Case study: Horse perineal laceration

Updated:

01 September 2015

Surgeon/center:

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Clinical/experimental data:

Eleven-year-old, trotter, maiden mare. Foaled May 14th 2014 – 3rd degree perineal laceration at time of foaling. Two attempts to reconstruct the deficit broken down due to excessive tension on the reconstruction. These were performed at the beginning of August and middle of September. The largest part of the defect is on the right side where there 's a large defect of the rectal/vaginal wall.

Three 27mm fast (14-day) expansion profile STEs were placed in the submucosa long the right side of the vagina (see photos), retaining sutures were placed cranially and ventrally to prevent device migration.

Comment/observations:
  • Implantation surgery proceeded well on the 25th of December 2014 (day 0)
    • Standing sedation on detomidine CRI. An epidural and local anaesthetic around the surgical site was used
    • The site was prepared aseptically, pre-operative antibiotic, Depocillian (Procain penicillian) and a non-steroidal anti-inflammatory was used (phenylbutazone)
    • Three individual pockets were made in the submucosa along the defect border on the right side. The mucosa was closed with vicryl suture material
    • Retaining sutures were placed cranially and ventrally (to prevent migration of the devices)
    • The horse was hospitalised for the duration of the device expansion 14 days
    • The two caudal most devices fell out early on in the expansion phase due to wound dehiscences. It is thought that had non-absorbable suture material been used this would not have happened and could be prevented.
    • The most cranial device remained in place for the 14 days of expansion where you can see from the photos an expanded area of mucosa
  • Device removal and reconstruction
    • The device was removed and the reconstruction stage one carried out. Please see drop box photos

    • The extra tissue provided by the tissue expander meant less tension on the reconstruction and this resulted in an excellent stage 1 reconstruction of the vaginal rectal wall

    • The mare went on to have the second stage reconstruction and is now due to be breed this season

Photographic record:
Conclusions/recommendations:

This was a very novel indication for tissue expansion and everyone involved were very pleased with the outcome. Given the dehiscence of two of the mucosal pockets non-absorbable suture material should be used to close the incisions. Given the complication rates and the difficulty in repairing third-degree perineal laceration, the use of tissue expansion as an adjunctive to routine surgery should be considered in this indication.

 

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