Managing Equine Wounds

As every horse owner knows, horses and ponies have a very well developed ‘fight or flight’ mechanism and they often react first and think afterwards. If they are tangled up with something or cast against a fence or stable wall, their first instinct is to flee; often without regard to whatever body part happens to be caught at the time. It’s the same when they ‘spook’ and why therefore, equines have a well-deserved reputation as being accident-prone.

Signs and symptoms:

Depending upon the wound location and the amount of time since it first occurred, you might see some of the following signs:

·         Lameness/unwillingness to bearweight on the affected leg and/or unwillingness to move.

·         Area of dried blood (may only be an accumulation of flies around a small wound)

·         Flap of skin hanging off

·         Profuse bleeding

·         Swelling or puffiness of the surrounding area

·         Heat associated with the swelling

Reasons to seek help from your vet:

·         Excessive bleeding

·         Significant contamination with dirt/debris

·         Lameness

·         Full-thickness wounds (the skin has been cut) or wounds involving deeper structures such as bone, muscle, joints, ligaments, tendons, tendon sheaths, vessels, and nerves

Diagnostics

Call your vet for a chat about any wound that your horse may have if you are at all concerned. Often, the smallest puncture wound may cause a more serious life threatening injury when compared to a very large wound. A very large wound on the upper body that is not close to joints and is not very deep may have a much better prognosis than a small puncture wound that may look less severe on the lower limb into a tendon sheath or joint.

Your vet may need to visit to evaluate your horse to carry out a thorough examination of the wound, which may involve sedation and local anaesthesia to assess severity of the damage and allow removal of any foreign bodies such as wood, wire, pieces of bone or hair, and to determine if any vessels, nerves, tendons, ligaments, muscle, bone, or joints are involved.

X-rays and ultrasound investigations may also be used, dependent on the nature of the wound and any associated injury.

If a joint or synovial sheath is potentially involved, this significantly complicates management and the wound healing process. Such an injury may well require repeated flushing of the structure under general anaesthetic and there may not be a successful outcome. 

Immediate treatment you can provide while waiting for your vet to arrive:

·         Application of direct pressure to any area that is actively bleeding with an absorbent pad covered by an elastic bandage

·         If possible, move your horse into a clean, quiet environment while waiting for your vet to arrive, if possible 

Your vet may provide the following additional treatments:

·         Thorough clipping, cleaning, and removal of any visible foreign matter

·         Removal (debridement) of damaged or contaminated tissue of the wound

·         Sutures or staples closure, if appropriate and possible

·         Bandaging or casting, depending on location

·         Administration of broad spectrum systemic antibiotics and anti-inflammatories

Aftercare and Outcome

Following initial evaulation and care of the wound, your vet may recommend that your horse be restricted to box rest with hand-walking, but the extent and location of the wound will dictate the level of exercise. Several factors can affect the eventual outcome.

Location:

·         Head – Involvement of the sinuses, nasal passageway, eye etc. Wounds to this area heal relatively well as long as critical structures are not involved

·         Upper limbs – Have skin/muscle covering, but motion in these areas can negatively affect healing.

Head and upper body wounds have a relatively good blood supply compared to lower limb wounds

·         Abdomen – If the wound is deep enough, it could penetrate the abdomen and cause peritonitis (infection of the abdominal cavity)

Upper body and abdominal wounds have sufficient skin and underlying muscle to allow significant wound contracture to help close even very large defects compared to wounds on the lower limbs

·         Lower limbs – have only skin covering very important structures such as bone, tendon, ligament, joints, tendon sheaths, vessels, and nerves

·         Over a joint – Movement of the skin/wound over this area can negatively affect healing

Wounds below the carpus (knee), hock or over a joint are complicated by minimal excess skin that is fairly inelastic, lacks underlying muscle tissue, and is subject to movement during limb flexion. These wounds are also prone to granulation tissue (‘proud flesh’), which will dramatically slow healing and may require surgical intervention

·         Contamination:

Dirt, manure, hair, or other foreign material can all too easily infect the site or underlying structures and may be life threatening if infection is not quickly resolved.

Complications of the wound healing process include:

·         Cellulitis

·         Subcutaneous emphysema (air under the skin)

·         Hematomas/Seromas (accumulation of blood/serum)

·         Sarcoids

·         Exuberant granulation tissue (proud flesh)

·         Prolonged healing

·         Excessive scarring

·         Laminitis

·         Colic

If joints or tendons are involved, additional complications include:

·         Persistent infection that is resistant to treatment and can be life threatening

·         Development of arthritis

·         Adhesions of tendons

·         Persistent lameness

·         Restriction of motion due to excessive scar tissue

After evaluation and continued care by your vet of your horse’s wound, he or she will be able to discuss with you the specifics related to overall prognosis.