Distal limb cast sores in horses: risk factors and early detection using thermography

Evaluation of primary wound healing and potential complications after perioperative infiltration with lidocaine without adrenaline in surgical incisions in dogs and cats

BACKGROUND

Pre-emptive local analgesia with the use of lidocaine is practised increasingly in veterinary medicine as part of applied multimodal analgesia, despite its controversial impact on wound healing. The purpose of this prospective, randomised, double-blinded, placebo-controlled clinical study was to evaluate if preoperative subcutaneous infiltration of lidocaine has a negative impact on primary wound healing of surgical incisions. Fifty-two companion animals (3 cats and 49 dogs) were enrolled in the study. The inclusion criteria were as follows: American Society of Anaesthesiologists (ASA) score I or II, a minimum body weight of 5 kg, and a planned incisional length of at least 4 cm. Surgical incisions were infiltrated subcutaneously with lidocaine without adrenaline or NaCl (placebo). Follow-up questionnaires for owners and veterinarians and thermography of the surgical wound were used to assess wound healing. Antimicrobial use was documented.

RESULTS

There was no significant difference in either the total score or the individual assessment points between the treatment and the placebo group on the owner or the veterinary questionnaires in regard to primary wound healing (P > 0.05 for all comparisons). No significant difference was found between the thermography results of the treatment and placebo group (P = 0.78), and there was no significant correlation between the total score from the veterinary protocol and thermography results (Spearman's correlation coefficient - 0.10, P = 0.51). Surgical site infections developed in 5/53 (9.4%) surgeries and its occurrence varied significantly between the treatment and the placebo group as all cases of infection were in the placebo group (P = 0.05).

CONCLUSION

The results of this study indicate that lidocaine used as a local anaesthetic did not affect wound healing in patients with ASA scores I-II. The results suggest that lidocaine infiltration in surgical incisions can be safely used to reduce pain.

Proximal Interphalangeal Arthrodesis in Horses: A Meta-Analysis of Retrospective Studies

The aim of this study was to determine the clinical outcomes reported in retrospective studies of proximal interphalangeal arthrodesis (PIA) in horses through a meta-analysis of retrospective studies. CAB Abstracts, PubMed, ScienceDirect, Web of Science, and Scopus were searched. The primary outcomes included survival and surgical site infection (SSI) rates, return to activities, and time of hospital stay and casting. Subgroups were formed for fractures and other conditions. Meta-analyses were performed with fixed and random effects models to estimate proportions, mean values, and effect size by odds ratio (OR) with 95% confidence intervals (CI). Twenty-one full articles were included, totaling 458 horses. The survival rate was 90% (95% CI [86%-93%]), return to activities was 65% (95% CI [61%-70%]), and SSI was 12% (95% CI [8%-16%]). The mean hospitalization was 25 days (95% CI [18-35 days]) and time of casting was 29 days (95% CI [21-42 days]). The OR of survival (P = .769), return to activities (P = .576), and SSI (P = .467) were similar between cases of fractures and other conditions. PIA is an efficient and safe method to treat injuries in the pastern region, with a high survival rate and low SSI. However, the rate of return to soundness for intended use was modest, being potentially lower for fracture cases. Thus, investigations of more efficient interventions are needed to improve this outcome.

The Horse as a Model for the Study of Cutaneous Wound Healing

Significance: Cutaneous wounds are a major problem in both human and equine medicine. The economic cost of treating skin wounds and related complications in humans and horses is high, and in both species, particular types of chronic wounds do not respond well to current therapies, leading to suffering and morbidity. Recent Advances: Conventional methods for the treatment of cutaneous wounds are generic and have not changed significantly in decades. However, as more is learned about the mechanisms involved in normal skin wound healing, and how failure of these processes leads to chronic nonhealing wounds, novel therapies targeting the specific pathologies of hard-to-heal wounds are being developed and evaluated. Critical Issues: Physiologically relevant animal models are needed to (1) study the mechanisms involved in normal and impaired skin wound healing and (2) test newly developed therapies. Future Directions: Similarities in normal wound healing in humans and horses, and the natural development of distinct types of hard-to-heal chronic wounds in both species, make the horse a physiologically relevant model for the study of mechanisms involved in wound repair. Horses are also well-suited models to test novel therapies. In addition, studies in horses have the potential to benefit veterinary, as well as human medicine.

The Effect of Horse Shoeing with Egg Bar Shoes and Shoes with Wedge Pads on the Results of Thermal Imaging of the Equine Distal Limb

Simple Summary

Thermography is a non-invasive and contact-free imaging method that measures temperature on the surface of the body and determines temperature distribution across the examined surface. The aim of this study was to determine the effect of horse shoeing with egg bar shoes and shoes with wedge pads on hoof temperature measured by thermography. The authors decided to use egg bar shoes and shoes with wedge pads as they are commonly used in the treatment of navicular syndrome in horses. This study was conducted on 16 client-owned warmblood horses. The horses were directed for magnetic resonance imaging (MRI) according to unilateral front limb lameness, specifically associated with the hoof. For thermographic analysis, we took into consideration only one limb that was not lame and that showed no radiological changes. After the application of egg bar shoes, the temperature decreased on the palmar surface of the hoof. After shoeing with wedge pads, the temperature decreased in the dorsal and palmar views. Thermography, despite its great usefulness, is only an indirect method of assessing the blood supply in a given area, so we cannot uncritically conclude about the harmfulness of shoeing.

Abstract

The presented manuscript provides reference for practitioners when measuring normal hoof temperature, as well as controlling the temperature after shoeing with particular shoes. The aim of this study was to determine the effect of horse shoeing with egg bar shoes and shoes with wedge pads on hoof temperature measured by thermography. This was a prospective study conducted on 16 horses. The horses were divided into two groups: horses from group 1 were shod with egg bar shoes, while horses from group 2 were shod with shoes with wedge pads. Thermographic examination was performed below the metacarpophalangeal joint before and one month after shoeing. After shoeing with egg bar shoes, there was a decrease in the median of the minimal temperature in the palmar view. After shoeing with wedge pads, thermography revealed decreased hoof temperature in the dorsal and palmar views. Horse shoes may have a negative impact on the blood circulation and metabolism within the distal part of the limb; however, our study found this only to a minor extent.

Equine Wound Management: Bandages, Casts, and External Support

Successful management of equine wounds relies on knowledge of the stages of wound healing, factors that can alter those stages, how healing stages can be manipulated, and adherence to the principles of wound healing. Challenges that complicate wound management include the inability to immobilize and/or confine equine patients, and maintain a clean environment during the critical initial stages of healing. Because of these challenges, the equine practitioner relies heavily on bandaging and external coaptation techniques to successfully treat and manage wounds. The type of bandage used is dictated by the region of the body that is injured.

Evaluation of the effects of initial water temperature and curing time on fiberglass cast strength

OBJECTIVE

To determine the effects of water temperature and cure time on cast strength.

STUDY DESIGN

Prospective randomized experimental study.

METHODS

Two water temperatures were tested, 23°C (cold) and 42°C (warm). Cast constructs were made of 4-inch fiberglass casting material over a rubber mandrel. Each construct was divided into 3 segments and tested in 4-point bending at 0.5, 1, and 24 hours. Stiffness and bending moment, cumulative energy, and angular deformation at yield and failure were recorded and analyzed by using repeated measures ANOVA.

RESULTS

Mean time ± SD to complete the construct was 2.2 ± 0.8 and 2.3 ± 0.6 minutes for warm and cold water, respectively. Warm water and longer cure times produced constructs with greater stiffness (23.05 vs 20.88 newton-meter degrees [Nm°] at 0.5 hours), bending moment (121.75 vs 107.31 Nm° at 0.5 hours), and cumulative energy (557.33 vs 428.89 Nm° at 1 hour) at yield and failure. Longer cure time significantly increased angular deformation of rods at failure; however, water temperature did not. In general, the strongest casts were produced with warm water and after curing for 24 hours.

CONCLUSION

Fiberglass casts continued to gain strength for at least 24 hours. Use of warm water increased the rate of curing, resulting in stronger constructs at earlier time points.

CLINICAL SIGNIFICANCE

Use of warm water is recommended to initiate fiberglass cast curing, especially if the casted limb will be loaded soon after cast application.

Optimising lameness detection in dairy cattle by using handheld infrared thermometers

Lameness is one of the most serious economic and welfare issues in the dairy industry. Early detection of lameness can be difficult, but provision of early treatment is crucial. Previous studies have used infrared thermography to show that increased foot temperature (FT) is associated with lameness and foot lesions. However, poor accuracy has limited the management application potential. This study analysed ambient-temperature (AT)-adjusted foot-surface temperatures and temperature differences between the hind feet of individual cows to enhance lameness detection. Cow FTs were recorded on a 990-cow farm using an infrared thermometer fortnightly for 6 months. Additionally, mobility level was scored using the AHDB Dairy 4-point scale. The averages of FTs and ATs were 23.83 ± 0.03°C and 13.99 ± 1.60°C, respectively. The FT of cows with lameness was significantly higher than that of cows without lameness (P < 0.001). Increases in FTs correlated with the mobility score (MS) (P < 0.001). According to receiver operating characteristic (ROC) curves, the optimal threshold based on actual FTs was 23.3°C with 78.5% sensitivity and 39.2% specificity. However, the ROC curve for the AT-adjusted FT and FT difference parameters showed minimal improvements over the FT in detecting lameness. In conclusion, the infrared thermometer results demonstrated the association between elevated FTs and lameness, but further improvements to this detection technique will be required before it can be implemented as a management tool for detecting cows that could benefit from treatment. With additional validation, the technique could be used as a screening device to identify cows in need of further assessment.

Thermography as an early predictive measurement for evaluating epidural and femoral-sciatic block success in dogs

OBJECTIVE

To evaluate skin temperature increase as an early predictive measure for evaluating epidural and femoral-sciatic block success in dogs.

STUDY DESIGN

Prospective clinical trial.

ANIMALS

A total of 29 dogs undergoing orthopaedic surgery on one hindlimb.

METHODS

Dogs were anaesthetized and placed into lateral recumbency with the affected limb uppermost and the coat was clipped. Baseline infrared thermographic images (T0) of the affected limb, of the paw pad of the affected leg and of the ipsilateral paw pad were taken. Subsequently, dogs were administered either an epidural (EPI; n=11) or a femoral-sciatic block (FS; n=18) using bupivacaine 1 mg kg^-1. Then, 2 minutes after placement of the block, thermographic images were obtained every 3 minutes for a total of four measurements (T1-T4) and surgery was commenced. Rescue analgesia consisting of fentanyl 1 μg kg^-1 was administered if needed. A regional block was considered successful if the dose of fentanyl administered was less than the lower 95% confidence interval of the geometric mean of the total fentanyl used in each group. A ≥ 1 °C increase of skin temperature was considered as the minimum increase required for detection of a successful block.

RESULTS

A total of 12 out of 18 blocks in the FS and eight of 11 in the EPI group were considered successful based on fentanyl consumption. Out of these, only four of 12 in the FS and one of eight in the EPI group developed an increase in temperature of ≥ 1 °C. Contrarily, four of six of the nonsuccessful cases in the FS and three of three in the EPI group developed an increase in temperature of ≥ 1 °C.

CONCLUSIONS AND CLINICAL RELEVANCE

Contrary to reports in humans, thermography did not indicate regional block success prior to surgery in dogs. However further studies under more controlled conditions are needed to determine whether thermography can be used to indicate failure of regional blockade.

Modified Thomas splint-cast combination for the management of limb fractures in small equids

OBJECTIVE

To describe the management and outcome of limb fractures in small domestic equids treated with a modified Thomas splint-cast combination (MTSCC).

STUDY DESIGN

Retrospective case series.

ANIMALS

Client owned horses and donkeys.

METHODS

Medical records, including radiographs, were reviewed for details of animals diagnosed with a limb fracture and treated by external coaptation using a MTSCC (2001-2012). Follow-up >6 months after discharge was obtained via telephone consultation with owners or veterinarians.

RESULTS

Nine horses and 4 donkeys were identified with fractures of the tibial diaphysis (n = 4), ulna (n = 3), distal metatarsus (n = 2), proximal metacarpus (n = 1), radial diaphysis (n = 1), calcaneus (n = 1), and distal femoral physis (n = 1). Follow-up was available for 12 equids, of which 8 (67%) recovered from the fracture and became pasture sound. Six equids developed obvious external deformation of the affected limb.

CONCLUSION

Selected small equids with long bone fractures, and without athletic expectations, can be managed with external coaptation using an MTSCC. The owner should be informed that the treatment is considered a salvage procedure.

Medical infrared thermal imaging of cats with hyperthyroidism

OBJECTIVE

To determine the usefulness of medical infrared thermal imaging (MITI) as a screening tool for hyperthyroidism in cats, evaluate the need for hair clipping over the ventral aspect of the neck to achieve optimal images, and determine whether there is a change in thermal patterns at 1 and 3 months after radioactive sodium iodide I 131 treatment.

ANIMALS

17 cats with and 12 control cats without hyperthyroidism.

PROCEDURES

All cats underwent MITI first with the hair present and then after the hair was clipped. Each cat with hyperthyroidism was subsequently appropriately treated SC with radioiodide; reevaluations, including MITI before and after hair clipping and measurement of serum thyroxine concentration, were performed 1 and 3 months after treatment.

RESULTS

The MITI had 80.5% and 87.5% accuracy in differentiating hyperthyroid cats from clinically normal cats before and after the hair over the ventral aspect of the neck was clipped. Among cats with an initial serum thyroxine concentration > 4.0 μg/dL, the success rate for MITI-detected response to radioiodide treatment at the 1-month reevaluation was 92.86% in unshaved cats and 85.71% in shaved cats. The success rate for MITI-detected response to radioiodide treatment at the 3-month reevaluation was 100% in unshaved and shaved cats.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that MITI was successful in differentiating between hyperthyroid cats and clinically normal cats and identifying patients with thyroxine concentration within reference interval after radioactive sodium iodide I 131 treatment.

The use of infrared thermography as a rapid, quantitative, and noninvasive method for evaluation of inflammation response in different anatomical regions of rats

PURPOSE

Thermographic assessment of temperature distribution within the examined tissues allows a quick, noncontact, noninvasive measurement of their temperature. The aim of the study was to evaluate the usefulness of digital infrared imaging in monitoring experimental inflammation of pleura (PL), lower lip (LL), and left paw (LP) and right paw (RP) of lower limbs in rats.

MATERIALS AND METHODS

The inflammatory reaction was induced by injection of 1% carrageenin solution into pleural cavity, lip, or paws. With the use of digital infrared imaging temperature measurement was conducted at 0 to 72 hours of the inflammatory reaction.

RESULTS

The temperature decrease was observed at the site of injection directly afterwards. Next, it was gradually increasing and it reached the maximum on the third day of the inflammatory reaction. Statistically significant changes were observed after 48-hour period in PL and LL regions, as well as after 72-hour period in LP and RP regions (P < 0.005).

CONCLUSION

It was found that thermographic examination allows for indicating the presence of inflammatory reaction within examined tissues and determining the dynamics of this process. This method could be used as alternative procedure that allows using fewer animals for experiments.

A comparison of thermographic imaging, physical examination and modified questionnaire as an instrument to assess painful conditions in cats

Pain recognition in cats is difficult and requires a multidisciplinary approach for diagnosis. A total of 103 client-owned cats were enrolled in this prospective, blinded clinical trial. Cats were invited to the clinic, or presented for annual rechecks/vaccinations, or gastrointestinal, dental or locomotor problems. The cats were of different breeds; both shorthaired and longhaired cats were included. Those cats that tolerated it were palpated and all cats were examined with the non-invasive method of thermographic imaging. Owners filled out a questionnaire about their cat's behaviour and estimated whether the cat was in any pain. The agreement between a questionnaire and thermographic imaging or palpation was low. Also, the agreement between the owner's estimation of pain and thermographic imaging or palpation was low. The agreement between palpation and thermographic imaging was moderate, suggesting that thermographic imaging is a potential tool in clinical practice for detecting and screening cats that are, potentially, in pain.

Thermographic imaging of the superficial temperature in racing greyhounds before and after the race

A total of 47 racing greyhounds were enrolled in this study on two race days (in July and September, resp.) at a racetrack. Twelve of the dogs participated in the study on both days. Thermographic images were taken before and after each race. From the images, superficial temperature points of selected sites (tendo calcaneus, musculus gastrocnemius, musculus gracilis, and musculus biceps femoris portio caudalis) were taken and used to investigate the differences in superficial temperatures before and after the race. The thermographic images were compared between the right and left legs of a dog, between the raced distances, and between the two race days. The theoretical heat capacity of a racing greyhound was calculated. With regard to all distances raced, the superficial temperatures measured from the musculus gastrocnemius were significantly higher after the race than at baseline. No significant differences were found between the left and right legs of a dog after completing any of the distances. Significant difference was found between the two race days. The heat loss mechanisms of racing greyhounds during the race through forced conduction, radiation, evaporation, and panting can be considered adequate when observing the calculated heat capacity of the dogs.

Comparison of three thermal cameras with canine hip area thermographic images

The objective of this study was to compare the method of thermography by using three different resolution thermal cameras and basic software for thermographic images, separating the two persons taking the thermographic images (thermographers) from the three persons interpreting the thermographic images (interpreters). This was accomplished by studying the repeatability between thermographers and interpreters. Forty-nine client-owned dogs of 26 breeds were enrolled in the study. The thermal cameras used were of different resolutions-80 × 80, 180 × 180 and 320 × 240 pixels. Two trained thermographers took thermographic images of the hip area in all dogs using all three cameras. A total of six thermographic images per dog were taken. The thermographic images were analyzed using appropriate computer software, FLIR QuickReport 2.1. Three trained interpreters independently evaluated the mean temperatures of hip joint areas of the six thermographic images for each dog. The repeatability between thermographers was >0.975 with the two higher-resolution cameras and 0.927 with the lowest resolution camera. The repeatability between interpreters was >0.97 with each camera. Thus, the between-interpreter variation was small. The repeatability between thermographers and interpreters was considered high enough to encourage further studies with thermographic imaging in dogs.