46TH
ANNUAL
CONGRESS
OF
THE
SAEVA
SKUKUZA
16-‐20
FEBRUARY
2014
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for investigating possible synovial fluid involvement will always depend on the wound
location and configuration, the nature of the horse, and the facilities available.
Involvement of synovial structures often necessitates surgical lavage of the structure
in question in conjunction with aggressive antimicrobial therapy. In addition to
systemic antibiotic therapy, local antibiotic delivery methods can be invaluable at
achieving high concentrations of antibiotics locally both intra-operatively and postoperatively.3-7
Regional limb perfusions can be performed in standing patients or under general
anaesthesia providing an excellent means of delivering high concentrations of
antibiotics in a local area. It is important to use either a pneumatic tourniquet, or a
wide Esmarch tourniquet to achieve adequate local antibiotic concentrations.8-9
Aminoglycosides are most commonly used in distal limb perfusions, and it has been
documented that local antibiotic concentrations exceed MIC for 24-36 hours. A
table of drugs commonly used for limb perfusions and their dosages is provided
below. Acceptable diluents are sterile, isotonic solutions such as saline, Lactated
Ringers Solution or Hartmanns.2,3 Other antibiotics that have been investigated for
use in regional limb perfusions include vancomycin, marbofloxacin and
erythromycin.10-12
DRUGS
USED
PERFUSIONS
FOR
DISTAL
LIMB
Drug
Doses
Gentamicin
1 gm in 30-60 ml diluent
Amikacin
500 mg - 1 gm in 30-60 ml diluent
Ceftiofur
1-2 gm in 30 ml diluent
Timentin
125 mg-1 gm in 30 ml diluent
Wounds involving transection of the extensor tendons, especially in the hind limbs,
will often result in a horse that knuckles over at the fetlock, which can damage lower
limb structures and delay wound healing. The prognosis for the successful return to
athletic function ranges from poor to good.13-14 The use of a specialized shoe with a
removable and adjustable dorsal extension can prevent knuckling but still allows
access to the wound.
References:
1.
2.
3.
4.
Dart AJ, Dowling BA and Smith CL. Topical Treatments in Equine Wound Management. Vet
Clin NA Equine 2005; 21:77-89.
Janicek JC, McClure SR, Lescun TB, Witte S, Schultz L, Whittal CR, Whitfield-Cargile C “Risk
factors associated with cast complications in horses: 398 cases (1997-2006)” J Am Vet Med
Assoc (2013); 242(1): 93-8.
Rubio-Martinez LM, Cruz AM. Antimicrobial regional limb perfusion in horses. JAVMA 2006;
228:706-712.
Mahne AT, Rubio-Martinez LM, Marais HJ, Villarino NF, Rioja E. “Clinical and
pharmacokinetic effects of regional or general anaesthesia on intravenous regional limb
perfusion with amikacin in horses” Equine Vet J (2013) Jun 21. doi: 10.1111/evj.12125.
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