Much loved horse, 13-year old Domino, was viciously attacked by an assailant with a knife and hammer, while grazing in his field 18 months ago. The assault left him terrified and suffering horrific lacerations across his shoulder and face. He required hours of surgery and months of follow up care, with the public donating thousands of pounds towards his treatment. Nearly a year and a half later, despite everyone’s best efforts, Domino was recovering but was still left with an open fistula in his face. That was until a specialist veterinary surgeon and the Veterinary Wound Library HOPE fund stepped up to restore his health for Christmas.
Following his initial attack, Domino had to have an extended stay and several surgeries at Towcester Equine Vets. Although the care he received, thanks to generous donations from the public and the fund-raising efforts of his owner, Tracey Nash, ensured most of his wounds healed well, there remained a fistula in his face, which extended into the sinus. The missing bone and tissue meant that the fistula would not heal, so Domino needed daily wound cleaning and protection as well as antibiotics for frequent, intermittent infections, which could eventually have caused him severe health complications.
Finally, despairing of a solution, Towcester veterinary team and Tracey asked Georgie Hollis, Founder of the Vet Wound Library for help. Georgie had been involved in similar cases with injuries of this nature and knew they could be very difficult to repair, “This is the fourth case I’ve been involved in where a fistula is left after previous trauma. They seem to be particularly challenging as there is usually little tissue available to fill the gap and we often see a simple flap fail due to the lack of vascular tissue and airflow beneath.I was appalled at Domino’s ordeal and knew that the surgery needed would be complex but that there were specialists who had ideas that could work for him.”
The funds Tracey had raised to help Domino had been largely used to get him to this point. Georgie said “To have got so far only to have Domino put to sleep due to chronic infection after everything he has been through would have been an absolute tragedy.” She decided to support Domino through her newly formed HOPE Fund – a charitable fund which will be used to help animals like Domino, where providing specialist surgery will avoid long term costs and welfare issues on the basis that the experience can be used to teach others how to resolve challenging cases.
Georgie contacted European Specialist in Equine Surgery, Dr. Dylan Gorvy, BVSc PhD Dipl. ECVS, part owner and head of surgery at Mälaren horse clinic near Stockholm in Sweden. She had worked with him before and after explaining Dominio’s story he came up with the proposal plan for surgery and provided his expertise on a minimal cost basis for the Veterinary Wound Library HOPE Fund.
The surgery was performed on the 2nd of November at the Towcester practice. Dylan was accompanied in surgery by Veterinary Nurse Victoria Hegarty and Mike Sheldon BVM&S MRCVS, Towcester Equine Vets practice partner, who covered the anaesthesia and supporting care for Domino during the surgery to ensure he was comfortable throughout. Dylan provided follow up care advice communicating regularly with Mike to ensure things were going to plan.
Mike said “Despite the terrible cause of these injuries, it has been both refreshing and rewarding to be involved and to be able to follow such a challenging case through to a successful conclusion.”
Georgie says the team could not have been happier with how it went, “We have received regular updates from Tracey and the practice and wanted to allow four weeks for the healing of the layers to be complete to be sure the procedure had worked. Thankfully, we can now confirm that it has a complete success and we are all absolutely delighted that Domino can enjoy Christmas as a normal happy horse.”
She continued, “The plan for the Hope Fund is to support the cost of specialists and specialist techniques for veterinary patients of all shapes and sizes with the most challenging wounds. Domino’s case will be used to teach others how to approach these challenging wounds and I know that the lessons learned can help improve the outcomes for patients in the future.”
Dr. Gorvy explained the procedure, “Domino suffered a terrible trauma to the side of the head, that led to the loss of both bone and skin. Because the wound was so large, it was unable to heal by primary intention and resulted in a sinocutaneous fistula. Unfortunately, just suturing the skin over the bone defect usually results in failure of the repair. This is because underneath the skin ﬂap the air-ﬁlled sinus dehydrates the skin and results in it dying.”
He continued, “There are several techniques that can be used to repair the fistula, but a really important principle is to create a barrier with a great blood supply, between the defect and the skin. In Domino’s case, I created two layers of tissue; the first was a periosteal flap and the second, a muscle flap. Periosteum has an excellent blood supply and I lifted up the periosteum from either side of the defect and then flipped it over 180 degrees. This was then stitched together to cover the deficit. The second layer was created by taking one of Domino’s facial muscles, rotating it, and then stitching it in place, providing yet another barrier with a good blood supply. The levator labii superioris muscle lifts up the upper lip but as it’s bilateral, Domino won’t experience any noticeable difference. Once I had my double layer barrier in place, I was able to mobilise his skin to cover the fistula.”
It’s been a great result for Dr Gorvy, “Domino was a fantastic patient during both the surgery and the recovery. The wound has now completely healed after just four weeks and finally, he can live a normal life again, after suffering such a horrendous injury. I’m so pleased to have been able to help him.”
Tracey says she is over the moon to know that Domino is safe and well after all he has been through, “I can’t explain how shocked I felt when I found Domino – I thought I was going to lose him. He’s been through so much and I can’t thank the people who have helped him enough: Towcester vets, Dr Gorvy and Georgie and her team at the Veterinary Wound Library and of course all the people who made donations. They have all gone above and beyond in their efforts to restore Domino to health. We’ll never forget that terrible night but people have been so kind and on behalf of Domino and myself, we offer our heartfelt thanks for everything they have done.”