Regional Limb Perfusion for Distal Limb Injuries (AAEP 2011)

As majestic, beautiful, and graceful as they can be, horses are also flighty and frequently find themselves in hazardous situations. In light of horses’ propensity for lower limb injury, the environment in which they live, and the difficulty and expense associated with treating severe lower limb injuries, many equine practitioners have turned to a treatment technique called “regional limb perfusion” (RLP) in cases that might benefit from concentrated, targeted antibiotic treatment to an infected area.

This process involves the intravenous (IV) delivery of antibiotics to the lower limb via a vein close to the site of trauma. “RLP is popular because it can provide higher concentrations of antibiotics to the site of injury, including joints, with lower doses of antibiotics than need to be administered via the jugular vein or intramuscularly,” said Ashlee Watts, DVM, Dipl. ACVS, of the Department of Clinical Sciences at Cornell University’s College of Veterinary Medicine at the 2011 American Association of Equine Practitioners convention, held Nov. 18–22 in San Antonio, Texas.

Watts described additional benefits of RLP, including ease and speed of the technique, the use of standard equipment, the procedure’s minimal invasiveness and lack of major resulting complications, and minimal patient resistance.

Watts provided these tips to ensure successful RLP in the field:

  • The procedure is indicated for a myriad of distal limb musculoskeletal conditions where infection is or might be a problem;
  • The technique can be used as a stand-alone therapy (e.g., if there is a concern for antibiotic-induced diarrhea with systemically administered antibiotics), but usually RLP is performed in conjunction with systemic antibiotic administration, wound lavage, topical (local) therapy, and surgical intervention (e.g., to remove dead or infected tissue and/or granulation tissue);
  • The area around the vein needs to be shaved and aseptically prepared to minimize local inflammation. The vein can be increasingly difficult to puncture if daily RLP is required for several days, presumably due to local inflammation. Applying the topical non-steroidal anti-inflammatory drug Surpass (1% diclofenac sodium) might minimize inflammation and prolong the period that RLP can be performed.
  • Veterinarians most often perform RLP in standing, heavily sedated horses,  and applying a wide rubber tourniquet to the limb above where the injection is to be administered before administering the drug intravenously. The horse must remain as still as possible to promote maximal drug delivery; and
  • Each RLP treatment takes approximately 40 minutes to complete.

“In cases of severe trauma, daily RLP has the potential to improve prognoses, reduce costs, shorten recovery times, and turn previously hopeless cases into cases with positive outcomes. It is a highly useful technique to the equine practitioner,” concluded Watts.

Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.