Management of apposing, full‐thickness tracheal perforations in two horses

Abstract

Summary Two horses, one 15‐year‐old Arabian gelding and one 10‐year‐old Quarter Horse gelding, presented with a history of marked subcutaneous emphysema. The first case exhibited no external wound, although there was a depression noted on the ventral neck. The second case had a laceration on the ventral aspect of the neck over the trachea. Endoscopic examination revealed both horses to have concurrent dorsal and ventral perforations of the trachea. The horses were managed by placing a short, cuffed, J‐shaped tracheostomy tube in the ventral perforation, while the dorsal perforation healed. The dorsal perforation in the first horse was allowed to heal by second intention, whereas sutures were placed in the dorsal perforation in the second case to reduce the healing time. Both horses were maintained on oral antimicrobial and nonsteroidal anti‐inflammatory medications throughout treatment. The dorsal perforation healed after 13 days in the first horse, and 22 days in the second horse. The ventral perforation healed in both horses by second intention following tracheostomy removal, giving a cosmetically acceptable result. In addition to facilitating tracheal healing, the tracheostomy tubes prevented the progression of subcutaneous emphysema, and promoted its resolution.

Use of fibrin sealant in a horse with an intratracheal dorsal laceration

“…More recently, the concurrent presence of dorsal and ventral perforations has been described (Cudmore and Nath ; Gillen et al . ).…”

“…The combination of different diagnostic imaging procedures is recommended to diagnose and evaluate a tracheal lesion and to rule out the presence of further complications such as rib fractures (Gillen et al . ). Although upper airway endoscopy has been described not to be valuable in select cases to make a diagnosis and to determine the exact size and location of the injury (Caron and Townsend ; Saulez et al .…”

Management of tracheal perforations: Potential complications and pitfalls

“…This can be accomplished by inserting a cuffed tracheostomy tube through the tracheal wall defect (Gillen et al . ).…”

“…To avoid expansion of the subcutaneous emphysema and its potential sequelae, the perforation needs to be repaired or airflow should be diverted from the site of injury. This can be accomplished by inserting a cuffed tracheostomy tube through the tracheal wall defect (Gillen et al 2015).…”

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The article in this issue by Gillen et al (2015) describes 2 cases of concurrent ventral and dorsal tracheal perforations. While both horses responded well to the effective treatment, potentially serious complications can develop during the recovery from tracheal wall injuries.

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