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Die Anwendung einer präventiven Vakuumtherapie auf Laparotomiewunden beim Pferd
von Carolin NicolausThe application of preventive negative pressure wound therapy on midline laparotomy incisions in horses
Human studies identified vacuum therapy (VAC therapy) on both - wounds and surgical incisions as a beneficial factor for wound healing and the reduction of wound healing disorders. Veterinary publications on VAC therapy mainly focus on wound treatment but not of preventive use. The aim of this study was to evaluate the preventive use of negative pressure wound therapy (NPWT) on surgical incisions in horses. In addition, factors effecting the short and long-term outcome of wound healing of the midline incisions as well as the return to athletic function after convalescence were evaluated. In total, the data from 201 horses were included in the study. The incisions of 57 horses were treated using sterile vacuum wound coverings (Prevena ™ Peel & Place ™ Dressing, Prevena ™ Customizable ™, Incision Management System, KCI Medizinprodutkte GmbH, Wiesbaden). The control group consisted of 144 incisions treated with standard wound coverings (dry, nonadhesive wound dressing). Factors such as breed, gender, age, weight, vital and laboratory parameters, intraoperative diagnosis, number of laparotomies performed, as well as the surgery and anesthesia time and wound healing disorders were associated to outcome. Outcome parameters such as wound infection after the hospitalization, abdominal hernia, colic after convalescence, postoperative use and level of performance were collected from owners via standardized telephone questionnaire. Results indicated that preventive application of vacuum therapy to laparotomy incisions was not different to the control group. Significant correlations were found between wound infection and heart rate on arrival in the clinic, internal body temperature on the 5th and 10th day after the laparotomy, white blood cell count on the 5th day after surgery, diagnosis and duration of surgery and general anesthesia. Horses with small intestinal disease in combination with colonic enterotomy and horses that required repeated laparotomy developed significantly more often an abdominal hernia compared to the rest of this population. Preventive NPWT cannot be recommended for the reduction of wound healing disorders after midline laparotomy in horses.
Human studies identified vacuum therapy (VAC therapy) on both - wounds and surgical incisions as a beneficial factor for wound healing and the reduction of wound healing disorders. Veterinary publications on VAC therapy mainly focus on wound treatment but not of preventive use. The aim of this study was to evaluate the preventive use of negative pressure wound therapy (NPWT) on surgical incisions in horses. In addition, factors effecting the short and long-term outcome of wound healing of the midline incisions as well as the return to athletic function after convalescence were evaluated. In total, the data from 201 horses were included in the study. The incisions of 57 horses were treated using sterile vacuum wound coverings (Prevena ™ Peel & Place ™ Dressing, Prevena ™ Customizable ™, Incision Management System, KCI Medizinprodutkte GmbH, Wiesbaden). The control group consisted of 144 incisions treated with standard wound coverings (dry, nonadhesive wound dressing). Factors such as breed, gender, age, weight, vital and laboratory parameters, intraoperative diagnosis, number of laparotomies performed, as well as the surgery and anesthesia time and wound healing disorders were associated to outcome. Outcome parameters such as wound infection after the hospitalization, abdominal hernia, colic after convalescence, postoperative use and level of performance were collected from owners via standardized telephone questionnaire. Results indicated that preventive application of vacuum therapy to laparotomy incisions was not different to the control group. Significant correlations were found between wound infection and heart rate on arrival in the clinic, internal body temperature on the 5th and 10th day after the laparotomy, white blood cell count on the 5th day after surgery, diagnosis and duration of surgery and general anesthesia. Horses with small intestinal disease in combination with colonic enterotomy and horses that required repeated laparotomy developed significantly more often an abdominal hernia compared to the rest of this population. Preventive NPWT cannot be recommended for the reduction of wound healing disorders after midline laparotomy in horses.