Page 5 - Clinical Connections - Autumn 2023

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Page 5 - Clinical Connections - Autumn 2023
P. 5

Equine referrals

        EQUINE DEGLOVING CASE

        Andy Fiske-Jackson, Deputy Head of ºÚÁÏÉç Equine and Associate Professor in Equine Surgery

               annicus,   an     11-year-old  This, alongside the significant soft tissue   This can include stable-based exercises
               thoroughbred gelding, spent more   damage, led to the decision to place a distal   to maintain core stabilisation muscles. With
        G than  three  months  at  the  ºÚÁÏÉç   limb cast.                        Gannicus, the dedicated nursing team took
        Equine Referral Hospital earlier this year                              time to enrich his environment with various
        due to a degloving wound sustained by   Recovery and complications      toys, including a fruit and vegetable treat
        kicking through the side of a horsebox.   Gannicus remained in a cast for two weeks.   rope.
          On  presentation  the  left  hindlimb  was   This required four-hourly checks by our
        bandaged and he was reluctant to fully load   dedicated team of vets, veterinary nurses
        the limb. Removal of the bandage revealed   and students. Inevitably, due to the presence
        exposure of almost the entire medial aspect   of compromised tissue, a significant volume
        of the third metatarsal bone, from the distal   of wound exudate was seen emanating from
        tarsal joints to the fetlock joint.   the top of the cast. This led to the decision
          There was skin loss, loss of the outer   to remove the cast. At this point a significant
        surface of the medial metatarsal condyle,   amount of granulation tissue had formed,
        with marked contamination, and the tendons   almost completely covering the previously
        and ligaments at the back of the leg were   exposed metatarsal bone.
        visible.                              Continued communication between the
                                            fetlock joint and the wound could not be
        Diagnostic tests and procedures     ruled out but, on account of his comfort, and
        Radiographic  examination  revealed  the lack of healthy tissue to close the defect,
        substantial soft tissue loss but no evidence   Gannicus was maintained in a bandage and
        of a fracture. Due to the severity of the soft   monitored.
        tissue damage and suspicion of infection   Approximately two weeks after the cast   Environmental enrichment aided recovery
        of the fetlock joint, the team elected to take   was removed, Gannicus' level of comfort
        Gannicus to surgery and perform further   decreased and, on sampling the fetlock joint   When the cast was removed, the
        diagnostics under general anaesthesia.  fluid, repeat infection was confirmed.   wound  showed  significant  contraction  and
          A sample of synovial fluid retrieved from   Gannicus subsequently underwent a   granulation tissue was covering the whole
        both  the  digital  flexor  tendon  sheath  and   second surgery to lavage the fetlock joint,   wound. As the granulation tissue was slightly
        fetlock joint confirmed infection of the fetlock   and punch skin grafts were placed in the   exuberant it was debrided to encourage
        joint but not the digital flexor tendon sheath.   granulation bed.  These were harvested   epithelialisation.
        The  fetlock joint was arthroscopically   from the pectoral region. A distal limb cast   During subsequent bandage changes the
        lavaged, but the degree of tissue loss   was  placed,  which  was  maintained  for  a   exuberant granulation tissue was treated with
        compromised the ability to close the joint   period of six weeks.       a dehydrating agent, causing it to contract,
        capsule completely.                                                     allowing continued epithelialisation. He was
          The wound was meticulously debrided   Environmental enrichment by the   then able to be discharged to complete his
        but,  due  to  the  substantial  loss  of  tissue,   nursing team       convalescence at home.
        could only be partially closed. During the   When horses are on box rest for long   Gannicus experienced several mild colic
        procedure it became evident that the medial   periods it is vital that they are given regular   episodes  during  his  stay,  which  resolved
        collateral ligament of the fetlock joint was   human interaction and stimulation.   with medical  management.  On  the  last
        damaged.                                                                occasion there was suspicion of an ileal
                                                                                impaction, which resolved with intravenous
                                                                                fluid  therapy  overnight.  These  episodes
                                                                                appeared to be associated with sedation.
                                                                                 Gannicus is now being ridden out and
                                                                                enjoyed by his owners – something which
                                                                                seemed so far away at one point! His care
                                                                                involved the entire team at ºÚÁÏÉç Equine,
                                                                                from the students, technicians, nurses and
                                                                                vets, and his highly dedicated owners who
                                                                                refused to give up on him.






                                                                                       For equine referrals, please call: 01707
                                                                                     666297
                                                                                       Email:
         The wound upon initial presentation    The wound after discharge            equinehospital@rvc.ac.uk


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