Update on Managing Serious Wound Infections in Horses: Wounds Involving Bone

Most serious wound infections involve at least one, and usually a combination, of these factors: (1) extensive contamination or bacterial burden that overwhelms the patient's resources, (2) refugia which protect the bacteria from host defenses and antibiotic drugs, (3) immunocompromise, (4) poor perfusion, and (5) antibiotic resistance of the wound pathogen(s). In horses, wounds that involve bone, range in severity, complexity, and long-term impact from those containing a sequestrum, to septic osteomyelitis at the site of internal fixation. The principles of successful treatment are as follows: (1) debride the devitalized or irreparably damaged bone and soft tissue, (2) preserve and protect the vascular supply to bone and soft tissue, (3) maintain or restore structural integrity at the site, (4) control infection through appropriate local/regional and systemic antibiotic therapy and (5) protect the wound from further contamination, desiccation, maceration, and trauma.