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Review
. 2021 Jan;53(1):18-29.
doi: 10.1111/evj.13289. Epub 2020 Jul 17.

BEVA primary care clinical guidelines: Wound management in the horse

Sarah L Freeman  1 , Neal M Ashton  2 , Yvonne A Elce  3 , Anna Hammond  3 , Anna R Hollis  4 , Greg Quinn  5
Affiliations
Review

BEVA primary care clinical guidelines: Wound management in the horse

Sarah L Freeman et al. Equine Vet J. 2021 Jan.

Abstract

Background: There are currently no evidence summaries on wounds in the horse.

Objectives: To develop evidence-based guidelines on wound management in the horse.

Study design: Evidence review using the GRADE framework.

Methods: Research questions were proposed by a panel of veterinarians, and developed into PICO format. Evidence in the veterinary literature was evaluated using the GRADE evidence-to-decision framework. Searches for human evidence summaries were conducted in the NICE, Cochrane and JBI databases. Final recommendations were based on both veterinary and human evidence.

Results and recommendations: The research questions were categorised into three areas: A. Wound lavage and topical treatments; B. Wound debridement and closure; C. Therapeutics for wound healing. Three hundred and six veterinary publications were identified across thirteen different topics. Fourteen papers were assessed using the GRADE criteria. Twenty-five human evidence summaries were reviewed. The results were developed into recommendations: Wound lavage and topical treatments: (i) Tap water should be considered instead of saline for lavage; (ii) Povidone iodine lavage should be considered for contaminated wounds; (iii) Topical silver sulfadiazine may not be suitable for acute wounds; (iv) Optimal lavage pressures are around 13 psi. Wound debridement and closure: (i) Debridement pads should be considered for wound preparation; (ii) Larvae debridement should be considered in selected cases; (iii) Hydrosurgery should be considered in acute contaminated wounds. Therapeutics for wound healing: (i) Honey may reduce duration of some phases of wound healing. There was insufficient evidence to draw conclusions on the use of chemical debridement, therapeutic ultrasound, laser therapy, wound closure with staples compared to sutures, or identify optimal concentrations of antiseptic lavage solutions.

Main limitations: Low quality evidence in veterinary literature; majority of recommendations were based on human evidence.

Conclusions: These findings should be used to inform decision-making in equine primary care practice.

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References

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    1. Bowen IM, Redpath A, Burford JH, Hallowell GD, Dugdale A, Watson T, et al. BEVA primary care clinical guidelines: analgesia. Equine Vet J. 2020;52:13-27.
    1. Guyatt GH, Oxman AD, Kunz R, Atkins D, Brozek J, Vist G, et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol. 2011;64:395-400.
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