Modransky P, Welker B, Pickett J P
Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg.
Vet Clin North Am Equine Pract. 1989 Dec;5(3):665-82. doi: 10.1016/s0749-0739(17)30581-3.
Because of the excellent blood supply to the head region, superficial lacerations to the soft tissue structures of the head generally heal rapidly without treatment. Lacerations of the equine tongue frequently go unnoticed because difficulty in eating usually is not apparent. The majority of lacerations heal if left untreated, with no loss in function. Surgical repair is indicated to promote healing and prevent deformity, to amputate a severely compromised apex, and to alter a scar or defect that is unacceptable to the owner. Surgical principles to be adhered to include thorough debridement and copious lavage, multiple layer closure, and placement of tension sutures away from the primary suture line and tied on the dorsum of the tongue. Full-thickness lip lacerations should be repaired using multiple-layer closure and tension sutures tied on the skin surface away from the primary suture line. Reconstructive techniques have been described for extensive lip lacerations when primary repair was inadequate or tissue loss was severe. Thorough evaluation of the equine lid, adnexa, and orbit is essential in determining severity of injury and appropriate treatment methods as well as for establishment of a prognosis. The injury may be minor or more severe, leading to blindness, disfigurement, or loss of the eye itself. Depression fractures involving the frontal, maxillary, or nasal bones are frequently open fractures. Skin abrasions, epistaxis, facial deformity, crepitus, and pain are clinical signs seen with this type of injury. Bone and soft tissue reconstruction should be performed to minimize potential complications. Facial fractures left untreated can result in facial deformity, sequestration, sinusitis, and osteomyelitis.
由于头部区域血液供应良好，头部软组织结构的浅表裂伤通常无需治疗即可迅速愈合。马舌的裂伤常常不易被察觉，因为通常进食困难并不明显。大多数裂伤若不治疗也能愈合，且功能不会丧失。手术修复适用于促进愈合、防止畸形、切除严重受损的舌尖以及改变主人认为不可接受的瘢痕或缺损。需遵循的手术原则包括彻底清创和大量冲洗、多层缝合，以及在远离主要缝合线的位置放置张力缝线并在舌背打结。全层唇部裂伤应采用多层缝合，并在远离主要缝合线的皮肤表面打结张力缝线进行修复。当一期修复不充分或组织损失严重时，已有针对广泛唇部裂伤的重建技术描述。对马眼睑、附属器和眼眶进行全面评估对于确定损伤的严重程度、合适的治疗方法以及建立预后至关重要。损伤可能较轻或较重，导致失明、毁容或眼球本身丧失。涉及额骨、上颌骨或鼻骨的凹陷性骨折通常为开放性骨折。皮肤擦伤、鼻出血、面部畸形、骨擦音和疼痛是这类损伤的临床症状。应进行骨和软组织重建以尽量减少潜在并发症。未经治疗的面部骨折可导致面部畸形、骨坏死、鼻窦炎和骨髓炎。
