EQUINE VETERINARY EDUCATION / AE / JANUARY 2017
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Eight days after admission, when the splint bandage was
taken off, there was no improvement of the lameness, or closure of the fistula. Arthroscopic lavage and debridement of the wound using UAWT was repeated under general anaesthesia as previously described. Two days later (10 days post admission) the VAC therapy system was installed. At this time, the wound had not decreased in size and the granulation tissue had not changed in appearance. To achieve access to the wound between bandage
Fig 2: Large skin defect on lateral aspect of the carpus after surgical debridement of the abscess.
fluid was collected. The fluid was cloudy in appearance and
again there was not enough sample volume for complete fluid analysis. Standing joint lavage was performed using 3 l of sterile lactated Ringer’s solution. During this procedure it was confirmed that the fistula still communicated with the antebrachiocarpal joint. The joint was medicated again with 1 g of amikacin, the wound debrided using UAWT and the limb immobilised with the same type of splint bandage as before. This treatment was repeated every other day for another 6 days.
changes, VAC VeraFlo Instillation Therapy was used. This system consists of 2 separate tubes, one attached to a pump creating a constant vacuum within the wound of 125 mmHg. The second tube allowed topical wound treatment. The vacuum pump was turned off every 4–6 h for 15 min and the wound lavaged by injecting 5 ml of Octenidin HCL (Octenilin)10 wound solution into the second tube (Fig 4). To immobilise the limb and to achieve a constant vacuum, a double layered splint bandage was applied, with the tubing running from the proximal aspect of the bandage plaited into the horse’s mane and plugged to the portable therapy unit attached to an abdominal belt on the horse’s back (Fig 5). A constant vacuum of 125 mmHg could be achieved while the stallion was able to move around and lie down. At the first bandage change after application of the VAC system (12 days post admission) there was significant improvement in the appearance of the wound bed. At the second bandage change, 4 days post VAC application (2 weeks post admission) a smooth bed of granulation tissue was present but the horse remained nonweightbearing. Synoviocentesis of the left antebrachiocarpal joint demonstrated elevated total protein (74 g/l) and distension
of the joint confirmed continued communication via the fistula. Arthroscopic lavage under general anaesthesia was
Fig 3: The wound 2 days after initial surgery showing granulation tissue and the opening of the fistula into the radiocarpal joint.
Fig 4: Vacuum assisted closure VeraFlo Instillation Therapy in place, 2 separate tubes for treatment inbetween bandage changes.
© 2015 EVJ Ltd
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