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EQUINE VETERINARY EDUCATION / AE / JANUARY 2020


open wound probably as a result of repeated trauma. This area is prone to repeated trauma during recumbency and


there is marked movement and tension on the skin during flexion of the elbow. A prior publication also reported failure of healing with open drainage and medical management (Honnas et al. 1995). The treatment of a closed subcutaneous olecranon bursitis that is inflamed with clinical signs suggestive of infection should potentially be limited, at least initially, to medical management alone. If drainage of an infected closed bursitis is necessary then potentially the placement of an active suction drain with primary closure of the incision at the time of removal may be one option. Endoscopic debridement and lavage could also be considered as this has been extensively employed for treatment of calcaneal septic bursitis. Cultures were not performed in these horses and potentially needle aspiration and culture of the bursa would be recommended at the time of initial presentation to guide appropriate antimicrobial use. The application of NPWT to the equine wounds in this


Fig 5: A follow-up photograph of Horse 2, 2 years after discharge showing a scar and lack of hair regrowth at the site of the olecranon bursitis.


about the stall without twisting and eventually kinking the tubing. We have also attached the apparatus and canister to a surcingle when treating other wounds which also worked well. Using the fluid hook avoided potential damage to the suction apparatus by rolling. The cost of the treatment could not be compared with


conventional therapy as there were no control horses. The length of therapy was judged to be quite short (11, 9 and 22 days) compared with memory of other similar cases and bandage changeswere limited to every 3–4 days. Cost was not thought to be a limiting factor in the application of the NPWT. As antibiotics and anti-inflammatories were discontinued in two horses and sedation was not required for bandage changes the costs of maintaining the NPWT was minimal. The foam dressing and new canister and tubing were the most important costs. Several studies concerning the cost effectiveness of NPWT have been performed in the human medical field with some finding substantial cost savings with NPWT compared with traditional dressings (Liu et al. 2017) while some found comparable costs (Heard et al. 2017). Recently the development of a NPWT system with the


ability to allow instillation of topical wound therapies is thought to benefit wound healing even further than NPWT alone (Kim et al. 2015; Gupta et al. 2016). Investigation of this development in horses is warranted given the positive results in other species. The fact that two of the three horses had an iatrogenic


opening made by a veterinarian in order to drain a presumptively infected subcutaneous olecranon bursitis which then expanded to a large wound and failed to heal is also worthy of mention. While it is likely that in both horses an attempt was made to place the drainage incision laterally and of a small size, in both cases it progressed to a large


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study permitted rapid progression of a healthy appearing granulation tissue and marked contraction similar to clinical reports of beneficial effects of NPWT therapy in small animals in a clinical context (Ben-Amotz et al. 2007; Demaria et al. 2011; Pitt and Stanley 2014). Studies in dogs have also commented on the increased speed of healing in comparison to conventional bandaging (Nolff et al. 2015). The equine wounds reported here were large, deep,


chronically infected wounds in a challenging site and the final clinical outcome was judged to be excellent. The installation and management of the NPWT apparatus became easier with time and experience. The use of NPWT in horses has merit and deserves further study based on the clinical experience gained with these three horses.


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


Ethical animal research Not applicable.


Source of funding None.


Acknowledgements


Thanks are due to the referring veterinarians Drs Giguere, Surprenant and Cesari for their contributions of cases and follow-up information.


Authorship


All authors contributed to the study execution and final approval. Y. Elce prepared the manuscript and S. Laverty contributed to its development.


Manufacturers' addresses


1KCI and Acelity, San Antonio, Texas, USA. 2Cardinal Animal Health, Dublin, Ohio, USA.


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