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Topic:Diagnostic Imaging

Diagnostic imaging in horses encompasses a range of techniques used to visualize the internal structures of the equine body for the purpose of diagnosis and treatment planning. These techniques include radiography, ultrasonography, magnetic resonance imaging (MRI), computed tomography (CT), and nuclear scintigraphy. Each modality offers unique advantages in assessing different tissues and conditions, such as bone fractures, soft tissue injuries, and joint abnormalities. Radiography is commonly employed for evaluating bone structures, while ultrasonography is frequently used for soft tissue assessment. MRI and CT provide detailed cross-sectional images, facilitating the examination of complex anatomical regions. Nuclear scintigraphy can detect areas of increased bone activity, often used in lameness evaluations. This page compiles peer-reviewed research studies and scholarly articles that explore the applications, advancements, and comparative effectiveness of diagnostic imaging modalities in equine veterinary practice.
Erythrocytosis and fatigue fractures associated with hepatoblastoma in a 3-year-old gelding.
Journal of the South African Veterinary Association    March 28, 2019   Volume 90 e1-e5 doi: 10.4102/jsava.v90i0.1708
Tirosh-Levy S, Perl S, Valentine BA, Kelmer G.Hepatoblastoma was diagnosed in a 3-year-old Thoroughbred gelding presented with forelimb lameness with bilateral fatigue fractures of the proximal third metacarpal bones. An abdominal mass was detected on ultrasound examination of the abdomen. Absolute erythrocytosis was diagnosed after clinical and haematological evaluation. The fractured metacarpal bones were surgically removed but complications after surgery were fatal. The liver mass was diagnosed as a hepatoblastoma based on histology and immunochemical staining. The combination of hepatoblastoma and fatigue fractures has not been descri...
Transcutaneous Ultrasonography Is a Feasible Method for Characterizing the Cricoarytenoideus Dorsalis Muscle in Horses.
Journal of equine veterinary science    March 21, 2019   Volume 77 121-124 doi: 10.1016/j.jevs.2019.03.007
Satoh M, Higuchi T, Inoue S, Miyakoshi D, Gotoh T.Assessment of the cricoarytenoideus dorsalis muscle (CAD) in horses using a transesophageal ultrasound, computed tomography, or magnetic resonance imaging is available in a limited number of hospitals. This study assessed the ease of ultrasonographic imaging of the CAD using an external transcutaneous technique in horses. After confirmation of the CAD in the cadavers, ultrasonography in twenty live horses was carried out using a transcutaneous approach. In live horses, ultrasonographic imaging of the CAD was possible by pushing the larynx from the opposite side with the other hand. It is belie...
Standing magnetic resonance imaging of distal phalanx fractures in 6 cases of Thoroughbred racehorse.
The Journal of veterinary medical science    March 21, 2019   Volume 81, Issue 5 689-693 doi: 10.1292/jvms.18-0183
Mizobe F, Nomura M, Kanai K, Ishikawa Y, Yamada K.Six Thoroughbred racehorses with palmar process fractures of the distal phalanx were evaluated with standing magnetic resonance imaging (sMRI). In all the cases, the fractures were detectable on T1-weighted images and fat-suppressed images. Furthermore, multi-planar reconstruction images were useful for assessing the articular involvement of the fractures. Follow-up sMRI was obtainable in 3 cases, which revealed that the area of high signal intensity on fat-suppressed images decreased over time as symptoms improved. Our findings support the use of sMRI for the detailed evaluation of distal pha...
Use of non-contrast-enhanced computed tomography to identify deep digital flexor tendinopathy in horses with lameness: 28 cases (2014-2016).
Journal of the American Veterinary Medical Association    March 20, 2019   Volume 254, Issue 7 852-858 doi: 10.2460/javma.254.7.852
Jones ARE, Ragle CA, Mattoon JS, Sanz MG.To describe the use of non-contrast-enhanced CT to identify deep digital flexor (DDF) tendinopathy in horses with lameness attributed to pain in regions distal to the metatarsophalangeal or metacarpophalangeal joints. Methods: Retrospective case series. Methods: 28 client-owned horses. Methods: Medical records were searched to identify horses that underwent non-contrast-enhanced CT with or without high-field MRI as part of an evaluation for lameness localized to areas distal to the metacarpophalangeal or metatarsophalangeal joint in ≥ 1 limb. Horses were included in the study if they had ≥...
The Risk of a Shod and Unshod Horse Kick to Create Orbital Fractures in Equine Cadaveric Skulls.
Veterinary and comparative orthopaedics and traumatology : V.C.O.T    March 18, 2019   Volume 32, Issue 4 282-288 doi: 10.1055/s-0039-1683368
Joss R, Baschnagel F, Ohlerth S, Piskoty G, Fürst A, Bischofberger AS. The aim of this study was to compare the potential of an unshod and shod hoof to cause an orbital fracture in the event of a kick. Methods:  Thirty-four equine cadaveric orbitae were exposed to a steel or horn impactor in a dropping test set-up. An impactor velocity of 7 m/s was used for both materials. Testing was repeated on the same orbit at a velocity of 10 m/s with the horn impactor if no damage occurred. A high-speed camera was used to analyse the impact process. Physical parameters (peak force and impact duration) were calculated based on quantitative video-tracking. Computed tomog...
Gastrointestinal effects of general anaesthesia in horses undergoing non abdominal surgery: focus on the clinical parameters and ultrasonographic images.
Research in veterinary science    March 13, 2019   Volume 124 123-128 doi: 10.1016/j.rvsc.2019.03.011
Salciccia A, Gougnard A, Grulke S, de la Rebière de Pouyade G, Libertiaux V, Busoni V, Sandersen C, Serteyn D.The ultrasonographic images of the gastrointestinal tract in horses can be influenced by fasting and sedation but the proper effect of general anaesthesia (GA) on them has not been determined yet. This study aimed to evaluate the effects of GA on ultrasonographic images of the gastrointestinal tract in horses and to compare these effects with a clinical evaluation. Twenty horses undergoing non-abdominal surgeries were evaluated by ultrasonography before and 4 times within 24 h after GA. Each ultrasonographic exam focused on the stomach, the duodenum and on 5 locations on the jejunum. The fou...
Cardiac Monitoring in Horses.
The Veterinary clinics of North America. Equine practice    March 11, 2019   Volume 35, Issue 1 205-215 doi: 10.1016/j.cveq.2018.12.003
Shih AC.Monitoring variables of cardiac performance in horses is challenging owing to patient size, temperament, and anatomic peculiarities. Blood pressure is a major determinant of afterload, but it is not a reliable surrogate of cardiac performance and tissue perfusion. Cardiac output, together with arterial and venous oxygen content, provides insight as to the adequacy of delivery of blood and oxygen to the body as a whole and can be used to gauge the fluid responsiveness and cardiovascular status of the patient. Measurement of intracardiac pressures serves to assess cardiac filling pressures, myoc...
Artifact Induced by a Transponder During In Vivo Magnetic Resonance Imaging on Horse Brain.
Journal of equine veterinary science    March 6, 2019   Volume 77 63-67 doi: 10.1016/j.jevs.2019.02.025
Ella A, Gomot G, Lévy I, Dominici C, Adriaensen H, Reigner F, Keller M, Guillaume D.Magnetic resonance imaging (MRI) is now widely used in equine veterinary practice. However, the mandatory European legislation regarding horse identification imposes the implantation of a transponder within the fatty tissue of the neck cervical ligament. While performing brain MRI for scientific purposes in ponies, we faced artifacts produced by such transponder and reported here this problem. Indeed, pony mares were anesthetized for 2 hours and placed, bedded on their back, in a 3T MRI scanner. A four-element flexible antenna positioned around the head was used. Three MRI sequences were perfo...
Evaluation of pulse co-oximetry to determine haemoglobin saturation with oxygen and haemoglobin concentration in anaesthetized horses: a retrospective study.
Veterinary anaesthesia and analgesia    March 6, 2019   Volume 46, Issue 4 452-457 doi: 10.1016/j.vaa.2019.02.005
Zoff A, Dugdale AHA, Scarabelli S, Rioja E.This study compared the values of variables measured by pulse co-oximetry (Masimo Radical 7; Masimo Europe Limited, UK) with those measured by a co-oximeter-enabled blood gas analyser (Siemens Rapid-point 500; Siemens Healthcare Limited, UK) in anaesthetized horses. Methods: Retrospective study. Methods: A total of 30 anaesthetized horses. Methods: In total, 47 heparinized arterial blood samples were collected for blood gas analysis to determine haemoglobin concentration (tHb, g L) and percentage of haemoglobin saturation with oxygen (SaO). Arterial haemoglobin saturation with oxygen was deter...
Comparative efficacy of two-dimensional mode and color Doppler sonography in predicting gender of the equine fetus.
Veterinary world    February 23, 2019   Volume 12, Issue 2 325-330 doi: 10.14202/vetworld.2019.325-330
Mebarki M, Kaidi R, Azizi A, Basbaci M.Ultrasonographic fetal sexing is of utmost economic importance for horse breeders. Relatively, a few studies have been conducted to determine fetal sex in mare using transrectal Doppler ultrasound. This study aimed to compare two sexing techniques, two-dimensional (2D) mode and color Doppler ultrasonography. Methods: The study was conducted on 39 mares under field conditions. Examinations were performed using the ultrasonic model device (Medison SonoAce Pico, South Korea), equipped with real-time 3-7 MHz convex multifrequency transducer. Fetal sex diagnosis was carried out in two periods of pr...
Enhanced ultrasonographic imaging of the equine distal limb using saline injection of the digital flexor tendon sheath: A cadaver study.
Veterinary journal (London, England : 1997)    February 23, 2019   Volume 247 26-31 doi: 10.1016/j.tvjl.2019.02.007
Daniel AJ, Leise BS, Selberg KT, Barrett MF.Injuries to the structures within the digital flexor tendon sheath (DFTS) can lead to lameness with a variable degree of effusion in horses. In some cases, effusion is absent or minimal, and this may be related to the chronicity and type of injury, or veterinary interventions. The purpose of this study was to determine if saline injection into the DFTS would improve ultrasonographic and magnetic resonance imaging of the distal limb without introducing artifact. Nine normal equine cadaver forelimbs were collected. Non-weight-bearing ultrasonographic and magnetic resonance imaging (MRI) examinat...
Fluoroscopically guided neocanalization for treatment of nasolacrimal atresia in two horses.
Veterinary ophthalmology    February 15, 2019   Volume 22, Issue 4 538-544 doi: 10.1111/vop.12653
Berkowski W, Plummer CE, Ramos R, Czerwinski S, Brooks D, Gallagher A.A yearling Thoroughbred stallion and an 8-year-old Saddlebred mare were evaluated for persistent mucoid ocular discharge. Results: Examination of both horses revealed copious yellow-tan mucoid ocular discharge with a negative Jones I test, absent nasal punctum, and unsuccessful anterograde nasolacrimal duct (NLD) irrigation. Clinical abnormalities were present on the right side only in one horse and bilaterally in the other. Computed tomography (CT) with contrast confirmed nasolacrimal duct atresia in both horses. Results: Under general anesthesia, the affected NLD was catheterized anterograde...
Evaluation of equine corneal disease using spectral domain optical coherence tomography (SD-OCT).
Veterinary ophthalmology    February 15, 2019   Volume 22, Issue 6 791-798 doi: 10.1111/vop.12652
Blanchard A, Barr EM, Gilger BC.The purpose of this case series is to evaluate the use of spectral domain optical coherence tomography (SD-OCT) imaging in equine corneal disease to demonstrate the feasibility, diagnostic effectiveness, and limitations of this imaging modality. Methods: Retrospective study: Handheld SD-OCT (Envisu, Bioptigen Inc, Morrisville, NC) was used for high-resolution imaging of horses with corneal disease presenting to the North Carolina State University Equine Ophthalmology Service from 2013 to 2018. Results: Fourteen horses were included in this study, including six horses with corneal ulceration, t...
Usefulness of caudomedial-craniolateral oblique radiographic views for the diagnosis of injury to the origin of the cranial cruciate ligament in two horses.
Journal of the American Veterinary Medical Association    February 5, 2019   Volume 254, Issue 4 508-511 doi: 10.2460/javma.254.4.508
Aldrich ED, Goodrich LR, Contino EK, Kawcak CE, Barrett MF, King MR, Valdés-Martínez A.CASE DESCRIPTION A 12-year-old mixed-breed mare (horse 1) and 6-year-old Friesian gelding (horse 2) were examined for chronic lameness associated with the stifle joint. CLINICAL FINDINGS Lameness examination revealed effusion of the right (horse 1) or left (horse 2) femoropatellar and medial femorotibial joints and grade 3/5 (horse 1) or 4/5 (horse 2) lameness. A diagnosis of cranial cruciate ligament (CCL) injury with associated mineralization and avulsion (horse 1) or mineralization alone (horse 2) was facilitated in both horses with a caudomedial-craniolateral oblique radiographic view obta...
Computed tomographic dimensions of the normal adult equine eye.
Veterinary ophthalmology    February 4, 2019   Volume 22, Issue 5 651-659 doi: 10.1111/vop.12636
Hollis AR, Dixon JJ, Berlato D, Murray R, Weller R.There are limited data on whether the dimensions of the equine eye and its internal structures change with bodyweight in horses. The aim of this study was to identify whether the size of the equine eye and its individual structures varied in a predictable manner with bodyweight, and to examine the reliability of computed tomography (CT) scans in the measurement of the equine eye. Ninety horses which had undergone CT examination of the head for non-ocular disease were included. All measurements of the eye were performed twice on all eyes by the same operator to quantify intra-operator agreement...
Assessing the Effect of Packing the Sulcus on Image Quality in Equine Digital Radiography.
The Veterinary record    February 2, 2019   Volume 184, Issue 7 221 doi: 10.1136/vr.104737
Rowan C, Puggioni A, Hoey SE, O'Leary JM, Kearney C, Connolly SE, Skelly C.The requirement to pack the sulcus of the equine foot as an aid to diagnostic interpretation before acquisition of dorsoproximal-palmarodistal oblique projections is debatable. The purpose of this study was to investigate the benefit of packing the sulcus in the assessment of normal anatomy. 23 cadaver limbs were radiographed in a podoblock (https://www.podoblock.com/products-page/podoblock/podoblock/) A non-packed image (NP) and a packed image (P) of the same foot were acquired. The image quality of P was graded against the reference NP by five observers, where -1=P was superior, 0=no differe...
Three-dimensional CT observation of position and movability of the scapula in the horse using carcasses of Falabella.
Anatomia, histologia, embryologia    January 29, 2019   Volume 48, Issue 3 250-255 doi: 10.1111/ahe.12430
Endo H, Nguyen ST, Yoshida M, Kudo K.The three-dimensionally real position and movement of the scapula in the lateral side of the ribcage could not be clarified in the horse, since the body size of the horse is too large to apply the CT scanning and image analysis methods. In this study, therefore, we examined the position and the movability of scapula using a carcass of the Falabella which is one of the smallest breeds of the horse. The whole skeletal system in thoracic part of the Falabella could be three-dimensionally observed by CT scanning method. The three-dimensional images show that the scapula cranially slides and the ve...
Low field magnetic resonance imaging of the equine distal interphalangeal joint: Comparison between weight-bearing and non-weight-bearing conditions.
PloS one    January 28, 2019   Volume 14, Issue 1 e0211101 doi: 10.1371/journal.pone.0211101
Evrard L, Audigié F, Bertoni L, Jacquet S, Denoix JM, Busoni V.This descriptive study aimed to compare the magnetic resonance appearance of the distal interphalangeal joint articular cartilage between standing weight-bearing and non-weight-bearing conditions. Ten forefeet of live horses were scanned in a standing low-field magnetic resonance system (0.27 T). After euthanasia for reasons unrelated to the study, the non-weight-bearing isolated feet were scanned in a vertical positioning reproducing limb orientation in live horses. The same acquisition settings as during the weight-bearing examination were used. Thickness and cross-sectional area of the dist...
Two-dimensional echocardiographic measurements of the right coronary artery in healthy horses – a pilot study.
BMC veterinary research    January 28, 2019   Volume 15, Issue 1 43 doi: 10.1186/s12917-019-1792-1
Siwinska N, Michalek M, Zak A, Slowikowska M, Noszczyk-Nowak A, Niedzwiedz A, Paslawska U.Precise understanding of the dimensions of the vascular lumina is essential for accurate interpretation of cardiac vessels imaging. To the authors' best knowledge, this is the first study focusing on the ultrasound measurement of the right coronary artery (RCA) in the horse. The aim of this study was to determine both the ultrasonographic range of the normal diameter and lumen area of the RCA in horses and the influence of gender, age and level of training on the RCA dimensions. An additional aim of the study was to assess intra- and inter-observer repeatability of the collected measurements. ...
Association of catastrophic condylar fracture with bony changes of the third metacarpal bone identified by use of standing magnetic resonance imaging in forelimbs from cadavers of Thoroughbred racehorses in the United States.
American journal of veterinary research    January 27, 2019   Volume 80, Issue 2 178-188 doi: 10.2460/ajvr.80.2.178
Peloso JG, Cohen ND, Vogler JB, Marquis PA, Hilt L.OBJECTIVE To compare bony changes of the third metacarpal bone (MC3) of Thoroughbred racehorse cadavers with (cases) or without (controls) catastrophic condylar fracture by use of standing MRI. SAMPLE 140 forelimbs from 26 case horses (both forelimbs) and 88 control horses (single forelimb). PROCEDURES Bone marrow lesions (BMLs), identified as a decrease in T1-weighted (T1W) signal and increases in T2*-weighted (T2*W) and short tau inversion recovery (STIR) signals, and dense bone volume percentage (DBVP), identified as decreases in T1W, T2*W, and STIR signals, in the distopalmar aspect of MC3...
Osteochondroma of the First Phalanx in Tbourida Horses.
Frontiers in veterinary science    January 8, 2019   Volume 5 328 doi: 10.3389/fvets.2018.00328
Seghrouchni M, Bollo E, Piro M, Alyakine H, Bouayad H, Chakir J, Azrib R, Allali KE.This study aimed at describing anatomo-histopathological and imaging features, using computed tomography and magnetic resonance imaging on six forelimbs of Tbourida horses, that presented a particular bone exostosis on the dorsal and proximal part of the first phalanx, diagnosed by X-ray. Gross anatomy of the bone exostosis revealed an irregular surface with poly-lobulated tissue masses showing a cauliflower shape. The diameter/depth varied from 0.5 to 5.1 cm with a mean of 3.9 ± 0.9 cm. The capsule of the metacarpophalangeal joint was hypertrophic and showed many invaginations in the inner ...
Evaluation of standing low-field magnetic resonance imaging for diagnosis of advanced distal interphalangeal primary degenerative joint disease in horses: 12 cases (2010-2014).
Journal of the American Veterinary Medical Association    January 4, 2019   Volume 254, Issue 2 257-265 doi: 10.2460/javma.254.2.257
Rovel T, Audigié F, Coudry V, Jacquet-Guibon S, Bertoni L, Denoix JM.OBJECTIVE To report history, findings from clinical examinations and diagnostic imaging, treatment, and outcomes associated with distal interphalangeal primary degenerative joint disease (DIP-PDJD) and to evaluate diagnostic usefulness and limitations of standing low-field MRI, relative to radiography and ultrasonography, for the diagnosis of DIP-PDJD in horses. DESIGN Retrospective case series with nested evaluation study. ANIMALS 12 client-owned horses. PROCEDURES Medical records were reviewed, and data were collected regarding signalment, history, results of physical and diagnostic imaging ...
Outcome following computed tomographic imaging and subsequent surgical removal of keratomas in equids: 32 cases (2005-2016).
Journal of the American Veterinary Medical Association    January 4, 2019   Volume 254, Issue 2 266-274 doi: 10.2460/javma.254.2.266
Katzman SA, Spriet M, Galuppo LD.OBJECTIVE To describe the use of CT in the diagnosis of and presurgical planning for equids with keratomas treated by hoof wall resection and determine postoperative complications and outcome. DESIGN Retrospective case series. ANIMALS 29 horses and 3 mules with keratomas treated by partial or complete hoof wall resection following CT imaging of the distal portion of the affected extremity from 2005 through 2016. PROCEDURES For each equid, physical examination and lameness evaluation were performed, followed by imaging of the distal portion of the affected extremity. A tentative diagnosis of ke...
Impact of a void in the equine medial femoral condyle on bone stresses and peak contact pressures in a finite element model.
Veterinary surgery : VS    December 16, 2018   Volume 48, Issue 2 237-246 doi: 10.1111/vsu.13139
Frazer LL, Santschi EM, Fischer KJ.To predict bone and medial meniscal stresses and contact pressures in an equine stifle with a medial femoral condyle (MFC) intact or with a 2-cm subchondral bone void, under varying degrees of internal femoral rotation (IFR). Methods: Finite element model (FEM) of a cadaveric equine stifle loaded to 8000 N. Methods: The FEM was constructed from computed tomography (CT) of the right, extended stifle of a yearling. The CT image was segmented into relevant anatomic structures and meshed into 4-node tetrahedrons. Bone material properties were assigned according to Hounsfield units, soft tissue p...
Contrast enhanced magnetic resonance imaging of the foot in horses using intravenous versus regional intraarterial injection of gadolinium.
Open veterinary journal    December 15, 2018   Volume 8, Issue 4 471-478 doi: 10.4314/ovj.v8i4.19
Zani D, Rabbogliatti V, Ravasio G, Pettinato C, Giancamillo MD, Zani DD.The use of contrast enhanced magnetic resonance imaging (MRI) for the detection of orthopedic pathologies in equine patients is poorly described. In few studies, enhanced MRI allowed to differentiate active lesions from chronic ones and to classify ambiguous lesions. The aim of this clinical prospective pilot study is to describe and compare the MRI lesions observed in horses with lameness localized to the foot using a single intravenous bolus dose of gadolinium contrast versus regional intraarterial bolus of contrast agent. Ten horses that underwent contrast enhanced MRI were included in the ...
Quantitative Evaluation of Equine Articular Cartilage Using Cationic Contrast-Enhanced Computed Tomography.
Cartilage    December 2, 2018   Volume 12, Issue 2 211-221 doi: 10.1177/1947603518812562
Nelson BB, Stewart RC, Kawcak CE, Freedman JD, Patwa AN, Snyder BD, Goodrich LR, Grinstaff MW.To investigate the diffusion trajectory of a cationic contrast medium (CA4+) into equine articular cartilage, and to assess normal and degenerative equine articular cartilage using cationic contrast-enhanced computed tomography (CECT). In the first experiment (Exp1), equine osteochondral specimens were serially imaged with cationic CECT to establish the diffusion time constant and time to reach equilibrium in healthy articular cartilage. In a separate experiment (Exp2), articular cartilage defects were created on the femoral trochlea (defect joint) in a juvenile horse, while the opposite joint...
How to publish diagnostic imaging studies: Common mistakes and recommendations.
Equine veterinary journal    December 1, 2018   Volume 51, Issue 1 7-10 doi: 10.1111/evj.13037
Pease A, Marr CM.No abstract available
Bone marrow lesions of the distal condyles of the third metacarpal bone are common and not always related to lameness in sports and pleasure horses. De Guio C, Ségard-Weisse E, Thomas-Cancian A, Schramme M.The metacarpophalangeal joint is a common site of pain in horses. Little information is available about bone marrow lesions in the distal condyles of the third metacarpal bone in sports and pleasure horses. Aims of this prospective, retrospective, observational study were to evaluate the prevalence of bone marrow lesions in the distal condyles of the third metacarpal bone, to describe their anatomic distribution and to correlate lesions with the presence of lameness and the level and type of activity. All sports and pleasure horses undergoing standing low-field MRI of the front fetlock region ...
The prevalence of temporal bone fractures is high in horses with severe temporohyoid osteoarthropathy. Tanner J, Spriet M, Espinosa-Mur P, Estell KE, Aleman M.Temporohyoid osteoarthropathy is a well-recognized cause of equine neurologic disease. Temporal bone fractures associated with temporohyoid osteoarthropathy have been recognized with CT, however, little information is available regarding these fractures. The aims of this retrospective analytical study were to assess the prevalence of these fractures and to describe the specific configurations and associated imaging and clinical features. Fracture of the temporal bone was identified with CT in 16 of 39 included horses. All fractures were unilateral, minimally displaced and extended through the ...
Diagnostic Approaches to Understanding Equine Limb Wounds.
The Veterinary clinics of North America. Equine practice    November 19, 2018   Volume 34, Issue 3 461-471 doi: 10.1016/j.cveq.2018.07.001
Gaughan EM.An accurate and timely diagnosis of the systemic and local tissue influences of a wound are essential to target successful treatment measures and reach the best result for an affected horse. A complete physical examination should be completed for any wounded horse and appropriate systemic therapies instituted. Visual and manipulative examinations aid in the complete understanding of wounded tissues. Imaging and invasive diagnostic techniques also have value in determining the extent of a wound. Considering what tissues are involved from an inside-out perspective can assist in developing a comp...
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