Page 5 - Clinical Connections - Autumn 2023

Equine referrals

EQUINE DEGLOVING CASE

Andy Fiske-Jackson, Deputy Head of RVC Equine and Associate Professor in Equine Surgery

annicus, an 11-year-old This, alongside the significant soft tissue This can include stable-based exercises
thoroughbred gelding, spent more damage, led to the decision to place a distal to maintain core stabilisation muscles. With
G than three months at the RVC limb cast. Gannicus, the dedicated nursing team took
Equine Referral Hospital earlier this year time to enrich his environment with various
due to a degloving wound sustained by Recovery and complications toys, including a fruit and vegetable treat
kicking through the side of a horsebox. Gannicus remained in a cast for two weeks. rope.
On presentation the left hindlimb was This required four-hourly checks by our
bandaged and he was reluctant to fully load dedicated team of vets, veterinary nurses
the limb. Removal of the bandage revealed and students. Inevitably, due to the presence
exposure of almost the entire medial aspect of compromised tissue, a significant volume
of the third metatarsal bone, from the distal of wound exudate was seen emanating from
tarsal joints to the fetlock joint. the top of the cast. This led to the decision
There was skin loss, loss of the outer to remove the cast. At this point a significant
surface of the medial metatarsal condyle, amount of granulation tissue had formed,
with marked contamination, and the tendons almost completely covering the previously
and ligaments at the back of the leg were exposed metatarsal bone.
visible. Continued communication between the
fetlock joint and the wound could not be
Diagnostic tests and procedures ruled out but, on account of his comfort, and
Radiographic examination revealed the lack of healthy tissue to close the defect,
substantial soft tissue loss but no evidence Gannicus was maintained in a bandage and
of a fracture. Due to the severity of the soft monitored.
tissue damage and suspicion of infection Approximately two weeks after the cast Environmental enrichment aided recovery
of the fetlock joint, the team elected to take was removed, Gannicus' level of comfort
Gannicus to surgery and perform further decreased and, on sampling the fetlock joint When the cast was removed, the
diagnostics under general anaesthesia. fluid, repeat infection was confirmed. wound showed significant contraction and
A sample of synovial fluid retrieved from Gannicus subsequently underwent a granulation tissue was covering the whole
both the digital flexor tendon sheath and second surgery to lavage the fetlock joint, wound. As the granulation tissue was slightly
fetlock joint confirmed infection of the fetlock and punch skin grafts were placed in the exuberant it was debrided to encourage
joint but not the digital flexor tendon sheath. granulation bed. These were harvested epithelialisation.
The fetlock joint was arthroscopically from the pectoral region. A distal limb cast During subsequent bandage changes the
lavaged, but the degree of tissue loss was placed, which was maintained for a exuberant granulation tissue was treated with
compromised the ability to close the joint period of six weeks. a dehydrating agent, causing it to contract,
capsule completely. allowing continued epithelialisation. He was
The wound was meticulously debrided Environmental enrichment by the then able to be discharged to complete his
but, due to the substantial loss of tissue, nursing team convalescence at home.
could only be partially closed. During the When horses are on box rest for long Gannicus experienced several mild colic
procedure it became evident that the medial periods it is vital that they are given regular episodes during his stay, which resolved
collateral ligament of the fetlock joint was human interaction and stimulation. with medical management. On the last
damaged. occasion there was suspicion of an ileal
impaction, which resolved with intravenous
fluid therapy overnight. These episodes
appeared to be associated with sedation.
Gannicus is now being ridden out and
enjoyed by his owners – something which
seemed so far away at one point! His care
involved the entire team at RVC Equine,
from the students, technicians, nurses and
vets, and his highly dedicated owners who
refused to give up on him.

For equine referrals, please call: 01707
666297
Email:
The wound upon initial presentation The wound after discharge equinehospital@rvc.ac.uk

Autumn 2023 5