Wednesday, February 10, 2010

Wednesday, Feb 10, 2010 Face Lacerations

Vet Tip of the Day: Facial Lacerations
Key Words/Phrases: Wound healing, primary closure, golden period

We've been hammering limb anatomy and lameness for over a week, so I think it's time to take a break and look at something entirely different. Facial lacerations are a relaxing break out topic because while they often start with a horrified horse owner and a gaping wound such as this one, they are simple to treat and usually end with an excellent outcome.

The tissues of the face have a tremendous blood supply, and because blood is what carries all the magical factors necessary for wound healing to the site of injury, lacerations on the face have a healing advantage not present in other areas of the body.

The first six hours after a skin laceration occurs is called the "golden period" in wound healing.   In general, sutures placed in a wound more than 6 hours after its occurrence are likely to fail, no matter how carefully the wound is prepared and how correctly the sutures are placed.  With every minute that passes after a laceration is sustained, exposure to external factors increases the risk of infection while at the same time the lack of blood supply to exposed tissues decreases the chance that tissue will remain alive and reattach when sutured.  The one anatomical exception to the "golden period" rule applies to facial lacerations, where wounds often heal uneventfully when sutured 24 hours or more after they occur.  Even large wounds filled with debris that involve skin flaps with wide areas of exposed underlying bone usually heal well, due to the excellent blood supply to tissues of the face.

The horse pictured here sustained a high impact injury involving a rigid metal object. Following sedation with 10 mg of intravenous detomidine, and subcutaneous placement of a local anesthetic around the wound margins, this horse's wound was carefully cleaned with dilute betadine, then flushed copiously with sterile saline.   Skin staples were used to hold the skin flap back in position.  The staples were removed 14 days later and as you can see, the wound healed without any skin loss.  Even if you find a severe face laceration that is over 12 hours old (the thunderstorm during the night is a classic for this), don't despair - primary closure may still be possible and successful.

Horses that sustain lacerations to the face and have concurrent nose bleeds should always receive antibiotics.  The presence of bleeding at the nose indicates that the concussive force may have been severe enough to cause bleeding into one of the sinuses that underlie much of the space beneath your horse's forehead and nose.  Because the sinus cavities communicate with the nasal passages, bacteria in the nasal passages can gain access to the sinus.  If there are broken blood vessels in the sinus, bacterial infection (sinusitis) can set up housekeeping in the sinus cavity.  Treating a well established bacterial sinusitis is difficult, and the need to do so can be avoided by initiating antibiotic treatment at the time of facial trauma.  So don't forget - face lacerations accompanied by nose bleeds should be seen by your veterinarian, even if the laceration itself is not severe.

I'm late writing the Veterinary Tale for this week, so it may not get posted tomorrow, but I'll do my best to get it to you soon.  The practice website is being updated this week.  I really like the new look and will let you know as soon as it is on line so you can check it out and give us your opinion.

The sun was out today in Reno - halleluiah! We used to take it for granted, but after this winter, no longer.



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