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EQUINE VETERINARY EDUCATION


Equine vet. Educ. (2020) 32 (1) 12-17 doi: 10.1111/eve.12930


Case Report


Use of negative pressure wound therapy in three horses with open, infected olecranon bursitis Y. A. Elce1,*


, P. Ruzickova, E. Almeida da Silveira and S. Laverty Equine Hospital, College of Veterinary Medicine, University of Montreal, St Hyacinthe, Quebec, Canada


*Corresponding author email: Yvonne.elce@bristol.ac.uk 1Present address: Equine Hospital, Langford Vets, Langford House, Bristol, UK Keywords: horse; negative pressure wound therapy; olecranon bursitis; infection; granulation tissue


Summary This article describes the clinical use of negative pressure wound therapy (NPWT) in three horses with an open and infected subcutaneous olecranon bursa, in which prior surgical excision followed by primary closure was unsuccessful. The wounds filled in rapidly with granulation tissue and contracted during therapy. All wounds subsequently went on to heal without complications. The use of NPWT was well tolerated in all three horses and facilitated healing in a difficult area.


Introduction


Negative pressure wound therapy (NPWT) has been researched and used clinically in people and small animals. There is a single report describing its use in a horse (Gemeinhardt and Molnar 2005). Many terms have been employed to describe negative pressure wound therapy (NPWT) including vacuum-assisted closure and sub- atmospheric wound dressing. In this article, the term NPWT will be used for consistency with the recent literature. There is a significant body of research in the human


medical literature on the effects of NPWT without a clear consensus as to the specific effects at the molecular level (Glass et al. 2014). The removal of exudate, the increase in blood flow to the wound, and the formation of granulation tissue are recognised effects of NPWT (Pitt and Stanley 2014). A systematic review of the potential effects concluded that NPWT induces an anti-inflammatory cytokine profile in the wound bed combined with mechanical and chemoreceptor cell signalling effects on angiogenesis, remodelling of the extracellular matrix, and granulation tissue formation (Glass et al. 2014). In small animal veterinary medicine several articles have


been published regarding both the clinical use and efficacy of NPWT. Two clinical investigations of canine wounds managed with NPWT revealed that there was an associated learning curve in the application and management of the technology but also satisfaction with the final healing outcomes (Ben-Amotz et al. 2007; Pitt and Stanley 2014). Furthermore, two clinical controlled studies observed beneficial effects when open wounds and free skin grafts were managed with NPWT in dogs (Demaria et al. 2011; Stanley et al. 2013). The use of NPWT was also compared with a silver coated foam dressing on experimental open canine wounds and revealed that NPWT halved the healing time compared with foam dressings and that both had faster


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healing times compared with conventional bandages (Nolff et al. 2015). There is one published report of NPWT use in a horse in the English veterinary literature and it is mentioned elsewhere without specific details (Gemeinhardt and Molnar 2005; Pitt and Stanley 2014). A large equine neck wound was treated with NPWT and a satisfactory healing in a faster time than expected was noted. The NPWT system was applied


with a continuous negative pressure of 125 mmHg for 27 days with dressing changes every 3–4 days (Gemeinhardt and Molnar 2005). The goal of this descriptive case series is to report the


clinical use of NPWT following surgical excision of chronic, infected, open, subcutaneous olecranon bursitis. In the horse open olecranon bursitis is known to have a prolonged healing response because of the anatomical location and movement (Honnas et al. 1995). Complete surgical excision is recommended as management with drainage and wound care is commonly inadequate to effect healing (Honnas et al. 1995). The treatment with NPWT of three horses with open, draining subcutaneous olecranon bursitis in which the skin was unable to be closed by primary intention after excision are described.


Case details: history and clinical findings


Case 1 A 5-year-old Warmblood gelding presented to the equine hospital for an olecranon bursitis of the right elbow. The gelding had been previously admitted to the hospital 4 months earlier for an acute swelling of the right forelimb. At that time he had undergone physical, radiographic and ultrasonographic examinations. The final diagnosis was an infected, subcutaneous olecranon bursa and an associated cellulitis of the limb. The infected bursa had been lanced with a small stab incision of approximately 2 cm in length, drained under standing sedation, and the horse had been placed on systemic antimicrobials (oral trimethoprim-sulphonamide for 10 days). A culture and sensitivity were not performed. The swelling of the limb had rapidly resolved and the horse was discharged with instructions for continued care of the drainage and restricted exercise. When the horse returned 4 months later, it had a large, open, draining, subcutaneous bursitis of the right olecranon. The open wound was approximately 12 cm by 8 cm in size. The exposed tissue appeared necrotic and purulent drainage was present. At this time the limb was not swollen and there was no overt lameness.


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