EQUINE VETERINARY EDUCATION / AE / FEBRUARY 2022


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a) I


b)


II


III


Fig 4: a) Illustration demonstrating near-far-far-near (NFFN) suture pattern. b) Photograph of a clinical case using NFFN and inverted cruciate patterns to repair a laceration under tension.


of sutures are placed in a similar manner in the undermined skin on both sides of the wound until the wound can be sutured with less tension. A sutured stent is another helpful method to combat


I


tension on the incision. Suturing a towel in a horizontal mattress fashion can aid healing by protecting the incision from the environment and decreasing tension on the incision line (Fig 6). External devices that stretch the skin can be applied to


II III Fig 5: Illustration of a walking suture to allow tension releasing.


that side after the skin is stretched towards the centre of the wound. The undermined skin is moved slightly towards the centre of the wound as the suture is tightened and tied. Rows


skin on each side of the wound (or on each side of the mass to be removed) (Hirshowitz et al. 1993; Barnea et al. 2004). These external stretching devices, by applying steady traction to skin surrounding a large wound, permit the wound to be closed primarily without tension. Several systems (eg TopClosure) have been used to aid closure of wounds in people and small animals (Pavletic 2000; Topaz et al. 2014), but we are not aware of reports describing the application of these external stretching devices to close wounds of horses. One of us (G.K.) has used the Top Closure device to repair an incisional hernia and to close wounds of three horses (Fig 7), but the results were overall disappointing. Failure, however, was not due to malfunction of the device or inadequacy of the technique. In one case, the device was used to close an incisional hernia on the ventral midline of a horse, but the repair failed because the bands broke and because of lack of compliance by the client. In another case, the device was used to close two chronic cutaneous wounds, one over the fetlock and the other over a shoulder. The wounds contracted markedly, but did not close completely and eventually healed by second intension. In


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