Wound management in horses
Wound care is a difficult part of owning a horse. Horses are quite prone to injuries, and wounds can take weeks or even months of continued care to properly heal. Most of the time, the cause of injury is unknown. The location, duration, and extent of the injury plays an integral part in the required level of care your veterinarian will recommend. Prompt veterinary intervention is the best option to ensure optimum healing and cosmetic results.
Developing a management plan should be a fluid conversation with your veterinarian to provide the horse with an optimal environment that facilitates efficient wound healing. Every owner is different and finding what works for them and the horse’s needs, whether caring at the barn or in the veterinary clinic, depends on the case. The goal of wound healing is to restore the integrity of the skin through a series of stages including inflammation, cell migration, tissue deposition, and skin contraction. The stages of recovery are sequential, and veterinarian intervention throughout the process can allow for optimal healing with minimal scar tissue. While we wish all wounds followed a predictable pattern, complications may happen. Factors that influence the healing process are infection, high motion areas, age of the horse, metabolic status, nutrition status, and multiple injuries. Granulation tissue formation is an important step to wound healing but can become excessive under certain conditions. Proud flesh (excessive granulation tissue) is commonly seen in slow healing wounds, especially in the lower limbs. It appears as red or pink tissue within the wound bed that becomes known as "proud" when it grows above the level of the surrounding skin. Proud flesh can stop the healing process, as it physically prevents the wound from closing in from all sides - the processes of wound contraction and epithelialization. This requires veterinary intervention to know when the granulation tissue is warranted or when a trimming or debridement is needed for continued healing.
It is best to suture a wound closed within 6-12 hours of injury, as this provides the shortest healing time with minimal scarring. After 6-12 hours, the skin edges become dry and fragile and do not hold sutures well. This can lead to bacterial contamination. After the time frame for suturing the wound has passed, bandages are the next option; appropriate dressing aids to expedite wound repair.
What to do when you notice your horse is injured:
- Assess the situation and the horse: Always ensure the safety of yourself and others, and the horse. Check for non-weight bearing or severe lameness that may indicate more serious injury such as bone fractures or tendon/joint involvement. If practical, move the horse to a safe, dry, and clean area for immediate care.
- Carefully inspect all the wounds: Carefully inspect for sites of bleeding, and any exposed areas. The size of the wound is not as important as the location. Small puncture wounds, especially over joints or tendons, can be the most serious injuries, but are often overlooked.
- Call your veterinarian: Lower limb wounds or non-weight bearing lameness should always be evaluated by your veterinarian because of the severity of these injuries and the potential structure involved. Some questions your veterinarian may ask you include:
- Where, exactly, is the wound located?
- Can you provide a photo of the wound?
- Is the horse limping or lame? If so, how lame?
- When do you think the wound occurred? When did you first notice it?
- Have you done anything or given anything to your horse, such as Banamine, Phenylbutazone (Bute), or other medications?
- Has your horse been vaccinated for Tetanus? If so, when?
- First aid before the vet arrives (This can be discussed over the phone with your vet if applicable): First aid includes cleaning and covering to put pressures over bleeding wounds. Grossly contaminated wounds should be cleaned before covering by irrigating the area with sterile saline. Hosing the area would also work. The skin around the wound should be dried before wrapping while waiting for the veterinarian to arrive, or while you are transporting them to the clinic. All horse owners should have an equine first aid kit and know how to use all the supplies. First-aid fundamentals include:
- Thermometer (mercury or digital)
- Sterile saline solution (500 mL-1 L)
- A variety of dressings (gauze bandage, cast padding, elastikon, vet wrap)
- Poultice type dressings (manuka honey, calcium alginate, telfa)
- Topical medications: Silver sulfadiazine cream, manuka honey, triple antibiotic ointment
- Fly repellent spray or ointment
- Clean bucket
- Bandage scissors
- What is okay to use on wounds? You should avoid putting any type of topical medication on a wound until a vet has been able to assess it. Many common topical medications can delay healing. Other medications and solutions such as nitrofurazone (Furazin) ointment, hydrogen peroxide, betadine, and chlorhexidine are caustic to wounds, which means that healthy tissue gets damaged. These can delay wound healing rather than promote it. Irrigation to clean out the wound should ideally be done with 0.9% sterile saline solution or 7.2% hypertonic saline.