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Keywords:

  • horse;
  • surgery;
  • colic;
  • coeliotomy;
  • complication;
  • stent bandage

Summary

  1. Top of page
  2. Summary
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Authors' declaration of interests
  8. Source of funding
  9. Acknowledgements
  10. Authorship
  11. References

Reasons for performing study

Incisional infections are common in horses after colic surgery. There is a clinical impression that the use of a stent bandage reduces the prevalence of such infections.

Objective

To determine the effect of a stent bandage on the likelihood of incisional infection after ventral midline exploratory coeliotomy. It was hypothesised that the use of a stent bandage would reduce the likelihood of incisional infection.

Methods

Medical records of horses that underwent exploratory coeliotomy for colic between January 2005 and September 2011 were reviewed. Inclusion criteria were animals that had one ventral midline coeliotomy and had survived at least 10 days after surgery. Horses were categorised into 2 groups:no-stent group and stent group. The following data were collected for each case: age, sex, weight, heart rate, packed cell volume, primary lesion, performance of an enterotomy or intestinal resection, surgical classification, use of local antimicrobials, duration of surgery, intra-abdominal administration of sodium carboxymethylcellulose, intravenous administration of lidocaine, surgeon, use of a stent bandage, duration of stent use, and use of a belly band. Factors associated with the outcome measure ‘wound infection’ vs. ‘no wound infection’ were analysed using a generalised linear mixed model for logistic regression with surgeon as a random effect.

Results

The inclusion criteria were met in 130 horses: 55 were assigned to the no-stent group and 75 to the stent group. In the no-stent group, 12 (21.8%) horses developed incisional infections, whereas only 2 horses (2.7%) in the stent group had incisional infections. In the stent group, no incisional infections were observed during the last 20 months of the study. Statistical analysis showed that only the effect of the use of a stent bandage was significant (P = 0.005).

Conclusions

The prevalence of incisional infections when a stent bandage was used was 2.7%, a finding that compared favourably to information in the literature. Use of a stent bandage significantly reduced the likelihood of incisional infections.

Potential relevance

A stent bandage would reduce the likelihood of incisional infection in horses undergoing exploratory coeliotomy for colic.


Introduction

  1. Top of page
  2. Summary
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Authors' declaration of interests
  8. Source of funding
  9. Acknowledgements
  10. Authorship
  11. References

Over the past several decades, the survival rate for horses undergoing colic surgery has progressively increased. However, incisional infection continues to be an important complication after exploratory coeliotomy. The prevalence of incisional infection reported in several studies ranges from 7.4% to 37% [1-11], with complications such as oedema, drainage, infection, hernia formation and dehiscence being encountered all too frequently.

Several factors (patient, surgical, mechanical) associated with incisional complications have been identified. Of the patient factors associated with incisional complications, those identified most commonly include age, weight >300 kg, anaemia, chronic illness, dehydration, post operative leucopenia, haemorrhagic shock, hypoproteinaemia, duration and degree of colic, concurrent infection, neoplasia, sex (castrated male), post operative ileus, increased packed cell volume, and inadequate nutrition [4, 5, 10, 12-18]. Important surgical factors predisposing to incisional infection include the location of the incision, suture material, method of closure, degree of trauma to the surgical site, duration of surgery, and the difficulty of anaesthetic recovery [2-5, 12-16, 19-22]. Incisional infections occur to a greater extent with repeated laparotomy, with the reported risk of incisional infections being as high as 57% in some studies [3, 14, 17, 23], and 87.5% in another [2]. The mechanical factors predisposing to incisional infection include the increases in intra-abdominal pressure that occur during recovery from general anaesthesia, during post operative rectal palpation and coughing, and the fact that post operative abdominal pain may lead to frequent recumbency and contamination of the incision [24].

The results of several recent reports suggest that the use of wound protection to prevent and treat incisional complications is beneficial. For example, Ingle-Fehr et al. [6] concluded that most incisional infections probably occur from superficial contamination of the wound, either from skin bacteria or from environmental contaminants, and recommended that some kind of wound protection be used to prevent contamination of the wound. In a study investigating preoperative preparation of the skin for ventral midline incisions, Galuppo et al. [22] suggested that protection of the wound during recovery from anaesthesia and the immediate post operative period may reduce incisional drainage. Nieto et al. [25] reported that incisional complications could be reduced by in-hospital use of post operative abdominal bandages. In one recent study the use of an abdominal bandage (belly band) in the immediate post operative period significantly reduced the incidence and severity of incisional complications after colic surgery [18]. In that study, horses with an abdominal bandage had the risk of developing a post operative incisional complication reduced by 45% compared to horses without abdominal bandages.

For the past several years, it has been our clinical impression that the use of a stent bandage could provide an optimal environment for wound healing, reduce tension forces on the wound, and lead to a reduction in the prevalence of post operative incisional complications. However, relatively few reports in the literature directly address the effects of a stent bandage on incisional wounds, and the experiences shared in those reports vary considerably [2, 10, 11, 14]. Therefore, we performed this comparative retrospective study to determine the clinical effect of the use of a stent bandage on the likelihood of incisional infection after ventral midline exploratory coeliotomy in horses. It was hypothesised that the use of a stent bandage would reduce the likelihood of incisional infection after colic surgery.

Materials and methods

  1. Top of page
  2. Summary
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Authors' declaration of interests
  8. Source of funding
  9. Acknowledgements
  10. Authorship
  11. References

The case records of horses that underwent exploratory coeliotomy for colic between January 2005 and September 2011 were reviewed. The study population consisted of horses that fulfilled the following inclusion criteria: 1) had one ventral midline coeliotomy; and 2) had survived at least 10 days after surgery. The decision to use a stent bandage or not was based on surgeon's preference. Horses that had the stent dislodged during the recovery from anaesthesia were excluded from the study. Horses were retrospectively categorised into 2 groups: those in which no wound stent bandage was used (no-stent group) and those in which a wound stent bandage was used (stent group). Data were obtained from the case records for information relating to the preoperative, intraoperative and post operative time periods as follows: preoperative data: age, sex, weight, heart rate, packed cell volume (PCV) (%), heart rate (beats/min); intraoperative data: primary lesion identified, anatomical location of primary lesion, performance of an enterotomy or intestinal resection, surgical classification (clean, clean/contaminated or contaminated), local use of antimicrobials, duration of surgery (<2 h, 2–3 h, >3 h), intra-abdominal administration of sodium carboxymethylcellulose, surgeon; post operative data: stent, duration of stent (1–2, 3–4 and 5 days), intravenous lidocaine perfusion, use of a belly band (belly bands were never used simultaneously with a stent bandage). Information was also obtained from bacterial culture of infected cases.

For the stent group, the stent bandage included a sterile antiadhesive dressing (Melolin)a and an absorbent wound dressing (Zetuvit E)b that was sutured over the wound with no. 2 nonabsorbable monofilament suture material. In the first 11 stent cases the suture pattern consisted of 4 interrupted sutures using a single bite in the skin at each side of the bandage. In the remaining stent cases, 6 interrupted sutures were placed using a double inverted Z bite in the skin at each side of the bandage. A water-impervious, protective adhesive drape (Opsite)a was applied over the stent bandage during recovery from anaesthesia, and was removed immediately thereafter to avoid the accumulation of moisture within the bandage. If the stent remained in place and was dry or minimally wet, it was left on for as long as 5 days. The stent suture holes were disinfected once or twice daily. After the stent bandage was removed, an abdominal bandage was applied over the wound and changed every 48–72 h.

In the no-stent group, horses were recovered from general anaesthesia with the wound covered by a protective adhesive drape that was removed shortly after recovery, and then no bandage was used to cover the wound. Starting in 2008, a belly band was applied to horses in the no-stent group after recovery and was changed every 48–72 h.

If there were no incisional complications, the skin staples were removed 10 days post operatively. If there was evidence of incisional infection, the staples near the infection site were removed to improve drainage, and the other staples were usually removed approximately 10 days post operatively. Descriptions of the wound evident through the edges of the stent bandage were recorded daily and each time the belly band was changed. The wound was classified as ‘not infected’ if there were either no wound complications, or mild oedema, serous or serohaemorrhagic exudation for less than 24 h post operatively. The wound was classified as ‘infected’ if there was persistent serohaemorrhagic drainage with excessive oedema or purulent drainage with or without positive bacterial culture. Infected incisions were cultured for bacterial growth and identification.

Data analysis

The statistical variables used in this study are described in Table 1. Variables potentially associated with the outcome measure ‘wound infection’ vs. ‘no wound infection’ were analysed using a generalised linear mixed model for logistic regression, with surgeon as a random effect. The variables were included in the model in prioritised order: duration of stent use, surgery classification, local use of antimicrobials, belly band, duration of surgery, PCV, heart rate, intra-abdominal administration of sodium carboxymethylcellulose and intravenous administration of lidocaine. The initial model modelled the wound infection rate as a function of stent treatment and year. Additional predictors were added using a forward selection scheme, and after they had been added any nonsignificant predictors were removed from the model again. The final logistic regression model can be written as:

  • display math

where β0 is the baseline risk of the chosen outcome, β1, stent is the effect of stent and u is the random effect of surgeon.

Table 1. The statistical variables included in the study
  1. PCV = packed cell volume; SCMC = sodium carboxymethylcellulose.

Categorical variables
StentYesNo 
Duration of stent1–2 days3–4 days5 days
Surgical classificationCleanClean/contaminatedContaminated
Local antimicrobialsYesNo 
Belly bandYesNo 
Lidocaine intravenous perfusionYesNo 
Duration of surgery<2 h2–3 h>3 h
Intra-abdominal SCMCYesNo 
SurgeonA, B, C, D, E, F, G, H, I
Quantitative variables
PCV (%)Continuous parameter
Heart rate (beats/min)Continuous parameter

Results

  1. Top of page
  2. Summary
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Authors' declaration of interests
  8. Source of funding
  9. Acknowledgements
  10. Authorship
  11. References

A total of 130 horses met the inclusion criteria for the study: 55 were assigned to the no-stent group and 75 to the stent group. Table 2 summarises comparative data for the 2 groups. The same wound closure technique and suture material were used in both groups. Seven of the 9 surgeons in the study were involved in cases in both groups. A stent bandage was used for 1–2 days, 3–4 days or 5 days in 23 (31%), 17 (23%) and 35 (47%) cases, respectively. Table 3 shows that in the no-stent group 12 (21.8%) horses had incisional infections, whereas in the stent group only 2 (2.7%) horses had incisional infections. When incisional infections occurred, they did so within 9 days of surgery in both groups. In the no-stent group, the incisional infections occurred from 2005 to 2008, then in 2010; but there were no incisional infections in 2009. In the stent group, incisional infections occurred only in 2010; there were no incisional infections in this group during the last 20 months of the study (February 2010 to September 2011).

Table 2. Pre-, intra- and post operative data in horses without and with stent
DataNo-stent groupStent group
  1. PCV = packed cell volume; SCMC = sodium carboxymethylcellulose.

Case/year  
2005103
2006144
2007153
200877
2009125
2010413
2011 (until September)420
Total5575
Mean (range) age (years)6.9 (0–19)8.2 (0–21)
Breeds (no. [%] in group)  
Warmblood32 (58%)32 (43%)
Icelandic3 (5%)15 (20%)
Thoroughbred and Standardbred3 (5%)7 (9%)
Others17 (31%)21 (28%)
Mean (range) heart rate (beats/min)67 (20–140)57 (32–120)
Mean (range) PCV (%)32 (27–40)37 (24–50)
SurgeonB,C,D,E,F,G,H,IA,B,C,E,F,G,H,I
Surgical classification (no. [%])  
Clean14 (25%)18 (24%)
Clean-contaminated41 (75%)54 (72%)
Contaminated03 (4%)
Wound closure and material  
Linea alba (2 simple continuous, PDS 1 mm)YesYes
Subcutaneous (simple continuous, Glycomer 631)YesYes
Skin (staples)YesYes
Local antimicrobial (no. [%])2 (4%)38 (51%)
Duration of surgery (no. [%])  
<2 h25 (45%)41 (55%)
2–3 h26 (47%)24 (32%)
>3 h4 (7%)10 (13%)
SCMC (no. [%])7 (13%)51 (68%)
Belly band (no. [%])11 (20%)58 (71%)
Lidocaine intravenous perfusion (no. [%])7 (13%)21 (28%)
Table 3. Observations for wound infections and stent
GroupInfectionNo infectionTotalInfection rateConfidence interval
No-stent1243550.2180.12–0.35
Stent273750.0270.01–0.09
Total141161300.1070.06–0.17

The only significant effect identified was for the use of a stent bandage (P = 0.005). The estimated odds ratio for incisional infection was 0.10 (95% confidence interval = 0.02–0.50) for stent bandage compared to no-stent bandage. In other words, the odds of incisional infection decrease by approximately 90% if a given surgeon changes from using no stent bandage to using a stent bandage. Conversely, changing from use of a stent bandage to not using a stent bandage increases the odds of incisional infection approximately 10-fold (P = 0.0055).

Four out of 75 horses with stent bandages had mild purulent exudation at the stent suture holes, which were disinfected and caused no incisional infection. No horse in this study had incisional dehiscence or hernia before being discharged from the hospital. In 26% of the cases, more than one type of antimicrobial was applied to the incision after the sutures in the linea alba were completed. The antimicrobials used most commonly in this manner were ampicillin, cefquinome, penicillin and gentamicin; in all cases, the same antimicrobials were administered systemically. Lidocaine was administered intravenously in 13% of the no-stent cases and in 28% of the stent cases; this treatment was not associated with incisional infection (P = 0.97). Table 4 compares the study population based on the outcome parameter ‘infection’. Incisional infections were not encountered in 2009 or 2011. Antimicrobials were used locally in more of the noninfected cases (32%) than in the infected cases (21%). Of the noninfected cases, 63% had a stent bandage and 56% had a belly band.

Table 4. Data comparing horses based on the outcome parameter ‘Infection’
DataNo infectionInfection
  1. PCV = packed cell volume; SCMC = sodium carboxymethylcellulose.

Case/year  
2005103
2006153
2007162
2008122
2009260
2010134
2011 (until September)240
Total11614
Mean (range) age (years)7.6 (0–21)7.4 (0–14)
Breeds (no. [%] in group)  
Warmblood55 (47%)9 (64%)
Icelandic17 (15%)1 (7%)
Thoroughbred10 (9%)0
Others34 (29%)4 (29%)
Mean (range) heart rate (beats/min)61 (20–140)64 (44–120)
Mean (range) PCV (%)36 (24–50)32 (27–37)
SurgeonA,B,C,D,E,F, G,H,IB,C,D,I
Surgical classification (no. [%])  
Clean28 (24%)4 (29%)
Clean-contaminated85 (73%)10 (71%)
Contaminated3 (3%)0
Wound closure and material  
Linea alba (2 simple continuous, PDS 1 mm)YesYes
Subcutaneous (simple continuous, Glycomer 631)YesYes
Skin (staples)YesYes
Local antimicrobial (no. [%])37 (32%)3 (21%)
Duration of surgery (no. [%])  
<2 h58 (50%)8 (57%)
2–3 h44 (38%)6 (43%)
>3 h14 (12%)0
Stent (no. [%])73 (63%)2 (14%)
Belly band (no. [%]))65 (56%)4 (29%)
Lidocaine intravenous perfusion (no. [%])26 (22%)2 (14%)

Discussion

  1. Top of page
  2. Summary
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Authors' declaration of interests
  8. Source of funding
  9. Acknowledgements
  10. Authorship
  11. References

In this retrospective study, the prevalence of incisional infection was significantly lower in horses in which a stent bandage was used than in horses in which a stent bandage was not used. The prevalence of incisional infection when using a stent bandage was 2.7%, comparing favourably to values reported for ventral midline coeliotomies in other studies [1-11]. For the last 20 months of this study, no incisional infections were observed in the stent group. None of the horses in this series had wound dehiscence or developed incisional hernias before being discharged from the hospital, which typically occurred 10 days post operatively. However, because these horses were not followed up after discharge, information regarding the true prevalence of incisional hernias is lacking. In both groups, all incisional infections were identified within 9 days after surgery, a finding that is consistent with previous reports that incisional drainage tends to develop within 7–14 days after surgery [18, 22, 26]. Consequently, removal of the staples 10 days after surgery in our study might seem to be an early practice; however, we typically discharge our patients 1 or 2 days after staple removal with strict instructions to consult a veterinarian in case of any wound drainage.

In human patients, the factors most commonly influencing the risk of wound infection include dead space, amount of bacterial contamination, necrotic tissue and motion [27]. Contamination at surgery does not seem to be a critical factor in the development of incisional infection [2, 3, 6, 14, 17, 28], and our results are consistent with these findings. The results of recent studies indicate that true contamination occurs primarily in the early post operative period. For example, Freeman et al. [29] suggest that the status of the recovery stall plays a big part in the development of incisional complications and the status should be as clean and dry as possible during recovery from anaesthesia. We speculate that fluid that might collect in the preputial sheath during the surgery is a potential source of incisional infection in male horses, especially when these animals are transported with a hoist. Care should be taken to protect the wound from such contamination.

Recently, the use of an abdominal bandage has been advocated to protect the wound from contamination and trauma, reduce oedema and retain prolapsed bowel [12, 13, 20, 29, 30]. Some investigators contend that these bandages provide little support to the incision and the abdominal wall [30], or can become a source of contamination, especially if they become wet and remain in place for too long [12, 13]. The abdominal bandage is often applied after recovery from anaesthesia, or after removal of a stent bandage. Therefore, there has been some debate regarding the routine use of such bandages after colic surgery, primarily owing to the expense associated with these bandages, the risk of contamination with urine, especially in male horses, and serum from the belly band, or in hot weather as sweating occurs, leading to a moist warm environment near the incision [10, 12, 13, 20, 29, 31]. Indeed, conflicting results have been obtained in recent studies by Smith et al. [18] and Torfs et al. [11]. In human patients, wounds covered with synthetic occlusive dressings heal faster, but have increased concentrations of bacteria owing to the favourable environment created under the dressing [32].

The local use of antimicrobials was not identified as a significant factor for incisional infection in the present study. This variable might appear as a confounding factor in the stent group, as no incisional infections developed before 2008, before antimicrobials were used in this manner. There is some disagreement in the literature regarding the local use of antimicrobials, with some surgeons advocating that wounds be irrigated with antimicrobials prior to closure of the subcutaneous tissue [33]. Santschi [34] recommends that inclusion of antimicrobials in a lavage solution is useful as a prophylactic therapy, but not sufficient to control an established infection. Mair and Smith [10] reported that 26.4% of horses in their study had significantly fewer incisional complications when benzyl penicillin was used topically, compared to 40.1% in the absence of this treatment. Johnson and Keller [35] administered penicillin/streptomycin with or without 10% dimethyl sulfoxide-NaCl solution intraperitoneally, and reported a significant decrease in the occurrence of incisional complications. Torfs et al. [11] reported that local application of antimicrobials was a significant protective factor. For the past 4 years, we have administered sodium carboxymethylcellulose intraperitoneally in the majority of our ventral midline laparotomies. Use of this treatment was not identified to be a significant factor for incisional infection in this study. Mueller et al. [36] reported that no significant differences were noted between control horses and horses treated with sodium carboxymethylcellulose with respect to incisional infection. In recent years, intravenous administration of lidocaine has become a common treatment of horses with gastrointestinal diseases. This therapy was not identified as a significant factor for incisional infection in the current study. The results of a recent in vitro study indicate that therapeutic concentrations of lidocaine did not inhibit equine neutrophil migration or adhesion, and these functions were increased at higher lidocaine concentrations [37].

In 2010, incisional infection in both groups in the current study might be attributed to the use of cefquinome as the first choice broad-spectrum antimicrobial for horses undergoing colic surgery. The systemic use of this antimicrobial might have selected for the multi-antimicrobial resistant Escherichia coli that were detected that year in all of the infected incisional wounds. A recent study reported that hospitalisation followed by prophylactic treatment with cefquinome alone or in combination with other multimicrobials resulted in a higher rate of faecal shedding of CTX-M-producing E. coli [38]. Consequently, this study suggests that cefquinome should be used with caution for antimicrobial prophylaxis in equine hospitals. Therefore, we abandoned cefquinome in favour of penicillin and gentamicin as the first choice broad-spectrum antimicrobials for such surgeries.

In 2008, the surgical team moved to a new surgical facility. Although we did not evaluate the potential effect of the new facility in this study, in the new facility incisional infections occurred in the no-stent group in 2008 and 2010 and in the stent group only in 2010. In addition, there were no incisional infections in the stent group before 2008.

In addition to applying direct pressure, a stent bandage may reduce the tension on the primary incision line and function by helping cover a drain. The results of the current study showed that inclusion of a stent bandage significantly reduced the prevalence of incisional complications. Moreover, if a given surgeon changes from using no stent bandage to using a stent bandage, the odds of an incisional infection are reduced by approximately 90%. Some authors [2, 38] propose that a stent bandage increases the risk for incisional contamination, because any blood and exudate from the wound that accumulate beneath the bandage make the environment favourable for bacterial growth close to the incision. Mair and Smith [10] reported that the use of a stent bandage appeared to increase the rate of wound infection; however, they suggested that this observation was biased by using stent bandages in cases with anticipated compromised wound healing. In other studies, the use of stent bandages was not significantly associated with incisional complications [2, 14]. Some authors [10, 32, 39] propose that stent bandages can be useful in protecting the wound during recovery, and that incisional contamination associated with the bandage can be prevented if the bandage is removed after the horse is standing or within 24 h.

A useful adjunct to the stent bandage is an adhesive drape (Opsite) that is placed over the stent bandage during recovery. This drape protects the stent and the wound from contamination until the horse is standing, at which time the sticky drape is removed to allow good wound ventilation. Male horses tend to urinate on abdominal or stent bandages, but having the stent bandage short caudally and closely sutured to the skin may avoid this problem. In the current study, some horses had necrosis and infection at the stent sutures holes, probably because of excessive local tension, which induces necrosis and promotes local infection. Consequently, we changed the suture pattern of the stent from a single bite in the skin to a double inverted Z bite in the skin. This might have reduced the tension on the skin and resulted in less local infection. With this suture pattern, and with 6 interrupted sutures instead of 4, it appeared that more stent bandages remained in place, even if recovery from anaesthesia was not smooth.

Most of our stent bandages were left in place for 5 days (47%) or for 3–5 days (69%). The rationale is that in the wound healing process, the acute inflammatory phase lasts at least 3 days. Hence, we believe that the stent bandage should be used for at least 3 days, and preferably for 5 days. One of the benefits of a stent bandage is that it may reduce tension in the wound during recovery. In a recent study, horses that had prolonged and violent recoveries were more likely to develop oedema or discharge from the surgical site [40]. This finding is consistent with those of Torfs et al. [11], who reported that if a sutured stent bandage was used during anaesthesia recovery, there was less incisional infection than when the stent was maintained by an adhesive sheet. There is evidence from human studies that sutured-on stent bandages protect the wound from injury, absorb tissue fluid and exudates, and reduce the risk of infection [41].

In both groups in the current study, most of the surgeries (72–74%) were clean/contaminated or contaminated; however, surgical classification was a nonsignificant variable on incisional infection. This result is consistent with those of other reports [2-4, 6, 10, 14, 17, 28, 42, 43]. Although the majority of the horses with surgery duration exceeding 3 h were in the stent group in the current study, incisional infection was not affected by surgery duration; this finding is consistent with the report from Philips and Walmsley [3], but contrary to the results of a study in which surgery duration exceeding 2 h predisposed to incisional infection [4].

Starting in 2008, a belly band was included in 20% of horses in the no-stent group and in 71% of horses in the stent group. Therefore, the use of a belly band is a confounding factor when the effects of a stent bandage are being evaluated, as the belly band also helps protect the wound. However, it is the stent that protects the wound in the early post operative period, where the risk of contamination is the greatest [6, 22, 39]. In addition, there is a clear association between the stent and the belly band (i.e. the majority of horses with stent bandages also had a belly band) but when stent usage is kept in the statistical model then the belly band can be removed. In fact, if belly band is included in the final model (together with stent usage), then the effect on the logic scale changes from -2.28 to -2.29, evidence that the effect of a stent is not influenced by the presence or absence of a belly band. Kobluk et al. [2] recommended that stent bandages and belly bands should not be used concurrently, as this provides a good environment for bacterial growth. In our study, the belly band was used only after the stent bandage had been removed. We believe that a noncovered stent bandage allows a sufficient wound oxygenation and may reduce bacterial growth.

A stent bandage that is correctly applied might be effective in minimising incisional complications, and its use is simple and economically worthwhile. We believe that applying a stent bandage to reduce incisional wound infection is one of the key parameters in managing these frequent complications in horses.

Because our study was retrospective, it was subject to limitations such as inadequate recording of incisional problems in the medical records and incomplete data (e.g. detailed incisional wound description), a lack of similarity regarding some variables between both groups, a small number of horses, and a variety of surgeons involved in the study. This comparative retrospective study may be used as a basis for randomised controlled studies assessing the specific effect of stent bandages on incisional complications, and using larger case numbers.

Acknowledgements

  1. Top of page
  2. Summary
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Authors' declaration of interests
  8. Source of funding
  9. Acknowledgements
  10. Authorship
  11. References

The authors would like to thank the personnel at the Large Animal University Hospital at the University of Copenhagen for their assistance with data collection. The referring veterinarians are also greatly thanked for referring the cases.

Authorship

  1. Top of page
  2. Summary
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Authors' declaration of interests
  8. Source of funding
  9. Acknowledgements
  10. Authorship
  11. References

All authors contributed to the study design, data analysis and interpretation. Data collection and study execution were by K. Grubbe Lin and K. Thurøe Nielsen. All authors (especially A. Tnibar) contributed to the preparation of the manuscript.

Manufacturers' addresses
  1. aSmith & Nephew A/S, Hørsholm, Denmark.

  2. bHartmann A/S, Hillerød, Denmark.

References

  1. Top of page
  2. Summary
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Authors' declaration of interests
  8. Source of funding
  9. Acknowledgements
  10. Authorship
  11. References
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