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.