Repair large defects with inverted periosteal or muscle flaps combined with a cancellous bone graft.
Fig. S4L: A foal with a frontocutaneous fistula adjacent to the right eye.
Fig. S4N: A cancellous bone graft was subsequently applied over the periosteal flap.
Fig. S4M: From either side of the bone defect a periosteal flap was dissected free and sutured closed over the bone defect.
Fig. S4O: For tensionless closure of the skin defect, a relief incision was necessary.
Fig. S4P: A good cosmetic result was achieved with this reconstructed approach. An ultrasonographically bony union could be verified 3 months later.
4.2.5 Postoperative management
Take every precaution to prevent trauma during the recovery period. The surgical site should be protected by bandaging and/or a padded hood. Prevent subcutaneous accumulation of fluids by the insertion of drains. Anti-inflammatory drugs and antibiotics are mandatory to control inflammation and prevent postoperative infection. Sutures and any tension reduction devices should be removed 2–3 weeks postoperatively.
Prevent trauma to the surgical site during the postoperative period.
4.2.6 Complications
Complications include breakdown of the fixation through external trauma or selfmutilation. This may lead to disfigurement; possibly to sloughing of vital tissue. Postoperative infection is the only other important complication and should be prevented if at all possible. Both these complications may dictate further revision. Revision may also be indicated in cases in which per primam fixation was not possible.
4.3 References
1. Auer JA (1996) Internal fixation of long bone fractures in cattle/mandibular fractures in the horse. Proc Symp Am Coll Vet Surg; 6:72.
2. Beard W (1998) The skull, maxilla, and mandible. In: Auer JA, Stick JA, editors. Equine Surgery. 2nd ed. Philadelphia: W.B. Saunders Co, 887.
3. Park RD (1993) Radiographic examination of the equine head. Vet Clin North Am Equine Pract; 9:49–74.
4. Meagher DM, Trout DR (1980) Fractures of the mandible and premaxilla in the horse. Proc Am Assoc Equine Pract; 26:181.
5. DeBowes RM, Cannon JH, Grant BD, et al. (1981) Lag screw fixation of rostral mandibular fractures in the horse. Vet Surg; 10:153.
6. Gabel AA (1969) A method of surgical repair of the fractured mandible in the horse. J Am Vet Med Assoc; 155:1831–1834.
7. Colahan PT, Pascoe JR (1983) Stabilization of equine and bovine mandibular and maxillary fractures, using an acrylic splint. J Am Vet Med Assoc; 182:1117.
8. Dart AJ, Pascoe JR (1987) Treatment of a bilateral mandibular fracture in a mare using an intraoral acrylic splint. Aust Vet J; 64:382.
9. Krahwinkel DJ, Heffernan HJ, Ewbank RL (1969) Surgical repair of fractured maxillae and premaxillae in a horse. J Am Vet Med Assoc; 154:53–57.
10. Wallace CE (1971) Repair by open reduction of fractured mandible in a stallion. Aust Vet J; 47:57–60.
11. Wilson DG, Trent AM, Crawford WH (1990) A surgical approach to the ramus of the mandible in cattle and horses. Case reports of a bull and a horse. Vet Surg; 19:191.
12. Von Saldern FC, Gawaz M (1993) The dental intraoral fixation of mandibular fractures with dynamic compression plates (DCP) in the horse. Proc Ann Meet Europ Coll Vet Surg; 2:29.
13. Lischer CJ, Fluri E, Kaser-Hotz B, et al. (1997) Pinless external fixation of mandible fractures in cattle. Vet Surg; 26:14–19.
14. Turner AS (1979) Surgical management of depression fractures of the equine skull. Vet Surg; 8:29.
15. Blackford JT, Hanselka DV, Heitman JM, et al. (1985) Non-invasive technique for reduction of zygomatic process fractures in the horse. Vet Surg; 14:21.
16. Caron JP, Barber SM, Bailey JV, et al. (1986) Periorbital skull fractures in five horses. J Am Vet Med Assoc; 188:280–284.
17. Burba DJ, Collier MA (1991) T-plate repair of fracture of the nasal bones in a horse. J Am Vet Med Assoc; 199:909–912.
18. Bohanon TC, Gabel AA (1991) Cosmetic repair of a facial deformity by use of a silicone implant in a horse. J Am Vet Med Assoc; 198:1957.
19. Valdez H, Rook JS (1981) Use of fluorocarbon polymer and carbon fiber for restoration of facial contour in a horse. J Am Vet Med Assoc; 178:249.
20. Schumacher J, Auer JA, Shamis L (1985) Repair of facial defects with periosteal flaps in two horses. Vet Surg; 14:235.
21. Campbell ML, Peyton LC (1984) Muscle flap closure of a frontocutaneous fistula in a horse. Vet Surg; 13:185.
4.3.1 Online references
See online references on the PEOS internet home page for this chapter:
http://www.aopublishing.org/PEOS/04.htm
Dean W. Richardson
5.1 Description
Slab