In veterinary medicine, surgery tends to be divided between orthopaedic and soft tissue, however the surgery itself is just one element of the successful management of cases. The latest Special Focus issue of the Equine Veterinary Journal (EVJ) is showcasing the advantages of a multi-disciplinary management of cases, with a collection of articles on topics related to soft tissue surgery.
Interdisciplinary approaches to soft-tissue surgery is guest edited by Tim Barnett, Kira Epstein and EVJ’s North American Editor Louise Southwood, who has also provided a comprehensive editorial. It brings together 19 papers from reviews summarising current evidence and practice, to original clinical and experimental studies, adding to the knowledge bank of present and potential procedures and care.
“Although the common thread for the articles contained in this special issue is their relation to diseases with surgical management options, most are not focused on surgical techniques or procedures,” said Louise Southwood. “Instead, the articles cover a range of topics, including diagnostic testing, decision-making, anaesthesia and analgesia, medical management, post-operative complications and outcomes.”
Respiratory dysfunction is an important cause of poor performance and noise and is addressed in two articles in the collection: Unilateral laser ventriculocordectomy results in increased arytenoid stability in horses with severe left sided recurrent laryngeal neuropathy provides evidence that where noise is the main limiting clinical sign, this surgery may be adequate. Dynamic nasopharyngeal collapse in horses: What we know so far concludes that nasopharyngeal collapse carries a poor prognosis.
Colic is a common equine emergency and a major cause of mortality. Surgical treatment is high risk and costly and early recognition is vital. The horse owner’s decision-making process can be difficult. UK horse owners and veterinary practitioners' experiences of decision-making for critical cases of colic helps to create an effective approach to decision-making, including ways to prepare, share information and support owners during and after the process.
Automatic early detection of induced colic in horses using accelerometer devices reports on a promising technique for early detection of colic using accelerometer devices in horses with experimentally induced colic.
Dexmedetomidine preconditioning reduces ischaemia-reperfusion injury in equine model of large colon volvulus found a protective effect with use of a dexmedetomidine constant rate infusion prior to experimentally induced ischaemia reperfusion of the large colon, suggesting potential to improve outcomes in horses with large colon volvulus.
Optimisation of surgical decision-making and management also play an important role in improving colic case outcomes. Flowmetry and spectrophotometry for the assessment of intestinal viability in horses with naturally occurring strangulating small intestinal lesions aimed to identify viable and non-viable small intestine in horses with strangulating lesions.
When resection and anastomosis are performed for the treatment of small intestinal lesions, the location of the lesion determines the type of anastomoses that can be performed. Anastomotic techniques for small intestinal obstruction in horses: A scoping review highlights the need for more, higher-quality studies and the use of agreed-upon definitions to objectively compare techniques and determine best practices.
Another challenge with surgical decision-making in horses with small intestinal diseases is the diversity of underlying pathology. Clinical features and outcome of 40 horses with mesodiverticular bands identified during exploratory laparotomy for management of acute colic has resulted in the authors recommending excision of mesodiverticular bands at surgery.
Colic surgery has high complication rates which can increase costs and risks. Factors associated with development of post-operative reflux in horses with large colon volvulus and association with complications and outcomes found that horses developing post-operative reflux were 26 times less likely to survive discharge and 13.4 times less likely to be alive 3 years after surgery compared to those that did not develop post-operative reflux.
Colitis is another serious, expensive and potentially fatal post-operative complication. Risk factors associated with development of colitis in horses post-exploratory laparotomy reported an incidence of 8.3% and horses with infectious colitis had longer hospitalisation yet similar survival to discharge.
Castration is one of the most common surgical procedures but is not without complications. A scoping review on intraoperative and postoperative surgical castration complications in domesticated equids found little consensus in what clinicians actually considered to be a complication of castration and what should be considered ‘normal’ and proposed a new classification system for the surgical techniques used, to reduce the ambiguity.
The donkey usually needs different treatment to other equines when using pharmaceuticals. Sedation with dexmedetomidine-butorphanol or xylazine-butorphanol continuous intravenous infusions during unilateral ovariectomy reported the use of similar dose rates to other equines and suggested that a lower loading dose for donkeys may be worth investigating, in contrast to other studies suggesting a higher dose. At the same centre, A retrospective comparison of postoperative outcomes in ovariectomised jennies (Equus asinus) treated with phenylbutazone or flunixin meglumine concluded that although flunixin provides adequate analgesia, phenylbutazone should be considered inappropriate following abdominal surgery.
Skin grafting can shorten healing time of large wounds. Skin grafting with the modified Meek technique in the standing horse using full thickness skin: Evaluation of acceptance, wound contraction and wound closure in chronic wounds reported less initial wound contraction using a full thickness graft harvested from the pectoral region.
Pin repulsion of cheek teeth, although used by many clinicians when oral extraction methods have failed, has not been objectively evaluated. Equine cheek tooth repulsion using small diameter repulsion pins: 20 cases suggested this technique results in successful extraction with minimal complications.
Computed tomography (CT) is being increasingly used for the examination of the head. Management of paracondylar process fracture in three horses provides case studies to add to the list of conditions in which the identification of paracondylar process fractures by CT has been useful.
The final articles in the collection focus on the important areas of Antibiotics – our part in their downfall, The importance of practice-based clinical veterinary research and its legal and ethical implications andQualitative vs quantitative research – moving beyond the numbers.
“This special focus issue provides valuable, clinically relevant insight for vets treating horses with a variety of diseases,” said Louise Southwood. ”The wide variety of topics covered illustrates the diversity in the field of soft tissue surgery and the need for a well-rounded approach to achieve the best possible outcomes.”
The Special Focus issue can be found here.