Combined decongestive therapy including equine manual lymph drainage to assist management of chronic progressive lymphoedema in draught horses

Abstract

Summary Equine chronic progressive lymphoedema (CPL) is a disabling disorder of draught horse breeds. Combined decongestive therapy (CDT) is the treatment of choice for lymphoedema in man and has been adapted for use in horses. Equine CDT, which includes manual lymph drainage (MLD) and subsequent bandaging with short stretch bandages, was expected to improve the signs of CPL in draught horses because CPL resembles primary lymphoedema in man. Five affected horses ‐ Gypsy cob (n = 1), Clydesdale (n = 1), Shires (n = 3) ‐ were included. Lesions were documented pre‐ and post treatment. Percentage volume loss of the distal legs was calculated using the disc model. Initial plans for daily CDT had to be adapted; intermittent treatment of Chorioptes infections required alternating between CDT and MLD in 4/5 horses. Concurrent pyoderma (1/5 horses) was treated throughout the study. Development of unrelated lameness (hoof abscess) allowed limited CDT treatment only in one horse. Marked softening of previously firm tissue indicated the change from ‘brawny’ to pitting oedema in 2/5 horses. Fibrotic nodules and folds in the pasterns became markedly softened and smaller in 2/5 horses. Skin surface notably improved in all horses: hyperkeratosis decreased, erosions and ulcerations healed completely and crusts disappeared. After 2 weeks, a mean volume reduction of 11.25% was seen, ranging from 4.75–21.74% and quality of movement improved. This pilot study documents evidence that CDT assists management of CPL. Current CPL management is limited to palliative treatments of secondary infections. Whilst not a permanent treatment, CDT offers a promising tool to manage horses with CPL, improving their quality of life and potential usefulness. More extensive and prolonged studies with a larger number of horses are warranted to evaluate the full potential of CDT.

Chronic progressive lymphoedema in draught horses

“…It has been reported in several draught horse breeds, e.g. some German breeds , the Belgian Draught Horse , the Shire, the Clydesdale , the Gypsy Cob and Friesians (V. Affolter, personal communication) . These breeds are therefore referred to as CPL‐susceptible breeds.…”

“…Nodules of varying size result from fibrosis (H. De Cock, personal communication), and multiple skin folds develop from the combination of fibrosis and the progressive increase in extracellular matrix . Eventually, these nodules and folds will encircle the entire limb(s) up to the carpus/tarsus, hampering free movement; hence, such areas are often injured, especially around joints . Wounds, ulcers and the skin inside the folds are often exudative and produce a strong odour because of secondary bacterial overgrowth .…”

“…controlling the tissue oedema by supporting lymph flow, providing skin care and treating secondary infections. Management can be disappointing, and failure of supportive therapy and relapse of infections are common . Clipping of the feathering provides access to the skin surface and reveals ‘hidden’ lesions (Fig a, b).…”

Genetic parameters for chronic progressive lymphedema in Belgian Draught Horses

“…Chronic progressive lymphedema (CPL) affects several draught horse breeds (Ferraro ; Boema et al . ; Powell & Affolter ), including the Belgian Draught Horse (De Cock et al . ; De Keyser et al ., ).…”

“…Chronic progressive lymphedema (CPL) affects several draught horse breeds (Ferraro 2001;Boema et al 2012;Powell & Affolter 2012), including the Belgian Draught Horse (De Cock et al 2003;. Typical lesions occur at the level of the lower limbs, including a slight to severe swelling with progressively deteriorating skin lesions and deformation (De Cock et al 2003;Ferraro 2003).…”