Bone-Flap Surgery

Practical Horseman - - Rassing's lonoir -

Bone-flap pro­ce­dures sound grue­some, and while they are messy, horses tol­er­ate it well, says Ken­neth E. Sullins, DVM, MS, DACVS, a pro­fes­sor of surgery at Mid­west­ern Univer­sity’s Col­lege of Vet­eri­nary Medicine. The wound also heals nicely be­cause of good blood sup­ply in the head. “Horses are pretty tough. Give them some phenylbu­ta­zone and that same evening they’ll have their head stuck in a hay bag.”

How­ever, si­nus surgery can be risky and time is of the essence be­cause the good blood sup­ply that pro­motes heal­ing can hin­der surgery. Dur­ing a stand­ing pro­ce­dure, the horse must re­main quiet so the vet­eri­nar­ian can work quickly and ac­cu­rately. If the horse re­peat­edly shakes or jerks his head, surgery with the horse ly­ing down un­der gen­eral anes­the­sia may be nec­es­sary.

With stand­ing si­nus surgery, there is less blood loss be­cause the horse’s head is above his heart. When he is ly­ing down un­der gen­eral anes­the­sia, there may be in­creased blood loss be­cause the horse’s head is lower. Some horses also panic and thrash when com­ing out of se­da­tion, risk­ing in­jury.

If bleed­ing be­comes pro­fuse or blocks vis­i­bil­ity dur­ing surgery, the si­nus can be packed with gauze to stop the bleed­ing. The flap may then be closed and an­other stand­ing surgery per­formed a few days later to re­move any re­main­ing pieces.

“It’s not usu­ally the le­sion it­self that bleeds. What bleeds is nor­mal mu­cosa and ves­sels when you rip them. You have to get out as quickly as you can with­out caus­ing hem­or­rhage,” Dr. Sullins says.

Even if there is no pro­fuse bleed­ing and Dr. Sullins is able to com­plete a surgery, he usu­ally will re-open a flap and re-eval­u­ate in two or three days. “A huge com­po­nent of si­nus dis­ease does not go away on the first surgery and the rea­son is you can’t see with the bleed­ing. So un­pack it, flush it out, put a scope in there and look at all the cor­ners. My opin­ion is that’s what makes [the treat­ment] work.”

Dr. Sullins stud­ied 91 cases of horses who un­der­went stand­ing si­nus flaps us­ing this post-oper­a­tive treat­ment pro­to­col and pub­lished his find­ings with coau­thor Sa­man­tha K. Hart in the Equine Vet­eri­nar­ian Jour­nal in 2011. In a pa­per ti­tled “Eval­u­a­tion of a novel post-oper­a­tive treat­ment for sinonasal dis­ease in the horse,” they con­cluded this to be a “safe and ef­fec­tive means to thor­oughly as­sess and treat sinonasal dis­ease” that may help “re­duce long-term com­pli­ca­tions and re­cur­rence rates.”

For medium to large masses, the best way to ac­cess the si­nuses and en­sure that all ab­nor­mal tis­sue has been re­moved is to per­form a fron­tonasal bone flap, which can be done while the horse is se­dated and stand­ing or un­der gen­eral anes­the­sia.

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