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Wounds and Management

Wounds

Wounds are a common presentation here at Belvoir.  Due to the nature of horses and the type of work they carry out, they are more prone to accidental injury.  This is why as owners it is important to know how to assess the wound and act accordingly.

The main factors to take note of are as follows:

1) What type of wound has your horse sustained?

Abrasions: These are non-penetrating wounds of the skin.  Although the skin is intact the degree of the damage to underlying tissue or bony structures should not be underestimated.

Lacerations: Generally traumatic injuries that result in jagged edges of the skin and possibly underlying soft tissue.  The risk of contamination with this type of wound is higher and prompt medical attention is key.

Laceration beforeLaceration after
Puncture: Penetrating wound that generally looks minor but can cause significant damage to the underlying structures, especially if it is a synovial structure. I.e. joint, tendon sheath or bursa.

puncturepuncture 1

 Incisional: Smooth, clean edges generally caused by sharp objects.

 incisional

2) Where is the wound located?

Is it near a joint or other synovial structure? If so immediate action should be taken as penetrating injuries to synovial structures can be life threatening. Your vet can confirm if the wound communicates with a synovial structure.  Aggressive and urgent treatment include flushing of the affected area under general anesthetic followed by systemic +/- regional antibiotics to prevent infection from setting in.

3) How old is the wound?

The fresher the wound is at time of presentation to the vet the better.  This will reduce of contamination and will allow for suturing if needed.  Older wounds are subject to contamination and necrosis making management that bit more difficult. Such wounds generally require debridement of the dead/unhealthy tissue and are left open to heal by second intention healing.

Wound Management

Bandaging: is a crucial component in optimizing wound healing. Bandages provides stability, reduces contamination prevents further damage and protects delicate granulation tissues also known as proud flesh.  Please notify your vet if proud flesh develops as quite often debridement of exuberant tissue is required.

  1. The first layer of the bandage is in direct contact with the wound and may be adherent or non-stick dependent on

Examples of first layer wound dressings: Non-stick telfas, Amorphous gel dressings, Woven or non-woven gauze Foam pad dressings. This first layer bandage may be held in place by a soft thin, elastic or cotton wrap.

telfas

  1. The second layer of bandage material functions to provide padding, absorb fluid, provide support, and immobilize the limb if necessary.

Examples of second layer bandage material: Roll cotton, Cotton combine, Quilt/pillow padding, Sheet cotton.

cotton wool

  1. The third layer of a bandage is used to hold the other layers in place, apply pressure, and protect the first two layers from the environment.

Examples of third layer: Vetwrap, Powerflexm, Coflex all of these are cohesive elastic wraps

vetwrap

  1. A fourth bandage layer may be necessary or desired to provide added stiffness and pressure, improve durability, and hold the bandage in place.

  1. In addition to bandaging, splints or casts can be used or in the case of severe tendon injuries, toe extensions, equithane or even swan shoes. Allevyn non adhesive dressings are particularly useful in promoting granulation tissue over exposed bone.

 

IMG_0693

In some cases a wound may need a skin graft.  This type of technique is generally used for wounds that have a large skin defect that would not heal fully with standard wound therapy.

Medication: generally includes systemic/topical antibiotics and anti-inflammatories depending on wound type and severity. Steroid based creams can also be used to reduce proud flesh once a healthy granulation bed is established.

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