Equine wound care review sharpens focus on topical therapy choices

Equine wound care is getting a fresh evidence-focused review, with VETgirl’s 2025 educational coverage on topical therapies for wound healing in horses echoing a broader shift in the field: away from reflexive use of topical antimicrobials and toward more deliberate, stage-based wound management. The core message is that horse wounds, particularly on the distal limb, remain uniquely difficult to manage, and topical products should support, not replace, the basics of lavage, debridement, moisture control, and bandaging. (vetgirlontherun.com)

That emphasis reflects years of frustration in equine practice. Horses are especially prone to delayed healing and exuberant granulation tissue, with lower limb wounds often healing more slowly than wounds elsewhere. BEVA’s primary care clinical guidelines, published in Equine Veterinary Journal, were developed because there had been no evidence summaries for equine wounds despite how common and clinically challenging they are. Those guidelines concluded that the veterinary evidence base is still limited, and many recommendations rely partly on human literature. (pubmed.ncbi.nlm.nih.gov)

The practical details matter. According to the BEVA guideline, tap water can be considered instead of saline for lavage, povidone-iodine lavage may be useful for contaminated wounds, and optimal lavage pressure is around 13 psi. Just as notably, the guideline says topical silver sulfadiazine may not be suitable for acute wounds, a point that complicates its long-standing place in equine wound protocols. Vet Times similarly reports that saline plus gauze outperformed silver sulfadiazine or povidone-iodine solution in reducing bacterial loads in one cited comparison, and warns that many antiseptics can do more harm than good to healing tissue. (pubmed.ncbi.nlm.nih.gov)

Among the more supported topical options, medical-grade manuka honey continues to draw interest. A 2012 experimental study found that manuka honey reduced wound retraction, leaving treated distal limb wounds significantly smaller through day 42, although it did not shorten overall healing time in that model. Another study found manuka honey and manuka honey gel reduced wound retraction and overall healing time in contaminated and noncontaminated distal limb wounds, while a later study reported more organized granulation tissue early in repair, with decreased inflammation and increased angiogenesis, even without a significant change in bacterial counts. Expert commentary published by The Horse adds that honey may be especially useful in contaminated wounds or wounds with biofilms, with Andrew Dart noting evidence that treated wounds can retract less and heal faster in some settings. (pubmed.ncbi.nlm.nih.gov)

Other adjuncts are also in play, though with varying levels of evidence. Vet Times highlights ketanserin gel, hydrogels, PRP, and acemannan-containing products as options that may help in selected cases, especially when the goal is controlling exuberant granulation tissue or supporting healing over exposed bone. The strongest published support among those may be for ketanserin: in a multicenter randomized controlled field study of 481 horses and ponies, ketanserin-treated wounds were more likely to heal successfully than wounds treated with comparator products, with reported benefits in preventing hypergranulation tissue and infection. More recent work has also explored pectin-honey hydrogel for preventing surgical site infection after equine laparotomy, with one 2024 pilot study reporting a lower SSI rate in treated horses. (vettimes.com)

Industry and expert reaction is cautious rather than promotional, which is probably appropriate. The Horse quotes experts who support honey and newer silver technologies, but also stress that cleaning, debridement, and assessment for synovial involvement remain essential. Vet Times goes further, arguing that many commercial wound products don’t outperform a properly maintained moist wound environment and may even interfere with autolytic debridement or dressing performance. That aligns with the broader evidence review: topical therapy can help, but only when used in the right wound, at the right stage, for the right reason. (thehorse.com)

Why it matters: For equine veterinarians, this is less about a new product launch than about a maturing treatment philosophy. The evidence suggests clinicians should be selective with topical antimicrobials, skeptical of harsh antiseptics in clean healing wounds, and more willing to tailor treatment to wound phase, contamination status, location, and dressing strategy. It also reinforces antimicrobial stewardship: if medical-grade honey, appropriate dressings, and wound bed preparation can reduce reliance on systemic or indiscriminate topical antibiotics, that’s clinically and professionally significant. For pet parents, that may translate into more nuanced care plans and fewer assumptions that a spray or cream alone will solve a difficult wound. (pubmed.ncbi.nlm.nih.gov)

What to watch: The next step for the field is better comparative evidence in real-world cases, especially on distal limb wounds, biofilm management, and prevention of exuberant granulation tissue. Expect continuing interest in honey-based products, advanced dressings, PRP, and regenerative approaches, but also a sharper focus on whether these therapies improve outcomes beyond meticulous wound preparation, bandaging, and follow-up. (pubmed.ncbi.nlm.nih.gov)