Incisional complications after skin closure with n-butyl cyanoacrylate or stainless-steel skin staples in horses undergoing colic surgery

A systematic review of the prevalence of post-operative complications after general anaesthesia in adult horses (2000-2023)

BACKGROUND

Equine post-operative morbidity represents a significant concern for both veterinary surgeons and horse owners.

OBJECTIVES

To estimate the prevalence of post-operative complications in horses after elective/non-abdominal surgery or colic surgery.

STUDY DESIGN

Systematic review.

METHODS

A database search identified eligible studies which reported the prevalence of equine post-operative complications published as a full paper in English in a peer-reviewed journal between 2000 and 2023. Studies were evaluated using the JBI Critical Appraisal Checklist for Prevalence Studies and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework. Data for the most commonly reported complications were analysed using Chi-squared analysis of weighted means to answer 13 PICO (Population, Intervention, Comparator and Outcomes) questions.

RESULTS

Sixty-seven studies met inclusion criteria. Data for eight post-operative morbidities (colic, surgical site complications, myopathy/neuropathy, laminitis, diarrhoea/colitis, fever/pyrexia, jugular thrombophlebitis/thrombosis, respiratory complications) were sufficient to allow statistical analyses. The weighted mean of the overall proportion of post-operative complications after elective/non-abdominal surgery is 17.48% (95% confidence interval [95% CI]: 13.20-22.92), significantly increasing to 55.62% (95% CI: 45.79-65.03) after colic surgery (odds ratio [OR] 6.63; 95% CI: 5.83-7.56; p < 0.001). The most commonly reported morbidity was post-operative colic, with a weighted mean prevalence of 7.45% (95% CI: 4.83-11.76) after elective/non-abdominal surgery, significantly rising to 26.46% (95% CI: 19.11-35.97) after colic surgery (OR 4.11; 95% CI: 3.60-4.71; p < 0.001). The weighted mean prevalence of surgical site complications, laminitis, diarrhoea/colitis, fever/pyrexia, jugular thrombophlebitis/thrombosis and respiratory complications were significantly higher after colic surgery compared with elective/non-abdominal surgery. Myopathy/neuropathy was the only morbidity where prevalence was not different between groups (OR 1.86; 95% CI: 0.86-4.16; p = 0.16).

MAIN LIMITATIONS

The majority of studies were retrospective. Morbidity definitions, data collection periods, follow-up time and methods varied between studies.

CONCLUSIONS

Based on current evidence, the prevalence of post-operative colic, surgical site complications, laminitis, diarrhoea/colitis, fever/pyrexia, jugular thrombophlebitis/thrombosis and respiratory complications is significantly higher after colic surgery compared with elective/non-abdominal surgery under general anaesthesia.

Pectin-honey hydrogel to prevent laparotomy surgical site infection in horses: A pilot study

Surgical site infection (SSI) is a common complication after celiotomy in horses, leading to increased morbidity and costs. Increased concern about antibiotic resistance justifies evaluation of alternative preventive approaches, such a Manuka honey which has displayed antimicrobial properties. Pectin-Honey Hydrogels (PHH), composed by Manuka honey and pectin provide a moist wound environment and microbial growth inhibition. The aim of the study was to evaluate the effectiveness of PHHs in preventing SSI in horses subjected to emergency laparotomy. Horses undergoing laparotomy were evaluated. Horses were randomly divided into two groups: Group 1 received PHH application onto the sutured linea alba before skin closure, while Group 2 received no treatment. Horses with postoperative antimicrobial administration or survival of less than 5 days were excluded. The incidence of SSIs was reported as percentages and compared between groups. Out of 44 horses enrolled in the study, only thirty-six were ultimately included. Exclusions occurred either due to death before 5 days postoperatively (2 horses) or the administration of postoperative antimicrobials (6 horses). The median length of hospitalization was 9 days (range 8-14 days). The overall occurrence of SSI was 19.4 %. One out of eighteen horses (5.5 %) in Group 1 and 6 out of 18 (33.3 %) horses in Group 2 developed SSI. Group 2 had an 8.5-fold increased risk of SSI (p = 0.035, OR = 8.5, 95 % CI. 0.9-80.07). No macroscopically visible adverse reactions were associated with PHH. PHH placed at the abdominal incision during surgery was safe and reduced the prevalence of SSI in horses.

Colic Surgery: Recent Updates

The following article provides an overview of the last 5 years of research and innovation within the field of equine colic surgery, focusing on new techniques, new or recently described lesions, prevention of lesion recurrence or postoperative complications, and updates in prognoses. Early surgical intervention is an important factor in horse survival.

Benefits of cyanoacrylate mesh closure following exploratory laparotomy in horses

BACKGROUND

Skin closure of laparotomy incisions using topical 2-octyl cyanoacrylate (2-OCA) mesh provides a secure bactericidal barrier in humans, which may reduce the risk of postoperative incisional complications. However, the benefits of using this mesh have not been objectively assessed in horses.

METHODS

From 2009 to 2020, three methods of skin closure were used following laparotomy for acute colic, including metallic staples (MS), suture (ST) and cyanoacrylate mesh (DP). The closure method was not randomised. Owners were contacted 3 months or more after the surgery to record any postoperative complications that occurred. For each method of closure, the rates of surgical site infection (SSI) and herniation were recorded, as well as surgical time and treatment costs, including those for incisional complications. Chi-square testing and logistic regression modelling were used to assess differences between the groups.

RESULTS

A total of 110 horses were recruited (45 in the DP group, 49 in the MS group and 16 in the ST group) The overall rate of SSI was 15.5%, with rates of 8.9%, 18.4% and 25% for the DP, MS and ST groups, respectively (p = 0.23). In addition, incisional hernias developed in 21.8% of cases, with 8.9%, 34.7% and 18.8% of horses in the DP, MS and ST groups, respectively, being affected (p = 0.009). The median total treatment cost did not differ significantly between groups (p = 0.47).

LIMITATION

This was a retrospective study with non-randomised choice of closure method.

CONCLUSIONS

No significant differences in the rate of SSI or overall cost wwere demonstrated between treatment groups. However, MS was associated with a higher rate of hernia formation than DP or ST. Despite increased capital cost, 2-OCA proved to be a safe skin closure method in horses and was no more expensive than DP or ST by the time visits to remove sutures/staples and treat infections were factored in.

Comparison of the zip skin closure system with conventional suture for skin closure of ventral midline incisions in horses

OBJECTIVE

To compare the application and healing of the zip skin closure system (ZSCS) with sutured closure by use of a split-scar model of ventral midline incisions in horses in a prospective, randomized experimental study.

ANIMALS

8 adult horses.

PROCEDURES

All horses underwent an exploratory ventral midline celiotomy with a standardized 30-cm skin incision. Each horse was randomized to have either the cranial 15 cm closed with suture and caudal 15 cm with the ZSCS or vice versa (split-scar model). Skin closure time was recorded and compared. Photography and skin biopsies were taken preoperatively and 14 days postoperatively. Cosmetic appearance was assessed by use of a proposed equine celiotomy incision score. Healing at 14 days was assessed by histopathology.

RESULTS

Skin closure times were faster with the ZSCS compared to sutured incisions. At 14 days postoperatively, the cosmetic appearance (equine celiotomy incision scores) for ZSCS incisions were better than sutured closure and histologic healing scores were not different between methods of closure. Subcuticular sutures were associated with deep dermal inflammation and necrosis independent of epidermal closure methods.

CLINICAL RELEVANCE

While limitations to the utility of the ZSCS are recognized, the potential benefits of expedient closure, good cosmetic outcome, and satisfactory healing make this method viable for closure of linear wounds or incisions in horses.