A review of regional limb perfusion for distal limb infections in the horse
Authors: Biasutti S. A., Cox E., Jeffcott L. B., Dart A. J.
Journal: Equine Veterinary Education
Summary
# Regional Limb Perfusion for Equine Distal Limb Infections: Promise Versus Practice Whilst regional limb perfusion (RLP) has become commonplace in equine practice for treating focal distal limb infections, evidence supporting its clinical efficacy remains surprisingly inconsistent. Biasutti and colleagues reviewed three decades of experimental and clinical literature (1990–2019) to establish whether RLP delivers reliable, standardised outcomes in treating these infections, finding that profound methodological heterogeneity undermines meaningful comparison across studies. Critical variables diverge dramatically between published reports: antimicrobial agents, perfusate concentrations and volumes, dosing intervals, tourniquet application methods and duration, and whether procedures occur under standing or general anaesthesia all differ substantially, producing highly variable drug concentrations at the infection site. The authors conclude that whilst retrospective clinical studies suggest benefits, the absence of prospective trials, coupled with methodological inconsistency, makes it impossible to confirm whether RLP delivers superior outcomes compared with systemic antimicrobial therapy or other approaches. For practitioners relying on RLP, this review underscores the pressing need for standardised protocols—encompassing tourniquet specifications, perfusate composition, and dosing regimens—to establish which technique genuinely optimises local antimicrobial delivery and improves clinical outcomes for horses with distal limb infections.
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Practical Takeaways
- •RLP shows clinical promise for distal limb infections but current evidence does not support a single 'best practice' approach—standardize your own protocol within your practice and monitor outcomes closely.
- •When performing RLP, document your exact methodology (drug, dose, volume, tourniquet duration, application method) so you can evaluate what works best for your horses and refine your technique over time.
- •Recognize that conflicting published recommendations reflect genuine gaps in evidence, not practitioner error—advocate for and support prospective clinical trials that standardize RLP protocols to improve outcomes.
Key Findings
- •Regional limb perfusion (RLP) is widely used clinically but lacks standardized methodology, with major variations in drug, dose, volume, concentration, dosing interval, tourniquet type/duration, and application method (standing vs. anaesthetized).
- •Experimental and clinical literature from 1990-2019 shows conflicting results and highly variable outcomes due to methodological inconsistencies.
- •Prospective clinical studies are lacking; retrospective studies are limited in scope, making it difficult to confirm, quantify, or rationalize reliable clinical benefits of RLP.
- •The optimal method for performing RLP remains unestablished, preventing consistent and repeatable outcomes in equine distal limb infection treatment.