Wounds
Wounds are one of the most common emergencies seen in horses and are occur by many different causes. They vary in severity and can be potentially fatal if they involve a vital structure such as a joint or tendon sheath.
Puncture Wounds
Very dangerous because of the potential damage to underlying structures with a very small entry wound. The site of wound is very important especially if the underlying structures are joints, tendon sheaths or bursae (bags of fluid protecting bones e.g. over the point of the hock). When these structures are involved often the only way to ensure complete recovery is to flush the joints under general anaesthetic. One of the worst culprits is barbed wire because of the small punctures it causes.
Lacerated Wounds
These often appear horrendous but can be less serious than puncture wounds.
Preferably suturing is carried out ideally within 6 hours (the “golden period of wound healing”). However, distal limbs (especially areas like the cannon) have poor healing even when sutured immediately. Regions such as the bulbs of heel may be stapled and put in a cast to reduce the movement over these areas.
Lacerations over joints
As for puncture wounds, the site of these is vitally important. Lacerations over joints, tendon sheaths or bursae can be catastrophic unless treated correctly.
Lacerated Tendons
A very common injury with wire cuts over the cannon and pastern.
- Flexor tendons- MUST be sutured as they support the full weight of the limbs. This may possibly need to be done under GA.
- Extensor tendons- sutured if possible but not essential because they are only used to lift the lower limb forward
Coronary Band Injuries
These can involve the coffin or Distal Inter-Phalangeal (DIP) joint which is obviously extremely serious. However, more superficial injuries may have hoof growth consequences (i.e. permanent hoof cracks) unless they are sutured (or stapled) as soon as possible.
Wound First Aid
- Stop bleeding
- Direct pressure
- Swab or bandage
- Clean towel if nothing else
- Cold therapy
- Cold hosing (best)
- Ice (can cause thermal damage to skin if left on too long (greater than 10-15 minutes
- Sterile saline
- Remove hair with scissors or clippers but taking care to avoid the wound and preventing hair falling into the wound.
- Avoid chemicals such as chlorhexidine (Hibiscrub) on fresh wounds; they can often do more damage to the wound area.
Problems
- Bandaging reactions. These may occur if a bandage has been placed on the without using padding such as cotton wool/wadding/gamgee. The bandage then is put on the leg too tight and causes pressure sores. This can sometimes be inevitable when prolonged bandaging is necessary especially in regions such as the carpus or hock.
- Non-healing wounds. These may occur most commonly when there is excessive movement or infection in a wound.
Creams/treatments
Hydrogels are usually the safest and best application to put on a wound. They provide moisture for a wound to heal but do not interfere with the healing process by using chemicals or additives that can damage the epithelial cells.
Dressings
- Silver Dressings-infected wounds
- Telfa & Telfa AMD-surgical wounds
- Salt Dressings-infected & necrotic wounds
- Hydrocolloid Dressings-proud flesh
- Calcium Alginate Dressings-proud flesh + bleeding + infected wounds
- AMD Foam Dressings
- Cica-care or Dermatix. Cica-care is a silicone occlusive dressing used to reduce scar tissue. It is also available in a gel form (Dermatix) that can be placed over scars to improve cosmetic effect