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The Veterinary Journal 204 (2015) 229–231 Contents lists available at ScienceDirect The Veterinary Journal Short Communication A simple surgical treatment for bovine digital dermatitis-associatedwhite line lesions and sole ulcers J. Kofler a,*, J. Glonegger-Reichert a, J. Dietrich a, S. Sykora b, A. Tichy c, S. Brandt b a Department of Farm Animals and Veterinary Public Health, Clinic for Ruminants, University of Veterinary Medicine, A-1210 Vienna, Austriab Research Group Oncology, Equine Clinic, Department of Companion Animals and Horses, University of Veterinary Medicine, A-1210 Vienna, Austriac Department of Biomedical Sciences, Platform for Bioinformatics and Biostatistics, University of Veterinary Medicine, A-1210 Vienna, Austria Article history: Non-healing white line disease (nhWLD) and sole ulcers (nhSU) are seen increasingly in herds endemi- Accepted 17 March 2015 cally affected with bovine digital dermatitis (BDD). In 35 cows with 42 nhWLD or nhSU lesions, the healingprocess was monitored for up to 28 or 38 days following extensive debridement of loose horn and in- fected corium under regional anaesthesia, and topical application of tetracycline spray with bandaging.
Bovine digital dermatitis By 28 days, 27/42 (64%) nhWLD and nhSU were completely covered by a new horn layer and this White line lesion increased to 30/42 (71%) that had healed by 38 days. Lesion sizes on day 0 correlated with clinical healing within the study period. In view of this satisfying therapeutic result, the terms nhWLD and nhSU are Non-healing bovine hoof lesions proposed for BDD-associated white line disease (BDD-WLD) and BDD-associated sole ulcers (BDD-SU), 2015 Elsevier Ltd. All rights reserved.
Non-healing (nh) bovine hoof horn lesions, characterised by pen- painful, granular lesions within the claw horn (Fig. 1) exuding a etration of the horn capsule and association with white line disease typical, BDD-associated odour.
(nhWLD), and sole ulcers (nhSU) are frequently encountered in dairy Treatment of extended nhWLD and nhSU cases consisted of func- herds endemically affected by bovine digital dermatitis (BDD) tional claw trimming, application of a block on the sound partner (Blowey, 2011; Evans et al., 2011; Holzhauer and Pijl, 2011; Nouri claw, and retrograde intravenous anaesthesia using 15 mL of pro- and Ashrafi-Helan, 2013). The exposed corium is frequently in- caine hydrochloride 2% (Procamidor, Richter Pharma). Loose wall fected with Treponema spp. (Evans et al., 2011). In contrast to the or sole horn was removed and the horn rim trimmed around the more common types of BDD, nhWLD and nhSU are associated with lesion using a hoof knife. All infected corium was removed with a more severe lameness, often leading to claw amputation or slaugh- scalpel blade (Fig. 1). The wound was then rinsed using saline so- ter (Blowey, 2011; Evans et al., 2011). The disease poorly responds lution, treated topically with chlortetracycline spray (CTC Blauspray, to standard BDD treatment (Evans et al., 2011) and a more effec- Novartis) and protected from de novo infection by a bandage tive therapy for early lesions seems to consist of debridement consisting of 10 × 10 cm2 sterile gauze, two layers of cotton, and followed by topical antibiotic and copper sulfate dressing, topical self-adherent bandaging tape. The same regime was used for the salicylic acid powder, and/or parenteral cephalosporin treatment treatment of smaller nhSU (<2 cm) but here only ice spray (Eis- (Evans et al., 2011; Holzhauer and Pijl, 2011).
Spray-Ratiopharm) was used to allow painless removal of the This study investigated whether rigorous surgical debridement infected corium.
of nhWLD and nhSU lesions would promote clinical healing as evi- On day 0 (before treatment), and on days 10, 18 and 28, all lesions denced by coverage of the lesion with new horn. The Institutional were photographed, their morphology and maximum diameter Ethics and Animal Care Commission of the Veterinary University assessed (Fig. 1), and wound healing recorded. On days 10, 18, and Vienna approved this study.
28, topical tetracycline treatment was repeated and new ban- Twenty nhWLD and 22 nhSU cases from 35 cows on three farms dages were applied as indicated. Lesions were considered to have with endemic BDD were subjected to treatment. Locomotion was healed when they were completely covered by new horn.
scored (Sprecher et al., 1997) when cows were led to the trim- Lesions were especially prevalent in herd 3 and so affected cows ming table. Non-healing WLD and nhSU were diagnosed by clinical were treated twice with a 10-day interval in between (first visit: 9 examination after claw trimming. They presented as profoundly cows, 13 lesions; second visit: 14 cows, 16 lesions), leading to ad-ditional data for farm 3 patients on day 38. Tissue samples from eachlesion were PCR-screened for treponemal DNA (Brandt et al., 2011).
Acquired data were not normally distributed. Differences between * Corresponding author. Tel.: +43 1 25077 5223.
E-mail address: Johann.Kofl[email protected] (J. Kofler).
locomotion scores on day 0 and days 10, 18, 28 were assessed by http://dx.doi.org/10.1016/j.tvjl.2015.03.0161090-0233/ 2015 Elsevier Ltd. All rights reserved.

J. Kofler et al./The Veterinary Journal 204 (2015) 229–231 Table 1
Disease specifications and response to treatment.
Animals and disease Total number of cows Number of cows with nhWLD/nhSU Number of nhWLD/nhSU lesions Number of cows with BDD lesions Diameters of lesions before treatment nhWLD/nhSU diameter <2 cm nhWLD/nhSU diameter =2 cm nhWLD/nhSU diameter 2.1–3.9 cm nhWLD/nhSU diameter ≥4 cm Mean diameter nhWLD Mean diameter nhSU Lameness scores before and after treatment Day 0 lameness score 2 Day 0 lameness score 3 Day 0 lameness score 4 Day 10 lameness score 1 17.1% (n = 6), P = 0.01 Day 10 lameness score 2 31.4% (n = 11) Day 28 no lameness 14%, P = 1.00 Day 28 lameness score 2 Day 28 lameness score 3 Clinical healing rates after treatment Healing rate at 10 days Healing rate at 18 days Healing rate at 28 days Healing rate at 38 days Healing rate of nhWLD at 28 days Healing rate of nhSU at 28 days nhWLD, non-healing white line disease; nhSU, non-healing sole ulcer.
Wilcoxon test. The Mann–Whitney-U test served to analyse differ-ences in the healing rate between nhWLD and nhSU, and Fisher'sexact test was used to analyse differences in healing rate betweenunilateral and bilateral lesions within 28 days. Spearman correla-tion coefficients were calculated for lesion sizes at day 0 and healingwithin 28 days. Significance was set at P Disease specifications and responses to treatment are summarised in Table 1. Non-healing WLD and nhSU ranged from 1 to 5 cm indiameter. In seven cows, lesions affected the lateral claws of bothhind limbs. A significant decrease in lameness from day 0 (n = 35lame cows) was observed on day 10 with six cows found withoutlameness (17.1%) and 11 cows showing a score of 2 (31.4%; Wilcoxontest, P = 0.01). On day 28, 15 (35.7%) of lesions were smaller butnot completely covered by new horn. On days 10 and 18, it wasnecessary to renew blocks in seven cows.
Healing rates of the two different types of lesions such as nhSU (72.7%) and nhWLD (55.0%) within 28 days (Mann–Whitney-Utest, P = 0.23), and healing rates of lesions in cows with unilateraland bilateral (n = 7) lesions did not significantly differ on day 28 (Fis-her's exact test, P = 0.49). Lesion size at day 0 significantly correlatedwith healing at day 28 (r = 0.48; P = 0.01). Diagnosis of nhWLD andnhSU was confirmed by detected intralesional presence of BDD-related Treponema spp. DNA (Treponema medium, Treponema pedis) (Sykora et al., 2013). None of the cases required digital amputation.
The treatment strategy resulted in healing in 27 lesions (64%) within 28 days and in 30 (71%) with additional monitoring on day Fig. 1. (A, B, C) Non-healing white line disease (BDD-associated white line disease)
38. The procedure led to healing also in 28 (67%) of large lesions on the lateral claw of a right hindlimb before treatment (A) with the attached woodenblock on the medial claw, after removal of all the loose wall horn around using a (diameter ≥ 4 cm). In contrast to common acute BDD lesions in which hoof knife (B), and after surgical excision of the infected corium layer (C). Lesion post-treatment recurrence rates of 14.5–50% have been reported diameter was 5 cm.
within 3 weeks (Kofler et al., 2015) to 11 months (Berry et al., 2012),none of the clinically healed nhWLD and nhSU cases recrudescedwithin the observation period. However, a longer follow-up isrequired to rule out the possibility of recurrence.
J. Kofler et al./The Veterinary Journal 204 (2015) 229–231 There are reports on 61.5% and 90% of nhWLD and nhSU lesions International Conference on Lameness in Ruminants, Bristol, UK, being covered by new horn after 60 (Nouri and Ashrafi-Helan, 2013) 11th–14th August 2013.
and 90 days, respectively, when using topical debridement, sali-cylic acid and a bandage (Holzhauer and Pijl, 2011). For welfarereasons, no untreated control group was included in the present study, however, our results are comparable with the 68% healingrate of common sole ulcers after 30 days (Lischer et al., 2001).
Berry, S.L., Read, D.H., Famula, T.R., Mongini, A., Döpfer, D., 2012. Long-term Incomplete healing in 12 (29%) lesions may be explained by the observations on the dynamics of bovine digital dermatitis lesions on a Californiadairy after topical treatment with lincomycin HCl. The Veterinary Journal 193, short treatment duration (Holzhauer and Pijl, 2011; Nouri and Ashrafi-Helan, 2013), and loss of the block, resulting in continu- Blowey, R.W., 2011. Non-healing hoof lesions in dairy cows. Veterinary Record 169, ous pressure on the lesion and soaking of the bandage in slurry, thus Brandt, S., Apprich, V., Hackl, V., Tober, R., Danzer, M., Kainzbauer, C., Gabriel, C., promoting contamination of the still-exposed corium. Larger lesions Stanek, C., Kofler, J., 2011. Prevalence of bovine papillomavirus and Treponema required significantly more time to heal than smaller lesions.
DNA in digital dermatitis lesions. Veterinary Microbiology 148, 161–167.
In conclusion, the treatment procedure presented here can be Evans, N.J., Blowey, R.W., Timofte, D., Isherwood, D.R., Brown, J.M., Murray, R., Paton, implemented easily in practice. Regional retrograde anaesthesia allows R.J., Carter, S.D., 2011. Association between bovine digital dermatitis treponemesand a range of ‘non-healing' bovine hoof disorders. Veterinary Record 168, complete, painless removal of loose horn, provides excellent condi- tions for visual inspection and rigorous surgical debridement of Holzhauer, M., Pijl, R., 2011. Non-healing white line lesion, advanced experience.
infected tissue. Additional systemic antibiotic treatment (Evans et al., In: Proceedings of the 16th Symposium and 8th Conference of Lameness inRuminants, Rotorua, NZ, February 28–March 3, 2011, p. 149.
2011; Nouri and Ashrafi-Helan, 2013), which is usually associated Kofler, J., Innerebner, C., Pesenhofer, R., Hangl, A., Tichy, A., 2015. Effectiveness of with withdrawal times, is not necessary.
salicylic acid paste for treatment of digital dermatitis in dairy cows comparedwith tetracycline spray and hydrotherapy. Berliner und Münchener TierärztlicheWochenschrift 128, in press.
Conflict of interest statement
Lischer, C.J., Dietrich-Hunkeler, A., Geyer, H., Schulze, J., Ossent, P., 2001.
Heilungsverlauf von unkomplizierten Sohlengeschwüren bei Milchkühen in The authors of this paper have no financial or personal relation- Anbindehaltung: Klinische Beschreibung und blutchemische Untersuchungen.
Schweizer Archiv für Tierheilkunde 143, 125–133.
ship with other people or organisations that could inappropriately Nouri, M., Ashrafi-Helan, J., 2013. Observations on healing process of wall ulcers with influence or bias the content of the paper.
concurrent digital dermatitis in 52 cattle: Gross and light microscopic pathology.
Animal and Veterinary Sciences 1, 60–65.
Sprecher, D.J., Hostetler, D.E., Kaneene, J.B., 1997. A lameness scoring system that uses posture and gait to predict dairy cattle reproductive performance.
Theriogenology 47, 1181–1187.
We wish to thank the ÖBG (Austrian Buiatrics Association) for Sykora, S., Auersperg, C., Kofler, J., Dietrich, J., Reichert, J., Brandt, S., 2013. Prevalence financial support of this study, and the farmers and involved of Treponema sp. in bovine digital dermatitis-associated white line lesions andsole ulcers. In: Proceedings of the 17th International Symposium and 9th claw trimmers for their cooperation. Preliminary results were pre- International Conference on Lameness in Ruminants, Bristol, UK, August 11–14, sented as an abstract at the 17th International Symposium and 9th 2013, pp. 192–193.

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