Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Department of Pathology, Bacteriology and Poultry Diseases, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Equine Vet J. 2022 May;54(3):592-600. doi: 10.1111/evj.13487. Epub 2021 Jul 29.
Distal limb wounds in horses often show aberrant healing due to a slow inflammatory response. In human medicine, negative pressure wound therapy (NPWT) is used for the treatment of chronic wounds with a similar inflammatory response.
To compare the effect of NPWT to calcium alginate dressings on the healing of (non) contaminated equine distal limb wounds.
Controlled experiment.
Circular wounds were created on the left and right dorsomedial metacarpus of 10 horses. In five horses, the wounds were contaminated with Staphylococcus aureus and Pseudomonas aeruginosa. In all horses, one limb was treated with NPWT, the other with calcium alginate dressings. Treatments were applied during nine days for noncontaminated wounds and six days for contaminated wounds. Noninvasive (clinical assessment, bacteriology swabs, thermographic images and wound dimensions) and invasive (biopsies for histology and growth factor analysis) measurements were taken regularly for 71 and 29 days respectively. Effects of selected parameters on continuous dependent variables were analysed using ANOVA, while for discrete dependent variables, logistic regression was applied.
In noncontaminated wounds, there was significantly less wound retraction in the early healing stages when treated with NPWT (mean difference [95% CI] = 19.2% [13.3%-25.1%]; P = .005), although wound size was not significantly different between NPWT and control wounds at later healing stages. Noncontaminated control wounds had a significantly higher neutrophil influx (OR [95% CI] = 1.99 [1.49-2.66]; P < .001) and lower macrophage influx (OR [95% CI] = 0.75 [0.60-0.93]; P = .008) compared with NPWT-treated wounds. Bacterial load and the presence of growth factors did not differ between treatments in noncontaminated wounds. In contaminated wounds, no differences between treatments were observed in wound size, histological parameters, bacterial load or growth factor concentration.
Sample size is small.
No long-term advantage was detected with NPWT compared with calcium alginate dressings in noncontaminated or contaminated equine distal limb wounds healing by second intention.
马的四肢远端伤口常因炎症反应缓慢而出现异常愈合。在人类医学中，负压伤口治疗（NPWT）用于治疗具有类似炎症反应的慢性伤口。
比较 NPWT 与藻酸钙敷料对（非）污染的马四肢远端伤口愈合的影响。
对照实验。
在 10 匹马的左、右掌背内侧创建圆形伤口。在 5 匹马中，伤口被金黄色葡萄球菌和铜绿假单胞菌污染。所有马的一只肢蹄用 NPWT 治疗，另一只用藻酸钙敷料治疗。非污染伤口治疗 9 天，污染伤口治疗 6 天。分别在 71 天和 29 天定期进行非侵入性（临床评估、细菌学拭子、热成像图像和伤口尺寸）和侵入性（活检用于组织学和生长因子分析）测量。使用方差分析（ANOVA）分析选定参数对连续因变量的影响，而对于离散因变量，则应用逻辑回归。
在非污染伤口中，早期愈合阶段使用 NPWT 治疗时，伤口回缩明显减少（平均差异[95%置信区间]为 19.2%[13.3%-25.1%]；P=0.005），尽管在后期愈合阶段，NPWT 与对照伤口的伤口大小无显著差异。非污染对照伤口的中性粒细胞浸润显著增加（比值比[95%置信区间]为 1.99[1.49-2.66]；P<0.001），而巨噬细胞浸润显著减少（比值比[95%置信区间]为 0.75[0.60-0.93]；P=0.008）。与 NPWT 治疗的伤口相比，非污染伤口中的细菌负荷和生长因子的存在没有差异。在污染伤口中，在伤口大小、组织学参数、细菌负荷或生长因子浓度方面，两种治疗方法之间没有差异。
样本量小。
在非污染或污染的马四肢远端伤口二期愈合中，与藻酸钙敷料相比，NPWT 没有显示出长期优势。
