Sinocutaneous fistula repair with a masseter muscle transposition flap combined with wound matrix and cancellous bone graft in a horse: A new technique

Abstract

Objective: To describe a new technique to repair a sinocutaneous fistula with a masseter muscle transposition flap. Study design: Case report.Animal: One 13-year-old thoroughbred stallion. Methods: One 13-year-old stallion with a 3.5 × 6-cm sinocutaneous fistula over the right caudal maxillary sinus was treated with a transpositional masseter muscle flap. This repair consisted of a commercial wound matrix dressing placed directly over the hole in the maxilla and secured with suture material; a cancellous bone graft collected from the right tuber coxa placed on the dressing; and a portion of the superficial layer of the masseter muscle, with its pedicle at the facial crest, transposed dorsally over the bone graft, followed by a rotational skin flap with skin rostral to the fistula to close the defect.Results: Seroma formation and dehiscence of the skin flap occurred, but the transposed muscle flap survived, and the technique resulted in successful closure of the sinocutaneous fistula with excellent cosmetic and functional outcome. Conclusion: A chronic maxillary sinocutaneous fistula was successfully treated by using a transposition flap of the masseter muscle and a rotational skin flap with minor complications.Clinical impact: Transposition of the superficial layer of the masseter muscle should be considered for a repair of large maxillary sinocutaneous fistulas in horses.

Surgical repair of a full‐thickness ear pinna defect in a horse

“…Other skin substitutes and scaffolds have been used as biological dressings in horses (Bristol 2005) and to cover periosteal flaps used in the repair of nasocutaneous and sinocutaneous fistulae (Barber and Stashak 2017). In addition, the use of a commercial wound matrix and transpositional muscle flap to repair a sinocutaneous fistula has recently been reported (Yoshimura et al 2020). Although the defect had not entirely filled with granulation tissue before the second surgery, one Pelnac TM mesh was left in situ, utilising the silicone outer layer to provide structural support and prevent dermal desiccation of the subsequent skin graft.…”

“…In addition, the use of a commercial wound matrix and transpositional muscle flap to repair a sinocutaneous fistula has recently been reported (Yoshimura et al . 2020). Although the defect had not entirely filled with granulation tissue before the second surgery, one Pelnac™ mesh was left in situ, utilising the silicone outer layer to provide structural support and prevent dermal desiccation of the subsequent skin graft.…”

“…Where immediate or delayed closure of wounds by first intention healing is not possible, skin grafts or flaps can be employed to avoid the need for second intention healing. Both free skin grafts and pedicle flaps are used to manage ear defects in man and dogs (Pham et al 2003;Lanz and Wood 2004;Papadiochos et al 2017) and have been used to treat horse wounds at other anatomical locations (Stashak and Schumacher 2017;Yoshimura et al 2020). The successful use of a skin graft in treating a cosmetic defect in the outer aspect of a horse's pinna has also been described (Massoni et al 2005), but there are limited descriptions of reconstructive surgery of the equine ear in the literature.…”

“…2017) and have been used to treat horse wounds at other anatomical locations (Stashak and Schumacher 2017; Yoshimura et al . 2020). The successful use of a skin graft in treating a cosmetic defect in the outer aspect of a horse’s pinna has also been described (Massoni et al .…”

Review of skin grafting in equine wounds: Indications and techniques

“…Recently, the use of self-inflating tissue expanders has been described in 20 surgical cases with 75% of cases reaching an excellent clinical outcome (Cullen et al, 2023). The Examples where pedicle grafting has been performed include conjunctival pedicle grafts which are commonly used in ophthalmic procedures (Gilger et al, 2005;Holmberg, 1981;McMullen Jr, 2023) and to cover fistulas over the maxillary sinus in the head region (Yoshimura et al, 2020). This technique has also recently been reported in correcting dermal defects in the ear pinna (Cullen et al, 2022).…”