Treating wounds is one of my favorite things to do as a veterinarian. It is often a very demonstrable way to appreciate the healing capacity of the body. Especially when we provide an optimal environment for healing to take place. If your horse has the misfortune to have a wound that needs attention there are a few points that are probably worthy of your consideration.
Location of the Wound
This is probably the single most important consideration in determining how concerning any particular wound is. Wounds on or around joints or other synovial structures need to be thoroughly examined to make sure they do not involve the joint or synovial structure. Wounds, either from a puncture or laceration, are the most common cause of infected joints. For the uninitiated, infected joints are a very serious and potentially life threatening problem in a horse. These wounds always need to be evaluated by your veterinarian as quickly as possible because you really don’t want to wait around if there is a possibility of joint involvement. Lacerations around the eye or eyelid would be another area that should always be treated as an emergency.
The photo to the left is of a colt with wounds to his left carpus and the craniomedial (front and inside) right gaskin that have been being treated for 10-14 days. At this point they are both healing well. Initially the wound over the carpus was evaluated to see if it communicated with the radoiocarpal or intercarpal joints. The appearance of the wound left no doubt that the extensor tendon sheath was severely compromised. Luckily for this colt, that is usually not a cause of lameness although he will likely have a scar and some degree of enlargement above and over his knee due to fibrosis of the extensor sheath. The point of this photo is that the amount of damage done was very similar on both of this colt’s wounds visible in this photo, however, due to the location, the wound over his knee had to be much more carefully evaluated.
In my opinion the severity of a wound is very closely tied to the location of the wound. A wound that may not require much or any treatment on a horse’s chest may be much more problematic and fraught with complications if it is over a canon bone or joint. Other things that determine the severity of a wound besides location are the degree of contamination, degree of tissue trauma and timing.
The decision on whether or not a wound can or should be closed with suture or staples is based on location and extent of the wound, the degree of contamination and the amount of time that has passed since the wound occurred. Generally, anything that has been open for greater than 12 hours will need to be treated as an open wound or additional steps and precautions will need to be made to optimize success of the closure. Primary closure of a wound, when possible, is ideal because it shortens the duration of time to resolution, results in less scarring and in general seems to be more comfortable for the horse.
Even if a wound will not need to be extensively treated, tetanus prophylaxis is a good reason to call your veterinarian. He or she can help you decide if your horse needs a toxoid booster or if he may need anti-toxin.
Bandaging is one of those skills that can only be mastered with practice (see below). The following are the 5 P’s of bandaging:
- Practice—This is kind of a joke, but if bandaging is not something you’re comfortable with, ask your vet or a technician at your vet clinic for some pointers. Watch how they place bandages so that you can mimic the process at home.
- Preparation—Long before a wound ever happens, it is a good idea to think through what you need to have in a first aid kit. I keep my bandage materials packaged together in a palpation sleeve for convenience and to keep the dust off of them. A kit includes a Telfa pad, white roll gauze, 1 yard of heavy cotton, brown gauze, Vetrap and Elastikon. You can do this however you want but I will say it is nice to be able to grab one item and know that you have everything you need. Once you are dealing with a wound, be prepared by having all of your materials organized and within reach as you place your bandage. An additional item that may not be as obvious is a good pair of bandage scissors for removing bandages and cutting bandage dressings.
- Padding—Make sure you have enough of it. You will never be wrong for including a layer of heavy cotton in your bandage. The padding helps keep the pressure of the bandage evenly distributed, soaks up discharge from the wound and protects areas that are susceptible to pressure sores. When in doubt, use the cotton.
- Pressure—Assuming appropriate padding has been used, most pressure related problems with a bandage are not really due to a bandage being too tight but the pressure being uneven. In general, I would always be more concerned about a loosely placed bandage that may slip and then constrict or place uneven pressure than I would a very tight bandage that has plenty of padding. One of the most commonly bandaged exceptions to the pressure rule is behind the knee over the accessory carpal bone. This area is very susceptible to pressure sores which can be quite difficult to resolve.
- Placement—Using the correct materials and placing them correctly is the key to having a bandage that is effective and will stay in place and does not result in further complications to the horse.
At the risk of opening myself up to scrutiny, many of the salves, creams and ointments marketed for wound care are unnecessary, ineffective or scientifically unverified. Some of them have merit and have been studied and can be used effectively for a specific purpose. However, in my opinion, there is no topical that is superior to good bandaging (if needed), cleanliness and fly control. I use many other topical on occasion but these are the ones that for one reason or another I seem to use most often:
- Silver sulfadiazine (SSD) for initial treatment of open wounds and for wounds that were heavily contaminated or infected.
- Sugar under a bandage of a heavily contaminated wound can be a very cost effective topical.
- Hydrogels like Dermagel or Carrasyn have been helpful under a bandage to stimulate granulation tissue over exposed bone or large gaping wounds.
- Aluspray seems to be helpful as an adjunct to fly spray for wounds that cannot be bandaged and also very importantly, it looks cool.
Obviously, wound care is a broad topic and no two wounds are exactly the same. Treatments will vary and it is always a good idea to invite your veterinarian to examine the wound to initiate an appropriate treatment plan. If you have questions about wound care or how you can be prepared or if you find yourself in the unsavory position of having to deal with a wound on your horse give me a call and I would be happy to help you out!