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Regional Limb Perfusion, RLP



Severe lower limb infections (usually involving joint, tendon sheath or bone) in horses are notoriously difficult to treat and tend to result in chronic lameness.

It can be difficult to get high enough levels of antibiotic into the diseased tissues in order to effectively fight a deeply established bacterial infection. This is partly due to the relatively poor blood supply in the lower limb. In some cases, the blood supply is further damaged by the injury itself.

Regional limb perfusion is a treatment designed to provide high levels of an antibiotic (or other medications) to the tissues in the lower limb.

In this procedure, a tourniquet is applied to the limb above the site of infection. It is placed in a way that puts excess pressure on the veins of the limb to “dam” the blood and make it pool in the lower limb. A catheter is inserted into this dammed up vein and a dose of antibiotic diluted in saline is slowly injected into the vessel.

The horse stands with the tourniquet in place for 30 minutes. During that time, the antibiotic is absorbed into the tissues at levels that far exceed what would have been possible with systemic (oral or injectable) treatment. The effects of certain antibiotics persist in the tissues for variable periods of time following this treatment.

There are a variety of antibiotics used for RLP. In some cases, the specific antibiotic will depend on the culture and sensitivity for the organism. In other cases, we do not have this information and so choose an antibiotic with a wide spectrum of activity against likely bacterial species.

I have had improved success in very difficult lower limb infection cases since I started using RLP as a treatment for lower limb infections.

Consider Potential Side Effects & Complications

There are usually not many side effects. Veins being catheterized may become clotted and not useable for further injection. The tissues around vessels may also become very inflamed. If this happens, the vet finds other vessels to inject. In some cases, ultrasound may be useful to find suitable vessels for injection.

It is not thought that a 30 minute blockage of the blood supply to the lower limb is damaging to the horse.

Skills I might need

Is It working? Timeframe for effect

It is often difficult to discern whether RLP is effective because it is often used in conjunction with other treatments. If the infection is "beaten" then RLP might well have contributed to that good result.

Vets considers swelling of the area, pain, lameness, and changes in fluid laboratory values in order to assess the efficacy of treatment.

Questions To Ask My Vet

  • Is regional limb perfusion a good choice to help combat this severe lower limb infection?
Author: Doug Thal DVM Dipl. ABVP


Watts A E. How to select cases & perform field technique for regional limb perfusion. AAEP Proceedings 2011:385-92.


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