What is a Diplomate?
The term "ACVS Diplomate" refers to a veterinarian who has been board certified in veterinary surgery. Only veterinarians who have successfully completed the certification requirements of the ACVS are Diplomates of the American College of Veterinary Surgeons and have earned the right to be called specialists in veterinary surgery.Laceration repair is performed after external traumatic injury in horses. The most common cause of equine lacerations are due to accidental collisions with inanimate objects, kicking injuries associated with other animals or objects, or having the head or extremities in a precarious position while being startled. Often the cause is unknown and the resulting trauma is noted several hours following the incident. Evidence of the inciting cause can occasionally be identified which will assist in management alterations to prevent recurrence of the injury in other horses.
Time is of the essence when seeking medical care following trauma resulting in a laceration. Laceration assessment and repair is recommended in order to restore cosmetic and anatomic function, control infection, maintain blood supply, determine the extent of the injury and treat potential sequelae to the inciting trauma. Ideally laceration repair will take place within 6 hours. More commonly it is performed within 24 hours. When beyond a 24 hour period, further medical treatment is often required to reduce infection and inflammation before a laceration can be closed.
Conditions Commonly Treated Using Procedure:
- Superficial skin and muscle trauma
- Tendon and ligament lacerations
- Neurovascular injury
- Joint and bone trauma
- Hoof avulsion
- Infected and contaminated wounds
- Shock and sepsis associated with infection and/or blood loss
Although most of lacerations are minor and offer little systemic danger to the horse, several complications from the initial trauma can be catastrophic if not identified and treated aggressively at an early time point. For best cosmetic results, laceration repair should be performed early after the inciting injury. Ideally an assessment and initial treatment will be performed within 6 hours of injury. Delayed treatment is still important in order to reduce infection, attempt anatomic reconstruction, and identify and treat potential sequelae (Figure 2).
Beyond treatment and repair of the external injury, the deep extents of the laceration will also be investigated. Sterile probing, radiographs, and ultrasound may be used to determine the extent of the injury. Joint involvement can easily lead to contamination and infection yielding catastrophic results if not treated appropriately. Additionally, involvement of tendon, ligament, bone, and neurovascular structures need to be addressed in order to restore appropriate function and dictate treatment and rehabilitation. Laceration preparation with antiseptics, debridement, lavage, and systemic treatment with antibiotics, anti-inflammatories, and tetanus prophylaxis can further decrease the extent of systemic effects to the horse. Finally, local therapeutics including the local or regional administration of antibiotics to the affected region are commonly used to increase drug concentrations to the laceration and decease deleterious systemic effects. The most frequent examples of local treatments include regional limb perfusions with antibiotics using a tourniquet, application of antibiotic impregnated beads, and antibiotic infusion pumps (Figure 3).
Lacerations in the horse can often be far more complicated than their outward appearances may suggest. An evaluation and treatment following trauma resulting in a laceration will result in better cosmesis, more rapid healing, and a faster return to normal function. More importantly, thorough evaluation and treatment can prevent far more serious problems such as an infected joint, broken bones, systemic infection, or damage to a neurovascular structure.
The only time laceration repair may be contraindicated is after a prolonged period or in the face of established infection. For these reasons, it is important to have a veterinarian evaluate your horse as soon as possible after the inciting trauma.
