Traumatic wounds in horses often occur due to accidents in the pasture, barn, or even during travel or exercise. These wounds can be difficult for veterinarians to close with traditional suture techniques because they are typically irregular in shape and might vary in depth. Traditional surgical suture techniques can also fail to control the tension in traumatic wounds, and increased tension can lead to dehiscence, or the separation of the wound edges, which prolongs healing time.

Surgeons from Sweden, the U.K., and Australia have found a potential solution to reducing tension in traumatic equine wounds—a method referred to as the Tension Tile System (TTS).

“The Tension Tile system is a tension-relief technique designed to take advantage of the biomechanical properties of the skin by providing a wide surface area in contact with the skin, which reduces the risk of pressure-related damage,” said Francesco Comino, DVM, resident in equine surgery at the Swedish University of Agricultural Sciences, University Animal Hospital, in Uppsala, Sweden. In comparison, he said, more traditional suture techniques alone or combined with buttons or rubber tubing inadequately spread the pressure, increasing the risk of skin necrosis (death of skin cells).

Comino’s residency supervisor, Dylan Gorvy, Dipl. ECVS, was the first to adapt and try the wound closure technique, based on a suture technique developed in 2015 for closing large wounds in humans, on horses. The technique involves using the plastic backing of standard suture packs (Tension Tiles), and attaching them to the skin with four sutures on either side of the wound, Comino said. Using a special suture pattern, all shearing force is transmitted to the Tension Tiles, distributing the tension to the healthy skin surface area away from the wound.

From 2017 to 2021 the surgeons evaluated the effect of the Tension Tile System on traumatic wounds of 191 horses in Sweden, the U.K., and Australia. Specialists in equine surgery performed the procedure. The horses involved in the study were 3 months to 23 years old and of different breeds and sizes. “We classified the wounds according to their anatomical location, time elapsed before (surgical wound closure), depth of the wound, complicating factors, and post-surgical use of immobilization (preventing any movement around the wound area),” Comino said. The majority of the wounds were located on the limbs.

Two weeks after each procedure (the standard time for suture removal), the researchers assessed the success of primary intention healing, or using as much original skin as possible to close the wound. “Primary intention healing was achieved irrespective of the depth of the wound, complicating factors, or time elapsed before surgery,” said Comino. “However, good immobilization is mandatory in high-motion areas, which helps to counteract the dynamic forces generated on the skin during movement,” Comino said. None of the 191 horses experienced any complications secondary to their wounds.

Using the Tension Tile System, the success rate of primary intention healing increased to 69% compared to 28% in a large retrospective study from 2002 using traditional suture techniques, and 58% of all horses involved in the current study recovered within three to four weeks of their procedures.

“The advantage of the Tension Tile System compared with a traditional suture technique is the massive improvement in successful primary intention healing (meaning no excessive scar tissue), even in wounds considered impossible to close,” said Comino. “If this is achieved through correct surgical management, horses can often return to work within four weeks of injury.”

Therefore, the researchers said they consider the Tension Tile System a safe, effective, and economical surgical technique to treat large and complex equine wounds under tension. “We should always avoid secondary (intention) healing and aim for primary closure whenever possible,” Comino said. This will reduce overall recovery time in horses, he said, including stressful stall rest, and enable a faster return to work.

The study, “A novel tension relief technique to aid the primary closure of traumatic equine wounds under excessive tension,” was published in the Equine Veterinary Journal in August 2023.