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results in two smaller wounds. The width of the skin between each of these incisions and the wound should be equal to the half of the width of the wound. Wounds created by relaxing incisions heal by second intention, and one large relaxing incision heals more slowly than two smaller relaxing incisions. Creating multiple, staggered, parallel, relaxing incisions on each side of the wound provides less relaxation but results in small wounds that heal much faster than one or two long, relaxing incisions and impart a better cosmetic appearance (Fig 9). If techniques for decreasing tension described above
appear to be insufficient to allow a wound to be closed primarily, a skin graft can be applied to the wound. The rapid healing achieved with a skin graft may make grafting more economical than allowing the wound to heal by second intention. A healed skin graft contains epidermis, dermis and adnexa, including hair follicles, so is more cosmetic and durable than is a large epithelial scar. The most practical type of graft that can be applied to fresh cutaneous wound is the full-thickness graft (T
oth et al. 2010). A full-thickness graft
is most easily harvested from the cranial pectoral region—one of the few places on a horse where the skin is relatively mobile. The graft is usually harvested with the horse sedated, after desensitising the donor site with local anaesthetic solution. The donor site is sutured in one or two layers. Subcutaneous tissue is sharply excised to expose the dermal vasculature to permit plasmatic imbibition, inosculation and neovascularisation. The graft is attached to the recipient site with staples or sutures, after desensitising the recipient site with local or regional anaesthesia, or with cyanoacrylate glue. The owner should be informed that the epidermis may become necrotic and slough (Fig 10) but that sloughing of the epidermis has no effect on the final appearance of the graft. To conclude, when a surgeon is attempting to close a
gaping wound under tension, several techniques can be used, as described above. In cases when a significant gap is to be closed, one can either mobilise adjacent skin, by using skin flaps or recruiting skin from a distant body region by utilising skin grafts.
Authors’ declarations of interest No conflicts of interest have been declared.
Ethical animal research Not applicable to this clinical commentary.
Source of funding This work is not funded.
Authorship
E. Cypher contributed to the preparation of the manuscript and gave their final approval. J. Schumacher and G. Kelmer contributed to all stages of the manuscript preparation.
References
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Bowman, K.F. and Swaim, S.F. (1982) Double opposing Z-plasty for correction of stenotic naris in a horse. J. Am. Vet. Med. Assoc. 180, 772-775.
Harrison, I. (1991) Presuturing as a means of reducing skin tension in excisional biopsy wounds in four horses. Cornell Vet. 81, 351-356.
Hirshowitz, B., Lindenbaum, E. and Har-Shai, Y. (1993) A skin-stretching device for the harnessing of the viscoelastic properties of skin. Plast. Reconstr. Surg. 92, 260-270.
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Stashak, T. and Schumacher, J. (2016) Equine Wound Management, John Wiley & Sons, Hoboken, New Jersey.
Topaz, M., Carmel, N.N., Topaz, G., Li, M. and Li, Y.Z. (2014) Stress- relaxation and tension relief system for immediate primary closure of large and huge soft tissue defects: an old-new concept. Medicine (Baltimore) 93, e234.
T
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Whittaker, C.J., Reynolds, B.D., McCarthy, P.M., Taylor, S.F., Major, D., Caruso, K.A. and Smith, J. (2020) Use of a chronic soft tissue expansion device to facilitate blepharoplasty in a horse with lower-lid cicatricial ectropion with a 14-year follow-up. Vet. Ophthalmol. 23, 899-904.
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