Managing Horse Wounds Either Presenting or not with Exuberant Granulation Tissue Using an Innovative Wound Dressing: A Retrospective Non-Controlled Study
[1]
Fiorella Carnevali, Enea CR Casaccia, Via Anguillarese 301, 00123 Rome Italy.
[2]
Marco Argentieri, Veterinary Infirmary Service of the Mounted Regiment of Carabinieri, Viale Tor di Quinto 155, 00191, Rome Italy.
[3]
Graziano Ippedico, Veterinary Infirmary Service of the Mounted Regiment of Carabinieri, Viale Tor di Quinto 155, 00191, Rome Italy.
[4]
Carlo Alberto Minniti, Veterinary Service of Corazzieri Regiment of the President of the Italian Republic, via XX settembre, 00196 Roma.
[5]
Luigi Amodio, Veterinary Infirmary Service of the Mounted Regiment of Carabinieri, Viale Tor di Quinto 155, 00191, Rome Italy.
[6]
Luigi Mellano, Military Veterinary Hospital, Via Montelibrettese snc, 00010 Montelibretti, Italy.
[7]
Stephen Andrew van der Esch, Enea CR Casaccia, Via Anguillarese 301, 00123 Rome Italy.
Reasons for performing study: Because we used a different innovative protocol for treating equine traumatic wounds, it was decided to analyse retrospectively all the cases treated during the years 2005-2012. Objective: Evaluate the healing performances of traumatic horse wounds, either presenting or not with exuberant granulation tissue (EGT) or exposed bone, using an innovative plant-derived wound dressing and restricting the systemic antibiotic administration only to the first week after trauma. Methods: A retrospective analysis was conducted of all horses (n = 57) presenting with accidental wounds and treated with a plant-derived wound dressing. Classification of Wounds using COW score (Simple Wounds –SW- or Wounds presenting with Exuberant Granulation Tissue – EGT-W), Time To Heal (days), Epithelialisation Rate (cm/days), Health Of Wounds score, Time of First Epithelium appearance (TFE), Cosmetic Aspect of the final Scar (CAS), ease of handling, pain and complications were recorded and evaluated. Results: COW score determined 32 Simple Wounds (SW) with mean size varying from 12,72±6.48 cm2 (< 25 cm2), 50,76± 14,20 cm2 (25 and 100 cm2) to 310,023±132,(> 100cm2) and 25 EGT-Wounds (EGT-W) with mean size varying from 12,90±4,51cm2 (<25 cm2) to 62,76±26,55 cm2 (25 and 100 cm2). The SW healed faster than the EGT-W showing significant differences in the evaluated parameters (58,06±39,44 vs 79±54,32 days) (SW=0,14±0,06 vs EGT-W 0,0742±0,0342 cm/day) and in the TFE (of 7 vs of 18 days). CAS showed no significant differences between SW and EGT-W both presenting high quality of final scar. The dressing was able to keep the EGT formation under control without using surgical resection. Conclusions: This retrospective non-controlled analysis confirmed that equine wound complicated by the EGT have a lower healing performance but the EGT formation can be kept under control with a high quality of final scar. The treatment is simple to use and safe; it enables to reduce the intake of antibiotic and consequently limiting the risk of onset of antibiotic/antimicrobial resistance.
Horse Wound Healing, Exuberant Granulation Tissue, Proud Flesh, Keloid, Hypergranulation, Primary Dressing
[1]
Stashak TS. (1991) Principles of wound healing. In: Stashak TS ed. Equine Wound Management. First Edition pp 1-18.
[2]
Dart AJ Perkins NR, Dart CM, Jeffcott LB and Canfield P (2009) Effect of bandaging on second intention healing of wounds of the distal limb in the horses. Aust Vet J,87(6), 215-218
[3]
Theoret CL and Wilmink JM. (2008) Treatment of Exuberant Granulation Tissue. In: Stashak TS ed. Equine Wound Management. Second Edition pp445-462.
[4]
Lepault E, Cèleste C., Dorè M., Martineau D and Theoret C. (2005) Comparative Study on Microvascular Occlusion and Apoptosis in Body and Limb Wounds in the Horse. Wound Rep Reg, 13, 520-529.
[5]
Miller CB, Wilson DA, Keegan KG, Kreger JM, Adelstein EH and Ganjam VK. (2000) Growth characteristics of fibroblasts isolated from the trunk and distal aspect of the limb of horses and ponies.Vet Surg, 29,1-7.
[6]
Fretz PB, Martin GS, Jacobs KA et al. (1983) Treatment of exuberant granulation tissue in the horse: evaluation of four methods. Vet Surg, 12, 137-140.
[7]
Cochrane CA, Pain R and Knottenbelt DC. (2003. In-vitro wound contraction in the horse: differences between body and limb wounds. Wounds, 15(6), 175-181.
[8]
Theoret CL, Barber SM, Moyana TN and Gordon JR. (2001) Expression of transforming growth factors 1, 3 and basic fibroblast growth factor in full-tickness skin wounds of equine limbs and thorax. Vet Surg 30,269-277
[9]
van den Boom R, Wilmink JM, O’Kane S, Wood J and Ferguson MW. (2002) Transforming growth factor-beta levels during second-intention healing are related to the different course of wound contraction in horse and ponies. Wound Rep Reg, 10, 188-194.
[10]
Wilmink JM, Veenman JN, van den Boom R, Ratten VP, Nievold TA. Broekhuisen-Davies JM, lees R, Armstrong S van Weeren PR and Barneveld A. (2003) Differences in polymorphonucleocyte fuction and local inflammatory response between horses and ponies. Equine Vet J,; 35, 561-569.
[11]
Cochrane C. (1997) Models in vivo of wound healing in the horse and the role of growth factors: Vet Dermatol, 8, 259-272.
[12]
Miragliotta V, Raphae K, Ipin Z, Lussier JG and Theoret CL. (2009) Equine thrombospondin II and secreted protein acidic and cysteine-rich in a model of normal and pathological wound repair. Physiol Genomics 38, 149–157.
[13]
Knottenbelt DC. (1997) Equine wound management: are there significant differences in healing at different sites on the body? Vet Dermat; 8, 273-290.
[14]
Hendrickson D and Virgin J. (2005) Factors that affect equine wound repair. Vet Clin Equine, 21,33-44.
[15]
Gomez JH, Hanson RR. (2005) Use of dressing and bandages in equine wound management. Vet Clin North Am 21,91–104.
[16]
Barber SM. (1989) Second intention wound healing in the horse: the effect of bandages and topical corticosteroids.In: Proceedings 35th Annu Meet Am Assoc Equine Pract, 107-116.
[17]
Bertone AL. (1989b) Management of Exuberant Granulation Tissue. In: Booth LC ed. Wound management. Vet. Clin North Am Equine Pract. Philadelphia: WB Saunders Company, 5,551-562.
[18]
Howard RD, Stashak TS, Baxer GM. (1993) Evaluation of occlusive dressing for management of full-thickness excisional wounds on distal portion of the limbs of horses. Am J Vet Res 54, 2150-2154.
[19]
Berry D and Sullins KE. (2003) Effects of topical application of antimicrobials and bandaging on healing and granulation tissue formation in wounds of the distal aspect of the limbs in horses. Am J Vet Res, 64(1), 88-92.
[20]
Ducharme-Desjarlais M, Cèleste CJ, Lapault E and Theoret CL.( 2005) Effect of silicone-containing dressing on exuberant granulation tissue formation and wound repair in horses. Am J Vet Res, 66, 1133-1139.
[21]
Azari O, Mahdi Molaei M and HojabriR. (2010) Differences in second-intention wound healing of distal aspect of the limb between Caspian miniature horses and donkeys: macroscopical aspects. Comp Clin Pathol on line publications ©Springer-Verlag London Limited-2010 DOI 10.1007/s00580-010-1166-3.
[22]
Ghamsari SM, Azari O, Dehghan MM. (2007) Similarities of second intension wound healing between TB and Caspian miniature horses: macroscopical aspects. 10th Annual Scientific Meeting, November 15, Berlin, Germany, pp 31.
[23]
Knottenbelt DC. (2003a) Handbook of equine wound management. Elsevier Science, Sunders. pp. 5-23.
[24]
Knottenbelt DC. (2003b) Handbook of equine wound management. Elsevier Science, Sunders. pp. 39-77.
[25]
Wilmink JM. (2009) Chronic Exuberant Granulation Tissue-Any difference with “Regular” proud Flesh?.Large Animal: Equine- NAVC Conference 18-19.
[26]
Hanson RR. (2009) Complication of equine wound management and dermatologic surgery. Vet Clin Equine, 24, 663–696.
[27]
Stashak TS and Farstvedt E. (2008) Update on Wound dressing: indication and best use. In: Stashak TS ed. Equine Wound Management.Second Edition, pp 109-136.
[28]
Silveira A., Arroyo LG, Trout D, Moens NMM, LaMarre J and Brooks A. (2010) Effects of unfocused extracorporal shock wave therapy on healing of wounds of the distal portion of the forelimb in horses. Am J Vet Res, 71, 229-234.
[29]
Sanchez AR, Sheridan PJ and Kupp LI. (2003) Is platelet-rich plasma the perfect enhancement factors? A current review. Int J Maxillofacc Implants, 18, 93-103.
[30]
Wilmink JM and van Wereen R. (2004) Differences in wound healing between horses and ponies: application of research results to the clinical approach of equine wounds. Clin Tech Equine Pract, 3, 123-133.
[31]
Thomas GW, Rael LT, Bar-Or R, Shimonkevitz R, Mains CV, Slone D.S, Craun ML and Bar-Or D. (2009) Mechanisms of delayed wound healing by commonly used antiseptics. J Trauma, 66(1), 82-90.
[32]
Atiyeh B.S., Dibo S.A. and Hayek S.N. (2009). Wound cleansing, topical antiseptics and wound healing. I. Wound J 6, 420-430
[33]
Stashak TS, Farstvedt E, Othic A. (2004) Update on wound dressing. Clin Tech Equine Pract, pp 148-163.
[34]
van der Esch SA, Carnevali F and Cristofaro M. (2007) Mix 557: A topical Remedy with repellent, biocidal and healing properties for treating Myiasis both in Mammal as in Human. Proceeding EWMA, Glasgow.
[35]
Lauchli S. (2012) 1 Primary Wound Dressing®: clinical experience. A novel wound dressing, formulated from natural oils, promotes effective healing, protects periwound skin and leads to an impressive induction of granulation tissue, even in deep wounds. HHE 1-3.
[36]
Lauchli S. Hafner J., Wehrman C., French L.E. and Hunziker T. (2012) Post-surgical scalp wounds with exposed bone treated with a plant derived wound therapeutic. J. W. C., 21, 228-233.
[37]
Mainetti S and Carnevali F. (2013) An experience on pediatric burn wounds treated with a plant-derived wound therapeutic. JWC, 22, 12: 681-689;[38] Desbois AP and Smith VJ. (2010) Antibacterial free fatty acids: activities, mechanisms of action and biotechnological potential.Mini-Review. Appl Microbiol Biotechnol, 85, 1629-1642.
[38]
Drake DR, Brogden KA, Dawson DV and Wertz PW. (2008) Antimicrobial lipids at the skin surface. J Lipid Res, 49, 4-11.
[39]
Ketzner KM, Stewart AA, Byron CR, Gaughan EM, Vanharreveld PD and Lillich Jd. (2009) Wounds of the pastern and foot region managed with phalangeal casts: 50 cases in 49 horses (1995-2006). Austr Vet J, 87 (9), 368.
[40]
Stojadinovic A, Carlson JW, Schultz GS,Davis TA, Elster EA (2008) Topical advances in wound care. Gynecologic Oncology 111, S70–S80;
[41]
Hackett R. P. (2011)How to Prevent and Treat Exuberant Granulation Tissue AAEP PROCEEDINGS _ Vol. 57; 367-373-
