A withers fistula is an inflammatory condition affecting a horse’s withers. It may be accompanied by the formation of a tube-like passage to the skin’s surface, known as a fistula. This passage allows the pus to drain out.
The withers are located between the shoulder blades and mark the transition from the horse’s cervical to thoracic spine. The nuchal ligament, which runs from the back of the horse’s head along the cervical spine toward the withers, originates here. The withers consist of the spinous processes of the anterior thoracic vertebrae, which can be up to 30 centimeters long. At the highest point of these processes, a bursa is situated on the withers, which cushions the movements between the vertebrae and the dorsal ligament. The dorsal ligament continues from the nuchal ligament and runs over the spinous processes of the entire spine.
Inflammation in the withers area is often caused by ill-fitting saddles or driving harnesses, which lead to chronic irritation of the bursa. Even the smallest wounds, bruises, or puncture wounds can cause these inflammations to become infected, leading to the formation of abscesses or fistulas. Depending on the location of the fistula, prolonged existence can lead to necrosis (tissue death) of the nuchal ligament, the fascia (connective tissue sheaths surrounding muscles), the cartilage caps, and the bony ends of the spinous processes.
At the onset of the disease, only mild swelling in the withers area is usually observed. In some cases, the lymphatic vessels appear as circular patterns on the surrounding skin. As the disease progresses, purulent discharge may drain from fistula openings located on the sides of the withers, running down the chest wall. This results in hair loss and weeping skin inflammation. Affected horses show significant pain in the area of inflammation as well as difficulty moving their forelimbs.
In most cases, your veterinarian can make a diagnosis based on the clinical symptoms and your description of the history. By probing the fistula tract (i.e., determining its course and depth using a metal probe), your veterinarian can get an initial impression of the extent and location of the fistula.
However, to determine the exact location and course of a fistula, it is necessary to fill the fistula with contrast medium followed by an X-ray examination. The X-ray image can also reveal whether any bone structures have already been affected.
Treatment depends on the extent and severity of the condition. In most cases, local irrigation and cleansing are combined with the administration of high-dose antibiotics. To ensure targeted treatment, the choice of the appropriate antibiotic should, whenever possible, be determined by an antibiogram (a laboratory test to determine the sensitivity of bacteria to antibiotics).
In severe cases and those that do not heal with conservative therapy, surgical intervention may also be necessary. In this procedure, the base of the fistula is opened and cleaned through special incisions.
The prognosis for healing depends heavily on the extent of the condition and the timing of the diagnosis. Superficial fistulas with only minor tissue changes usually heal with consistent and intensive treatment, whereas deeper fistulas involving the fascia or forming pockets often do not heal completely even after months of intensive treatment.
If the pus-causing pathogens are carried into the bloodstream, life-threatening systemic infections and extensive organ damage, such as pneumonia, can further worsen the prognosis.
Thanks to significantly greater awareness of the importance of a well-fitting saddle or harness, withers fistulas are much less common today than in the past. Have the fit of your saddle or harness checked regularly by a specialist to prevent pressure sores or chafing in the withers area. In the case of open wounds or cuts in the withers area, it is recommended to avoid using a saddle, lunge girth, or harness for a certain period of time to prevent further irritation and allow injuries to heal without complications.
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