BEVA primary care clinical guidelines: Wound management in the horse

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: A 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. B 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. C 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. | 19 FREEMAN Et Al.

The granulation (t)issue: A narrative and scoping review of basic and clinical research of the equine distal limb exuberant wound healing disorder

“…The recently published BEVA guidelines for evidence-based medicine on equine wound healing clearly pointed out the overall poor evidence in wound healing studies (Freeman et al, 2020). To establish practical evidence-based guidelines, clear parameters that can be objectively scored are a prerequisite.…”

“…The delay or failure to heal is multifactorial and probably related to disruption of the delicate balance of growth factors and inflammatory mediators (Knottenbelt, 1997;Theoret and Wilmink, 2016). A recent systematic literature study on equine wound management revealed that peer-reviewed literature provides insufficient data to establish evidence-based wound management recommendations (Freeman et al, 2020). Currently, practitioners rely on textbooks paired with their personal experience to determine the strategy for wound treatment (Knottenbelt, 2003;Hendrickson, 2004;Theoret and Schumacher, 2016).…”

Biofilm and Equine Limb Wounds

“…A recent systematic review concluded that there is no evidence to recommend any topical therapy over another for treating biofilm in chronic wounds in humans [124]. Further, the British Equine Veterinary Association (BEVA) recently (2021) published a review article on primary care clinical guidelines for equine wound management [125], however no guidance on topical treatment of equine wounds is provided as the evidence is lacking. No studies have investigated the effect of any treatment on biofilms in equine wounds.…”

Study design synopsis: Evidence syntheses—What are they and why do we need them?

“…They are considered the highest level of evidence and are used to inform and guide national and international medical health care policies and guidelines. 9,12,13 The challenge in veterinary medicine compared with human medicine is that our data sets are much smaller, and study approaches and methodologies often vary significantly which means that it may not be possible to combine or collate data sets. 2 A logical first step therefore may be to review the evidence/ publications that are currently available, organise these into broader areas or categories, and identify any suitable bodies of evidence for a systematic review.…”

“…All have their place in evidence-based clinical practice and bring different advantages and disadvantages (Table 1). As increasing numbers of evidence syntheses are published, these will increase our understanding of the current bodies of evidence in veterinary medicine, 7,8 inform how we use evidence in our practices and policies 12,13 and shape how we develop future research to generate the best evidence going forwards. 15,16 Equine Veterinary Journal is publishing increasing numbers of papers describing evidence synthesis.…”