine wound management / Ted S. Stashak. 1991.
Includes bibliographical references and index.
ISBN-13: 978-0-8138-1223-6 (alk. paper)
ISBN-10: 0-8138-1223-2 (alk. paper)
1. Horses–Wounds and injuries–Treatment. 2. Horses–Surgery. I. Stashak, Ted S. II. Theoret, Christine.
III. Stashak, Ted S. Equine wound management.
[DNLM: 1. Horses–injuries. 2. Horses–surgery. 3. Wounds and Injuries–therapy.
4. Wounds and Injuries–veterinary. SF 951 E647 2008]
SF951.S77 2008
636.1′08971–dc22
2008016810
A catalogue record for this book is available from the U.S. Library of Congress.
Set in 10 on 12 pt Palatino by SNP Best-set Typesetter Ltd., Hong Kong
Printed in Singapore by Markono Print Media Pte Ltd
Disclaimer
The contents of this work are intended to further general scientifi c research, understanding, and discussion only and are not intended
and should not be relied upon as recommending or promoting a specifi c method, diagnosis, or treatment by practitioners for any
particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of
the contents of this work and specifi cally disclaim all warranties, including without limitation any implied warranties of fi tness for a
particular purpose. In view of ongoing research, equipment modifi cations, changes in governmental regulations, and the constant fl ow
of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information
provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the
instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate.
The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not
mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may
make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this
work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither
the publisher nor the author shall be liable for any damages arising herefrom.
1 2008
Dedications
To my wife, Gloria, and my children, Angela, Stephanie, and Ryan, for their love and untiring support.
To my parents, Theodore and Ann, for emphasizing the value of an education.
Ted S. Stashak
To my parents, Susan and André, for encouraging excellence.
Pour Alain qui me procure cet équilibre ô si bénéfi que et pour Mozelle, Marek et Francesca qui me comble
de leur allégresse!
Gràcies, en especial, a la Pilar i en Jordi per la seva visió positiva i generosa contribució en aquest llibre.
Christine Theoret
v

Table of Contents
Preface ix Chapter 5 Principles and Techniques For
Acknowledgments xi Reconstructive Surgery 239
Contributors xiii
Chapter 6 Management of Wounds of
the Head 273
Chapter 1 Wound Healing 3
Chapter 7 Management of Wounds of
1.1 Physiology of Wound Healing 5
the Neck and Body 333
1.2 Differences in Wound Healing
between Horses and Ponies 29
Chapter 8 Wounds of the Distal
1.3 Wound Repair: Problems in
Extremities 373
the Horse and Innovative
8.1 Management of Wounds of
Solutions 47
the Distal Extremities 375
8.2 Degloving Injuries 427
Chapter 2 Factors That Infl uence
8.3 Treatment of Exuberant
Wound Infection and
Granulation Tissue 445
Healing 69
2.1 Selected Factors That
Chapter 9 Diagnosis and Management of
Negatively Impact Healing 71
Wounds Involving Synovial
2.2 Management Practices That
Structures 463
Infl uence Wound Infection
and Healing 85 Chapter 10 Tendon and Paratendon
Lacerations 489
Chapter 3 Topical Wound Treatments 107
3.1 Update on Wound Dressings: Chapter 11 Free Skin Grafting 509
Indications and Best Use 109
Chapter 12 Management of Severely
3.2 Topical Wound Treatments
Infected Wounds 543
and Wound Care Products 137
3.3 The Extracellular Matrix as
Chapter 13 Burn Injuries 569
a Biologic Scaffold for
Wound Healing in Veterinary
Chapter 14 Sarcoid Transformation at
Medicine 161
Wound Sites 585
Chapter 4 Approaches to Wound Closure 175 Chapter 15 Lasers: Effects on Healing and
4.1 Selection of Approaches to Clinical Applications 609
Wound Closure 177
4.2 Selection of Suture Materials, Chapter 16 Bandaging and Casting
Suture Patterns, and Drains Techniques for Wound
for Wound Closure 193 Management 623
4.3 New and Innovative
Approaches to Wound
Closure 225 Index 659
vii

Preface
The second edition of this textbook was long overdue. Indeed, since the fi rst edition appeared in 1991, a
number of ground-breaking studies have modernized the art of wound management in both human and vet-
erinary patients. New topical medications, interactive dressings, and surgical procedures are now available,
enabling veterinarians to treat serious injuries once deemed incurable. Moreover, research has shown, unequivo-
cally, that many aspects of the horse’s healing response are unique, such that a textbook dedicated to the art
and science of wound management in this species would be a most valuable tool for equine practitioners. Sub-
sequent to the recent publication of two journal volumes on this topic (Clinical Techniques in Equine Practice, June
2004, TS Stashak, guest editor; Veterinary Clinics of North America, April 2005, CL Theoret, guest editor), it seemed
most opportune to provide readers with a single, comprehensive source of theoretical and practical information,
enhanced by an abundance of helpful tables, line drawings, and color fi gures. Thus, the purpose of this book
is to provide an authoritative, state-of-the-art text on equine wounds and their management.
The fi rst chapter provides an update on the physiology of cutaneous wound healing, with a special focus
on the newly discovered mediators that govern the mechanisms underlying repair. Horses have a distinctive
response to trauma; therefore, the second section of the chapter endeavors to describe the major differences
from the relatively normal healing profi le of ponies. The chapter concludes with an enlightening discussion of
innovative solutions to the specifi c problems encountered when dealing with a traumatic wound in a horse.
Chapter 2 addresses selected factors that can exert a negative impact on the physiologic mechanisms that
contribute to repair. This is followed by a review of wound management practices that infl uence infection and
healing. The chapter emphasizes the importance of thoroughly assessing the wound and the patient as well as
various measures such as hemostasis, cleansing, debriding, and disinfecting the wound in the fi rst few hours
following injury. The subject is approached in the order in which a case involving a wound would be evaluated
and managed clinically. Because infection is a major cause of delayed healing, this chapter emphasizes manage-
ment practices that reduce its incidence.
The third chapter is devoted to topical wound treatments. It includes an updated list of dressings and wound-
care products. The authors have prepared a number of valuable tables in an effort to guide the practitioner
through the maze of commercially available products; they outline indications and suggest the best use for each.
This chapter is enhanced by a new and separate section focusing on the use of biologic scaffolds engineered from
the extracellular matrix as a potential therapeutic option for treating soft tissue injuries in veterinary medicine.
The fourth chapter leads the reader through the decision-making process preceding the closure of a trau-
matic wound. Factors which may preclude this approach are considered, as are the selection of suture materials
and patterns as well as the use of drains and alternative, innovative approaches to wound closure in the event
that this method is deemed appropriate.
Chapter 5 begins with a review of the physical and biomechanical properties of skin which will help the
practitioner develop an appropriate surgical plan. That is followed by a detailed description of practical recon-
structive techniques that can be used in conjunction with primary or delayed wound closure.
The next series of chapters (6, 7, and 8) is devoted to the management of wounds in various regions of the
body: the head, the neck and body, and the distal extremities, with a focus on how to treat degloving injuries
and how to prevent or manage the species-specifi c problem of exuberant granulation tissue.
Chapters 9 and 10 focus on the fact that a fair proportion of traumatic wounds in horses compromise deep,
underlying structures. They present detailed anatomical reviews that should enable the practitioner to identify
involvement of synovial structures or tendons/ligaments and promptly instigate the recommended therapy to
improve the overall prognosis.
ix
x PREFACE
Chapter 11 addresses skin grafting, which should be considered for a wound that cannot heal by epitheli-
alization and contraction or be closed using conventional or reconstructive suturing techniques. This chapter
describes the principles and various techniques of free skin grafting, the advantages and disadvantages of each
technique, and the effects of grafts on the wound.
Chapters 12 through 14 focus on the management of wounds suffering from serious debilitating conditions:
severe infection, burn injury, and tumor development. Chapter 12 emphasizes the proper selection of antibiotic
agents and reviews methods for optimizing their delivery and effi cacy at the site of infection. Chapter 13 reviews
the pathophysiology of burn injury and associated pulmonary damage and advises the reader on the appropri-
ate treatment for immediate disorders as well as long-term wound care. While burns are uncommon in horses,
management of such injuries can be expensive and time consuming. Moreover, cardiovascular involvement,
smoke inhalation, and corneal ulceration can compromise the outcome. Finally, Chapter 14 addresses the trans-
formation of a wound into a sarcoid tumor, which suspends the healing process, often indefi nitely. It provides
the reader with tips on recognizing and solving this unusual problem.
Chapter 15, which addresses laser surgery, was added to this edition of the textbook in response to the
wider usage of this modality in veterinary medicine following the introduction in the 1990s of a more affordable
waveguide-delivered CO laser. The author discusses various clinical applications of laser surgery pertaining
2
to wound management: debridement, removal of exuberant granulation tissue, graft bed preparation.
Chapter 16 is a well-illustrated chapter intended to guide the practitioner in the art of applying bandages,
splints, and casts to support wound healing in different regions of the body.
We thank the contributing authors for their willingness to bring all of their valuable experience to this text-
book. We are indebted to these people who generously contributed their clinical insight and current research
data.