Figures
Figure 1: Case example 1. 7-day old Warmblood foal was
presented for acute swelling of the right tarsus. An approximately 2cm x
2cm abrasion was noted over the lateral aspect of the tarsus with
moderate periarticular edema was appreciated. Radiographs of the tarsus
revealed no significant abnormal findings and fluid analysis of synovial
fluid from the tibiotarsal joint was within normal limits. Ultrasound of
the umbilicus, abdomen and thorax revealed no significant abnormal
findings. Within 3 days following presentation, the colt developed
marked cellulitis of the right hindlimb which was initially with a
compression/sweat bandage, and intravenous antibiotic therapy (amikacin,
potassium penicillin) and anti-inflammatories (flunixin meglumine).
Ultrasound of the limb revealed a suspected extra-articular subcutaneous
abscess forming near the level of the distal intertarsal and
tarsometatarsal joints. Five days after initial presentation,
strike-through was noted diffusely throughout the bandaged limb and when
the bandage was removed a generalized necrotic open wound extending from
the level of the tarsus to the fetlock was appreciated. Culture and
sensitivity yielded Citrobacter, Enterobacter andStaphylococcus aureus . Based on sensitivity results, antibiotics
were transitioned to ceftiofur sodium. Repeated daily to every other day
topical debridement, lavage, and wound care with kerlix AMD surfactant
impregnated gauze dressings were performed. Approximately 3 weeks after
initial presentation, the wound bed was deemed healthy enough for skin
grafting. Full thickness mesh graft obtained from the ventral abdomen
was performed under general anesthesia. Two weeks later he received a
second mesh graft to cover the remaining area of the wound, obtained
from his pectoral region. The tissue here obtained from the ventral
abdomen was a different color but overall, the result was considered a
good cosmetic outcome. The foal was dismissed to the care of his owners
after approximately 5 weeks hospitalization and continued to do well at
home with approximately four years follow-up to date.
Figure 2: Case example 2. A 14-year-old Quarter Horse gelding
was presented for evaluation of a 5-month-old wound on the dorsal aspect
of the tarsus, sustained the previous summer on barbed wire fence. He
had been initially treated with trimethoprim sulfamethoxazole
antibiotics. Radiographs of the tarsus were performed which revealed no
significant abnormal findings and he was turned out on pasture. When the
wound continued not to heal, he was brought to Colorado State University
Veterinary Teaching Hospital for further evaluation. Radiographs at that
time revealed no sequestrum or osseous involvement. The gelding was
induced under general anesthesia and the wound was sharply debrided and
lavaged. He was maintained on antibiotics with bandaging in kerlix AMD
and splinting to minimize motion through the tibiotarsal joint. A second
debridement was performed approximately 3 weeks following the first and
samples collected for culture. He was transitioned from trimethoprim
sulfamethoxazole antibiotics to enrofloxacin based on culture and
sensitivity results. Additionally, he was enrolled as a pilot case in a
study evaluating the effect of mesenchymal stromal cell therapy to
improve wound healing. The lateral half of the wound bed was treated
with 3 doses of intralesional doses of 30 million stem cells. At
approximately 3 months following initial presentation, the wound bed was
considered healthy enough to support a graft. A pinch skin graft was
performed from skin obtained from the left ventral abdomen.
Interestingly, although the wound did fully epithelialize by 10 months
following initial presentation, the lateral aspect of the wound that had
been injected with stromal cells did so more rapidly, indicating that
the antimicrobial and immunomodulatory properties of MSC may help to
accelerate healing and warrants further investigation.