Wound-Care Guide

How well will your horse’s wound heal? Learn how you can make a dif­fer­ence with this ex­pert guide.

Horse & Rider - - Contents - BY BARB CRABBE, DVM

How well will your horse’s wound heal? Learn what you can do to make a dif­fer­ence with the help of this handy guide from an ex­pert.

Your horse comes in from the pas­ture with a gash on his knee. No prob­lem. Your first-aid kit is filled with wound-care op­tions, in­clud­ing plain old io­dine and a prod­uct that prom­ises to pre­vent proud flesh. But which one should you use?

Stop right there!

Avoid vig­or­ously scrub­bing or clean­ing the wound when it’s very fresh—es­pe­cially if it bled a lot.

Even some­thing as sim­ple as plain old io­dine can cause tis­sue dam­age that might com­pro­mise your horse’s heal­ing. Your wound treat­ment could cause more harm than good. Here I’ll go over the four stages of wound heal­ing. I’ll first tell you what’s hap­pen­ing in­side your horse’s body to help him heal. Then I’ll ex­plain what you should (and shouldn’t) do when car­ing for a wound.

(For a wound-care kit, turn to page 45.)

STAGE 1

He­mosta­sis (Con­trol of Bleed­ing)

When it oc­curs:

Im­me­di­ately af­ter in­jury.

What’s hap­pen­ing in­side:

Blood ves­sels con­strict to re­duce blood flow. Within sec­onds, cells called platelets ad­here to ves­sel walls. Within min­utes, strands of fib­rin (a stringy pro­tein) ad­here to dam­aged ves­sels where they be­gin to form a ma­trix or “mesh” to sup­port clot de­vel­op­ment. Platelets re­lease sub­stances that stim­u­late clot­ting. Once a clot is formed, bleed­ing stops.

DO: Ap­ply di­rect pres­sure.

If bleed­ing is ex­ces­sive at this stage— es­pe­cially if it “pumps,” in­di­cat­ing that a high-pres­sure artery may have been cut—it might over­whelm your horse’s body’s abil­ity to form an ef­fec­tive clot. Ap­ply di­rect pres­sure with a small pad of clean gauze un­der your fin­gers to help stop the bleed­ing. Hold for at least five min­utes to en­sure that it has stopped. If blood is still flow­ing freely, re­peat. In se­vere cases, you might have to sim­ply sit tight with di­rect pres­sure ap­plied while wait­ing for your vet to ar­rive.

DO: Ap­ply a ban­dage.

If bleed­ing is mod­er­ate—“pud­dling” not “pump­ing”—ap­ply pres­sure us­ing a ban­dage over a non­stick pad and thick layer of gauze. (To make this layer, take eight to 10 4-inch-by-4-inch gauze pads, and fold them in half.) This should con­trol bleed­ing un­til your vet ar­rives.

DON'T: Ap­ply cau­ter­iz­ing pow­der.

Although it might be tempt­ing, avoid ap­ply­ing any type of pow­der, spray, or other dress­ing de­signed to “cau­ter­ize” (“burn”) tis­sue to con­trol blood flow. These prod­ucts can se­verely dam­age tis­sues and lead to dif­fi­cult heal­ing down the road.

DON'T: Vig­or­ously clean the wound.

It doesn’t take much to dis­rupt a frag­ile clot your horse’s body forms to help con­trol bleed­ing. Avoid vig­or­ously scrub­bing or clean­ing the wound when it’s very fresh—es­pe­cially if it bled a lot.

DO: Take a pic­ture.

Af­ter you’ve con­trolled the bleed­ing, take a photo of the wound both up close and far enough away to make it easy for your vet to see where the wound is lo­cated.

DO: Call your vet for ad­vice.

Af­ter you’ve con­trolled the bleed­ing, call your vet while the wound is still very fresh. Fol­low your vet’s ad­vice about what treat­ment he or she would rec­om­mend. If the wound needs su­tur­ing, it’ll al­ways heal bet­ter if su­tured than if left to heal on its own. Even if your vet has to make an emer­gency visit, you’ll save both time and money in the long run. Your pho­tos will likely help him or her make de­ci­sions about whether a visit would be rec­om­mended.

STAGE 2

In­flam­ma­tion

When it oc­curs:

Within min­utes of in­jury and lasts ap­prox­i­mately three to five days.

What’s hap­pen­ing in­side:

Af­ter you’ve con­trolled the bleed­ing, ves­sels di­late to al­low in­creased blood flow. Dam­aged ves­sels leak fluid into sur­round­ing tis­sues. An in­flux of cells, en­zymes, and nu­tri­ents helps pre­vent in­fec­tion and al­lows heal­ing to be­gin. This in­crease in blood flow is what causes the wound to be­come hot, swollen, and painful—the hall­mark signs of in­flam­ma­tion. In­flam­ma­tion is es­sen­tial for heal­ing, but if it’s ex­ces­sive, it can de­lay the heal­ing process.

DO: Rinse the wound.

As soon as you’ve con­trolled the bleed­ing, gen­tly clean the wound with sa­line so­lu­tion to help re­move con­tam­i­na­tion. Con­tam­i­nants can lead to an in­fec­tion or oth­er­wise ham­per heal­ing. Sa­line is ideal, be­cause it has the same elec­trolyte bal­ance as your horse’s body tis­sues. This helps main­tain fluid bal­ance and causes the least amount of dam­age. (To make your own sa­line so­lu­tion, mix 1 tea­spoon of salt into 1 quart of cold wa­ter.) If the wound is very dirty, or sa­line sim­ply isn’t avail­able, a gen­tle flush­ing with cold wa­ter is an ac­cept­able al­ter­na­tive.

Cold wa­ter con­stricts blood ves­sels to min­i­mize bleed­ing and help con­trol in­flam­ma­tion. If the wound is as­so­ci­ated with a sig­nif­i­cant amount of trauma, cold hos­ing might even be your vet’s first choice to help keep swelling to a min­i­mum.

DON'T: Ap­ply ran­dom oint­ments.

While it might be tempt­ing to slather the wound with what­ever oint­ment you find it your first-aid kit, don’t do it! Thick oint­ments can trap con­tam­i­nants in the wound or hin­der move­ment of cells that are nec­es­sary for clean­ing up de­bris. Many oint­ments are also dam­ag­ing to tis­sues—and the most im­por­tant thing that you can do to en­cour­age heal­ing is to treat del­i­cate tis­sues with ut­most care.

DON'T: Clean the wound with strong an­timi­cro­bial agents.

Be­ta­dine, chlorhex­i­dine, and hy­dro­gen per­ox­ide are all po­ten­tially dam­ag­ing to tis­sues at this stage—and the stronger they are, the more dam­age they cause. Con­trary to what you might think, flush­ing a wound with some­thing like full-strength be­ta­dine is more likely to cause an in­fec­tion than to help pre­vent one.

DO: Ad­min­is­ter anti-in­flam­ma­tory med­i­ca­tions as di­rected.

Caveat: Take this step only on the ad­vice of your vet. Your vet may opt to ad­min­is­ter an anti-in­flam­ma­tory med­i­ca­tion—such as phenylbu­ta­zone or flu­nixin meg­lu­mine—at the time of su­tur­ing. Or, he or she will rec­om­mend that you ad­min­is­ter these med­i­ca­tions your­self to help min­i­mize swelling and con­trol ex­ces­sive in­flam­ma­tion.

STAGE 3

Pro­lif­er­a­tion (Re­pair)

When it oc­curs:

This stage over­laps in­flam­ma­tion, be­gin­ning as early as eight to 10 hours af­ter in­jury.

What’s hap­pen­ing in­side:

Dur­ing this stage, your horse’s body be­gins a process called an­gio­gen­e­sis, in which dam­aged blood ves­sels are re­placed within the wound area. Cells called fi­brob­lasts de­velop. Fi­brob­lasts act like bridges across the dam­aged tis­sues and even­tu­ally re­or­ga­nize to form a kind of scaf­fold­ing that sup­ports the heal­ing process. Fi­brob­lasts se­crete a pro­tein called col­la­gen that helps hold ev­ery­thing to­gether. Dur­ing this stage of heal­ing, you’ll see a bed of healthy (pink) gran­u­la­tion tis­sue. This tis­sue fills in the de­fect, pro­vides a sur­face for ep­ithe­lial (skin) cells to crawl across (called ep­ithe­lial­iza­tion), and even­tu­ally con­tracts (shrinks) as the wound be­comes smaller over time. The process of ep­ithe­lial­iza­tion can be very slow, as cells mi­grate only 0.1 to 0.2 mil­lime­ters per day. The size of the gap will de­ter­mine the length of time the re­pair stage lasts—and is one rea­son why a su­tured wound (where skin edges are pulled to­gether) heals so much faster than one that’s left to heal on its own.

DO: Keep the wound ban­daged.

Keep­ing a wound ban­daged helps pre­vent move­ment that can de­lay heal­ing (es­pe­cially im­por­tant on the lower legs); con­trols ex­ces­sive swelling; and helps main­tain an ideal heal­ing en­vi­ron­ment that’s clean, warm, and moist.

DO: Ap­ply ap­pro­pri­ate oint­ments.

For most un­com­pli­cated wounds, a sim­ple an­timi­cro­bial oint­ment, such as a triple an­tibi­otic or sil­ver sul­fa­di­azine, is ac­cept­able. These oint­ments have been shown to speed heal­ing by keep­ing the wound moist and help­ing to pre­vent in­fec­tion. In re­al­ity, a non-- an­timi­cro­bial oint­ment may be just as good, be­cause the real ad­van­tage lies in keep­ing the wound moist, un­less there are signs of in­fec­tion, such as ex­ces­sive heat, swelling, or pain. (Most vets agree it’s best to avoid ni­tro-fu­ra­zone on a fresh wound; stud­ies in­di­cate this oint­ment can ac­tu­ally slow heal­ing.) Fi­nally, your vet might rec­om­mend a spe­cific oint­ment at cer­tain

Cold wa­ter con­stricts blood ves­sels to min­i­mize bleed­ing and help con­trol in­flam­ma­tion.

times dur­ing the heal­ing process, such as one con­tain­ing a cor­ti­cos­teroid to help con­trol proud flesh (more on that in a minute). Only use these oint­ments as rec­om­mended by your vet, as they can slow the heal­ing process.

DON'T: Leave a wound open to ‘dry out.’

Does your horse’s wound look “gooey” with a yel­low­ish dis­charge? Good! This type of dis­charge is a nor­mal part of the heal­ing process, es­pe­cially dur­ing the early days when white blood cells are busy do­ing clean-up du­ties. That’s right—it doesn’t mean the wound is in­fected, and it’s usu­ally a good thing! The worst thing you can do is leave the wound “open” to al­low it to dry out. A moist wound is a happy wound. (As an in­ter­est­ing side note: Do you think the wound needs oxy­gen? A ban­dage ac­tu­ally low­ers the pH of un­der­ly­ing tis­sues, which in­creases oxy­gena­tion.

This means that when you leave the wound open, you’re ac­tu­ally com­pro­mis­ing its oxy­gen sup­ply.)

DO: Closely mon­i­tor the gran­u­la­tion bed.

Horses can be very en­thu­si­as­tic heal­ers, es­pe­cially when lower-leg wounds are in­volved. The de­vel­op­ing bed of gran­u­la­tion tis­sue must stay be­low the level of the sur­round­ing skin mar­gins to en­able the skin cells to suc­cess­fully “crawl across” them dur­ing ep­ithe­lial­iza­tion. If gran­u­la­tion tis­sue pro­trudes above the skin edges (proud flesh), heal­ing can’t progress, be­cause skin cells have to crawl “up­hill.” If this oc­curs, call your vet. He or she may want to sur­gi­cally trim back the tis­sue to al­low heal­ing to progress.

STAGE 4

Mat­u­ra­tion (Re­mod­el­ing)

When it oc­curs:

Af­ter the wound ap­pears com­pletely healed.

What’s hap­pen­ing in­side:

Dur­ing this process, the tis­sues be­come ma­ture and re­or­ga­nize to gain strength. Mat­u­ra­tion can take months to years—it’s what makes that once-hor­ri­ble scar harder and harder to see as time go by.

DON'T: Pull su­tures too soon.

If your horse’s wound was su­tured, it may look com­pletely healed—un­til you pull out the su­tures too soon, and the whole thing un­zips. Re­move su­tures only when your vet gives you the green light. If you’re un­cer­tain, con­sider re­mov­ing ev­ery other su­ture ini­tially, then re­move the re­main­ing su­tures sev­eral days later.

DO: Wean care­fully from a ban­dage.

If a lower-leg wound has been ban­daged for a pe­riod of months, weeks, or even days, it’s likely to have re­flex swelling when a sup­port­ive ban­dage is re­moved. Re­flex swelling oc­curs when tis­sues that are used to be­ing sup­ported swell when the sup­port is re­moved. Once the wound ap­pears com­pletely healed, care­fully wean the wound from the ban­dage. Be­gin by re­mov­ing the ban­dage for only

two to three hours per day. Grad­u­ally in­crease the time you leave the ban­dage off over a pe­riod of sev­eral days. Be­fore be­gin­ning the ban­dage-wean­ing process on a su­tured lower-leg wound, en­sure that the wound is hold­ing to­gether af­ter you pull the su­tures.

DO: Con­tinue to pro­tect the wounded area.

Even af­ter heal­ing is com­plete (which may take a year or more), wounded tis­sues may never be as strong as they once were. If the wound was in a vul­ner­a­ble area, con­tinue to pro­tect it. For ex­am­ple, con­sider us­ing per­for­mance boots or bandages dur­ing your horse’s work­outs, and out­fit your horse in ship­ping boots dur­ing travel to pro­tect a once-in­jured lower leg.

DO: Ap­ply emol­lient dress­ings.

Af­ter your horse’s wound has healed, ap­ply lano­lin-based oint­ments to help re­store mois­ture and elas­tic­ity to dam­aged skin. Ap­ply oint­ment daily—or at least sev­eral times per week—un­til tis­sues ap­pear moist and healthy.

Bot­tom line:

When your horse gets a wound, the most im­por­tant thing you can do is to op­ti­mize his own heal­ing process by pro­tect­ing his tis­sues and pro­vid­ing an op­ti­mal heal­ing en­vi­ron­ment.

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