Scientific Communication

The value of veterinary wound

adrid Spain

management for human wounds

and wound care EWMA GNEAUPP 2014
n

Submitted to the EWMA

Journal, based on a pres-
entation given a EWMA
symposium (VWHA/EWMA
Symposium on Veterinary

THE FIRST IN A SERIES: There remains much to learn appears in the EWMA Journal as the first in a series of Wound Management and
Antimicrobial Resistance:
about the science of wound healing in humans. It may articles that looks outside of the traditional topics Animal Wound Care - Best
be possible to improve our understanding of wound covered. We hope that you enjoy learning about wound practice and new knowl-
healing by looking to other disciplines. Veterinary wound healing in another species and will gain a better under- edge) at the EWMA
GNEAUPP 2014, Madrid.
healing research has something to offer and this article standing of the similarities that exist.

Wound healing and management is a challenge
not only in human medicine but also in
veteri- nary medicine. The struggles to heal
complicated wounds in companion animal
species are strik- ingly similar to those in
human patients despite major differences
between species. A comparison of the
similarities in healing between species may
identify new mammalian wound models with
a much higher concordance rate, and a critical
analysis of the differences may contribute to the
common good. Sharing clinical problems, treat-
ments, research, models, and ideas between hu-
man and veterinary experts can therefore benefit
both human and veterinary wound healing and
management, which speaks for an intensified
col- laboration between human and veterinary
wound healing associations.
the contribution of wound contraction and
epithelialisation to second intention healing of
cutaneous wounds varies significantly across spe-
cies due to differences in the gross and
histologic structure of the skin. Rapid
contraction is a com- mon feature of loose skin,
which is present in the body/trunk of most Jacintha M. Wilmink
companion animals, includ- ing horses, dogs, DVM, PhD,
Diplomate RNVA
and cats. In contrast, extremity wounds in
these animals heal in a manner more similar to Veterinary Wound
Healing Association
wounds in tight-skinned species (e.g., humans
(VWHA)
and porcines), primarily as the result of re- Past President and
epithelialisation2. Limb wounds in horses and Council Member
human leg wounds heal in a similar way: Correspondence:
healing in both species occurs mainly through info@woumarec.nl
epitheli- alisation with only limited wound
Conflicts of interest:
contraction (Table 1, Fig. 1). None.

Animal wound models Table 1: Comparative cutaneous wound healing across species.
Although the majority of animal Wound
models in wound healing resear ch reduc6on by Specie

are based on rodents, the concord-

ance rate between rodents and hu- Homo sapiens
mans is only 53%, which suggests
Roden6a
that results from rodent models
are not likely to translate into im- Porcine

proved clinical outcomes. A lack of Carnivora

concordance is not surprising Carnivora
given the anatomical, Equus ferus
physiological, and immunological caballus

differences between rodents and Equus ferus

humans1. For example; caballus

EWMA Journal 2014 vol 14 no 2 39

Scientific Communication

Figure 1: An example of a horse limb wound
that has healed almost completely by epithe-
lialisation.
Figure 2: An example of a horse limb wound
with unhealthy granulation tissue, necrotic
parts, and biofilm formation, which most
likely is subject to chronic inflammation.
Some excess granulation tissue has already
formed.
Figure 3: Fibroproliferative disorders in the
horse.
This horse exhibits EGT in the central part
of the wound, hypertrophic scarring along
the wound margins, congestion, edema, and
fi- brosis in the tissues around the wound
and distal limb.

EqUINE WOUNDS AS A MODEL FOR
HUMAN WOUNDS AND WOUND CARE:
DIFFERENCES AND SIMILARITIES
Differences between human and equine patients and
wounds
At first glance, human and equine patients do not
seem to have much in common, and their wounds
seem very different. Human patients are often elderly
and sometimes obese or with nutritional deficiencies.
Many human pa- tients suffer from systemic diseases
that lead to vascular, diabetic, or pressure ulcers. These
ulcers occur gradually with the progression of the
disease, must heal by second intention, and often
develop into chronic, difficult to heal wounds. In
contrast, equine patients are usually less than
3 years of age and in normal nutritional condition.
Their wounds are the result of sudden trauma, and the
aim of treatment is primary intention healing. Not all
wounds can be sutured, however, and wound
dehiscence occurs frequently, which means that many
wounds must heal by second intention and can develop
into chronic, difficult to heal wounds.
Similarities between human and equine wounds
Although human and equine patients and wounds are
initially very different, both species can suffer strikingly
similar problems with second intention healing. It is close
to normal for the limb wounds of horses to form
unhealthy granulation tissue that is covered in biofilm
and subject to chronic inflammation (Fig. 2). In
contrast to human wounds, that often have a lack of
granulation tissue, exu- berant granulation tissue (EGT)
is a regular complication in horse wounds (Fig. 3). The
clinical presentation of EGT is similar to that of human
keloids, except that equine EGT is not epithelialised.
Horse limb wounds sometimes develop scars that look
like keloids, but histology shows that these are
hypertrophic scars rather than true keloids. Horses, but
not ponies, have a genetic predisposition for developing
EGT and hypertrophic scars. Likewise, a ge- netic
susceptibility to keloid formation has been observed in
humans. Similarities in the histological appearance and
dysregulated cytokine profiles of these fibroproliferative
disorders in horses and humans have been shown3.
Another similarity between humans and equines is the
hypoxia of wounds. In horses, wound hypoxia is caused
by the anatomy of the limbs, which have only 2 main
arteries running to the distal limb and limited
collateral alternatives. When a horse limb is injured, the
perfusion of the wound and the distal part of the limb
can be dam-

40 EWMA Journal 2014 vol 14 no 2

aged, both by vessels that are cut and/or obstructed by
clots or by the swelling of the tissues as a reaction to THE EWMA EWMA 2015
the traumatic incident. Equine wounds can therefore UNIVERSITY LONDONUK
suffer from impaired oxygenation as well as problems
with the venous return, which can lead to congestion, CONFERENCE 13 -15 MAY 2015
oedema, and finally to fibrosis (Fig. 3). MODEL (UCM)
The final similarity between human and equine wounds
is the susceptibility of limb wounds to the
development of pressure sores. Equine pressure sores
in London
occur due to treat- ment with bandages or casts. The
causes are the same as those that are known in humans:
the amount of pressure,

the duration of time in which the pressure is present,
and shearing forces. A similar division in the severity and
depth of pressure sores or ulcers can be made in
equine and humans.
Comparative physiology
It has been shown that within the equine species horses
heal much slower and with more complications than po-
nies. By comparing many aspects of the physiology of
wound healing between these sub-species, it has
been determined that most of the differences in clinical
heal- ing can be explained by the course of the
inflammatory response and the capacity of leucocytes
to produce in- flammatory mediators. This knowledge
has resulted in enormous improvement in clinical
treatment strategies.
The EWMA UCM programme offers students of wound
management from institutes of higher education across Europe
the opportunity to take part of their academic studies whilst
participating in the EWMA Conference.
The opportunity of participating in the EWMA UCM is available
to all teaching institutions with wound management courses for
health professionals.
The UCM programme at the EWMA 2015 Conference
in London will offer networking opportunities between the
students from various UCM groups, UCM Lectures as well as
assignments and workshops arranged specifically for the
UCM students.
EWMA strongly encourages teaching institutions and students
from all countries to benefit from the possibilities of interna-
tional networking and access to lectures by many of the most
experienced wound management experts in the world.
Yours sincerely

Comparing the (patho)physiology of human and equine Dubravko Huljev

wounds may also reveal new elements of wound heal- Chair of the Education Committee
ing and wound management. The similarities in the
epithelialisation/contraction ratio, the development of
Participating institutions:
fibroproliferative disorders, biofilm formation, chronic
inflammation, dysregulated cytokine profiles, hypoxia,
and problems with pressure may introduce some
promising modeling alternatives to consider. In
addition, naturally occurring horse wounds may be
useful for clinical trials
3. Theoret CL and
because neither equine nor human wounds can be Wilmink JM. Aberrant
Donau Universitt Krems
Austria
easily mimicked in experimental set-ups. The wound healing in the
horse: naturally
correlation be- tween human and equine wounds may occurring conditions
reminiscent of those
lead to the devel- opment of new insights and observed in man.
WRR. 2013;21:365-
treatments for both species. We conclude that further 71.
collaborations between human and veterinary experts in
HUB Brussels
wound healing and management will be of benefit to Belgium
both fields. m

References
1. Special Section Wound Repair and Regeneration: Wound healing in Veterinary
Medicine; Asking the right questions to find the keys to wound healing. WRR
2013;21:363.
2. Volk SW and Bohling MW. Comparative wound healing- Are the small animal University of Hertfordshire
veterinarians clinical patients an improved translational model for human wound United Kingdom
healing research? WRR. 2013;21:372-81

EWMA Journal 2014 vol 14 no 2 41

 Haute cole de Sant L
Geneva, Switzerland i
t
h
u
a
n
i Universidade Catlica Portuguesa
a Porto, Portugal
Lithuanian University of Health Sciences

For further information about the EWMA UCM, please visit

the Education section of the EWMA website www.ewma.org
or contact the EWMA Secretariat at ewma@ewma.org

EWMA Journal 2014 vol 14 no 2 42

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