Limited added value of negative pressure wound therapy compared with calcium alginate dressings for second intention healing in a noncontaminated and contaminated equine distal limb wound model.

BACKGROUND: Distal limb wounds in horses often show aberrant healing due to a slow inflammatory response. In human medicine, negative pressure wound therapy (NPWT) is used for the treatment of chronic wounds with a similar inflammatory response. OBJECTIVES: To compare the effect of NPWT to calcium alginate dressings on the healing of (non) contaminated equine distal limb wounds. STUDY DESIGN: Controlled experiment. METHODS: Circular wounds were created on the left and right dorsomedial metacarpus of 10 horses. In five horses, the wounds were contaminated with Staphylococcus aureus and Pseudomonas aeruginosa. In all horses, one limb was treated with NPWT, the other with calcium alginate dressings. Treatments were applied during nine days for noncontaminated wounds and six days for contaminated wounds. Noninvasive (clinical assessment, bacteriology swabs, thermographic images and wound dimensions) and invasive (biopsies for histology and growth factor analysis) measurements were taken regularly for 71 and 29 days respectively. Effects of selected parameters on continuous dependent variables were analysed using ANOVA, while for discrete dependent variables, logistic regression was applied. RESULTS: In noncontaminated wounds, there was significantly less wound retraction in the early healing stages when treated with NPWT (mean difference [95% CI] = 19.2% [13.3%-25.1%]; P = .005), although wound size was not significantly different between NPWT and control wounds at later healing stages. Noncontaminated control wounds had a significantly higher neutrophil influx (OR [95% CI] = 1.99 [1.49-2.66]; P < .001) and lower macrophage influx (OR [95% CI] = 0.75 [0.60-0.93]; P = .008) compared with NPWT-treated wounds. Bacterial load and the presence of growth factors did not differ between treatments in noncontaminated wounds. In contaminated wounds, no differences between treatments were observed in wound size, histological parameters, bacterial load or growth factor concentration. MAIN LIMITATIONS: Sample size is small. CONCLUSIONS: No long-term advantage was detected with NPWT compared with calcium alginate dressings in noncontaminated or contaminated equine distal limb wounds healing by second intention.

Comparison of antibacterial effects among three foams used with negative pressure wound therapy in an ex vivo equine perfused wound model.

OBJECTIVE To compare antibacterial effects among 3 types of foam used with negative-pressure wound therapy (NPWT) in an ex vivo equine perfused wound model. SAMPLES Abdominal musculocutaneous flaps from 6 equine cadavers. PROCEDURES Each musculocutaneous flap was continuously perfused with saline (0.9% NaCl) solution. Four 5-cm circular wounds were created in each flap and contaminated with 106 CFUs of both Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). After a 1-hour incubation period, 1 of 4 treatments (NPWT with silver-impregnated polyurethane foam [NPWT-AgPU], polyurethane foam [NPWT-PU], or polyvinyl alcohol foam [NPWT-PVA] or a nonadherent dressing containing polyhexamethylene biguanide without NPWT [control]) was randomly applied to each wound. An 8-mm punch biopsy specimen was obtained from each wound immediately before and at 6, 12, 18, and 24 hours after treatment application to determine the bacterial load for both P aeruginosa and MRSA. RESULTS The bacterial load of P aeruginosa for the NPWT-PVA treatment was significantly lower than that for the other 3 treatments at each sampling time after application, whereas the bacterial load for the NPWT-AgPU treatment was significantly lower than that for the NPWT-PU and control treatments at 12 hours after application. The bacterial load of MRSA for the NPWT-PVA treatment was significantly lower than that for the other 3 treatments at each sampling time after application. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that wounds treated with NPWT-PVA had the greatest decrease in bacterial load; however, the effect of that treatment on wound healing needs to be assessed in vivo.