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146 Cards in this Set

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chars wounds involving the coronary band
- healing of the coronary band is difficult to predict
- abnormal hoof development might be the result of this type of wound
managements of wounds involving the coronary band
- wait several days following injury to debride (allows more accurate determination of the devitalised tissue)
- snug pressure bandage is required for optimum healing with non stick pad + gauze sponges tightly under elasticon tape (normal leg wrap doesn't apply adequate pressure)

caustic or irritating dressings are contraindicated!
prognosis wounds involving the coronary band
- removal of less than 1 inch segment of coronary band usually results in regeneration of a normal coronary band
chars wounds involving a tendon sheath
- small puncture wounds of the tendon sheath are considerable problems since owners many times don't realise the severitu and delay treatment
- take every opportunity to explain to oweners the severity of puncutr wounds of joints and tendon sheaths
surgical management of wounds involving a tendon sheath with primary closure
- surgical prep
- flush with saline
- close under suture if wound meets necessary criteria
- consider placing a drain in the tendon sheath
- parenteral antibiotics
- consider regional limb perfusion
delayed surgical closure for management of wounds involving a tendon sheath
- if wound more than 10 hours old and there is adequate tissue to close without undue tension
- surgical prep + flushing
- maintain under sterile bandage for 3 days with adequate antibiotic therapy
- close as in primary closure
- continue on parenteral antibiotics and a suction drain and/or regional limb perfusion
medical manegement of wounds involving tendon sheath if small puncture wound that has recently occured
- maintain on adequate levels of antibiotics
- consider regional limb perfusion
medical management of wounds involving tendon sheath if open sheath without adequate tissue to close surgically
- maintain drainage
- maintain under sterile bandage
- provide adequate parenteral antibiotic therapy
- periodic flushing and cleaning

fair prognosis if adequate drainage is maintained
medical management of wounds involving tendon sheath if established infection in a closed tendon sheath
best managed by establishing liberal drainage
- anesthesia (regional or general)
- incision on palmar/plantar aspect of P1 to open great digital sheath
- incise skin and pull penrose drain down tendon sheath
- maintain area under bandage with parenteral antibiotics under tendon sheath closes

results in pasture sound animal
chars wounds caused by encircling material
- wire, rubber bands, twine most commonly involved
- if material is tight, leg swells, skin sloughs and material becomes buried
diagnosis of wounds caused by encircling material
- presence of a lesion that goes completely around the leg
- marekedly swollen limb
- wound that doesn't heal
management of wounds caused by encircling material
- remove offending material
- normal wound management
diagnosis of wounds complicated by a foreign body
- wounds on anterior surface should always be thoroughly explored
- all wounds that don't heal as expected should be explored
- digital exploration with bare finger (most effective)
- ultrasound is helpful
- radiographs should be taken if wound is in close proximity to bone to rule out a sequestrum
treatment wounds complicated by a foreign body
- remove the foreign body
- wound therapy as necessary
etiology abscesses
- localisation of a hematogenous infection
- secondary to poorly draining wound
development of abscesses
- bacteria localise
- white blood cells migrate
- purulent exudate is formed by living and dead white blood cells, bacteria and cellular debris
Diagnosis of abscesses
classic signs of inflammation are present:
- redness, heat, swelling, pain and function loss
- confirmation by test puncture and/or ultrasound
management of abscesses
- wait until abscess matured (will be initially hard and firm and will become fluctuant with time)
- clip, shave, scrub
- perform test puncture
- consider analgesia or local anesthesia
- incise to provide adequate ventral drainage
- use drains if ventral drainage is compromised
- use of caustics to destroy abscess wall may be indicated (usually not in horses)
def: indolent wounds
wounds that reach a stage of healing and then don't get worse but don't heal
possible etiologies of indolent wounds
- animal in a poor nutritional state
- epithelial fatigue (occurs in large wounds where the epithelium has to proliferate a considerable distance)
- chronic infection
- over-exuberant attempts to control granulation tissue (steroids, caustic agents, DMSO)
management of indolent wounds
- correct underlying problem
- stimulated epithelialisation: surgically undermine wound edges, stimulate wound edge with mild irritant such as Scarlet red, insert pinch graphs, use occlusive dressings
etiology: subcutaneous air
- wounds that pump air (wounds to axilla most commonly)
- wounds in the respiratory tract (trachea, early removal of trachel tube)
- gas forming organisms (hematogenous spread of Clostridial species in deeper tissues from Banamine usage)
management: subcutaneous air from a wound that pumps air or involves the respiratory tract
- no treatment required: wound will be absorbed in few days
- condition can be prevented or reduced by limiting the amount of movement (tying or stalling animal)
management of subcutaneous air secondary to clostridial infections
- establish drainage and debride
- high doses of antibiotics (Crystalline penicillin)
- anticipate large muscle slough
- warn owner of severity, death is likely!
chars sarcoids
- most common skin tumour on the horse
- most commonly first develops in 3-6 year olds and incidence decreases after 15
- linked to an inheritance to equine leukocyte antigen W13 (genetic susceptibility?)
- Arabians, Appaloosas and Quarter horses most commonly
- more common in donkeys, i.p. males
- worldwide distribution
- described as benign tumours but some act malignant
indications for skin grafting
to increase speed of wound epithelialisation when:
- defects cannot be closed by conventional suturing techniques
- wounds are in areas where healing by wound contraction is minimal
economic considerations of skin grafting
initial expense may be considerably more but the reduced length of healing time may easily reduce the total cost of wound care
types of grafts classified by donor-host relationship
- autografts/autogenous grafts: transfeered to a recipient site on the same animal
- allografts/homografts: transferred between genetically different animals of the same species
- xenografts or heterografts: transferred between animals of different species
types of grafts classified by thickness
- full thickness
- split thickness: thin, intermediate or thick
appearance following skin grafting
- generally, the better the appearance the less likely the graft is to take
- cosmetic appearance from best to worst (tendency to take from worst to best)
*full thickness
*thick - partial thickness
*thin - partial thickness
* pinch, punch and tunnel
preparation of the graft bed
- for mesh, full thickness or split thickness grafts, a healthy non-infected granulation tissue bed is required
- for pinch, punch or tunneled grafting a granulation tissue bed must be healthy but some degree of infection can be present
- routine daily wound care is indicated to minimise the time it takes for the animal to produce healthy granulation tissue prior to grafting
common donor sites for skin grafts
- pectoral region
- ventral abdomen
description: pinch grafts
- performed on standing animal
- involves harvesting a very small segment of skin (iris forceps and a Bard parker blade to remove as small a segment as possible)
- at recipient site make pockets in granulation tissue by inserting a bard parker blade very superficially and parallel to the surface of the granulation tissue bed
- donor skin is placed in the depths of the small packet
- wound is bandaged with a non-stick dressing
- leave bandage in place for up to 7 days to avoid removing the graft when changing the bandage
- takes 2-3 weeks to determine if the grafts have taken
description: punch grafts
- pectoral region is normal donor site
- donor skin can be removed as a full thickness segment of skin and then cut with a biopsy punch or it can be harvested directly with a biopsy punch (all the subQ tissue is renived with either method)
- 6 mm biopsy punch is usually used to cut the donor grafts and a 4 mm punch to produce recipient sites in granulation tissue
- recipient sites are routinely prepares first and sterile cotton swabs are placed in them to control hemorrhage
- following placement of the grafts a non-stick bandage is applied and if necessary splints or casts used to control motion
description: split thickness grafts
- performed under general anesthesia
- requires equipment to handle the graft (hand held dermatome, electric or penumatic dermatomes)
- donor site requires a relatively large flat skin surface (ventral abdomen most commonly)
- very thin grafts take better, but result in a less esthetic appearance and results in an epithelium that has less strength
- grafts are applied and either sutured or glued to the wound edges or sutured to the granulation tissue
- P bandages applied over non-stick pads
- splints or casts may be indicated to prevent motion
description: mesh grafts
- performed under general anesthesia
- full or split thickness grafts that are modified by cutting numerous small slits in them: cutting allows for expansion so that a smaller amount of skin can be used to cover a defect and prevents serum accumulation under the graft
- applied in essentially the same manner as a split thickness graft
description: tunnel and strip grafts
- performed under general anesthesia
- modification of the split thickness graft
- allows grafting in areas where there is considerable motion
- long split thickness segments of skin are removed
these are applied to adhesive tape with sticky side of tape applied to the hair side of the graft
- tape is trimmed to the same size as the graft
- graft and tape unit are attached to a long straight needle which is threaded just under the surface of the granulation tissue (position the tape towards the surface of the granulation tissue)
- wound is bandage and a week later the granulation tissue over the tape is cut and tape is carefully removed leaving the graft in place
- technique can be modified by using long alligator forceps to produce the granulation tissue tunnel or by not using the adhesive tape and just pulling the graft through the tunnel (more difficult to get the hair side of the graft positioned toward the surface of the granulation tissue
description: full thickness grafts
- performed under general anesthesia
- full thickness of the epidermir is used
- provides a much more cosmetic appearance
- do not take as well as other grafts
skin grafts and presuturing
- technique that can be used to close a defect or more commonly to remove a blemish
- stay sutures are placed to markedly stretch the skin for 2-3 hours prior to closure
- this technique minimises the tension applied to the skin edge at the time of closure and allows for removal of a larger defect or closure of a larger wound
situations that complicate wound healing
- joint wounds
- excessive granulation tissue "proud flesh"
- phycomycosis (includes both pythiosis and conidiobolomycosis)
- cutaneous hambonemiasis "summer sores"
- wounds involving periosteum and bone
- wounds involving the coronary band
- wounds involving a tendon sheath
- wounds caused by encircling material
- wounds complicated by a FB
- abscess
- indolent wounds
- subcutaneous air
joint wounds and wound healing
- if the joint capsule is intact the healing is only slightly more complicated than any other wound. Increase in motion usually results in some increase in healing time.
- when the joint capsule has been penetrated the situation is critical
diagnosis of an open joint
- synovial fluid in the wound
- flushing through the joint: surgically prepare a joint injection site remote from the wound, insert a needle into the joint and infuse sterile saline under P, if the fluid flows from the wound the joint is obviously involved
- evaluation of synovial fluid (culture, sensitivity, cytology)
culture of synovial fluids
- negative culture doesn't mean the joint isn't infected -> synovial fluid represses bacterial growth (bacterial might be present in the synovial membrane with a negative culture)
- positive culture proves infection and allows for sensitivity testing to determine the appropriate antibiotic to use
cytology of synovial fluid
<10,000WBC/uL - probably not infected
>50,000WBC/uL - probably infected
>90% neutrophils - probably infected
management of a wound involving an open joint <8hrs old with minimal tissue loss
- flush the joint with several litres of saline and close under suture
- maintain adequate parenteral antibiotics levels
- consider regional limb perfusion
management of a wound involving an open joint >8 hours old with minimal tissue loss
- thoroughly clean and debride the wound
- bandage and maintain on antibiotics with daily bandage changes for 3 days
- close with delayed primary closure: continue on parenteral antibiotics
- consider regional limb perfusion
management of joint wounds so extensive that they cannot be closed under suture
- thoroughly clean and debride
- maintain under sterile dressing with daily cleansing and parenteral antibiotics until the joint capsule closes
lameness and joint infections
open infected joints are usually not extremely painful until the joint capsule closes
1- if there is an infection present when the joint cpasule closes, the animal will be leg carrying lame
2- when drainage stops and the animal is not lame, infection has been controlled, secondary osteoarthritis is still a possible complication
predisposing factors to excessive granulation tissue "proud flesh"
- minimal muscle mass
- limited excess skin
- continual irritation (tall grass, chronic infection, motion)
description "proud flesh"
when granulation tissue proliferates above the skin edge.
interferes with epithelialization and wound contraction
surgical methods of removal of excess granulation tissue (proud flesh)
probably the best choice
1- sedation +/- regional anesthesia
2- esmarch bandage
3- scalpel to remove tissue to slightly lower than the skin edge
4- pressure bandage to control hemorrhage
caustic methods of removal of excess granulation tissue (proud flesh)
1- Podophyllin in compound tincture of benzoin (expensive, EOD)
2- copper sulfate powder (5-100% concentration)
3- antimony chloride (v. potent!)
4- hydrochloric acid and sulfur (v. potent!)
technique for application of severe caustics for removal of proud flesh
- clip area
- apply petroleum liberally to normal tissue
- apply caustic to granulation tissue
- cover with pretrolatum impregnated gauze
- apply pressure bandage
- re-bandage with caustic application EOD

important to prevent the animal from chewing bandage and getting potent caustics in mouth or eyes!
methods to control development of excessive granulation tissue (proud flesh)
- reduce irritation and motion with P bandage over a nonstick pad or splints and casts
- corticosteroid containing ointments (some reduction in the rate of epithelialization and wound contraction)
- mild caustic agents (25% podophyllin in tincture of benzoin or 5% copper sulfate)
- enzyme preparations (meat tenderizers)
commonly used corticosteroid containing ointments for the control of development of excessive granulation tissue (proud flesh)
- Panalog ointment
- Silvadene ointment plus Predef or Azium
definition phycomycosis
a general term to include both pythiosis and conidiobolomycosis
etiology of pythiosis
Hyphomyces destruens
pythiosis aka
- leeches
- swamp cancer
etiology of conidiobolomycosis
Entomophthora coronata
geographical location of phycomycosis
- in the US almost exclusively within 250 miles of the Gulf Coast
- in tropical and subtropical areas around the world
anatomical location of pythiosis
- usually involves the lower extremities
- horses spending time in ponds sometimes have involvement of the upper limbs or mammary glands
anatomical location of conidiobolomycosis
occurs almost exclusively in the nasal passages
CS pythiosis
- infection is extremely invasive, lesions are extremely - granulomatous with rough textured grey to yellow exudate ("leeches")
- marked pruritis associated with infection
- infection causes production of excessive granulation tissue
CS conidiobolomycosis
- single or multiple usually ulcerated nodules and granulomas in the nasal passages
- significant thickening of the nasal septum
Dx phycomycosis
- CS, geographic area and appearance are adequate for a field Dx
- histopath and culture for a def Dx (not on ice! cold kills organsm)
- don't delay treatment of intensively pruiritic granulating lesions might make a difference between success and euthanasia
etiology: sarcoids
possible viral etiology:
- bovine papilloma virus (BPV) 1 and 2
- viral DNA can sometimes be found in normal skin, unknown stimuli can cause development of sarcoid
common areas of sarcoid development
- face and muzzle
- ears
- periocular region
- distal limbs
- neck
- ventral abdomen
- areas of previous injury
(can occur anywhere really, tend to vary with geography)
common areas of sarcoid development in US and Australia
distal limbs and face
common areas of sarcoid development in England and Switzerland
more common on trunk
types of sarcoid based on clinical appearance
- occult
- verrucous or warty
- nodular
- fibroblastic
- malevolent
description: occult sarcoid
mild cutaneous scaling and alopecia
description: verrucous or warty sarcoid
raised scaly with hair loss and thickened skin (crack on the surface but rarely ulcerate)
description: nodular sarcoids
freely moveable, raised masses with normal or ulcerated skin
description: fibroblastic sarcoids
proliferative, ulcerated masses that many times are confused with excessive granulation tissue
description: malevolent sarcoids
- infiltrate locally along fascial planes and vessels
- grow rapidly and have a high recurrence rate following excision
- uncommon but are the most aggressive
which types of sarcoid can transform to more malignant or agressive types?
all types are capable of transformation, occurs more frequently after injury or irritation (many times associated with biopsy, treatment or attempted removal)
sarcoid definitive diagnosis
- histopath
- PCR for detection of BPV
sarcoid management
- no complete and routinely satisfactory method available
- cryosurgery (liquid nitrogen, will cause tissue slough)
- chemical cautery
- immune stimulation
- anti-cancer drugs: interfere with cell development (Cisplatin)
- laser surgery
- sharp surgical dissection (recurrence common)
- radiation with iridium (most successful)
products used for chemical cautery of sarcoids
- Podophyllin
- Efudex/5-Fluorouracil
- Tea Tree Oil,
- Topical Formalin
- Indian Mud
products used for immune stimulation for management of sarcoids
- Regressin V
- BCG
- mammalian tuberculin
- caprine serum factor
- Equi-stim
- autologous tissue implantation
chars squamous cell carcinoma
- 20% of neoplasms recorded in the horse
- commonly develop at muco-cutaneous junction
- may develop in any cutaneous area
common sites of SCC
exposed areas of light colored animals most commonly
- eye and adnexa (33%)
- prepuce (27%)
- glans penis (17%)
- perineum of the mare (12%)
- head (10%)
Dx SCC
- appearance: usually papillary to cauliflower like to multi-nodular with varying amounts of ulceration and inflammation
- usually invade locally but are slow to metastasise
- histopath for definitive Dx
management SCC
- wide surgical excision usually best
- post surgical radiation reduces recurrence
- other possibilities: cryosurgery, hyperthermia, radiation, laser surgery
chars melanoma
- one of the more common neoplasms of horses
- most melanomas has metastatic potential (but usually slow to metastasise)
- occur most commonly in gray and chestnut horses >10 years
- associated with fading hair colour (Arabs and Lipizzan)
frequent areas involved in melanoma
- perineum, tailhead, anus, external genitalia, parotid salivary gland
- can occur in any area
- sometimes are only internal with no external evidence
melanoma prognosis as a result of size
- smaller masses less likely to metastasise
- literature indiciates that tumors over 4 cm in diameter more likely to metastasise
melanoma prognosis as a result of coat colour
non gray horses are more likely to develop metastatic forms
diagnosis melanoma
- gross appearance, coat colour, and area of involvement usually adequate
- histo confirmation usually not necessary
melanoma management
- surgical removal
- cryosurgery
- cisplatin
- 5 fluorouracil injection or cream
- BCG
- injections from special lab Dr Jeglum
- Cimetidine
description: verrucous dermatitis
chronic villus proliferative growth, names vary with location:
- canker
- grease heel
- scratches
- grapes
description: canker
verrucous involvement of frog and sole
description: grease heel
verrucous dermatitis involves the heel area
description: scratches
verrucous dermatitis involving the pastern
description: grapes
verrucous dermatitis involving the pastern and fetlock with proliferative lesions
etiology: verrucous dermatitis
- predisposed by but not always the result of filthy conditions
- occasionally seen when animals continuously on wet pasture
diagnosis verrucous dermatitis
- very typical appearance
- canker and thrush involve the same area of the foot but thrush is erosive and cankers are proliferative
- definitive Dx with histopath
management verrucous dermatitis
- requires radical surgical excision of all diseases tissue
- best to perform under general anesthesia with an Esmarch bandage
- control haemorrhage with bandaging
- topical medications under bandage
topical medications for verrucous dermatitis
- phycofixer
- thiabendazole powder and DMSO paste
- thiabendazole powder, iodoform and salicylic acid powders
- chloramphenicol tincture
- tetracycline
- metronidazole
etiologyu: keloid
- commonly the result of an improperly managed wound
- usually secondary to irritation for prolonged periods: overzealous application of caustics to control granulation tissue or inadequate protection from the environment
keloid Dx
appearance of a large thickened scar
keloid management
- surgical excision and closure of defect is only way to correct the problem (surgery is difficult because usually in areas with minimal excess tissue)
- daily application of emollient ointments to increase the pliability of the area
etiology: pressure sores
usually the result of the animal spending a considerable amount of time laying down (usually result of chronic laminitis)
Dx: P sores
typical lesions developing over bony prominences
management of pressure sores
- keep wounds as clean as possible
- treat with antiseptic or antibiotic ointments
- mixture of Malox and zinc oxide paste has been suggested
- minimise pain so less pain spent lying down
- use appropriate bedding in stall (deep straw, no pine shavings because of turpentine, peat moss is easy on skin but dirty)
- sheets or blankets to minimise irritation
etiology: burns
- usually the result of barn fires
- occasionally trailer bedding catching fire
burn management
- treatment to control complications (laminitis, shock, respiratory infection)
- topical medications to control pseudomonas infection
- debride area as necessary to remove eschar
- skin grafts requires many times
topical medications to control pseudomonas infection
- silver sulfadiazine ointment
- gentamicin
- dilute vinegar (low pH causes inhibition)
definition: abrasion
a wound which doesn't extend through the dermis
definition: laceration
- tearing without extreme loss of tissue
- classic example: barbed wire cut
definition: incision
results from a cut by a sharp instrument or scalpel
definition: avulsion
tearing wound with a considerable loss of tissue
definition: contusion
- no break in the skin but deeper damage
- classic example: kick with considerable muscle damage and no break in the skin
definition: puncture wound
wound that is produced by a sharp pointed instrument that produced a small external opening, causes internal damage and usually has poor drainage
basic wound management
- control hemorrhage
- evaluate animal and wound
- discuss with owner extent of treatment desired and management techniques available
- tetanus prophylaxis
methods to control hemorrhage
- apply pressure to arteries crossing bone
- apply pressure to the wound and bind tightly
- ligate bleeding arteries
- agents to reduce clotting time are of limited value in wound management
tetanus prophylaxis in various species
- horses are quite susceptible: all horses with wound should have their vaccination status evaluated and appropriate steps taken to maximise protection
- sheep and goats are moderately susceptible
- cattle and swine are not nearly as susceptible
chars tetanus antitoxin
- 1500 units of tetanus antitoxin provides immediate protection
- dose is commonly reduced to 150 units to protect lambs at castration and docking
- caution when giving to horses >2years, can cause serum hepatitis (Theiler's disease) secondary to administration, poor prognosis for recovery
chars tetanus toxoid
- 2 injections given one month apart provide very good immunity
- in horses it is routine to booster yearly even though they probably develop as good an immunity as humans (10 years), but recommended because often lose identity
- effective in all species but infrequently used in animals other than horses
tetanus prophylaxis guidelines
- tetanus antitoxin and toxoid can be given at the same time to provide immediate as well as long-term immunity, injections should be given in different muscles with different syringes
- combined use is often used when the vaccination history is unknown
parenteral antibiotics for open wound management
- indicated in severe flesh wounds for 3 to 4 days to control cellulitis
- indicated in wounds involving synovial structures until joint capsules and/or tendon sheaths are closed
topical medications for open wound management
- large number are available
- specific medications have been touted by owners and veterinarians for their ability to markedly reduce healing time
- most upper extremity and body wounds respond quite well if they are cleaned frequently and no topical medications are applied
- ointments for lower legs: furacin (delays epithelialization), silvadene, neosporin
- medications to control excessive granulation tissue are often necessary on lower legs
purpose of bandages
- prevent filth from gaining access to deeper tissue planes
- reduce irritation
- reduce motion
bandages of open wounds
- upper leg wounds and body wounds are difficult to bandage and are of limited value unless periosteum, nerves or vessels are exposed: use tape, sutures, or velcro closures to attach if they are
- lower leg wounds usually respond better if bandaged: P bandage over a non-stick pad and antiseptic ointment suggested
advantages of surgical closure of wounds
- many times markedly reduces healing time
- total cost of wound management may be reduced by initial surgical closure even if initial expense is much greater
primary factors to consider when determining if a wound can be repaired by surgical closure
- age: wound should be less than 10 hours old (except for head and perineum)
- all foreign material must be removed prior to closure
- must be in an area where movement of the wound edges is minimal or can be minimised with bandages, splints or casts
- enough tissue must be present to close the wound without excessive suture tension
- must be adequate blood supply to the tissue
- general condition of the animal
secondary factors to consider when determining if a wound can be repaired by surgical closure
- prognosis for healing without surgery
- temperament of the animal
- wishes of the owner
- available facilities
technique for primary surgical closure of wounds
- preop parenteral antibiotics
- thorough cleansing and debridement of wound
- acceptable surgical technique to close the wound
- consider the use of drains
- minimise tension with stay sutures, splints, casts, bandages or restricted motion
technique for delayed primary surgical closure of wounds
- must have all the criteria for primary closure except that the wound may be heavily contaminated and a number of hours old
- initially the wound is thoroughly debrided and cleansed
- animal is given parenteral antibiotics
- wound is medicated and bandaged to control infection for approximately 3 days
- after 3 days the wound is carefully debrided and closed as in primary closure
technique facilitated wound contract
- indicated if there is inadequate tissue to close the wound without extensive tension
- basic aim is to minimise the size of the area that must be closed by epithelialisation
- wound is initially cleaned and debrided
- monofilament suture material and tapered needle are used to place intradermal sutures in a continuous horizontal mattress type of pattern
- adjustments are made daily to tighten the suture, which stretches the skin
management of phycomycosis
- immunotherapy with vaccine is relatively effective in treating pythiosis but ineffective in the treatment of conidiobolomycosis: vaccinate to reduce size and extent and then surgery to remove
- radical surgery if all infected tissue can be removed
- cryotherapy
- amphotericin B: parenteral or topical 1% mixed with equal parts DMSO (parenteral expensive and must monitor BUN!)
- iodine therapy IV or PO
- phycofixer topical (ketoconazole + hydrochlorid acid + rifampin in DMSO)
chars cutaneous hambonemiasis "summer sores"
- granulation tissue that does not respond to routine treatment
- associated with warm weather
- very small cores of exudate
- associated with wounds
- in thin skinned areas: prepuce, penis, medial canthus of the eye
etiology: cutaneous hambonemiasis "summer sores"
- allergic reaction to the aberrant larvae of the Habronema species: H. musca, H. microstoma and Draschia megastoma
chars H. musca and H. microstoma
adults live in the stomach mucosa
chars Draschia megastoma
adults live in granulomas in the stomach wall
Dx cutaneous hambonemiasis "summer sores"
- typical lesion in typical locations
- biopsy and larva ID is definitive
management cutaneous hambonemiasis "summer sores"
- remove the larvae with parenteral ivermectin
- topical medication: antibacterial ointment with added ivermectin , a corticosteroid and DMSO
- control and/or remove excessive granulation tissue
- control the allergic response, sometimes necessary to use parenteral corticosteroids
Habronema normal life cycle
- adults are in the stomach
- eggs passed in the faeces
- house or stable flies ingest eggs (IH)
- habronema larvae emerge grom fly and are deposited around mouth of larvae
- find their way into the oral mucosa and then to stomach
- adults mature and pass eggs in feces
Habronema abnormal life cycle
- fly feeds on wound exudate or in thin skinned areas
- Habronema larvae deposited in these areas
- larvae in area cause allergic response and excessive granulation tissue
to interrupt Habronema life cycle
- control flies: remove manure, install spray sustem, screen stalls
- repellants on horses
- Habronema species sensitive to most all routinely used equine anthelmintics
- Draschia more difficult to remove is sensitive to avermectins
common wounds involving periosteum and wound
- bone sequestrum
- osteomyelitis
- periosteal proliferation
etiology of bone sequestrum
- trauma causing periosteal damage
- open wound causing drying of the periosteum
- application of caustics to periosteum or bone
etiology osteomyelitis
- poor drainage of wounds that involve bone
- hematogenous infection (most common in foals)
medical management of wounds involving bone
- radiograph if necessary to determine possible fractures
- protect with bandages until granulation tissue covers the bone
- establish good drainage
- use systemic antibiotics as necessary
- don't use caustics or healing powders on exposed bone
- less chance for sequestrum, osteomyelitis or periosteal proliferation to occur
surgical management of wounds involving bone
- fx repair
- exploration and removal of bone fragments
- removal of sequestrum (can be reabsorbed if small)
technique for sequestrum removal
- radiographic identification
- parenteral antibiotics
- GA
- Esmarch bandage
- surgical prep
- incision to bonme
- ID sequestrum (intraop rads if needed)
- remove sequestrum and abnormal surrounding bone
- collect tissue for culture and sensitivity to check if antibiotics will be effective
- consider use of a positive suction drain
- routine closure
- remove drain when quits drainings (48 hrs)