Surgical Closure of Equine Abdomen, Prevention, and Management of Incisional Complications

Complications of equine ventral midline laparotomy incisions are unpopular because even if they are rarely life-threatening, they increase hospitalization, cost, and duration, and they may prevent return to athletic function. In this study, we addressed the prevention and management of complications related to equine ventral midline laparotomy.

We have implemented negative pressure therapy, not only as a treatment of post incisional infections requiring drainage, but also on close incisions with a higher risk of infection. Although large numbers would be needed to further establish the benefit of this technique, it proved saved and seemed to facilitate healing.

We are now looking at alternative tracings to protect the surgical incision during the postoperative period.

[Narrator] After performing the ventral midline laparotomy on the anesthetized horse, dissect the subcutaneous tissue one to two centimeters along the line of the incision. To pre-place tension sutures of the vertical U-mattress, place the far-far loop, approximately 1.5 centimeters from the linea alba incision and the near-near loop about 0.5 centimeters from the incision. Maintain each suture with long strands and place a hemostatic clamp on both strands of each suture. Once all sutures are pre-placed, have an assistant hold them under tension and knot each of them separately. Next, place interrupted sutures in between the vertical mattress sutures to obtain a tight closure of the linea alba. Verify the tightness of the closure with the closed tip of a needle holder. Rinse the incision with one liter of saline solution and remove blood clots using gauze. Using a zero metric poliglecaprone suture, thread it on a cutting needle. Close the subcutaneous tissue in a simple continuous suture pattern. Apply staples on the skin at every five millimeters. Put on a moisture vapor permeable spray, dressing over the incision, and cover it with sterile gauze. Then cover the ventral abdomen with a non-iota 4 adhesive drape. Immediately upon arrival in the recovery stall, lift the horse and, with the help of an assistant, place a gamgee cotton over the incision. Then roll elastic adhesive bands over the cotton and around the abdomen. Apply tape over the elastic band at the cranial and caudal ends of the bandage. After the recovery of the horse from anesthesia, remove the entire bandage, including the adhesive drape. Inspect the surgical site and apply gentle pressure on the incision to evacuate any accumulated subcutaneous blood. With the help of an assistant, place a gamgee cotton covered by a layer of antiseptic ointment in contact with the ventral incision and two rolled gamgee cotton pads on each side of the dorsal spine. Roll elastic adhesive bands around the abdomen and apply tape over the elastic band at the cranial and caudal parts of the bandage. After evacuating accumulated subcutaneous blood, as demonstrated previously, apply a thin layer of sterile antiseptic gel over the incision. To apply a negative pressure bandage, use a sterile paper ruler to measure the incision length. While protecting the surgical incision with sterile gauze, spray the ventral abdomen with adhesive spray. Then remove the gauze and leave the glue to set for approximately two minutes. Cut the specific foam dressing five centimeters longer than the surgical incision. Remove protective film numbered 1 from the foam dressing. After cutting two small hydrocolloid strips, apply them to the cranial and the caudal ends of the dressing on the side that will contact the skin. Now, apply the negative pressure dressing over the incision with the white tissue side in contact with the skin and purple foam outside. Remove the protective film numbered 2 from the foam dressing. Remove the central protective layer numbered 1 on the adhesive drape, and apply the drape over the foam dressing on the ventral abdomen of the horse. Then peel away the lateral protective layers numbered 1 and pat the drape on the skin to form a seal. Now, remove the external protective layer numbered 2 and perforated blue handling tabs from the extremities of the drape. Overlap several adhesive drapes on the ventral abdomen to cover the entire dressing and form a seal with the surrounding intact skin over seven centimeters in all directions. Pinch the adhesive drapes at the center of the foam and, using scissors or a scalpel blade, create a two-centimeter hole. Remove the protective layer numbered 1 on the pad and apply it with the pad opening in the central disc. After removing the protective layer number 2, pat the central disc and pull back the external blue tab. Suspend the negative pressure therapy machine above the horse and the electric cables with isolating foam polyethylene sheaths. Insert the canister into the machine and connect the pad tubing to the canister tubing. Switch on the machine and adjust the negative pressure to minus 125 millimeters of mercury in a continuous mode. To confirm the accurate performance of the negative pressure therapy, observe the flattening of the foam against the wound, achievement of desired negative pressure, and absence of an audible alarm sound. To apply a negative pressure bandage on an open wound, use a sterile paper ruler to measure the wound length. While protecting the open wound with sterile gauze, apply an adhesive spray on the ventral abdomen. Cut a piece of silver foam to the exact dimensions of the wound and place the foam on the wound and inside the cutaneous rims, ensuring it does not overlap intact skin. After following the steps of the placement of the negative pressure bandage as demonstrated for closed wounds, place an abdominal hernia belt over the elastic bandage to prevent the risk of abdominal hernia formation. To begin, place the wounded anesthetized horse in a dorsal recumbent position. Once the horse is prepared aseptically and draped for the surgery, cut sterile stainless steel cerclage wire into 50 to 60 centimeter segments. After removal of all infected tissue from the edge of the incision, using a 14-gauge eight-centimeter long needle, pre-place cerclage wires in an interrupted vertical U-mattress pattern three centimeters apart through the horse skin, subcutaneous tissue, and muscular layer. Once all cerclage wires are pre placed, place several retention sutures of six metric polyglactin 910 between the cerclage wire while an assistant maintains tension on the polyglactin sutures. Knot each suture separately to achieve incision edge apposition. Next, while assistants maintain maximal tension on the cerclage wires, twist the ends of each vertical mattress suture separately. Using cutting pliers, cut the ends of each wire to a three-centimeter length, then tuck and glue the cut ends of the wires into a section of plastic tubing. Remove the polyglactin 910 sutures. Apply a moisture vapor permeable spray, dressing over the incision, and cover it with sterile gauze. Finally, cover the ventral abdomen with a non-iota 4 adhesive drape. The retrospective study examined 606 laparotomies performed on 564 horses presenting with colic. Incisional complications were reported in 9.5% of cases after a single laparotomy and 33.3% after a repeat laparotomy. The rate of actual incisional infection was 5.3% for single laparotomy and 26.7% for repeat laparotomy. The incisional complications included serous, or seros-sanguinous discharge, hematoma, infection, acute, partial, or complete wound breakdown, and hernia formation without infection.