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EQUINE VETERINARY EDUCATION Equine vet. Educ. (2022) 34 (2) 66 doi: 10.1111/eve.13423_1
Case Report Use of random pattern skin flaps for wound closure in two horses
J. Jansson†* , D. Knottenbelt‡ and S. Hennessy† †Lisadell Equine Hospital, Navan, Co. Meath, Ireland; and ‡Equine Medical Solutions Ltd, Stirling, Scotland, UK *Corresponding author email:
josefin.janzon@hotmail.com
Keywords: horse; skin flap; z-plasty; rotation flap; skin expander
Summary Case 1 A 9-year-old Thoroughbred broodmare presented with a mass rostral to the medial canthus of the left eye. Due to economic reasons, themasswas removedwithoutpriorbiopsy. The mass was removed under general anaesthesia using
a diode laser. An extension of the mass protruded into the maxillary bone overlying the maxillary sinus. It was removed and two reverse periosteal flaps were created to cover the defect. The size of the skin defect prevented primary closure. A Z-plasty permitted closure of the ventral component of the surgical site (Fig 1). Dorsally, the incision was only partially closed due to the size of the skin defect. The bed of the mass was injected with an emulsion of carboplatin. Histopathology identified a spindle cell tumour likely to be
sarcoid, sarcoma or leiomyoma. Based on these findings, a follow-up local infusion of carboplatin was performed at 3 weeks post-surgery. The mass recurred and subsequently was resected twice. It has not recurred 68 weeks post-treatment.
Case 2 Ayearling Thoroughbred colt presented with a chronicwound on the dorsomedial aspect of the right metatarsus. Histopathology revealed non-neoplastic, chronicinflammatory tissue. Removal of the chronicwound was required to achieve satisfactory cosmesis for sales purposes. The use of skin expanders was elected in this case to achieve primary closure of the defect. During the first surgery, the skin expanders were placed around the dorsal, proximalanddistalaspectsof thewound. The chronicwoundwas superficially debridedusinghydrosurgical debridement. Removal of the mass and closure of the wound under general anaesthesia was done 18 days after the first surgery. A
Fig 2: Case 2. Photograph taken after the final surgery. It is illustrating the fusiform incision (red dashed marking) used to remove the wound tissue and the incision line (yellow dashed marking) for the rotational flap which was moved plantarly to close the remaining defect. The pressure sore from the previous underlying skin expander is also highlighted (green circle).
single curvilinear incisionwasmade over the dorsal aspect of the wound. All skin expanders were removed. The entire nonhealing wound was removed, and the periosteum was curetted. Attempts to close the wound directly failed due to excessive central tension. A random pattern rotational flap was created with a semi-circular incision distally along the expanded skin to allowprimary closureof themaindefect (Fig 2). The incisionhealedprimarily withgoodcosmeticappearance.
Key points
• The use of skin flaps provides surgical options when dealing with similar wound types, especially when cosmesis and function are paramount.
• Self-expanding soft tissue skin expanders are useful in equine surgery.
Fig 1: Case 1. Closure of the surgical site proved difficult due to the lack of tissue available. To overcome this, a z-plasty (red lines) was created to allow closure of the ventral component of the defect.
• Multimodal chemotherapy and surgical debunking are often required for management of equine sarcoids.
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