Refereed
MANAGEMENT OF TRAUMATIC FISTULOUS WITHERS AND
WOUNDS OF THE LUMBAR DORSAL SPINOUS PROCESSES
OF HORSES AND DONKEYS USED FOR PACK ANIMALS
MVZ Miguel A. Villalva Sohi, 1
Jill Johnson McClure, DVM, MS 2
SUMMARY
Over a three year period, eighty-nine (89) traumati-
cally induced wounds on the withers and lumbar area of
donkeys and horses were treated by the ambulatory clinic
at Universidad Nacional Aut6noma de M6xico. The wounds
generally resulted from poorly fitting pack equipment.
Treatment regimens were divided into two categories: 1)
conservative topical therapy plus padding or 2) surgical
debridement and primary wound closure. Conservative
therapy with topical medications and padding was success-
ful in many cases in spite of the fact that the animals
generally continued working. However, recurrence of le-
sions following conservative therapy was common. Surgi-
cal treatment was used primarily in cases refractory to
conservative therapy. As a result of surgical intervention,
clients tended to comply with recommendations to stop
working the animal. The convalescent time was shorter,
and the recurrence rate was lower following surgery than
for conservative therapy.
INTRODUCTION
Pack animals are essential to the economy of many
Authors' addresses: 1Universidad Nacional Aut6noma de Mexico,
Mexico, Mexico, 2Department of Veterinary Clinical Sciences, School of
Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803
Acknowledgements: The authors wish to acknowledge the assistance of
MVZ MsC Aline Schunemann de Aluja and Francisco Lopez Fernandez.
This work was supported by the International Donkey Protection Trust.
Volume 17, Number 1, 1997
parts of the world. Pack animals often perform functions
that cannot be performed by machines because of terrain
and/or economy. Pack animals often play a significant role
in the livelihood of families and/or the economy of a
community in an otherwise marginal economic setting. In
the Mexican states of Mexico, Tlaxcala, Guerrero, Puebla,
Queretero, Guanajato and Morela, donkeys, mules and
horses represent a significant form of transportation for the
market economies of small villages. A marginal economy
and lack of education often do not allow for use of appro-
priate tack equipment nor do they allow for time off for
recuperation from illnesses which do not completely pre-
clude work. Many animals are forced to work under condi-
tions which predispose to saddle sores and work is contin-
ued even after the development of problems.
MATERIALS AND METHODS
Patients were examined and treated free of charge at
mobile outpatient clinics sponsored by the International
Horse Protection League, International Donkey Protection
Trust, and Universidad Nacional Aut6noma de M6xico
(UNAM). Clinics were operated at weekly to monthly
intervals at various markets in the states of Mexico, Districto
Federal, Tlaxcala, Guerrero, Queretaro, Puebla, Guanaj ato,
and Morelos. Follow-up examinations and treatments were
performed during the regularly scheduled return visits to
the same markets.
Animals with wounds were either identified by the
owners and presented for treatment, or identified by clinic
43
personnel by inspection of all donkeys in the donkey
parking lots at the markets. Animals under treatment with
identified problems were marked over the rump with
indelible spray paint to allow easy recognition by clinic
personnel at a later date.
Lesions were distributed on the dorsal midline from
the withers to the caudal lumbar region. Most animals had
solitary lesions, although several had multiple sites in-
volved. Lesions ranged in size from 2 x 2 cm to 20 x 25 cm.
Craters containing fluid-filled bursa-like structures were
often observed within wounds located at the withers.
Lesions located more caudally were generally character-
ized by mounds of granulation tissue emerging from eroded
skin, without bursa-like structures.
i ~"I I11 i I--.I--"
Conservative medical therapy was initially used in
most cases. Wounds were initially cleansed with a solution
of 2% povidone iodine; abscesses were surgically opened
to provide ventral drainage and lavaged with hydrogen
peroxide. Penrose drains were occasionally placed in large
cavitating wounds to maintain drainage for two days. An
ointment prepared with a mixture of 200 g nitrofuran
ointment, a 10 ml dimethyl sulfoxide and approximately 40
g of cumafos ointment b was applied. Owners were rou-
tinely instructed to clean the wound and apply the ointment
topically each day.
'Donut' pads were fabricated to fit under tack to
protect circumscribed lesions. A 50 cm wide rectangular
strip of heavy 5 m m thick felt was cut to the length of the
estimated circumference of the area which needed protec-
tion. The felt was then rolled lengthwise to create a tube and
the ends of the tube were opposed to create a circle. The felt
"donut" pad was wrapped with gauze to maintain its
circular form. Donut pads encircled the lesions to alleviate
pack saddle pressure on the lesion. In some cases, 'rolls' of
the same construction approximately 10 to 15 cm in diam-
eter and 50 cm long fabricated out of the same materials
were placed on each side of the vertebral column over the
abaxial musculature to protect dorsal midline lesions from
pressure from the pack saddle.
Surgical treatment included radical debridement of
affected tissue and a variety of reconstructive procedures
f/-'l /.... F"
(Figure 1) designed to achieve primary closure of the
wounds. The pattern selected was based on the judgment of Figure 1. Surgical closure patterns used in different cases
the surgeon as to which would allow primary closure of the to manage traumatic wounds of the withers and dorsal
wound. Hair was shaved from the periphery of the lesions lumbar area. Selection of the pattern used in an individual
and the area was prepared with povidone iodine. Proce- patient was based on the judgment of the surgeon as to
which would allow primary closure.
dures were performed under local anesthesia by local
infiltration with 2% xylocaine. The reconstructive pattern initial size of some lesions and because of the necessity to
of incision to be used was selected prior to the procedure, undermine tissue to allow release of enough tension for
based on the size of the lesion to be closed. Absorbable reconstruction. Penrose drains were routinely placed for up
suture (00 vicryl or 00 dexon) was used to close the to three days to allow drainage from the surgical site.
subcutaneous tissue. Skin was closed with 0 nylon. Large Drains maintained for more than 3 days in donkeys initi-
amounts of dead space were encountered owing to the ated intense local inflammatory reactions. Full-thickness
punch skin grafts, harvested aseptically from anesthetized
aFuracin
bNegasunt areas on the neck were sutured (00 nylon) in place at the

44 JOURNAL OF EQUINE VETERINARY SCIENCE

lesion site in one animal in which complete primary closure
was not possible.
Skin sutures were removed after 14 days. Owners
were instructed on methods to improve the padding and fit
of the tack to prevent recurrence of wounds.
RESULTS
The average time for wound healing with conservative
treatment was 4 months. Supplemental padding was effec-
tive in protecting the wounds and, in nearly all cases of
conservative therapy, the animals continued to work. Le-
sions recurred in 80% of the animals treated conserva-
tively. This was probably due to the fact that the areas
tended to heal with fragile, unpigmented fibrous tissue
which was easily traumatized. Animals which appeared to
have a true bursitis (fistulous withers) as judged by the
location of the lesion and the presence of a fluid-filled
bursa-like structures within the lesion, tended not to re-
spond to conservative treatment, but healed following
surgical reconstruction.
Ten cases were treated by surgical management. The
average time for healing of wounds treated surgically was
3 months. Primary closure was achieved in 9 of 10 cases.
One of the 10 (10%) had recurrence of the problem. In the
case failing primary closure, the size of the lesion was
significantly reduced by surgery and the lesion healed
completely following a subsequent punch graft.
Eighteen of the animals were tested for Brucella
antibody and one of the 18 tested was positive. This animal
was the one surgical case which did not result in primary
closure and required a skin graft.
factor. Onchocerciasis cannot be eliminated as a factor;
however, other manifestations of onchocerciasis including
ventral midline dermatitis are not common in this region
suggesting that the parasite is not common. In addition,
most of these animals had been dewormed with ivermectin
as part of the sponsored health programs. The apparent
absence of these factors in the cases treated in this and
another study 6 may be one of the reasons why the success
rate of surgical intervention was relatively high (90%
resulting in primary closure).
REFERENCES
1. Rashmir-Raven A, Gaughan EM, Modransky P, Clem MF:
Fistulous withers. Comp Cont Ed 1990;12:1633-1640.
2. Duff HMM: Fistulous withers and poll evil due to Brucella
abortus. Vet Rec 1936;48:175-177.
3. O'Sullivan BM: Brucella abortus titres and bursitis in the
horse. Aust Vet J 1981;57:103-104.
4. Ottley ML, Dallemagne C, Moorhouse DE: Equine
onchocerciasis in Queensland and the Northern Territory of
Australia. Aust Vet J 1983;60:200-203.
5. Cohen ND, McMullan WC, Carter GK: Fistulous withers:
The diagnosis and treatment of open and closed lesions. VetMed
1991 ;4:416-426.
6. Gaughan EM, Fubini SL, Dietze A: Fistulous withers in
horses: 14 cases (1978-1987). J Am Vet Med Assoc 1988;193:
964-966.

DISCUSSION

Factors which predispose to development of chronic

traumatic wounds of the withers and dorsal lumbar midline
are heavy loads, poorly fitting tack and marginal nutri-
tional status (body condition) of the pack animalsfl The
option to decrease load size, release animals from work to
recuperate or provide more feed are usually not economi-
cally feasible in marginal market systems. Client compli-
ance with recommendations to rest animals met with more
success following surgery, which undoubtedly improved
the success rate for the procedures. Factors relating to
equipment which tend to minimize traumatic wounds in-
clude additional padding, lighter loads, earlier intervention
with treatment of lesions, better nutrition and client educa-
tion.
Brucellosis and onchocerciasis have been implicated
as causative agents in some cases of fistulous withers, a5
Only 1 of 18 animals tested positive for Brucella antibody
in this study; thus, Brucella did not appear to be a common

Volume 17, Number 1, 1997 45