Wounds are a common injury with horses. What we do when we care for a wound should only encourage healing and not harm the tissue further. The healing process starts right after the injury occurs and consists of several overlapping stages. These include blood clotting and scab formation, inflammation, and the repair process with scar formation and remodeling.
Anything that disrupts the process (such as presence of foreign material in the wound, infection, or excess movement of the area) may result in the wound 'breaking down.' Healing can still occur but it is likely that an increased amount of scar tissue will result.
Wound Care – Actions that are Generally Not Recommended:
Some procedures may actually interfere with healing, and hence are generally not recommended as routine procedures:
- Applying strong disinfectants (e.g. alcohol, tincture of iodine) directly to wound.These can cause further tissue damage
- Contaminating the wound with your hands or other non-sterile objects.
- Applying wound medications while waiting for vet.
- The medication can obscure the site and make wound evaluation more difficult. Also, some materials may actually damage tissue further or slow healing.
- Applying wound powders: see above; some powders act as "foreign bodies."
- Swabbing wounds: this action may further traumatize tissues.
- Removing (large) embedded objects: Their presence may actually be preventing bleeding by pressing against damaged blood vessels. Hemorrhage may follow their removal so talk to your veterinarian first.
Wound Care – Generally Recommended Actions:
- Calm the patient.
- Calming will help you perform an assessment and first aid, and will help in control of bleeding
- Wash your hands. This avoids further contamination of the wound by you.
- Control any bleeding.
- Direct pressure is the best approach using a sterile bandage. Apply a thick bandage and keep adding bandage material until control of bleeding has been achieved – sterile is recommended but 'clean' may be acceptable when a sterile one is not available and arresting hemorrhage is critical.
- Cleanse area around the wound with gentle soap or antiseptic scrub.
- Trimming of the surrounding hair may be required. Scissors or clippers may be used but avoid getting the hair into the wound.
- If the area around the wound requires washing, do this gently remembering to swab away from the wound to keep dirt and debris from getting into it. A gentle soap can be used, and then the soap removed with saline.
- Cleaning the wound should be done gently by flushing with sterile saline using a syringe or spray bottle to ensure the appropriate pressure is maintained. This removes contamination. However you may need to gently pick off any adherent foreign material – again, avoiding further contamination. Discontinue flushing if the tissue takes on a grey hue.
- Using antimicrobial products:
- For minor wounds, complete cleaning may be all that is required.
- Some wounds may benefit from application of a topical antimicrobial product. These are used to reduce surface contamination of the wound by bacteria or to reduce infection. Your veterinarian will be able to recommend an appropriate product and when to use it.
- Systemic antimicrobials (these are given orally or by injection) may be prescribed by your veterinarian for specific types of wounds. For example, if the wound is deep and involves disruption of muscles; if after a thorough cleaning and removal of contaminated tissue, there is still "questionable" tissue present; if the horse is immune compromised; or if the horse shows systemic signs of infection such as fever, depression, lack of appetite.
- Suturing wounds: Your veterinarian may recommend that a particular wound be sutured.
- There are no hard and fast rules as to what wounds require suturing.
- In general, the following are usually sutured: clean-cut wounds with minimal tissue damage and veterinary attention within a few hours; eyelid wounds – to maintain conformation and protection of eye; and wounds involving joint structures but only after thorough cleaning has been carried out.
- Wounds on the body have the potential to heal well if sutured or not.
- Distal leg wounds might or might not be sutured, depending on the injury.
- Ensure that your horse is up-to-date on his Tetanus vaccination; if not, a booster should be given.