Closure of sinocutaneous fistula aided by temporary titanium mesh plate following treatment of ethmoid haematoma

Chronic sinocutaneous fistulae represent a rare yet serious complication of equine sinus surgery, particularly when extensive osseous defects prevent soft‐tissue closure. This case report describes successful treatment of a persistent sinocutaneous fistula in a 13‐year‐old warmblood mare following surgical treatment of progressive ethmoid haematoma. Initial bone flap surgery was complicated by severe intraoperative haemorrhage, incomplete lesion removal, wound dehiscence and subsequent fistula formation. The mare was referred 1 year later for treatment of the chronic fistula. Computed tomography (CT) revealed a large defect in the right caudal maxillary bone with direct communication with the sinus system. Revision surgery consisted of debridement and placement of a titanium mesh plate as a temporary structural scaffold to support cutaneous advancement and epithelialisation. Postoperative management was complicated by methicillin‐resistant Staphylococcus aureus infection, requiring prolonged wound care and adjunctive therapies. Progressive epithelialisation occurred over a 7‐month period. Following radiographic confirmation of implant loosening, the titanium mesh was removed, and wound closure was then achieved without recurrence. This case highlights the importance of structural support in the management of chronic equine sinocutaneous fistulae, the potential role of titanium mesh as a temporary scaffold and the challenges associated with infection control during prolonged wound healing.