Clinical Connections  –  Autumn 2016

A horse was treated at the RVC’s Equine Referral Hospital after becoming caught up in a fence, which left barbed wire and hedge material embedded in her wounds.    

Ginger, a seven-year-old Hanoverian used for leisure riding, was found to be non-weight-bearing when her owner did her usual morning check. To her horror she discovered that during the night Ginger had suffered a severe laceration to the coronary band.

There were parts of a bramble hedge embedded in the wound and a lot of swelling. There had been a considerable amount of blood loss, although the bleeding had almost stopped by the time Ginger was found. The owner then called her practice, who attended immediately.

The veterinary surgeon attending could see it was likely that the wound involved synovial structures and that there was heavy contamination, in addition to the foreign body in the wound. There was also a visible laceration to the flexor tendon.

Given the serious, potentially life-threatening, nature of the injuries, the vet referred Ginger to the RVC referral team. She was given an anti-inflammatory drug (flunixin meglumine) and a nerve block was placed to desensitise the injured region prior to transport.

On arrival to the Equine Referral Hospital, Ginger was admitted by the surgery service. A blood sample indicated that, although she had lost blood from the wound, she did not require a transfusion.

Scan showing extent of damage

Having been sedated, the wound was evaluated by the diagnostic imaging team using radiography, and the integrity of adjacent synovial structures assessed by contrast radiography. The investigations revealed that not only was there a piece of hedge and other plant material in the wound but also that a barbed wire spike was embedded deep in the wound into the coffin joint.

Contrast radiography confirmed that the coffin joint had been punctured but, luckily, that the adjacent joints 
and tendon sheaths were intact. A 
sample of coffin joint fluid confirmed bacterial infection.

Ginger was immediately prepared for surgery and, under general anaesthesia, the wound was opened up, explored, debrided and the foreign bodies removed. The damaged joint was flushed using an arthroscope and pieces of plant material were removed from within the joint.

The partially severed flexor tendon was also debrided surgically to remove the damaged and infected tissue. The wound was repaired and a cast was applied to support the area and reduce the amount of tension and movement on the wound.

Commenting on her recovery, Equine Referral Hospital Clinical Director Josh Slater said: “Ginger recovered well from her anaesthetic and within a day of surgery was much more comfortable and was able to bear weight. She spent two weeks in the hospital being treated with pain relief, antimicrobials and with her cast monitored for problems.

“At the end of the two weeks Ginger was weight-bearing well and judged sufficiently out of danger to be allowed home. Two weeks later the cast was removed and, to the owner’s delight, the wound had healed remarkably well. Ginger continues to make good progress and it is likely she will return to full athletic use having had a very lucky escape from what could have been a fatal injury.”

Wound post-surgery

Equine Referral Hospital PSS

The Equine Referral Hospital has joined RVC Small Animal Referrals in gaining ‘Outstanding’ designations across the board from the revised Practice Standards Scheme (PSS). The Hospital was judged Outstanding in the four key categories of ‘Client Service’, ‘In-patient Service’, ‘Team and Professional Responsibility’ and ‘Diagnostic Service’. The awards were made after two visits from PSS assessors, who examined the facilities and systems in place to ensure exceptional care, and also interviewed a broad range of team members to ensure that these systems translated to the highest possible standards.

The revised PSS requires all members of the clinical team to be working and thinking to the highest possible standards, and for behaviours to be driving a strong culture of continuous improvement in patient care, where performance is measured, changes are made and outcomes audited.Commenting on the team’s success, Professor Josh Slater, Clinical Director of the Hospital, said: “The inspectors were not only impressed with our outstanding facilities and equipment but also with the professionalism, commitment and enthusiasm of everyone in the RVC equine team they talked to. These awards are designed to be difficult, and it is a magnificent team effort to have been awarded Outstanding for each of these awards. Our achievement reflects our commitment to delivering the very highest standards of patient care and to our culture of continuous improvement in everything we do.”

As reported in the summer issue of Clinical Connections, RVC Small Animal Referrals also received Outstanding designations. The categories assessed included ‘In-patient Service’, ‘Team and Professional Responsibility’, ‘Diagnostic Service’ and ‘Emergency and Critical Service’.

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