APPLICATION OF TOPICAL NEGATIVE PRESSURE (VACUUM-ASSISTED CLOSURE) MANAGING THE HORSE'S WOUNDS:LITERATURE REVIEW AND THREE YEARS EXPERIENCE.
Creators: name: LAZZARETTI, SARA SIMONA
Publisher: name: Universit� degli Studi di Milano
Year: 2013

description: Traumatic injuries causing major soft-tissue damage to the extremities are commonly encountered in animals (Ben-Amotz et al., 2007).
Horses often suffer wounds in relation to their habitat, their use, and their natural instinct. Veterinarians in equine practice are frequently called on to manage traumatic wounds, which can be labor-intensive and expensive. Healing of these wounds is often delayed and complicated compared with that occurring in other species, which leads to significant wastage, because a considerable number of animals are not able to continue their athletic career as a result of persisting lameness, swollen limbs, and extensive scars (Wilmink &amp; van Weeren, 2005). 
In a large, multicenter retrospective study of 122,642 cases presented to nineteen American Veterinary Colleges in a four-year period, 2% of all cases required wound treatment and 61% of these wounds were treated with debridement only and healed by second intention (Lindsay, 1990). Although primary or delayed closure is the preferred way of treatment, this can be followed by partial or total dehiscence of the wound, necessitating second-intention healing. Also, in cases of unmanageable contamination, excessive tissue loss, or severe compromise of the tissue, wound healing by second intention is often the only option (Caron, 1999). 
To compound the problem, repair of full-thickness wounds by second intention is subject to numerous complications which compromise aesthetic and functional outcome in the horse, including:
?Chronic inflammation;
?Poor contraction;
?Development of exuberant granulation tissue (proud flesh);
?Slow epithelialization (Theoret, 2006).
To minimize cost and time spent on treatment, practitioners must be meticulous in their selection of techniques, dressing, and medications, which should be based on a clear understanding of the mechanisms involved in wound repair (Theoret, 2005). Therefore a lot of alternative strategies for traumatic wounds have been presented in the last years to avoid keloids formation and reduce healing time (Alford et al., 2012). The important of reliable and efficacious treatment is crucial not only to improve patient quality of life, but also to reduce cost of management. However, studies that clarify the correct utilization of medications are not available in literature; in fact, wound management is often labors and frustrate for veterinarians in equine practice. The aim of this study was to evaluate the technical feasibility and the effectiveness of VAC� in horses with traumatic wounds and report our preliminary experience. The principles of this therapy are based on the delivery of subatmospheric pressure to the wound bed through an open pore sponge dressing that is placed in the wound and covered with plastic adhesive drape. Five limb wounds (three dorsal hock, dorsal carpus, upper cranial antebrachium), one thorax wound and one neck wound were treated. The occurrence of healthy granulation tissue and the absence of secretions at every bandage change was observed in all patients. The application of VAC� therapy to horses revealed to be an effective tool in the management of large and non-healing wounds.