Chronic Cellulitis With Open Wounds
ABSTRACT
This sixteen year old Quarter Horse mare was sore at the walk (approximately ⅘) and her right hind limb was swollen from inguinal region to distal limb with several open wounds on the limb. From July 27 until November 11, Dashy was treated without success using traditional cellulitis and wound treatments.
Transdermal carbon dioxide therapy was commenced on November 12. Swelling decreased substantially after first treatment and movement in a circle was visibly improved after the second treatment. Over the course of nine treatments, granulation of the wounds developed and progressed, she was comfortable on the limb while bearing full weight and she became willing to move freely about her stall and walk and jog on hand walks. By the end of treatment Dashy appeared sound when walking and jogging. She was discharged with only a small amount of residual swelling.
Clinician: Equine Sports Medicine and Surgery (Weatherford, Texas)
Laszlo Hunyadi DVM, MS, DACVIM, PhD
Kristen McCurdy, BVM&S
Client Information: Dashy, 2003 Quarter Horse mare
CASE HISTORY AND CLINICAL SIGNS
Dashy was initially admitted July 27. Her right hind limb was swollen from the inguinal region down to distal limb. The saphenous vein was dilated in the inguinal region. Her limb was sore to the touch and she was reluctant to move. She was discharged and continued treatment at home. Upon being readmitted in November because of the owner's concerns, Dashy's right hind limb was still swollen and had several open sores. When ambulating in the stall, she would not pick up her right hind limb to turn in circles and instead planted her foot and pivoted on it.
TREATMENT
Initially admitted on July 27. Right hind limb swollen from inguinal region down to distal limb. Saphenous vein dilated in the inguinal region. Temperature 103.9˚. Sore at walk, approximately 4/5 lame. She was put on Equisul, Bute, Dexamethasone, Aspirin, cold hydro therapy, pressure bandaging and hand-walking. Stayed until July 31.
Seen on the farm on Aug 20. Right hind limb was still very swollen with open sores. Recommended cleaning wounds and bandaging with SSD.
Admitted on Nov 11 for reassessment of right hind cellulitis. She had been on various antibiotics (most recently 2-week course of minocycline) and aspirin powder 1x a day. The owner was concerned because the limb hadn’t decreased in size since her discharge in July. The owner was also worried that the hoof wall was being compromised. Right hind limb was swollen above the hock to the distal limb and had scabbed lesions.
Performed regional limb perfusion with 1g ceftazidime and 250ml sodium iodide IV. Continuing 5g aspirin PO q24.
Nov 12th - Dashy’s soundness was monitored and evaluated at 6am - she had trouble ambulating in the stall, would not pick up her RH limb to turn in circles in stall, instead planted her RH and pivoted on it. We performed RLP before noon. The vein was difficult to find due to the swelling. We were only able to inject ~5ml (250mg) before the vein blew. 3D cream with sweat wrap and afull limb bandage were applied. We performed the first transdermal carbon dioxide treatment at approximately 5:30pm.
Nov 13th - RH limb swelling had decreased substantially after the carbon dioxide treatment. We gave her 250ml sodium iodide IV. Performed right hind
tarsus RLP with1g ceftazidime. The swelling had decreased and the vein was more noticeable. 3D sweat and a full limb bandage were placed. We performed a second transdermal carbon dioxide treatment. After treatment, it was noticed that she would pick up her RH limb to walk circles in stall, rather than pivoting on her RH.
Nov 14th - We performed a transdermal carbon dioxide treatment and started hand walking her after the bandage was removed for treatment. 3D sweat and a full limb bandage were replaced after treatment. She appeared to be much more comfortable when walking and ambulating in her stall.
Nov 15th - Her RH was about half as swollen as it was on presentation on Nov 11. The scabs had fallen off and the wounds had granulated over after carbon dioxide treatments. We performed the transdermal carbon dioxide treatment, hand walked her and applied 3D sweat and a full limb bandage.
Nov 16th - Her RH was now similar in size to her LH and the swelling is almost unnoticeable. We completed transdermal carbon dioxide treatment, hand walked her, and applied 3D sweat and a full limb bandage. She was frisky on hand walks and would walk and jog and appeared to be almost sound.
Nov 17th - We completed a transdermal carbon dioxide treatment, hand walked her, and applied 3D sweat and a full limb bandage.
Nov 18th - We completed a transdermal carbon dioxide treatment, hand walked her, and applied 3D sweat and a full limb bandage.
Nov 19th - No treatment.
Nov 20th - Her leg swelled slightly without bandage. We completed a transdermal carbon dioxide treatment, hand walked her, and applied 3D sweat and a full limb bandage because of residual swelling. She still appeared comfortable on the limb, while bearing full weight and she was willing to walk, jog and ambulate around stall.
Nov 21st - We completed a transdermal carbon dioxide treatment, hand walked her, and applied a full limb bandage, without sweat
Nov 22nd - We completed a transdermal carbon dioxide, hand walked her and applied a full limb bandage. Her leg had returned to almost normal size. All of the sores were healing well.
Nov 23rd - No treatment.
Nov 24th - We performed our final transdermal carbon dioxide treatment, hand walked, and applied a full limb bandage. She appeared sound when walking and jogging. She was discharged that evening with only a small amount of residual swelling. Dashy was relocated to California, so no follow up will be available.
SUMMARY
Dashy’s cellulitis and her open wounds responded immediately to the transdermal pharmaceutical carbon dioxide treatments. And, within 24 hours she was putting weight on the sore leg and ambulating with comfort. Her quick improvement was observed by our team and by our client. Not only was the clinical response impressive, the transdermal carbon dioxide treatment made her much more comfortable than any other modality we previously administered. At the conclusion of treatment her cellulitis was resolved, her wounds were healed and she appeared sound at the walk and at the jog. We’ll recommend pharmaceutical transdermal carbon dioxide for all of our cellulitis and wound cases.