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Wounds and Their Treatment

Wounds, Scratches and Lacerations

By Clare ScanlanPublished 7 years ago 16 min read
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Wounds, scratches, lacerations, etc. are probably the most common form of injury in horses. They are extremely lively animals, they can be inquisitive, which along with their flight or fight response and the dominance hierarchy within the herd, which can make them very accident prone. So owners and carers cannot hope to get away without some form of injury at some time.

It is important that the person treating the horse should stay calm. A relatively small, and non-life threatening quantity of blood can look much worse than it actually is. It is very important that the injury is treated immediately and correctly to promote healing and to reduce the chances of infection. It is vital to follow a logical pattern when deciding on the extent of the injury and the appropriate treatment. The extent of the initial treatment depends on this logical assessment.

Types of Wounds

Wounds can be open or closed. Closed wounds are ones where the skin is not broken, usually bruises, sprains or strains. They are usually characterised by bruising and swelling of the skin and underlying tissues, due to the bleeding under the skin. Kicks, falls or collisions can cause them or self inflicted, such as through brushing or over-reaching.

Open wounds are where the skin is damaged and can range from abrasions which are minor to puncture wounds which can cause major problems and take a lot of time and effort on the part of the carer to heal.

Abrasions are caused by friction between the horse’s body and a hard surface, such as a road, badly fitting or dirty tack or a rope burn. The bleed a little and are often contaminated with debris and dirt and are usually very sore if touched.

Incised wounds are caused by glass or other sharp objects like knifes. They are characterised by clean, straight, matching edges. They bleed freely and usually do not involve bruising or tissue damage, although they can be very deep.

Lacerations or tear wounds have jagged and irregular edges, which may be gaping open. There may be flaps of skin torn and sections of skin and tissue may have been lost completely. The amount of bleeding will vary and the wound may not always be as painful as it appears. It could be caused by barbed wire or protruding nails and could also be a sign of a fracture.

Puncture or penetration wounds are usually more serious than they look. They are dangerous because they can easily be overlooked. The wound may be very deep, even when the opening looks very small. They are generally very painful and they may or may not bleed. They are caused by the penetration of the skin or sole of the hoof by a thin pointed object such as a splinter, stake, nail, piece of wire or thorn. They are especially common in the foot. They are vulnerable to deep-seated infection as bacteria are carried deep into the tissue and so infect it.

Immediate Action

1. Calm the horse.

Move the horse to a safe, quiet place, as he may be frightened, distressed or excited.

2. Control the bleeding.

Most minor wounds will stop bleeding very quickly on their own. As long as the wound is not bleeding profusely or haemorrhaging from an artery, it should be allowed to stop on its own as this will help to clean the wound and start the healing process.

If the bleeding needed to be stopped apply pressure to the wound using a sterile gauze pad and hold it in place with a bandage if possible. The bleeding should stop within a few minutes, but if it did not, continue to apply pressure.

Most bleeding from wounds appears to be a much larger volume of blood than it actually is, but if there is haemorrhage, there should be an attempt to control it. Signs of blood loss shock include weakness, sweating all over, colic, progressively elevated heart rate, and pale/white mucous membranes (inside lips and gums).

3. Assess the injury.

Assess the injury to see if the vet needed to be called. If the wound was caused by barbed wire or protruding nails it would probably not cause much lameness, swelling or heat unless it was quite an old wound that had got infected.Part of the treatment for a wound caused by barbed wire or a protruding nail would be to find the offensive object and remove it or make it safe, so that there would be no repeat of the accident.

Stand the horse on a hard, clean surface. Ensure that there are enough people present to safely restrain the horse for the examination, without causing unnecessary distress to the horse or injury to the person examining the wound.

To predict the potential severity of the situation and act accordingly, it is necessary to think about the structures underlying the wound. Is it bone, muscle, ligament, tendon or joint?

Damage to bones of the horse’s limb can occur following apparently minor superficial trauma, as they are relatively unprotected by muscle and, therefore, exposed to potential injury. Also the site of the wound may not reflect the full extent of the underlying injury. Extensive examination of other areas of the horse should be considered if the degree of lameness does not coincide with the visible wound.

4. Protect the wound.

Once the bleeding was under control, it would be important to prevent further damage or contamination. Dust, mud, flies, wood shavings and straw could all introduce infection, which would delay healing.

There is often a lot of confusion about whether a wound is infected or just contaminated. Once a wound has been present for six to eight hours, bacteria can multiply to such an extent that they cause infection. The chance of infection increases when the blood supply is disrupted, there is extensive tissue damage or there has been a high level of initial contamination by soil, mud, straw, etc.

If the horse were going to be transported in a horsebox, which contained bedding or walked through mud, bandage with an adherent dressing and, if a wound were below the knee or hock, place a pad of Gamgee over the wound.

At this stage, if the vet had been called, ensure that the horse is comfortable and not likely to injure himself further. It is better that the vet should be able to decide what to do with the horse and any further treatment may mean that the vet would be unable to stitch or suture the wound on his arrival.

If, however, the vet were not coming to see the horse it would be important to continue with the treatment of the wound as soon as possible.

5. Clean the wound.

Make sure that the wound is cleaned thoroughly. This should be done in an area with good light and a clean floor so the wound doesn't become further contaminated.

Flush out the wound by spraying or by running water from a hose onto it. Make sure that the water pressure is not so strong as to drive the debris into the damaged tissue. Start by hosing below the wound and gradually work upwards making sure that dirty water doesn’t run into the wound.

Alternatively, use a sterile saline solution and a large syringe (without the needle) to flush out the wound.

Cold hosing is a good way of treating the swelling but with open wounds, it should not be used after the initial cleaning.

If you are going to call the vet out, protect the wound with a clean dressing and a firm support bandage to minimise the swelling.

6. Treat the wound

It is essential that anybody who was going to be treating the wound should wash their hands.

Trim or clip away hair overhanging the wound edges, without letting hair drop into the wound.

Clean the skin with boiled water that had cooled or sterile saline solution. Use cotton wool or gauze swabs to wipe from the centre of the wound outwards taking care to discard each swab as soon as it is dirty. Then rinse the wound with sterile saline solution using a syringe.

Strong antiseptics should not be used as they can damage exposed tissues. For cleaning minor wounds a very dilute solution of Hibiscrub or ‘an anti-microbial cleanser’ may be used. If the wound were likely to need stitches I would not apply topical creams, wound powder or ointments etc. As they could actually hamper the vet's assessment of the injury, his ability to suture the wound and the healing process.

7. Dress the wound

Ideally a wound should be left uncovered to heal but a wound of this size would probably become dirty and infected if left open to the air. So, after cleansing the wound apply an antiseptic cream or spray.

During the early stages of open wound healing, dress the wound with a non-adherent dressing, and then cover the dressing with a clean pad of Gamgee or bandage padding and finally bandaged.

When to Call the Vet

If you are in any doubt as to the severity of the wound always call the vet. Listed below are some examples of situations when the vet should be called.

  • Excessive bleeding to wound - blood is bright red and spurting, which indicates an artery has been damaged.
  • The entire skin thickness has been penetrated - the wound may need stitches or staples.
  • The wound occurs near or over a joint.
  • Any structures underlying the skin are visible.
  • A puncture has occurred in the frog, near a joint or tendon sheath. Poulticing may not draw out infection, and antibiotics or additional treatment may be needed.
  • A severe wound has occurred in the lower leg at or below knee or hock level.
  • The wound is severely contaminated - e.g. 'broken knees' where dirt and grit will have penetrated the wound.
  • An apparently minor wound has developed heat and swelling and shows signs of infection.
  • The horse may not have had a tetanus vaccination.
  • Suspected fractures of bones - horse is reluctant to move or put foot to the ground.
  • Any case where you are not sure what to do. It's always better to be safe than sorry!

Follow Up Treatment

You should check the bandage regularly to ensure it is comfortable and secure. Make sure that the pressure is firm enough to provide support without restricting the blood supply.

The wound should be examined twice a day to check for secondary infection, which can develop under the wound. If pus is present, the groom should remove the scab and clean the wound before applying more dressing. Otherwise they should change dressings every other day.

  1. Thoroughly clean the wound daily.
  2. Do whatever you have to do to keep the flies away. This will include putting on topical ointments that have fly repellents in them.
  3. Keep the wound covered if possible
  4. Make sure where ever the horse is living is immaculately clean. This means that if the horse is stabled, the stable is mucked out several times a day.
  5. Keep the horse fly sprayed to deter as many insects as possible.
  6. Be sure to have plenty of air movement throughout the area where the horse is living. Stale, standing air is a perfect invitation for flies.
  7. Thoroughly clean anything that is going to come in contact with the horse's skin; this would include saddles, rugs, bridles, brushes, girth covers, blankets and even your hands!
  8. Exercise should be restricted during healing.

After the initial cleansing of the wound to remove debris and contamination, the objective is to assist the wound in its healing. Sometimes this means treating less rather than more. Many products applied to the wound will destroy the fragile cells. If this is done, new cells try to fill in for the older cells. If the wound is submitted to repeat applications of the damaging substance, the healing cells are all destroyed. Now all the body knows to do is fill in the wound with a fibrous tissue that we know as a scar.

The scar becomes thicker and harder because it is having to resist the destructive effects of the well-intended treatment. Many of these treatments are used because the formula is a family secret, or because this is what we have always used, or it has resulted in perfect healing without fail. Some of these products include hydrogen peroxide, iodine, lime, turpentine or kerosene, and salty bacon grease. All but the grease will burn fresh tissue (as seen by their effects on the edges of a fresh wound). These same effects are not as obvious after a few applications. The fragile cells have been killed off and only the scar remains. The grease may be the better of this group, but it draws flies.

A few of the other common treatments include antibiotic aerosols, which, if frequently used, result in drying of the wound surface. Frequent cleansing of the wound will remove the new cells that have formed a scab, and those underneath. Essentially, we sometimes have attractive wound healing in spite of, instead of because of, the efforts we have taken to assist in the healing process.

Infection

The groom should look for signs of infection - increased reddening, heat, swelling and pain. Normal discharge is reddish to red yellow and clear. Infected discharge is whitish, cloudy or cloudy yellow. If the site looks infected call the vet.

They should clean wound or suture line daily. Use clean gauze or cotton, wet & squeeze out all excess water. Using a dabbing rather than a rubbing motion, gently clean with iodine soap. Repeat the procedure without soap & remove all the soap. Be very gentle over the incision line.

If the wound is draining, the skin below the wound should be cleaned carefully. Afterwards petroleum jelly should be applied over the area where the drainage has occurred. This will protect the skin from future drainage. Petroleum jelly should not be applied directly on to wound or suture line.

Sutures or staples should be removed in 10-14 days.

Antibiotics should be administered at the dosage indicated by the vet. Keep a record of the dosage and when given on the clipboard placed by the stable door.

It is important that the horse receive all the antibiotics recommended.

Different Ways Wounds Heal

The ideal way for a wound to heal is by “first intention.” This is when the skin edges reattach to each other. For this to happen, the treatment of the wound must be started very quickly after the accident. The normal timescale for the closure of the wound is within four hours. The longer the time until closure, the more we have to do to offset the tightening of the skin, more debriding (removing dead tissue), and more care in preventing infection.

Once a wound occurs, the underlying tissue is exposed to the air. This is detrimental to this tissue and it rapidly dies. This dead tissue must then be removed before closing the skin over the wound. Dead tissue will be replaced by new tissue and is part of the drainage normal to all wounds. If this dead tissue is trapped under a sutured wound, it will build up in volume and put pressure on the covering skin and the sutures holding it. By removing the dead tissue, the fresh tissue beneath will form a bond with the skin.

  • First intention healing is accomplished by closing a wound while still fresh.
  • The skin will reattach to itself and the underlying (subcutaneous) tissue.
  • This may be aided with the help of a bandage, if it’s location makes this possible.
  • There is a minimum of scarring, and healing time is rapid, usually within two weeks.

If the wound is not found immediately, if the decision to seek treatment is postponed, or if the vet is delayed, the time that lapses may make “second intention” healing occur. The horse has a distinctive method of healing in this case, brought about by the need for speedy closure of the wound.

Second intention healing occurs when the skin edges do not reattach to each other:

  • The blood resulting from the injury forms a clot.
  • The clot consists of a mesh of fibres that trap blood cells.
  • These form a dam to prevent further bleeding.
  • The fibres then contract, squeezing the “juice” out of the cells and forming a firm layer between the skin edges.
  • This layer helps to protect the subcutaneous tissue, and is the first step in second intention healing.
  • It also provides a healthy bed for new cells.
  • As these new cells form, they migrate towards the centre of the wound, from the edges of the wound, in single layers.
  • This layer is just a few cells deep.
  • Once the first layer has developed, the next layer spreads out over it, and so on...
  • The clot holds the edges of the skin together, so that they do not spread any further, which would disrupt the clot and tear the cells free.

This gives a very fragile tissue covering the wound. This must be kept in mind when treatment is administered. Each time the wound is even touched, the outer cell layers are damaged. Therefore, any initial treatment will have disrupted the wound in its attempt to heal itself. But hopefully, the measures then taken will result in more efficient healing. From this point on treatments must be used that are of assistance to the wound and do not repeatedly destroy those fragile cells.

Proud Flesh

If the horse has a wound that just won't heal, it may develop proud flesh.

As the horse's wound begins to heal, pinkish granulation tissue fills in the gaps between soft tissues. Granulation tissue normally stops forming as the skin edges grow together to close the wound. But when healing doesn't go according to plan, the granulation tissue becomes active - it keeps growing until it projected above skin level, so new skin can't grow over the wound. That's proud flesh.

Proud flesh tends to form in wounds below the horse's knees and hocks, where there's little soft tissue between skin and bone, and where movement constantly tugs the wound's edges. It's most likely to occur in places with lots of movement, such as over joints, or when a complication, such as infection, slows healing.

If proud flesh appears, this approach will help alleviate it.

Ask the vet to trim the tissue back to skin level, so the horse's skin can begin to grow across the wound. (Note: Proud flesh bleeds heavily when trimmed, but it has no nerves-so the horse won't feel pain.).

Keep a pressure wrap on the wound to prevent the proud flesh from swell above the skin again. This also helps to immobilize the wound and promote the healing process.

Ask the vet to recommend a topical cortisone preparation (often combined with an antibiotic). Cortisone slows the growth of granulation tissue and can even help reduce the proud flesh.

Check with the vet before applying over-the-counter proud-flesh "remedies." Some are designed to cauterise, or burn the tissues. While this may make proud flesh appear smaller, it discourages the wound from healing properly.

If the proud flesh bulges again, it may need another trimming-and another, and another.

Conclusion

In conclusion, the speed with which the wound is treated is of great importance. The sooner treatment can begin, the better the chance of full recovery.

Hygiene is of paramount significance. The cleaner the wound can be made and kept, the less the likelihood of infection.

It is essential that carers do not interfere too much with the wound as this will impede healing and could cause proud flesh. Creams, ointments, powders, etc should be kept to a minimum as they could also interfere with the healing process.

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About the Creator

Clare Scanlan

I am passionate about writing! Passionate about animals, especially horses, passionate about women's and children's rights!

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