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Regional limb perfusion in horses
  1. Gal Kelmer, DVM, MS, DipACVS, DipECVS
  1. Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot 7610001, Israel, e-mail:

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REGIONAL limb perfusion (RLP) is a well-known method for treating and preventing distal limb infection, which significantly decreases morbidity and mortality associated with trauma to these regions (Rubio-Martínez and Cruz 2006, Rubio-Martínez and others 2012). The procedure entails attaching a tourniquet proximal to the target area and injecting a diluted antimicrobial solution (perfusate) intravenously into the isolated portion of the limb. When venous access is not available the procedure can be performed via an intraosseous route. Although the RLP technique is well established, there are huge gaps in knowledge regarding this versatile modality. In recent years, there has been a surge of research regarding RLP, with some studies having investigated a few of the procedure's basic concepts while others looked at innovative directions of therapy.

Historical perspective

RLP originated in human medicine to facilitate surgical procedures in the extremities and was first described as regional anaesthesia in 1908 by Bier. The technique was subsequently studied and used for administration of antimicrobials and anticancer drugs. For some tumours it is still one of the most effective anticancer modalities available today (Moreno-Ramirez and others 2010). It was years later when Dietz and Kehnscherper (1990) first described antimicrobial regional perfusion in horses.

Indication and rationale

Synovial infection of the distal portion of a limb is one of the most common causes of morbidity and mortality in horses (Lugo and Gaughan 2006). To eliminate the pathogenic bacteria, antimicrobial agents need to reach adequate concentrations in the injured joints. Systemic administration of antimicrobials is often inadequate when eliminating infections, due to poor blood supply to the distal portion of the limb and insufficient synovial concentrations (Whithair and others 1992, Lugo and Gaughan 2006). During RLP, high concentrations and pressure gradients between the intravascular and extravascular compartments are obtained. This facilitates diffusion of the antimicrobial drug into the surrounding tissues, …

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