Surgical Closure of Equine Abdomen, Prevention, and Management of Incisional Complications

Summary

This paper describes a method of abdominal wall closure using tension and apposition sutures in horses undergoing ventral midline laparotomies. It also describes methods for prevention and management of postoperative incisional complications, such as bandaging, negative pressure therapy, and in case of wound breakdown, the application of retention sutures.

Abstract

Although rarely fatal, complications of ventral midline laparotomy incision in equine patients increase hospitalization cost and duration and may jeopardize return to athletic function. Therefore, many techniques have been developed to reduce their occurrence and expedite their resolution when they occur. Our technique of celiotomy incision closure includes the use of tension sutures (vertical U mattress) of polyglactin 910 on the linea alba, which is then apposed by polyglactin 910 interrupted sutures or a simple continuous pattern suture with a stop midway before routine closure of the superficial layers. The celiotomy incision is protected by an elastic bandage during the immediate postoperative period. This technique has been associated with favorable results: 5.3% confirmed incisional infections after a single celiotomy and 26.7% after repeat celiotomy. The overall incisional complication (serous/sanguineous discharge, hematoma, infection, hernia formation, and complete wound breakdown) occurrence was 9.5% and 33.3% after single and repeat laparotomy, respectively. In cases considered more susceptible to infection (early relaparotomy or laparotomy incisions longer than 30 cm), negative pressure therapy was found easy to apply on closed incisions. No detrimental effects were observed. However, the potential prophylactic benefit of this therapy needs to be confirmed in a larger group. In infected laparotomy wounds requiring drainage, the use of negative pressure therapy seemed to have a positive effect on the formation of granulation tissue. However, there was no control group to allow statistical confirmation. Finally, one case of complete breakdown of the laparotomy incision was managed by stainless steel retention sutures, the application of negative pressure therapy, and a hernia belt. At re-evaluation 15 months post-surgery, several small hernias were detected, but the horse had returned to his previous level of sports performance and had not shown any episode of colic.

Introduction

The ventral midline celiotomy is the most frequent surgical approach to the abdomen in horses with acute colic¹ or in need of cesarean section². The created ventral incision may be the site of several postoperative complications, such as (sero) sanguineous discharge, infection, hernia formation, and complete wound breakdown³. Except for the case of complete wound breakdown, laparotomy incision complications are rarely fatal, but they increase hospitalization duration and costs and may prevent return to athletic function^4,5.

Protocol

This retrospective study is based on our clinical records. Our practice fully respects the animal care guidelines of our institution, the Equine Clinic of the University of Liège. Animals included in the study were horses and ponies (mares, intact and gelded males) of various breeds (mainly Warmbloods), of various ages (from 5 months to 34 years, with a mean age around 10 years) and of various weights (from 50 kg to 840 kg, with a mean weight around 500 kg).

1. Surgical techniq.......

Discussion

In our clinic, the technique for closure of the equine abdomen is based on a combination of an interrupted vertical U mattress and apposition sutures on the linea alba. In our experience, disadvantages associated with an interrupted pattern suture, such as a greater amount of suture material within the incision and a slower application⁵, are balanced by several other advantages. Interrupted vertical mattress sutures are particularly indicated for regions under tension and at risk of .......

Materials

Name	Company	Catalog Number	Comments
300 ml canister (with gel) for ACTIV.A.C. Therapy system	KCI	M8275058/5 M8275058/10	canister for negative pressure therapy
Alfatec 6 HRTX 50	Prodivet Pharmaceutical produced by Chirina T Injecta	PG0649P	6 metric polyglactin 910
Appose ULC Slim Body Skin Stapler	Covidien	88868037 12	skin staples
AquaPharm NaCl 1l	Ecuphar	366 4174	1 L saline
Bovivet reinforced disposable needle 14G x 3 1/4'' . 2.1 x 80 mm	Kruuse	112462	needle used when placing the stainless steel retention sutures
Buster Surgery Cover 120 cm x 180 cm	Kruuse	141 850	surgical drapes
Clexane 15.000 UI	Sanofi	BE-230185	enoxaparin
CM Hernia Belt	CM Equine Products		Hernia belt: various sizes, to be adapted to the horse's dimensions
Cutting plier 24 cm maxi 3 mm 1456	Alcyon	8387671	cutting plier
Dermanios Scrub	Anios	BE-REG-00679	Chlorhexidine digluconate soap
Dermincise 80 cm x 60 cm	Vygon	38 80 60	non-iodophor adhesive drape
Digital Ultrasonic Diagnostic Imaging System	Mindray	DP-50Vet	ultrasound machine
e band	Millpledge	DQ05100	elastic adhesive roll
Ethanol 70%	Savetis		Isopropyl alcohol
Fil de cerclage AO 1 mm x 10 m	Alcyon	8022030	1 mm diameter stainless steel cerclage wire
Flammazine 1% creme	Alliance Pharma	BE270505	silver sulfadiazine dressing
Flat-nosed pliers 180 mm	Alcyon	8368113	flat-nosed pliers
Furacine Soluble Dressing	Limacom nv	BE300876	nitrofurantoin dressing
Genta Equine 100 mg/ml	Divasa-Farmavic	BE-101491	gentamicin
Heparine Leo 5000 U.I./ml	Leo	1361-559	heparin
Info.V.A.C.	KCI	413781 Rev B	negative pressure therapy machine
Intrafix  Primeline	B Braun	4062182	plastic tubing (for buttress effect for retention sutures)
Ioban  56 cm x 60 cm	3M	6648EU	iodophor adhesive film
Iso-Betadine  Dermicum	Mylan	BE007077	dermic povidone iodine
Iso-Betadine  Savon	Mylan	BE007095	Povidone iodine soap
Kruuse adhesive spray	Kruuse	141865	adhesive spray
Laparotomy Sheet with Incise Film Eclipse	Medline	29511CEA	laparotomy drape with incise film
Leukotape  Classic	BSN medical	01703-00	adhesive tape
Leukotape  Remover	BSN medical	97285-05	Liquid adhesive remover
Meganyl 50 mg/ml	Syva	4117-446	flunixine meglumine
Monocryl 0 CP-1	Ethicon	C267	0 metric polyglecaprone, cutting needle
Opsite	Smith and Nephew	66004978	Moisture vapour permeable spray dressing
Penicilline 5.000.000 UI	Kela	7E33729E19	Sodium Penicillin
Peni-Kel 300.000 UI/ml	Kela	1370-881	Procain Penicillin
Poviderm Sol	Emdoka	BE-V196971	Povidone iodine in isopropyl alcohol solution
Prevena Plus Customizable dressing	KCI	PRE4055	Kit for negative pressure therapy on closed wounds
Prontosan	B Braun	400 505	Gel continaing 0,1% Polyaminopropyl Biguanide (polihexanide)
Saddle pad (equine size)	CM Equine Products	SP-E1	large foam pad for protection of the horse's back
SENSAT.R.A.C. Pad	KCI	M8275057/10	Pad with central disc for negative pressure therapy
Thilo-Tears	Alcon NV	233866	Polymer eye ointment
Universal Pack Eclipse	Medline	29105CEA	universal pack (drapes)
V.A.C. Drape	KCI	M6275009/10	adhesive drape for negative pressure therapy
V.A.C. Granufoam silver Dressing	KCI	M8275099/5 M8275099/10	silver foam for negative pressure therapy
Vetivex Ringer Lactate solution 5000 ml	Dechra	BE-V442032	5 L Pouch of Lactated Ringer's Solution
Vicryl 2 CTX	Ethicon	V367H	2 metric polyglactin 910
Zorbo-G-Padding	Millpledge	DX05200	Gamgee cotton