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Posted by: admin on Sep 15, 2009 - 10:37 AM
equinehealth
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Dominique Bouchard, DVM
New England Equine Medical and Surgical center
Dover, NH 03820
www.newenglandequine.com
“Chester is a 10 year old Thoroughbred who was found extremely painful on his right hind this evening. He was ridden this morning without any lameness. Now his leg his swollen, firm, warm and he does not bare any weight on the limb.”
Major potential causes for an acutely painful swollen limb:
-Cellulitis: inflammation or infection of the subcutaneous tissues
-Thrombophlebitis: inflammation of a vein cause by a blood clot
-Vasculitis: inflammation of vessels caused mainly by infectious agents or hypersensivity
-Limb abscess
-Trauma: fracture, infected joint
-Insect/snake bite
-Topical irritant to the skin
Cellulitis is one of the most common causes of what veterinarians call painful peripheral edema. Because it involves an infectious agent (mainly bacteria) almost in all cases, this term is used and refers to the infection of the subcutaneous tissues.
Most of the time; the underlying cause is unknown as no lesion is observed by the owner or veterinarian. Some type of penetration through the skin is strongly suspected as a cause in most cases. Wounds, intra-articular injections, surgical procedures, abrasions and bruises are all examples of skin damage that has been associated with cellulitis. When the skin barrier is broken, the normal bacterial population of the skin may then infiltrate the underlying tissue and cause inflammation and possibly infection. This explains why bacteria common to the skin (mostly Staphyloccocus spp and Streptoccocus spp) are often isolated in this condition.
The swelling is caused when the bacteria release toxins in the tissues causing inflammation of blood vessels and lymphatic channels. This results in increasing fluid leakage from the vessels and decreasing fluid resorption from the lymphatic which leads to fluid accumulation under the skin, a process we call edema.
Cellulitis is a treatable condition, but has a high recurrence rate. Because it often involves an infectious cause, antibiotic therapy is usually necessary. Penicillin and gentamicin are the most frequent combination of antibiotics used to treat cellulitis. When a bacterial culture is performed, the antibiotic choice is adapted as needed. Anti-inflammatory and pain management are an essential part of the treatment as the condition is very painful. An epidural is necessary in cases of severe rear limb pain when other methods of pain management are ineffective. Hydrotherapy, hand walking and limb bandaging are also important treatment tools as they mechanically help the blood and lymph circulation allowing the edema to resorb.
The prognosis for this condition is guarded to good as some horses can return to their previous use if they response well to treatment. Cases where the limb swelling returns multiple times are more challenging as the chronic inflammation can lead to scar tissue formation. These horses may have a thicker leg permanently. Also, recurring cellulitis may damage the lymphatic channels with scar tissue. Chronic limb severe limbs welling may also damage the coronary band and may lead to laminitis. Laminitis may also occur in the opposite leg due to the extra weight carried on the healthy limb. Other principal complications are skin necrosis secondary to compromise vasculature associate with the severe swelling, vascular thrombosis associated with bacterial toxins and persistent lameness.
As cellulitis can be a life-treatening condition and has a guarded prognosis, early recognition can increase the survival outcome. Good hygiene, wound management and aseptic techniques are favorable preventive measures to take. If you have any questions about cellulitis or about matters relating to your horse’s health in general, please talk to your veterinarian about them, or feel free to contact the veterinarians at New England Equine Medical and Surgical Center.
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