So you have a horse… it is in an open field, you walk up to it and notice it bleeding. You look around and there is nothing for miles! Somehow, somewhere and on something, your horse has lacerated itself. It is a truly amazing skill of the equine species to cause injury on pretty much thin air. The longer you own horses, the more you realize how special horses are when it comes to trauma. Here are some tips that will help healing go smoothly.
1. Cleaning – When you notice the laceration, one of the first things to do is clean it off. The easiest method of cleaning a wound is cold hosing it. That means running cold water from the hose over the wound. The cold of the water also acts like an ice pack and will reduce inflammation as well as get any debris and dirt out of the wound. Horses usually tolerate this very well as it typically feels good. A length of 20 to 30 minutes is usually sufficient, although you should assess the wound after 5 minutes of cold hosing and call your veterinarian as well. After the 20-30 minutes is done, an antimicrobial or antibacterial cleaner such as diluted betadine or chlorhexadine can be used to gently scrub the wound. Rinse clean with the hose afterwards.
2. Assessment – This is a very important part. There are a few questions you should ask yourself. Does the wound go through the skin? Can you see other types of tissue such as tendons, muscle, fat tissue? Does it continue to bleed and not slow down after 5 minutes of observation/cold hosing? Does the wound look fresh or old? Does there seem to be a flap or deep hole that may hide further damage? How is the horse behaving due to this wound? Are they lethargic, having trouble moving or breathing? Where is the wound located and are there vital organs in that area?
If the wound goes through the entire skin layer and you can see any other types of tissue, or if the wound continually bleeds, the laceration should be seen by a veterinarian and may require stitches. In some cases stitches aren’t useful or won’t work, but in those cases your veterinarian will guide you on proper healing care. Stitching wounds is also time sensitive, the faster you suture the wound, the better it heals. After 8 hours, suturing wounds sometimes can have a negative impact as it can trap bacteria. So it is important to see your veterinarian sooner rather than later if you suspect your horse will need stitches.
Flaps can make a serious wound look not so serious. If you notice a flap of tissue or a deeper hole, it is wise to call your veterinarian as there might be foreign body lodged in that area and it needs to be removed or the wound will not heal and an infection will set in. Also flaps that are hanging away from the horse tend to heal poorly on their own and may need some ‘debridement’ from the veterinarian.
Lastly, is your horse acting strangely? Some horses know they need help and will seek their owners out, others may act fearful and afraid when normally they are calm and collected. The more unusual your horse behaves, usually the more serious the wound is. The exceptions are naturally very docile horses, they may simply remain docile and have a high pain threshold. This is typical of draft and draft cross horses. If that describes your horse, always err on the safe side and phone your veterinarian. And if your horse is having difficulty breathing, faints or has a seizure, call the veterinarian immediately and describe that behaviour in detail as they may give you instruction that may save your horses life.
3. Wrapping – after your horses wound is clean and assessed and your waiting for your veterinarian to arrive, its important to try stop any bleeding and to keep the wound clean. Infection can inhibit healing and become very costly. if you have clean bandaging material, place a non-stick pad onto the wound (no salves or ointments at this point as they may interfere with the veterinarians treatment plan), wrap with cling wrap or cling gauze snugly and then apply a self adhering wrap such as vet wrap, or similar. If you don’t have these, clean quilted or pillow wrap followed by a tight polo wrap with suffice for short term.
With early intervention, the hope is to suture the wound closed thereby decreasing the time needed for the wound to heal along with reducing any blemishes that might occur and the chance of proud flesh developing. In some instances wounds cannot be closed, and the wound will be managed by what is called “secondary intention” which is a slower process of healing but occasionally the only option available. All horse owners (myself included) have this innate drive to do something for the wound. This often leads us to driving to the feed store and buying the latest and greatest salve that claims to kill bacteria, stop proud flesh and save the world all for $11.99. Contrary to the claims on these products, they can and frequently do hinder wound healing rather than help it. Unless its recommended by your veterinarian, its better to stick with the medically proven healing techniques and salves. There are several “fad” treatments and therapies which are just that. Fads often can be worse than doing nothing. For example, applying an oil to a wound doesn’t speed healing in most cases; in fact it slows it and traps bacteria onto the wound while providing a wonderful growth medium. There are very few instances where oil is helpful.
4. Management – if the wound doesn’t appear to need veterinary care, or the veterinarian has come and gone (and not given any specific directions) then wound care is the next step. A tetanus booster is always recommended when any new wound occurs. Daily cleansing with dilute betadine (the water should be light ice tea colour) followed by cold hosing for 10-20 minutes will help reduce any debris or infection present in the wound bed. If you cannot overcome the urge to place a salve on the wound, stick with a triple antibiotic ointment, silver sulfadiazine, or a chlorhexadine cream for the first three to five days in a fresh wound. After this period, no creams or medications should be placed in the wound because they will stop new cells from bridging the gap between the wound edges. Products marketed to reduce proud flesh should be avoided because they will kill any new cells that come into the wound thus stalling the wound healing process.
Bandaging is an important part of wound therapy, but too much of a good thing can do harm. The point of bandaging is to keep the exposed tissue clean and protected while allowing the granulation tissue (pink bumpy stuff) to fill the wound. Proud flesh is the over-exuberant growth of granulation tissue, and for full healing, it may need to be shaved below the skin level. This is a common occurrence in lower limb wounds and there is no known product that is effective in preventing proud flesh completely. The trick with bandaging is that it promotes granulation tissue formation. So how do we know when to stop? Daily bandage removal, cold hosing and re-assessing will help to decide the correct time frame. Once the graduation tissue fully covers or fills the wound, the bandage can be removed. This may seem inappropriate as the wound won’t be healed but granulation tissue is a natural barrier to bacteria and debris. Over time a scab will form and the skin will move across the bed of granulation tissue at a rate of 1mm per day. So depending on the size of wound, it may be a while before you see resolution. If we tamper with the wound too much, remove the scab, place a topical medication on the wound or keep wrapping it, we deter the normal wound healing process.
Sometime, no matter how hard we try, proud flesh rears its ugly head and causes loads of frustration. Wounds more prone to developing proud flesh occur in areas of high motion. Every time the leg moves, microscopic cracks develop in the granulation tissue, the body responds by filling these cracks with more granulation tissue and over time it builds up and we call it proud flesh. How can you stop proud flesh? There are no known products that reduce proud flesh and encourage wound healing because reducing proud flesh means you are destroying good healthy cells which actively heal wounds. As the product reduces proud flesh it also destroys any new skin causing any progression in healing to be lost. This allows more time for more microscopic cracks to develop, more proud flesh to try fill those cracks and a vicious cycle develops preventing wound healing. The best treatment, with the??fastest healing results, is tissue debridement (shaving the excessive granulation tissue off) by your veterinarian. This can be bloody as there are a lot of vessels in granulation tissue so if you get faint with blood, warn your vet before they begin! A veterinarians worst nightmare is working on a species we weren’t trained for (humans).
No wound will be the same as another. The amount of blood and the appearance can cause panic but it is important to have a plan in place for fast, efficient care and management: Clean, Assess, Call the vet, Wrap and then Manage. Doing these things can help your horse heal and return to comfort as soon as possible and save you money, frustration and time.
– Dr. Stacey