Page 149 - Manual of Equine Field Surgery

Tracheostomy 145

and distal to the created stoma, is apposed in a11

interrupted pattern.

POSTOPERATIVE CARE

P91topera ive Care

Exercise Restridion: The horse should be con-

fined to a stall for 2 weeks with controlled hand-

walking only.

Medications: Broad-spectrum antibiotics and

nonsteroidal antiinflammatory agents are recom- A

mended for 1 to 2 days.

Suture Removal: The sutures are removed in

1 O to 14 days.

Other: The surgery site should be cleaned once

or twice daily until the sutures are removed and

once daily indefinitely.

EXPECTED OUTCOME

Tracheostomy sites generally heal with minimal

complications, but slight dehiscence may occur

and may require additional repair. Owners should

be warned that in some cases it may take as long B

as 4 months for sufficient stoma healing to occur Figure 24-3 A, Immediate postoperative appearance

before the required once or twice daily cleaning is of tracheostomy. B, View 3 weeks after surgery.

reduced to maintenance levels. The required long-

term maintenance varies from cleaning once

per day to less than once per month. Long-term

outcome of tracheostomy is generally favorable. stoma size can be repaired by enlargement of the

In one study, more than 900/o of owners were stoma, either by removing the ventral portion of

additional tracheal rings or by removing greater
pleased with the results (Figure 24-3).4
portions of muscle to reduce the tension on the

tracheal mucosa-skin suture line. Removal of a

COMPLICATIONS 3 x 6-cm portion of skin over the stoma site to

decrease the chances of functional appositional

The most common complications include partial closure of the stoma site has also been described. 3

dehiscence of the tracheal mucosa-skin suture Additionally, small elliptical portions of skin may

line, excessive inflammation, granulation tissue be taken out of either side of the stoma after it is

formation, stricture, skin growth or apposition created to reduce the chances of functional appo-

over the tracheostomy site, and coughing. Long- sition. If partial dehiscence occurs, the granula-

term complications include coughing during tion tissue, if present, should be resected and

exercise, stridor, and exercise-induced dyspnea.4 sutures placed to reattach the mucosa to skin.

Complications can be reduced if sufficient por- Tracheostomy affects pulmonary defense

tions of the paired sternothyrohyoideus and por- mechanisms by disruption of the mucociliary

tions of the omohyoideus muscles are removed, escalator, reduced airway temperature control,

the mucosa-to-skin suture line is placed with little and altered humidification of inspired gases.

to no tension, and care is taken to place sutures Horses with preexisting pulmonary disease may

sufficiently close together to eliminate all gaps experience an exacerbation of the existing disease

between mucosal edges or between mucosa and resulting from this reduction in pulmonary

skin. Stricture of the stoma size or insufficient defense mechanisms. 5