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Wounds in Horses
Spencer Barber, DVM, DACVS
Despite owners providing excellent facilities, wounds are common in all types of horses. An owner should have an excellent working relationship with his/her veterinarian to provide optimal care. While waiting for your veterinarian, there are a number of things a horse owner should not do. Placing fingers in the wound can contaminate it, as can hair from clipping around the wound. Do not apply medication to the wound as many antiseptics, detergents, greasy ointments and powders interfere with healing. Direct pressure can be applied to the wound to stop bleeding using a thick bandage, but a tourniquet is almost never applied, and in those rare cases when it is needed, should only be applied by a veterinarian.
Many factors must be taken into account to determine the best treatment choice. When there is excessive tension, motion, contamination or tissue loss, suturing might not be successful and could lead to increased costs of treatment and risks of complications. Some wounds can be sutured a few days after swelling and contamination is reduced, while excessive tissue loss dictates some wounds must heal without suturing. Typically, open wounds on the body heal faster and with fewer complications than leg wounds.
Bandages help protect wounds from further contamination and trauma, and they provide a warm, moist environment that promotes rapid wound repair. However, bandaging body wounds is difficult, and often impossible. Therefore, veterinarians frequently recommend hydrotherapy (hosing) to cleanse the wound, increase wound circulation and stimulate healing. An ointment may be applied afterward to the wound to prevent desiccation (drying out). Bandages stimulate proud flesh production on leg wounds, so numerous methods are used to control or prevent proud flesh, including the daily application of a topical corticosteroid cream. Severe wounds in areas of excessive motion often require a cast to facilitate healing.
Puncture wounds can result in devastating infections if bacteria are carried into a joint or tendon sheath. These cavities need to be flushed – usually using an arthroscope under general anesthesia – and regional perfusion (pumping of fluid and antibiotics into the area) performed. Then a high concentration of antibiotics administered to the distal limb through a vein or a hole drilled into the cannon bone while a tourniquet is temporarily applied. The regional perfusion is usually repeated daily for two to four days with the horse standing.
Punctures of the soles of the foot can cause abscessation, but respond well to draining and have an excellent prognosis. Punctures of the frog or lateral sulci of the foot can result in infection of either the navicular bursa and/or coffin joint. Both have a guarded prognosis for survival, especially if not identified immediately and treated aggressively.
Laceration of tendons certainly is a frightening thought for owners. If the extensor tendons are severed, the leg will knuckle forward at the fetlock. Rarely is it possible (or necessary) to suture the tendon ends. The fetlock should be maintained in a normal position with a bandage and splint for three to four weeks for the ends of the tendons to scar down, and to prevent secondary contraction of the flexor tendons. There is an excellent prognosis for return to normal activity. The flexor tendons are very important for maintaining normal angulation of the fetlock during weight bearing and to keep the foot flat on the ground. When they are lacerated, they must be sutured and a cast applied. The prognosis for survival is guarded and the likelihood of a return to athletic activity is poor.
Wood, often from fences or trees, can be forced deep into the chest or thigh. If not removed, the wound fails to drain, or it breaks open later and has large volumes of purulent exudates. Since wood cannot be seen on an X-ray, special imaging techniques – such as contrast radiography or ultrasound – are required to locate the foreign body before it can be removed. Many serious wounds can be successfully treated if they are identified early and receive veterinary attention.
Reprinted with permission from the AAEP