Medical Grade Honey Can Reduce Equine Surgical Site Infections
By Mark Andrews
Abdominal surgery is a major undertaking in horses, and not without significant risks to the patient. Colic operations, especially those that involve opening the gut wall, risk contaminating the wound with bacteria. One of the most common complications after equine abdominal surgery is surgical site infection (SSI) of the abdominal incision.
Medical grade honey (MGH) has been used successfully to treat established infections in both humans and animals, and has been shown to improve wound healing of equine lacerations and significantly reduce infection rate. Would the application of MGH also help equine abdominal surgical wounds to heal?
A study by Dr. Kajsa Gustafsson and colleagues at the Department of Large Animal Medicine and Surgery, Koret School of Veterinary Medicine, part of the Hebrew University of Jerusalem in Israel, investigated whether medical grade honey gel, applied on the linea alba during wound closure, would decrease the prevalence of incisional infections in horses undergoing colic surgery.
Almost all equine colic surgeries are emergency procedures. Surgical site infection of the abdominal incision is one of the most common complications after equine abdominal surgery.
An example of intra-incisional application of medical-grade antimicrobial honey following colic surgery.
The linea alba is the fibrous band that runs along the midline of the belly between the abdominal muscles. Being composed of fibrous connective tissue it contains no major blood vessels, making it a suitable site for incisions for abdominal surgery.
In this prospective randomized controlled trial, 108 horses that underwent colic surgery at Koret School of Veterinary Medicine were enrolled. Horses were randomized to a control or treatment (MGH) group. In the treatment group, following closure of the linea alba, MGH gel (L-Mesitran Soft) was placed in the incision followed by routine closure of subcutaneous tissue and skin.
Horses were subsequently excluded from the study if they needed a second abdominal surgery (four horses) or did not survive for at least two weeks post-operatively (15 horses). This left 40 horses in the control group, and 49 in the treatment group.
An assessment of the incision and post-operative complications was done at five time points: 24 hours, 48 hours, 5 days, 15 days, and 3 months.
The clinicians report that a single intra-incisional application of MGH gel strongly reduced incisional infection rate from 32.5 percent (13 out of 40) in the control group to 8.2 percent (4 out of 49) in the treatment group. No adverse reactions were observed with the subcutaneous application of MGH after colic surgery.
“The study was ongoing for one and a half years, and in the end we realized that this Medical Grade Honey made a difference for the horses participating. The horses that received Medical Grade Honey were four times less likely to get a surgical site infection after surgery,” reports Kajsa Gustafsson, DVM.
The authors conclude that intra-incisional application of MGH gel on the linea alba was a simple and rapid procedure that was safe and did not result in any adverse effects. A single local prophylactic treatment with MGH in the abdominal incision during surgery significantly decreased the prevalence of incisional infections in horses undergoing colic surgery. They suggest that more research is necessary to explore this promising approach in indications outside the equine colic field, e.g., in surgeries with a high risk of SSIs.
A full report is published in the Equine Veterinary Journal.
Published with the kind permission of Mark Andrews, Equine Science Update.
Main photo: Dr. Kajsa Gustafsson