QUARTERLY BEAT / OCTOBER 2025
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TOPICAL THERAPIES FOR WOUND HEALING IN HORSES
Holly Roessner DVM, DACVS-LA North Carolina State University, Raleigh, NC
Wound infection is common in equine patients due to a high likelihood of contamination at the time of injury. Additional risk factors for infection include the presence of foreign material or sequestrum formation, poor vascular supply to wounds on the distal limbs, and the immune status of the patient. Horses with uncontrolled pituitary pars intermedia dysfunction (PPID) have reduced tissue healing and increased likelihood for infection. Clinical signs of wound infection include excessive discharge, poor quality granulation tissue, signs of local infection, and a failure to respond to therapy. Systemic antimicrobials are generally utilized in addition to topical therapies. Wound debridement is critical and may need to be performed multiple times, as biofilm is often present and can reform within 24-72 hours. Tissue culture and sensitivity is recommended to guide therapy in any chronic, non-healing wounds. Struggling with how best to manage wounds in your equine patients? In this VETgirl Webinar, “Topical Therapies for Wound Healing in Horses,” Dr. Holly Roessner, DACVS-LA, reviews practical approaches to second intention healing, infection management, and topical therapy selection to optimize outcomes. Missed the webinar? Watch the replay HERE or check out the highlights below!
Wounds are a common part of equine practice. If possible, primary closure is preferred to result in a better functional and cosmetic outcome. Successful primary closure results in shorter healing times and decreased costs. Unfortunately, primary closure may not always be possible, especially if there is significant tissue loss or infection present. Alternatively, primary closure can fail due to excessive tension, motion, or underlying infection, resulting in the need for second intention wound healing. Many topical therapies exist to aid in this process, with three main goals in mind: maintaining a moist environment, reducing the antimicrobial load, and enhancing the wound environment to support the phases of wound healing.
Wound healing is comprised of four phases: 1. Hemostasis 2. Inflammation 3. Proliferation 4. Maturation or Remodeling
These phases overlap and total timing depends on multiple factors, including wound size, presence of infection, and immune status of the patient. • Phase 1: Hemostasis lasts up to 48 hours, characterized by vasoconstriction and clotting factors and platelets working to prevent further blood loss from damaged vessels. • Phase 2: Inflammation lasts up to 7 days in acute wounds but can last longer in chronic wounds. The inflammatory phase is characterized by an influx of white blood cells to clear bacteria and debris. Clinically this is manifested by heat, pain, and edema around the wound. • Phase 3: Proliferation lasts days to weeks, with the primary role of granulation tissue formation. Additionally, the wound bed experiences angiogenesis, contraction, and epithelialization. • Phase 4: Maturation/Remodeling can last weeks to years and comprises the formation of scar tissue. New tissue will become stronger and more flexible over time but always remains weaker and less elastic compared to normal skin.
A shoulder wound with primary closure failure and infection, treated with manuka honey (Photos courtesy of Dr. Holly Roessner, DACVS-LA) There is an abundance of topical medications available for use, with limited scientific evidence and regulatory oversight.
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