From Sterilization to Stitches: Handling Horse Wounds
What to do when you find a wound
Wounds are tricky. What appears to be a tiny, unoffensive knick to the knee could actually be a serious puncture wound, while a swath of missing skin—and enough blood smeared about to look like a crime scene—might just require a quick vet check to ensure there are no complications. For these reasons and more, it’s important that you be comfortable and familiar with what steps to take and when to call the veterinarian if you find a wound.
We’ve asked two veterinarians to weigh in on the do’s and don’ts of wound care, from discovery to recovery.
When you first notice your horse has sliced or slashed some part of his body, don’t panic. Take a deep breath, exhale, and assess the situation, says Alexandra Tracey, DVM, Dipl. ACVS-LA, of Palmetto Equine Veterinary Services, in Townville, South Carolina. Note the wound’s location—this is usually the easy part. To minimize contamination, hold off on inspecting the depth and extent of the injury if it’s not immediately obvious; your veterinarian can evaluate this when he or she arrives.
If the horse is actively bleeding, apply pressure by hand using a clean towel or, if it’s a limb wound, apply a clean, snug, adequately padded bandage or wrap. Clean the area very gently, says Tracey, to gain a clearer sense of what structures are involved. If you get too aggressive, you can do more harm than good.
Tracey recommends using a mild antiseptic to clean the wound, such as chlorhexidine surgical scrub or povidone iodine or betadine scrub, if available. Gently rinse with hose water or clean water from a bucket, if there’s not a lot of bleeding. Just be careful not to drive debris deeper into the wound by being overly aggressive in your cleaning. You might also dab the area gently with a gauze square to remove obvious debris, says Tracey.
Dean Hendrickson, DVM, MS, Dipl. ACVS, professor of surgery at Colorado State University, in Fort Collins, says clean, cool water works very effectively to remove blood and debris. After flushing the area with water, he recommends applying a hypertonic 20% saline dressing, which you can concoct by adding ½ cup of salt to 1 quart of water.
“The hypertonic saline dressing helps to debride the wound and remove bacteria,” he says. “Almost all wounds have some sort of contamination. I’m pretty much against lotions and potions—the things people commonly put in wounds—and really try to stay away from those.”
Pick Up the Phone
Once you’ve assessed the situation, it’s time to decide whether to call the veterinarian or to take a wait-and-see approach. “I always encourage my clients to err on the side of getting me involved,” says Hendrickson. “If the wound is over a part of the horse that bends (i.e., a joint), you should call the vet; it’s so important we know all that’s going on with the wound right away. If you miss something like a joint, tendon sheath, or bone, it could mean the difference between function and nonfunction of your horse.”
Echoing that sentiment, Tracey says, “I can’t say enough about treating a wound while it’s fresh, so I can clean contamination out and get everything started back in the right direction. I’m not a huge fan of the ‘wait-and-see,’ unless it’s a scrape or something that doesn’t need to be closed.” Tracey recommends calling the veterinarian right away if the horse is bleeding; if a joint, tendon, ligament, or bone might be involved; or if the horse is not bearing weight on a limb.
Regardless of the wound type, relay as much information as possible when you call the veterinarian so he or she can respond with the appropriate treatment plan. Tracey encourages her clients to send photos of the injury, as well.
When the veterinarian arrives, he or she might first clip the hair from around the wound, then assess the injury and the tissues involved, particularly deeper structures such as joints, bones, tendons, or ligaments.
“The veterinarian has the advantage of being able to sedate the horse if it appears a joint is involved, which is always a top concern,” says Tracey.
If Tracey and Hendrickson do suspect a synovial (joint) structure is involved, they will flush it with sterile saline or a similar solution.
“If (the saline) drains out of the wound, we know it communicates with the wound and we need to treat that joint as aggressively and as soon as possible,” says Tracey. Treatment options include antibiotics, arthroscopy, and regional limb perfusion.
Radiographs are in order if the veterinarian believes the horse could have a concurrent bone injury. He or she might also use ultrasound to check for tendon or ligament injury. “Once we have a complete diagnosis and we know what’s involved, there are things we can do to help a wound heal faster,” says Tracey.
Clean and Support
To reduce bacterial contamination, says Tracey, “the solution to pollution is dilution.” In other words, it’s important to lavage (flush) the wound with large volumes of sterile fluids. The next step might be suturing the wound edges, starting with tissues beneath the skin if necessary. If the wound is very contaminated, your veterinarian might postpone this step for a few days until the wound bed is healthy enough to hold sutures.
“If I can at all suture a wound to close it, I will,” says Hendrickson. “I think it gives the horse the most functional end result and the client the most cosmetic end result.”
Tracey says she might place drains within the wound to prevent pockets of fluid from developing beneath the closure. After she sutures a limb wound, she wraps it with a sterile bandage to minimize contamination while healing.
Our sources say leg wounds require an additional layer of support, particularly in areas where the joint flexes every time the horse moves. In this scenario a splint helps reduce the amount of motion over the wound and helps keep the horse comfortable. Just be sure to watch for possible overloading or straining of the opposite, uninjured leg (e.g., shifting weight to the sound limb constantly).
Treating the Trauma
Your veterinarian might prescribe pharmaceuticals such as antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs), depending on the severity of the injury. Hendrickson’s catchphrase regarding medications, however, is to “act sparingly.”
“I tend to not use a lot of antibiotics unless the wound involves a synovial structure, because I think most of the time we can treat the wound topically very effectively with just debridement dressings like the hypertonic saline,” he says. “I try not to put extra things in the wound that I don’t need to. I like to use NSAIDs judiciously to reduce inflammation, but I’m also very careful.”
You don’t want to administer a large enough dose of NSAIDs, for instance, that the horse doesn’t protect his wound in the early stages of healing or mount a poor inflammatory response post-injury. After all, we know that some inflammatory response is necessary to marshal white blood cells and other beneficial cells to the wound for healing.
“I opt for a low dose of non-steroidal and treat everything topically,” if possible, says Hendrickson.
For serious or infected leg wounds, Tracey is a proponent of regional limb perfusions, which involve the veterinarian applying a tourniquet above the injury and injecting antibiotics into the vessel below the tourniquet.
“You leave this on for 30 minutes, allowing the antibiotic to diffuse into the tissues below the tourniquet; you get high level of antibiotics in those tissues without having to overdose the horse’s entire body,” she says.
Complications With Cuts
If you don’t catch a wound early or treat it appropriately, you might run into some otherwise avoidable complications, says Tracey, including:
- Infection, ranging from general infection all the way to joint infection, which often occurs with puncture wounds;
- Secondary tendon and ligament injuries that went unrecognized at the time of the original injury;
- Skin loss on large wounds;
- Exuberant granulation tissue (commonly referred to as proud flesh) in wounds that aren’t able to be sutured due to their location or level of contamination. Proud flesh protrudes from the wound margins and prevents the skin edges from coming together to heal. Your veterinarian can treat it by trimming the excessive tissue with a scalpel rather than applying a caustic commercial product or home remedy, says Tracey;
- Bone sequestrum, when a piece of bone dies as a result of poor blood supply, infection, or both and subsequently separates from healthy bone; and
- Loss of blood supply, such as with injuries that affect the limb’s entire circumference (i.e., wire fencing wrapped around a leg), which Tracey says pose potentially serious risks to the hoof if the blood vessels supplying that region are involved.
Therefore, it’s important to keep your veterinarian informed post-treatment. You might also schedule a follow-up visit to be sure the recovery process stays on track for healing.
Calling your veterinarian early is key to helping your horse recover from a wound. Hendrickson says that, in his experience, the biggest problem is the delay in making that call, especially when managing a wound with a complication such as infection or compromised blood supply. “Wounds that are chronically infected don’t tend to heal well with good tissue,” he says.
Along with early intervention, surgical management ranging from arthroscopy to debride and clean wounds that impact joints to applying skin grafts to replace lost skin can provide a better prognosis and offer hope in challenging wound cases.
“We have a lot of options to help now,” Tracey says. “It’s easiest if we can identify a problem early and treat as aggressively as possible. In addition, if there are joint structures involved, there is so much we can do surgically.”
Tracey recommends learning as much as possible about what your veterinarian is doing so you can be actively involved in your horse’s care and recovery. This includes an understanding of basic anatomy, particularly to enhance your ability to communicate with your veterinarian, and hands-on skills, such as correct bandaging. She says many veterinary clinics, such as her own, offer opportunities for clients to learn more about these topics.
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