References
Best practices for use of regional limb perfusion in a field setting
Abstract
Regional limb perfusion is an effective method of local antimicrobial delivery to the distal extremities of the horse. This technique is easy to perform and can augment the treatment of infectious orthopaedic injuries and wounds. Understanding the benefits and limitations of the procedure, recognising appropriate case selection and optimising the approach to regional limb perfusion will enable the field practitioner to incorporate this technique into their clinical approach and skillset, and implement it effectively.
Critical evaluations of regional limb perfusion and reports on its use in horses have expanded over the past 40 years. The increased interest in regional limb perfusion for treatment of equine orthopaedic infection began with a series of papers published in the early 1990s evaluating experimental intraosseous regional limb perfusion of the carpus in horses (Whitehair et al, 1992a; 1992b), and a small case series evaluating the treatment of implant-associated osteomyelitis (Whitehair et al, 1992c). Since then, dozens of studies have been performed evaluating the efficacy of the technique with a breadth of variables and mostly using normal, healthy horses (Levine et al, 2010; Hyde et al, 2013; Kelmer et al, 2013; Aristizabal et al, 2016; Godfrey et al, 2016; Harvey et al, 2016; Moser et al, 2016; Oreff et al, 2016; Sole et al, 2016). Thus, information on the effect of local and systemic disease and prospective evaluation in naturally occurring cases is limited. While defined endpoints of successful treatment differ between studies, resolution of clinical infection, return to clinical soundness and ultimately, return to previous level of activity remain the goals in treatment of any orthopaedic infection.
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