Limited added value of negative pressure wound therapy compared with calcium alginate dressings for second intention healing in a noncontaminated and contaminated equine distal limb wound model.
Authors: Haspeslagh Maarten, Van Hecke Lore L, Hermans Katleen, Chiers Koen, Pint Eva, Wilmink Jacintha M, Martens Ann M
Journal: Equine veterinary journal
Summary
# Editorial Summary Distal limb wounds in horses frequently heal poorly due to delayed inflammatory responses, prompting researchers to investigate whether negative pressure wound therapy (NPWT)—a technique already established in human chronic wound management—could improve outcomes compared with standard calcium alginate dressings. A controlled experiment was conducted on 10 horses with surgically created wounds on both metacarpi, with five animals receiving contaminated wounds inoculated with *Staphylococcus aureus* and *Pseudomonas aeruginosa*; one limb per horse received NPWT whilst the contralateral limb was dressed with calcium alginate, with treatments maintained for 9 days (noncontaminated) or 6 days (contaminated wounds) and follow-up assessments continuing to 71 days. In noncontaminated wounds, NPWT demonstrated early advantages including significantly less wound retraction during initial healing stages (19.2% difference, P = 0.005) and altered inflammatory cell recruitment—notably higher neutrophil and lower macrophage infiltration in control wounds—yet these differences did not translate to improved final wound dimensions or measurable changes in bacterial load or growth factor expression. Contaminated wounds showed no discernible benefit from NPWT across any measured parameter. For equine practitioners managing distal limb wounds, these findings suggest calcium alginate dressings represent a pragmatic, cost-effective alternative to NPWT, with no evidence supporting the additional expense and application complexity of negative pressure systems for second-intention healing in this anatomical location.
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Practical Takeaways
- •Calcium alginate dressings appear to be equally effective as NPWT for equine distal limb wound healing, potentially offering a simpler and more cost-effective alternative
- •NPWT may provide minor early benefits in wound retraction for clean wounds, but this advantage does not translate to faster long-term healing
- •Standard dressing protocols may be sufficient for both contaminated and noncontaminated distal limb wounds in horses without need for more complex negative pressure systems
Key Findings
- •NPWT reduced wound retraction by 19.2% in early healing stages of noncontaminated wounds (P=0.005), but wound size was not significantly different at later stages
- •Control wounds showed significantly higher neutrophil influx (OR=1.99, P<0.001) and lower macrophage influx (OR=0.75, P=0.008) compared to NPWT-treated wounds
- •Bacterial load and growth factor presence did not differ between NPWT and calcium alginate treatments in noncontaminated wounds
- •No differences were observed between treatments in contaminated wounds for wound size, histology, bacterial load, or growth factors