Wound Healing: What the Research Says
Evidence from 18 peer-reviewed studies
What Professionals Should Know
- •ECSWT remains an experimental treatment with insufficient evidence for routine clinical use in equine or companion animal practice
- •If considering ECSWT, reserve use for short-term analgesia, ligament injury, or osteoarthritis cases where conventional options have failed, while acknowledging limited scientific support
- •Request high-quality outcome data from ECSWT providers and maintain realistic client expectations regarding evidence base for this therapy
- •Current veterinary evidence for honey is weak—mostly case reports in dogs and horses; before adopting honey protocols, seek controlled trial data specific to your species and condition
- •Wound healing is the most researched application, but veterinary-specific evidence remains limited; medical-grade honey may differ from non-medical products, so clarify formulation in any studies you review
- •This scoping review identifies a major evidence gap: the field needs rigorous controlled trials in equine and cattle practice to move beyond anecdotal use
- •eAM products may be beneficial for substantial wounds where rapid granulation tissue production is needed, though they do not accelerate overall healing time
- •eAM appears safe and does not compromise final wound healing quality compared to standard dressings
- •Consider eAM for wounds requiring prompt vascularization and tissue fill rather than for faster closure
- •A simple natural composite of honey, rosemary, and chamomile oil appears more effective than conventional wound treatments in equine practice—worth trialling for routine wound management
- •The composite showed complete histological skin regeneration, suggesting it may reduce scarring and improve functional outcomes compared to standard treatments
- •Natural product formulation is easy to apply (once daily dressing), cost-effective, and shows promise for both acute and chronic equine wounds in field conditions
- •Bandaging strategy should account for anatomical location, as limb and body wounds develop different microbial environments that may require different management approaches
- •Monitor for shifts in wound microbiota during healing, as bacterial community changes may indicate progression or complications in the healing process
- •Consider location-specific wound care protocols, as the natural differences in microbiota between limb and body wounds suggest different biological healing environments
- •Ponies and horses have fundamentally different inflammatory responses to injury; pony wounds heal faster due to stronger initial inflammatory mediator production that eliminates contaminants more rapidly
- •The enhanced inflammatory response in ponies may explain their superior wound healing outcomes—therapeutic modulation of inflammatory response could improve healing in horses with problematic wounds
- •Species-level differences in leucocyte function should be considered when interpreting infection risk, immune response, and healing outcomes across equine practice
- •When selecting wound dressing materials and topical treatments, consider that the gel carrier itself may influence both healing outcomes and bacterial colonization patterns
- •Wound dressings can be submitted for microbiota analysis to monitor wound infection risk without invasive sampling of wound tissue or fluid
- •Propylene glycol-based products warrant clinical evaluation for their effects on wound healing speed and infection prevention in working horses
- •While MSC conditioned medium shows promise for fibroblast activation in laboratory settings, direct intradermal MSC injection did not accelerate healing in this small equine trial—larger studies and alternative cell sources are needed before clinical adoption
- •Allogenic MSCs appear immunologically well-tolerated in horses, reducing concerns about rejection when using donor cells from other horses
- •Consider that positive in vitro results may not translate to in vivo efficacy; practitioners should await larger, controlled trials before investing in MSC therapies for routine wound management
- •Exuberant granulation tissue in horses shows persistent osteopontin expression similar to human keloids, suggesting common fibroproliferative mechanisms that could be therapeutically targeted to reduce excessive scarring
- •Downregulation of osteopontin represents a rational therapeutic objective for managing problematic wound healing and excessive granulation tissue in equine practice
- •Understanding osteopontin's role in fibrosis may guide development of topical or systemic interventions to improve healing outcomes and reduce cosmetic and functional complications in equine wounds
- •Novel silver-containing foam dressings may offer an antimicrobial alternative to traditional non-adherent dressings for lower limb wounds in horses
- •Semi-occlusive foam dressings warrant further investigation for their potential to reduce bacterial load while promoting healing in this high-motion, contamination-prone region
- •Results from this preliminary study suggest need for larger comparative trials before adopting new dressing protocols in clinical practice
- •Shockwave therapy is a potential supplemental treatment option for extensive burn wounds in horses when standard treatments are insufficient
- •This approach showed no adverse effects in the reported case, making it worth considering for severe burn injuries
- •Treatment decisions should still be guided by wound severity and individual case circumstances, as this is evidence from a single case only
- •Understanding TGF-beta receptor expression during different wound healing phases may guide optimal timing for receptor antagonist use to reduce scarring in equine limb wounds
- •The heightened receptor activity in exuberant granulation tissue supports the biological basis for interventions targeting this pathological healing response
- •Limb wounds show fundamentally different receptor activity patterns than thoracic wounds, suggesting location-specific treatment approaches may be warranted
- •Use tap water instead of saline for routine wound cleaning, and maintain lavage pressure around 13 psi for optimal cleaning without tissue damage
- •For contaminated wounds, incorporate povidone iodine lavage and consider larvae debridement or hydrosurgery in acute cases; avoid topical silver sulfadiazine on acute wounds
- •Consider honey as a topical treatment to potentially accelerate healing phases, though evidence quality remains limited
- •Distal limb wounds require individualized treatment planning based on thorough wound evaluation to optimize healing and minimize cost and labor.
- •Staying current with emerging commercial products and techniques can improve your ability to manage these common, challenging cases.
- •Early intervention with evidence-based wound care strategies can meaningfully reduce recovery time and improve client outcomes.
- •Traditional skin grafting in horses has significant limitations for large wounds due to limited donor sites and high complication rates—tissue engineering may offer future alternatives
- •Understanding that equine skin loses regenerative capacity as pregnancy progresses helps explain why wound healing becomes more fibrotic and scar-prone in adult horses
- •Emerging tissue engineering strategies combining appropriate cell sources with scaffolding materials could eventually provide better options for managing catastrophic wounds in practice
- •This in vitro model enables laboratory investigation of equine skin biology and wound healing mechanisms, potentially leading to improved therapeutic approaches for chronic equine dermatological conditions
- •The characterization of equine keratinocyte behavior on different substrates may inform future development of bioengineered skin products or wound treatments specific to horses
- •Establishes a foundation for understanding equine-specific epidermal responses that differ from other species, relevant for developing targeted therapies for equine wound complications
- •Differences in wound healing between horses and ponies cannot be attributed to basic fibroblast function; focus management strategies on inflammatory response control and local tissue factors instead
- •Limb wounds may heal faster through contraction than buttock wounds due to fibroblast maturity differences, not inherent species or tissue type variations
- •Optimize wound management by addressing inflammatory response and cytokine profiles rather than expecting fibroblast-level interventions to overcome species or anatomical differences
- •This foundational in vitro model provides a platform to test potential therapeutic agents for enhancing muscle regeneration in horses
- •The differential response of equine satellite cells to growth factors suggests species-specific considerations for future regenerative medicine approaches
- •Development of standardized assays for myotube differentiation enables systematic evaluation of wound healing and muscle recovery treatments
Key Research Findings
27 relevant articles identified on ECSWT in horses, 9 in dogs, 0 in cats published 1980-2020
Scientific evidence for ECSWT clinical effects is very limited across all indications studied
Many studies had methodological flaws with favorable results typically not replicated in independent studies
Most promising results found for short-term pain relief, ligament ailments, and osteoarthritis warranting further high-quality research
397 articles reporting 436 primary research studies on medicinal honey in animals were identified, with biomedical research (n=350) vastly outnumbering veterinary studies (n=47)
Veterinary literature consisted primarily of low-evidence case reports/series (n=23) rather than controlled trials (n=8), limiting clinical applicability
Wound healing was the most commonly examined indication across all studies, with honey derivatives and medical-grade formulations representing only 8% of interventions studied
High-quality controlled trials in veterinary species are substantially lacking, preventing evidence-based assessment of honey efficacy in equine and other clinical practice
StemWrap+ contained moderate concentrations of TGF-β1 (494.10 pg/mL), VEGF (212.52 pg/mL), and PGE2 (1811.61 pg/mL)
Equine amniotic membrane allograft did not affect time to healing or histologic quality compared to control groups
eAM treatment was associated with increased granulation tissue production early in healing, particularly on day 7
Composite ointment (rosemary, chamomile oils with honey) healed experimentally induced wounds faster than gentamycin, zinc, Kruuse Manuka, and Revan treatments
Histopathological analysis showed complete and efficient skin regeneration (epidermis and dermis) in composite-treated wounds versus incomplete regeneration in control groups
Clinical application of composite ointment accelerated healing across various forms of equine wounds in 122 field cases
Bacterial microbiota composition differs significantly between body and limb wound locations during healing
Evidence Base
Systematic Review of Complementary and Alternative Veterinary Medicine in Sport and Companion Animals: Extracorporeal Shockwave Therapy.
Boström Anna, Bergh Anna, Hyytiäinen Heli et al. (2022) — Animals : an open access journal from MDPI
A Scoping Review of the Evidence for the Medicinal Use of Natural Honey in Animals.
Vogt Nadine A, Vriezen Ellen, Nwosu Andrea et al. (2020) — Frontiers in veterinary science
Effects of acellular equine amniotic allografts on the healing of experimentally induced full-thickness distal limb wounds in horses.
Fowler Alexander W, Gilbertie Jessica M, Watson Victoria E et al. (2019) — Veterinary surgery : VS
A Novel Organic Composite Accelerates Wound Healing: Experimental and Clinical Study in Equine.
Anis Anis, Sharshar Ahmed, Hanbally Saber El et al. (2021) — Journal of equine veterinary science
Use of next generation sequencing to investigate the microbiota of experimentally induced wounds and the effect of bandaging in horses.
Kamus Louis J, Theoret Christine, Costa Marcio C (2018) — PloS one
Differences in polymorphonucleocyte function and local inflammatory response between horses and ponies.
Wilmink J M, Veenman J N, van den Boom R et al. (2003) — Equine veterinary journal
Wound healing of experimental equine skin wounds and concurrent microbiota in wound dressings following topical propylene glycol gel treatment.
Labens Raphael, Raidal Sharanne, Borgen-Nielsen Cathrine et al. (2023) — Frontiers in veterinary science
Caruso Michael, Shuttle Shannon, Amelse Lisa et al. (2022) — Frontiers in veterinary science
Osteopontin expression in healing wounds of horses and in human keloids.
Miragliotta V, Pirone A, Donadio E et al. (2016) — Equine veterinary journal
A preliminary study of silver sodium zirconium phosphate polyurethane foam wound dressing on wounds of the distal aspect of the forelimb in horses.
Kelleher Maureen E, Kilcoyne Isabelle, Dechant Julie E et al. (2015) — Veterinary surgery : VS
Shockwave therapy for treatment of a burn injury in a horse
Johnson J. E., McClure S. R., Liskey C. C. (2010) — Equine Veterinary Education
Spatial and temporal expression of types I and II receptors for transforming growth factor beta in normal equine skin and dermal wounds.
De Martin Isabelle, Theoret Christine L (2004) — Veterinary surgery : VS
BEVA primary care clinical guidelines: Wound management in the horse.
Freeman Sarah L, Ashton Neal M, Elce Yvonne A et al. (2021) — Equine veterinary journal
Equine distal limb wounds: new and emerging treatments.
Alford, Caldwell, Hanson (2013) — Compendium (Yardley, PA)
Tissue engineering in wound repair: the three "R"s--repair, replace, regenerate.
Theoret Christine (2009) — Veterinary surgery : VS
Cultivation and characterisation of primary and subcultured equine keratinocytes.
Dahm A M, de Bruin A, Linat A et al. (2002) — Equine veterinary journal
Differences in wound contraction between horses and ponies: the in vitro contraction capacity of fibroblasts.
Wilmink J M, Nederbragt H, van Weeren P R et al. (2001) — Equine veterinary journal
In vitro model of equine muscle regeneration.
Byrne K M, Vierck J, Dodson M V (2000) — Equine veterinary journal