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caudolateral arthroscopic portal. Limited space could be compensated by using the fistula as a further arthroscopic instrument portal. Many wounds in horses are not suitable for VAC therapy


due to their location and size or the equipment not being tolerated by the patient. Achieving a constant vacuum often precludes its use on hairy skin and limiting its application to cooperative horses with wounds predominantly in the distal limbs. In this case the patient was cooperative and a constant subatmospheric pressure of 125 mmHg (suggested value by KCI)2 could be achieved. After the third arthroscopic surgery we recovered the stallion from general anaesthesia without the VAC system in place since the risk for the animal and the machine was found to be too high. The patient was recovered in a full limb splint bandage and the VAC therapy continued at the next bandage change 2 days post surgery. Exuberant granulation tissue, a common complication in


horses with distal limb wounds, (Theoret 2004; Rheiner et al. 2011) was not seen at any time. UAWT resulted in an improvement of the wound bed and the tip of the probe gives the option to treat small pockets underneath the skin as well as tracts reaching into deeper tissue layers, where traditional surgical debridement is not feasible. Horses usually tolerate the treatment well even without sedation. Systemic and intra-articular antimicrobial treatment of


cases with septic arthritis (Schneider et al. 1992) is a widely performed and recommended treatment option. In chronically infected wounds, the antimicrobial regime should always be based on an antibiogram. Systemic treatment using marbofloxacin (Voermans et al. 2006) and the use of local treatment with amikacin in equine synovial structures has been reported to be effective due to its broad spectrum against most pathogens (Schneider 1998; Sanchez Teran et al. 2012). Distal limb wounds are quite often successfully treated using intravenous regional limb perfusion (Lallemand et al. 2013; Zantingh et al. 2014). We considered this option, but, due to the swelling of the limb, we were not able to get intravenous access for this type of antimicrobial therapy. Laminitis is a common and often catastrophic


complication in cases where a horse has reduced weightbearing on an injured limb for an extended period of time. The strategy employed to reduce the incidence of supporting limb laminitis was frog support on the contralateral limb. The light bodyweight of the horse (approximately 300 kg) might have also reduced the risk of developing laminitis. In this particular case we felt the negative pressure


wound therapy and a regular wound treatment using Octenilin7 (wound irrigation solution for cleansing, moistening and decontamination) every 6 h allowed closure of the fistula and resolution of the septic osteoarthritis in combination with the other treatment modalities. The infection with multiresistant microorganisms was the reason why we used the VAC VeraFlo Instillation Therapy in this case. This tubing system is indicated for human patients who would benefit from vacuum assisted drainage and controlled delivery of topical wound treatment solutions and suspensions over the wound bed between bandage change intervals. Although the VAC system is fairly expensive, time consuming to place and maintain, its use is justified in cases that do not respond to standard therapy or treatment. In the authors’ opinion, this treatment aided in the resolution of the septic osteoarthritis


and wound, improved patient comfort, and potentially decreased hospitalisation time. This modality should be considered as an adjunctive therapy in chronic synovial- cutaneous fistula or wounds communicating with synovial structures.


Authors’ declaration of interests No conflicts of interest have been declared.


Ethical animal research


This is a case report of an animal treated in the clinic and owner consent was given.


Authorship M. Rettig decided to write up the case and prepared the manuscript and C. Lischer supervised and gave final approval of the manuscript.


Manufacturers’ addresses 1S€


oring Medizintechnik, Quickborn, Germany.


2KCI Medizinprodukte GmbH, Wiesbaden, Germany. 3Diprom GmbH, Hamburg, Germany. 4Karl Storz, Tuttlingen, Germany. 5Laboratorios Normon, Cantos-Madrid, Spain. 6Boehringer Ingelheim Vetmedica GmbH, Ingelheim/Rhein, Germany. 7Selectavet, Weyarn, Germany. 8bela-pharm GmbH & Co.KG, Vechta. 9Vetoquinol GmbH, Ravensburg, Germany. 10Sch€


ulke & Mayr GmbH, Norderstedt, Germany. 11Noba Verbandsmittel Danz GmbH, Wetter, Germany.


References Baxter, G.M. (2008) Diagnosis and management of wounds involving synovial structures. In: Equine Wound Management, Ed: T.S. Stashak, Wiley-Blackwell, Ames. pp 463-488.


Bertone, A.L. (2011) Noninfectious arthritis. In: Diagnosis and Management of Lameness in the Horse, Eds: S.J. Dyson and M.W. Ross, W.B. Saunders, St Louis, Missouri. pp 687-693.


Gabriel, A., Shores, J., Bernstein, B., de Leon, J., Kamepalli, R., Wolvos, T., Baharestani, M.M. and Gupta, S. (2009) A clinical review of infected wound treatment with vacuum assisted closure (VAC) therapy: experience and case series. Int. Wound J. 6, 1-25.


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Lallemand, E., Trencart, P., Tahier, C., Dron, F., Paulin, A. and Tessier, C. (2013) Pharmacokinetics, pharmacodynamics and local tolerance at injection site of marbofloxacin administered by regional intravenous limb perfusion in standing horses. Vet. Surg. 42, 649-657.


Llewellyn, H.R. (1979) A case of carpal intersynovial fistula in a horse. Equine Vet. J. 11, 90-92.


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