This case study involves a 13-year-old Lusitano mare, who suffered a large abdominal laceration after running into a fence. The wound became infected with MRSA, the use of our Medical-Grade Honey-based L-Mesitran Ointment proved effective in eradicating the infection and stimulating wound healing.
How the equine trauma happend?
Refilona, a 13 year old Lusitano mare, was scared off by something, ran and fell on the pole of a fence on April 17 2011. This accident resulted in a large abdominal laceration of approximately 90cm. The pole penetrated through the abdomen leaving the body through the
chest, fortunately no vital organs were affected. She also had a couple of small wounds on her legs. The animal was otherwise in good health and did not need any medication. The horse was brought directly to the University clinic in Utrecht (NL) and the horse was operated under general anesthesia for 3,5hrs. All wounds were cleansed thoroughly and primarly closed with appr. 300 stitches.
First treatment of the patient
Product: L-Mesitran Ointment
Case study done by:A. Brander, RN, Hoorn, The Netherlands (info@veterinairewondzorg.nl)
Method: On the 10th of May the horse was discharged from the hospital, with still the MRSA infected wound. The abdominal wounds were cleansed 2-3x daily with tapwater and the debris was manullay removed with wettened gauze. Afterwards a layer of honey ointment was applied. The honey ointment was also applied on the wound edges, with the aim to prevent maceration. It was impossible to dress the wound with bandages, because the horse felt reasonably good and was relatively active. No antibiotics were administered after discharge. Roughly 40-50 tubes of ointment were used (+/-2.5kg).
The horse spent the summer in the meadow.
Medication during the horse surgery
The horse was administered the following medication on the day of surgery:
- Midazolam (17/4)
- Butorfanol (for the pain)
- Benzylpenicillin sodium
- Detomidin hydrochlorid (Domosedan)
- Ketamin (Narketan)
- Ringer’s solution and (Metacam)
Also used:
- Procain penicillin (depocilline (until April 26)
- Gentamicin (until April 23)
After surgery the wound was only dressed with bandages. Prior to discharge the wound was infected with MRSA, the horse was quaranteened in the clinic. The wound produced large amounts of exudate which caused the wound edges to tear and the wound opened up again. The tensile strength on the sutures was probably too much in combination with the MRSA infection. The wound thus had to heal per secundam.
Soon after the honey treatment started, the exudates reduced, after 2 weeks the MRSA appeared to be gone. The fibrinous slough dissolved and granulation tissue started to form. The wound was fully healed in September 2011, 4 months post trauma. No adverse effects were observed.
Discussion on effects of Medical-Grade Honey
Abdominal wounds of this kind are hard to close with sutures, the tensile strength on the abdomen is high and can cause the sutures to break (Magee, 1999), especially when an infection with MRSA keeps producing high amounts of exudate.
Healing per secundam is then the only option, although the biggest risk is (further) wound infection (Hanson, 2008).
In this case the antibacterial honey ointment (Brander, 2011) eradicated the MRSA quickly and allowed the granulation and epithelisation to progress to full wound healing in only 4 months time. The use of honey based ointments can, in the event of large trauma, be beneficial to reduce or irradicate infection (such as MRSA) and stimulate wound healing per secundam.
References
– Magee A, Galuppo L (1999) Comparison of incisional bursting strength of simple continuous and inverted cruciate suture patterns in the equine linea alba. Veterinary Surgery 28(6):442–447
– Hanson R (2008) Complications of equine wound management and dermatologic surgery. Vet Clin North Am Equine Pract. 24(3):663-96,
– Brander A (2011) Equine acute wound healing with honey. Poster presentation at the International Equine Congress for Veterinarians, 22-23 January 2011, Brussels