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Topic:Post-Operative Period

The post-operative period in horses refers to the timeframe following surgical procedures during which the animal undergoes recovery and rehabilitation. This period involves careful monitoring and management to ensure proper healing and to minimize complications. Key aspects of the post-operative period include pain management, wound care, and the prevention of infections. Horses may require restricted movement, dietary adjustments, and regular veterinary evaluations to assess recovery progress. This page compiles peer-reviewed research studies and scholarly articles that explore the management strategies, physiological responses, and outcomes associated with the post-operative period in equine patients.
J-incision to approach the cranial abdomen in the adult horse.
Veterinary surgery : VS    February 24, 2021   Volume 50, Issue 3 600-606 doi: 10.1111/vsu.13597
Bauck AG, Nelson E, McLain A, Cock G, Sanchez LC, Freeman DE.To describe a modified celiotomy to improve access to cranial abdominal structures in horses. Methods: Four horses. Methods: Short case series. Methods: Three horses with gastric impactions were treated with gastrotomies. One horse was treated for a diaphragmatic hernia with herniorrhaphy and mesh augmentation. In all horses, the ventral midline celiotomy was modified cranially with a J-incision through the body wall, along the paracostal arch. Results: The only surgical complications were midline incisional infections in all horses. Three of the four horses had good long-term outcomes; the re...
Polyaxial pedicle screw external fixation to stabilize oblique mandibular fractures in three standing, sedated horses.
Veterinary surgery : VS    February 19, 2021   Volume 50, Issue 3 659-667 doi: 10.1111/vsu.13587
Nelson BB, Easley J, Steward SKT, Smanik LE, Koch DW, Rawlinson JE, Easley JT.To report the radiographic, surgical and postoperative features in horses with unstable oblique mandibular fractures secured with polyaxial pedicle screws (PPS) external fixation construct and intraoral wiring. Methods: Three client-owned horses. Methods: Short case series. Methods: Two horses each had a unilateral fracture, which did not improve after conservative management, and one horse had bilateral fractures. Clinical and radiographic features were documented. Polyaxial pedicle screw external fixators and intraoral tension band wiring were applied in standing horses after combining sedat...
Retrospective evaluation of association between perioperative antimicrobial protocol and complications following elective equine synovial endoscopy.
Veterinary medicine and science    February 17, 2021   Volume 7, Issue 3 609-620 doi: 10.1002/vms3.447
Pezzanite LM, Griffenhagen GM, Krause DM, Hendrickson DA.Prophylactic perioperative antimicrobial protocols in equine synovial endoscopy have been described but not compared with respect to post-operative outcomes and complications. Increasing antimicrobial resistance in equine practice and interest in promoting judicious use of antimicrobials has prompted reevaluation of drug selection and dosing strategies. To determine the frequency of and compare post-operative complications following elective synovial endoscopy between horses receiving different perioperative antimicrobial protocols. Records from the Colorado State University Veterinary Teachin...
Implications of the neuroanatomy of the equine thoracolumbar vertebral column with regional anaesthesia and complications following desmotomy of the interspinous ligament.
Equine veterinary journal    February 15, 2021   Volume 53, Issue 4 649-655 doi: 10.1111/evj.13402
Derham AM, Schumacher J, O' Leary JM, Kelly G, Hahn CN.Impinging/overriding dorsal spinous processes (DSPs) of the thoracolumbar vertebrae are a common cause of poor performance in horses. In the last five decades, numerous surgical treatments have been reported on, from transverse transection of the affected DSPs, and endoscopic resection of the affected DSPs, to transection of the interspinous ligament. Until recently, cosmetic outcomes have been reported as good to excellent in studies. However, a previously unreported complication of neurogenic atrophy of the contralateral epaxial muscle following desmotomy of the interspinous ligament has bee...
Incomplete Ileocecal Bypass for Ileal Pathology in Horses: 21 Cases (2012-2019).
Animals : an open access journal from MDPI    February 5, 2021   Volume 11, Issue 2 403 doi: 10.3390/ani11020403
Giusto G, Cerullo A, Labate F, Gandini M.Incomplete ileocecal bypass can be performed in cases in which an ileal disfunction is suspected but resection of the diseased ileum is not necessary. Objective: To describe the clinical findings, the surgical technique, and the outcome of 21 cases of colic with ileal pathologies that underwent an incomplete ileocecal bypass. Methods: Historical, clinical, and surgical features of cases diagnosed with pathologies involving the ileum or the ileocecal valve that underwent ileocecal anastomosis without ileal resection were retrieved. Clinical (heart rate, duration of symptoms, presence of reflux,...
Towards an improved pain assessment in castrated horses using facial expressions (HGS) and circulating miRNAs.
The Veterinary record    February 2, 2021   Volume 188, Issue 9 e82 doi: 10.1002/vetr.82
Dalla Costa E, Dai F, Lecchi C, Ambrogi F, Lebelt D, Stucke D, Ravasio G, Ceciliani F, Minero M.Pain in horses is an emergent welfare concern, and its assessment represents a challenge for equine clinicians. This study aimed at improving pain assessment in horses through a convergent validation of existing tools: we investigated whether an effective analgesic treatment influences the horse grimace scale (HGS) and the concentration of specific circulating microRNAs (miRNAs). Eleven stallions underwent routine surgical castration under general anaesthesia. They were divided into two analgesic treatment groups: castration with the administration of preoperative flunixin and castration with ...
Vaccination against GnRH as a prelude to surgical castration of horses.
Equine veterinary journal    January 20, 2021   Volume 53, Issue 6 1141-1149 doi: 10.1111/evj.13411
Birrell JR, Schulman ML, Botha AE, Ganswindt A, Fosgate GT, Bertschinger HJ.Surgical castration is one of the most frequently performed surgeries in horses and is associated with various post-surgical complications ranging in severity. Objective: We investigated the effects of administering an anti-GnRH vaccine to colts for reduction of testis size on the incidence of complications associated with their subsequent surgical castration. Methods: Randomised open controlled trial. Methods: Nineteen colts were randomly assigned to one of the three groups. Treatment Groups V1-57 and V2-100 received two treatments of Improvac (Zoetis, South Africa) before their castration in...
Effects of Leaving Amputated Ovaries Intra-Abdominally during Elective Bilateral Standing Laparoscopic Ovariectomy in Equids.
Animals : an open access journal from MDPI    January 18, 2021   Volume 11, Issue 1 232 doi: 10.3390/ani11010232
Devick IF, Hendrickson DA.There is risk of dropping an amputated ovary within the abdomen during standing laparoscopic ovariectomies in mares. If the ovary can no longer be directly visualized with the laparoscope, the procedure is then converted to a flank laparotomy for manual retrieval of the ovary which negates the minimally invasive nature of the laparoscopic procedure. The objective was to identify if ovaries left in the abdomen after amputation would atrophy or if they re-vascularize. Standing bilateral ovariectomies were performed in mature mares, but after transection of the ovarian pedicle, the ovaries were i...
Surgical Repair of a Unicortical Condylar Fracture in a Thoroughbred Racehorse Using a Bioabsorbable Screw.
Journal of equine veterinary science    January 16, 2021   Volume 99 103384 doi: 10.1016/j.jevs.2021.103384
Ravanetti P, Hamon M, Lechartier A, Zucca E.Surgical repair of unicortical fractures of the distal condyles of the third metacarpal/metatarsal bones (MCIII/MTIII) has been described. In the present case, a bioabsorbable screw was used to stabilize a unicortical fracture in the palmar aspect of the medial condyle of MCIII in a National Hunt Thoroughbred racehorse. The clinical, radiographic, and magnetic resonance imaging findings before and after surgery were recorded. Eighteen weeks after surgery, the lameness had resolved and the bone surrounding the fracture had recovered its normal architecture. One year after surgery, the horse was...
Intraincisional medical grade honey decreases the prevalence of incisional infection in horses undergoing colic surgery: A prospective randomised controlled study.
Equine veterinary journal    January 15, 2021   Volume 53, Issue 6 1112-1118 doi: 10.1111/evj.13407
Gustafsson K, Tatz AJ, Slavin RA, Sutton GA, Dahan R, Ahmad WA, Kelmer G.Medical grade honey has previously been described as a prophylactic treatment for wounds. Local prophylactic treatment may be valuable in preventing post-operative incisional infections in horses undergoing colic surgery but has not been evaluated. Objective: To establish whether medical grade honey gel, applied on the linea alba intraoperatively, decreases the prevalence of incisional infections in horses undergoing colic surgery with no associated adverse effects. Methods: Prospective blinded randomised controlled clinical study. Methods: Horses older than 4 months that underwent colic surg...
Experimental evaluation of cortical screw placement in lag fashion into the distal phalanx in standing horses.
Acta veterinaria Hungarica    January 15, 2021   Volume 68, Issue 4 399-404 doi: 10.1556/004.2020.00054
Izing S, Béni D, Molnár S, Bakos Z, Bodó G.The objectives of this in vivo experimental study were to evaluate the feasibility of cortical screw insertion into the intact distal phalanx in standing sedated horses and to document potential postoperative complications. One cortical screw was randomly inserted in lag fashion into each distal phalanx in 9 horses. The second surgery on the contralateral limbs was performed 2-3 weeks after the first operation, when a 4.5-mm cortical screw was inserted in lag fashion into the distal phalanx of sedated horses following perineural analgesia. Following surgery, the drill hole was filled with an a...
Questionnaire on the process of recovering horses from general anesthesia and associated personnel injury in equine practice.
Veterinary anaesthesia and analgesia    January 12, 2021   Volume 48, Issue 2 223-229 doi: 10.1016/j.vaa.2020.12.005
de Miguel Garcia C, Campoy L, Parry S, Miller JE, Martin-Flores M, Gleed RD.To collect data about the current practice of recovering horses from general anesthesia and recovery personnel safety. Methods: Online survey. Methods: An online questionnaire, including questions on general demographic data, recovery drugs, modality and characteristics of equine recovery and morbidity and mortality, was designed and distributed via e-mail to equine practitioners worldwide. Results: Practitioners from 22 countries completed 373 questionnaires; 53% of the participants were board-certified equine surgeons, and the remainder were board-certified anesthesiologists (18%), large ani...
Equine nutrition in the post-operative colic: Survey of Diplomates of the American Colleges of Veterinary Internal Medicine and Veterinary Surgeons, and European Colleges of Equine Internal Medicine and Veterinary Surgeons.
Equine veterinary journal    January 9, 2021   Volume 53, Issue 5 1015-1024 doi: 10.1111/evj.13381
Lawson AL, Sherlock CE, Ireland JL, Mair TS.Evidence is lacking concerning re-introduction of feed and water following colic surgery. Objective: To describe current approaches of European and American specialists to re-introduction of feed and water in adult horses following surgical treatment of common intestinal lesions, assuming an uncomplicated recovery. Methods: Cross-sectional survey. Methods: Electronic invitations, with a link to the online survey, were sent to 1,430 large animal specialists, including Diplomates of the ECVS, ACVS, ECEIM and ACVIM colleges. Results: The response rate was 12.6% including partial respondent data. ...
Equine colic associated with small intestinal epiploic foramen entrapment.
Veterinary journal (London, England : 1997)    January 8, 2021   Volume 269 105608 doi: 10.1016/j.tvjl.2021.105608
van Bergen T, Wiemer P, Martens A.Intestinal epiploic foramen entrapment (EFE) is an important differential diagnosis in horses with colic, but disappointing short- and long-term outcomes are reported in the scientific literature. Many horses are euthanased during surgery due to a predicted poor prognosis or due to uncontrollable intraoperative haemorrhage. The ileum is involved in the majority of cases. Several risk factors for the development of EFE are described; crib-biting/windsucking being the most important one. The recurrence rate of EFE is low despite the described risk factors, probably due to spontaneous closure of ...
Effects of Intravenous Flunixin Meglumine, Phenylbutazone, and Acupuncture on Ocular Pain Scores in the Horse: A Pilot Study.
Journal of equine veterinary science    January 6, 2021   Volume 98 103375 doi: 10.1016/j.jevs.2021.103375
Makra Z, Csereklye N, Riera MM, McMullen RJ, Veres-Nyéki K.In this controlled, blinded, randomized block pilot study, the main objective was to evaluate the effectiveness of intravenous flunixin meglumine, phenylbutazone, and acupuncture on ocular pain relief using a multifactorial pain scale in the horse. Four experimental horses underwent corneal epithelial debridement in four sessions, when a randomly selected treatment or a control was used. All horses were pain scored before corneal wounding, then at 18 time points, when 11 parameters were allocated. Differences in the area under the curve of pain scores between the treatment groups were analyzed...
Hand-assisted laparoscopic cystotomy for cystic calculus removal in male horses (3 cases).
The Canadian veterinary journal = La revue veterinaire canadienne    January 5, 2021   Volume 62, Issue 1 22-26 
Merchan A, Barrett EJ, Rodgerson DH.A technique for hand-assisted laparoscopic removal of cystic calculi in male horses is described. Three cystic calculi ranging from 5 to 10 cm in diameter were removed successfully using bilateral para-inguinal laparoscopic portals assisted by a human hand within the abdomen, effectively sealing the midline incision. Long-term follow-up information obtained from referring veterinarians and owners indicated that the patients returned to their previous activity level and had no recurrence of clinical signs in the following 6 to 12 months. Key clinical message: Hand-assisted recumbent laparoscopy...
A Retrospective Study of Cryptorchidectomy in Horses: Diagnosis, Treatment, Outcome and Complications in 70 Cases.
Animals : an open access journal from MDPI    December 21, 2020   Volume 10, Issue 12 doi: 10.3390/ani10122446
Straticò P, Varasano V, Guerri G, Celani G, Palozzo A, Petrizzi L.The aim of the study was to investigate the breed predisposition and the diagnostic and surgical management of horses referred for cryptorchidism. The breed, localization of retained testis, diagnosis, type of surgical treatment and complications were analyzed. Seventy horses were included in the study; the Western Riding horse breeds were the most affected (Quarter Horse 34/70, 48.5%; Appaloosa 9/70, 12.8%). In unilateral cryptorchids (65/70, 92.8%) the most common location for a retained testis was the left abdomen (28/65, 43%), while in bilateral cryptorchids (5/70, 7.1%), bilateral abdomin...
Outcome following neurectomy of the deep branch lateral plantar nerve and plantar fasciotomy for hindlimb proximal suspensory desmopathy in western performance horses: 21 cases.
Veterinary surgery : VS    December 16, 2020   Volume 50, Issue 2 273-282 doi: 10.1111/vsu.13552
Tatarniuk DM, Hill JA, Modesto RB, Swor TM, Caston SS, Kersh KD.To report the outcome of horses used in western performance disciplines after deep branch lateral plantar neurectomy/fasciotomy surgery for hind limb proximal suspensory desmopathy (PSD). Methods: Retrospective analysis. Methods: Twenty-one client-owned horses. Methods: Medical records were reviewed (2009-2019) for horses involved in western performance disciplines that had been treated with deep branch lateral plantar neurectomy and plantar fasciotomy for lameness due to hind limb PSD. Follow-up was obtained by reexamination and/or verbal interviews with owners >2 years postoperatively. ...
A long-term study of sinoscopic treatment of equine paranasal sinus disease: 155 cases (2012-2019).
Equine veterinary journal    December 14, 2020   Volume 53, Issue 5 979-989 doi: 10.1111/evj.13393
Dixon PM, Kennedy R, Poll K, Barakzai S, Reardon RJM.There is little objective information concerning the intra- and post-operative complications or the long-term outcome of sinoscopic treatment of equine sinus disorders. Objective: To document the long-term outcome, including intra-operative complications, reasons for treatment failure and other complications, in horses undergoing standing sinoscopic treatment of sinus disorders. Methods: Retrospective clinical study. Methods: Records of sinus disease cases presented to The University of Edinburgh Veterinary School between January 2012 and July 2019 were reviewed. Follow-up information was obta...
The Impact of Surgical Excision of the Orbital Lacrimal Gland on the Aqueous Tear Production and Ocular Surface Health in Donkeys (Equus asinus).
Journal of equine veterinary science    December 13, 2020   Volume 97 103344 doi: 10.1016/j.jevs.2020.103344
Ibrahim A, Ahmed AF.The exact contribution of the orbital lacrimal gland (OLG) is unknown and is still a subject of debate and inconsistency in literature. Currently, there are no detailed studies addressing the influence of the OLG removal on tear production in equines. This study aimed to address the influence of surgical excision of the OLG on aqueous tear production and ocular surface health in donkeys. The study was conducted on six clinically healthy donkeys with no ophthalmic abnormalities. In each donkey, the OLG of the left eye was surgically excised, whereas the right eye was served as a control. Extern...
Prospective Feasibility and Revalidation of the Equine Acute Abdominal Pain Scale (EAAPS) in Clinical Cases of Colic in Horses.
Animals : an open access journal from MDPI    November 29, 2020   Volume 10, Issue 12 doi: 10.3390/ani10122242
Maskato Y, Dugdale AHA, Singer ER, Kelmer G, Sutton GA.Assessment of the severity of pain in colic cases is subjective. The Equine Acute Abdominal Pain Scale (EAAPS), previously validated using film clips of horses with colic, was tested for feasibility and revalidated in both medical and surgical colic cases in Israel and the UK. Feasibility qualities evaluated were quickness and ease-of-use. Pain in 231 horses, presented for colic, was assessed by 35 participants; 26 in the UK and 9 in Israel. Without prior training, participants assessed the severity of pain using two scales; the EAAPS and a visual analogue scale (VAS). Convergent validity comp...
Histologic effects of MicroPulse™ transscleral cyclophotocoagulation in normal equine eyes.
Veterinary ophthalmology    November 29, 2020   Volume 24, Issue 1 59-70 doi: 10.1111/vop.12846
Foote BC, Smith JD, Allbaugh RA, Sebbag L.Determine the immediate post-operative effects of MicroPulse transscleral cyclophotocoagulation (MP-TSCPC) in healthy equine eyes. Methods: Ten adult horses. Methods: MP-TSCPC was performed on sedated horses in 12 eyes (4 groups) using the following parameters (power, duration, duty cycle): (1) 2000 mW, 180 seconds, 31.3%; (2) 3000 mW, 180 seconds, 31.3%; (3) 3000 mW, 270 seconds, 31.3%; and (4) 3000 mW, 270 seconds, 50%. Three additional eyes were left untreated (control). Eyes were monitored clinically until euthanasia (mean = 3 hours post-procedure). Histologic sections were asse...
Minimizing Equine Tooth Extraction Complications.
The Veterinary clinics of North America. Equine practice    November 16, 2020   Volume 36, Issue 3 641-658 doi: 10.1016/j.cveq.2020.08.004
Galloway SS, Earley ET.Oral extraction has become the most popular extraction technique owing to its high rate of success with minimal major complication. Repulsion continues to produce unacceptably high iatrogenic complication rates. To avoid tooth repulsion, veterinary dentists have introduced procedures to facilitate difficult intraoral extractions and surgical extraction techniques. Minimizing complications is best achieved preoperatively. A comprehensive preoperative evaluation and treatment plan allows the dentist to predict intraoperative complication and prepare for procedures to produce the best outcome. Wi...
Comparison of histomorphometric characteristics of dorsal colon and pelvic flexure biopsy specimens obtained from horses with large colon volvulus that underwent resection.
American journal of veterinary research    October 28, 2020   Volume 81, Issue 11 899-903 doi: 10.2460/ajvr.81.11.899
Gonzalez LM, Baker WT, Hughes FE, Blikslager AT, Fogle CA.To determine the degree of histomorphometric damage in dorsal colon and pelvic flexure biopsy specimens (DCBSs and PFBSs, respectively) obtained from horses with large colon volvulus (LCV) and assess the accuracy of predicting short-term outcome for those horses on the basis of DCBS or PFBS characteristics. Methods: 18 horses with ≥ 360° LCV that underwent large colon resection. Methods: During surgery, biopsy specimens from the dorsal colon resection site and the pelvic flexure (when available) were collected from each horse. Interstitial-to-crypt (I:C) ratio (ratio of the lamina propria s...
Incisional complications after skin closure with n-butyl cyanoacrylate or stainless-steel skin staples in horses undergoing colic surgery.
Veterinary surgery : VS    October 27, 2020   Volume 50, Issue 1 186-195 doi: 10.1111/vsu.13534
Martinez-Lopez J, Brown JA, Werre SR.To compare the prevalence of incisional complications after skin closure with n-butyl cyanoacrylate (NBC) or stainless-steel skin staples (SS) after ventral midline celiotomy for colic surgery in the horse. Methods: Retrospective study (2014-2018). Methods: Two hundred eighteen horses. Methods: Medical records of horses that underwent exploratory celiotomy for colic were included when the skin was closed with NBC or SS and the horse survived ≥15 days after surgery. Records and a follow-up questionnaire were used to determine in-hospital and posthospital discharge incisional complications. ...
Plasma histamine concentrations in horses administered sodium penicillin, guaifenesin-xylazine-ketamine and isoflurane with morphine or butorphanol.
Veterinary anaesthesia and analgesia    October 24, 2020   Volume 48, Issue 1 17-25 doi: 10.1016/j.vaa.2020.10.003
Duke-Novakovski T, Jimenez CP, Fujiyama M, Beazley SG.Various drugs administered to horses undergoing surgical procedures can release histamine. Histamine concentrations were evaluated in horses prepared for surgery and administered butorphanol or morphine intraoperative infusions. Methods: Prospective studies with one randomized. Methods: A total of 44 client-owned horses. Methods: In one study, anesthesia was induced with xylazine followed by ketamine-diazepam. Anesthesia was maintained with guaifenesin-xylazine-ketamine (GXK) during surgical preparation. For surgery, isoflurane was administered with intravenous (IV) morphine (group M: 0.15 mg ...
Equine Sinus Surgery.
The Veterinary clinics of North America. Equine practice    October 14, 2020   Volume 36, Issue 3 613-639 doi: 10.1016/j.cveq.2020.08.003
Pigott J.The anatomy of the equine paranasal sinuses is critical to understand to assess the extent of the disease process, the optimal surgical approach, and the ability to drain through the normal nasomaxillary pathway. By following established anatomic landmarks, direct sinus access can be used to further explore the sinus compartments, remove compromised cheek teeth, remove any purulent debris or feed contamination, and establish drainage. Many complications can be avoided or minimized by thoroughly evaluating all sinus compartments and critically assessing the ability of the sinus to drain.
Incidence of incisional complications after exploratory celiotomy in equids affected with enterolithiasis.
The Canadian veterinary journal = La revue veterinaire canadienne    October 6, 2020   Volume 61, Issue 10 1085-1091 
Crosa AT, Katzman SA, Kelleher ME, Nieto JE, Kilcoyne I, Dechant JE.This study reports the prevalence of and risk factors for incisional complications in equids after ventral midline celiotomy for enterolithiasis. This study covered the years 2008 to 2015 and included 72 equids. Enteroliths were removed from the ascending or descending colon through 1 or more enterotomies. Complications were defined as surgical site infection and/or incisional hernia formation. Follow-up by telephone questionnaire or medical records determined that 10/72 (13.9%) equids experienced complications, with 6/72 (8.3%) developing a surgical site infection and 5/72 (6.9%) a hernia. Se...
Surgical excision of a malignant metastatic melanoma located in a skeletal muscle of the lateral thorax of a horse.
Veterinary medicine and science    September 29, 2020   Volume 7, Issue 2 297-302 doi: 10.1002/vms3.366
Billi T, Karadima V, Tyrnenopoulou P, Apostolopoulou EP, Brellou GD, Diakakis N.A 20-year-old grey Warmblood gelding that had history of dermal melanomatosis. To report surgical treatment of a 6-cm large malignant metastatic melanoma located in the cutaneous trunci muscle of the left lateral thorax of a horse. A 20-year-old grey Warmblood gelding was referred for evaluation of a large, rapidly growing, thoracic mass. Clinical examination revealed an ovoid, firm, non-painful, movable mass, approximately 6 cm in diameter, located in the cutaneous trunci muscle of the left lateral thorax. Multiple melanocytic nodules were also found at the perianal region and ventral tail. ...
Nephrosplenic Space Ablation in Horses After Homologous Pericardium Implant Using a Laparoscopic Stapler.
Journal of equine veterinary science    September 25, 2020   Volume 95 103275 doi: 10.1016/j.jevs.2020.103275
Spagnolo JD, Castro LM, Corrêa RR, Garcia Filho SG, Ambrósio AM, Baccarin RYA, Hagen SCF, de Sá LM, Silva LCLC.This study aimed to describe and evaluate a laparoscopic technique to promote nephrosplenic space ablation in horses using a homologous pericardium implant, preserved in 98% glycerin and fixed using laparoscopic polydioxanone staples. In this experimental study, six Arabian horses without previous related abdominal diseases were used. The surgical procedures were performed in the standing position under sedation with alpha-2 agonists and opioids, associated with local infiltration of the local anesthetic in the portal sites. The horses were restrained in a stock, and the left flanks were clipp...
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