If you’ve been around horses for some time, you’ll know that wounds and horses unfortunately go hand-in-hand. Today, we’re gonna break down some of the most important aspects of wound management so, in the event that you’re faced with a wound, you will know what to do!
Being horse owners, we have an innate drive to “do something” for the wound. This usually entails driving down to the feed store and buying the latest and greatest ointment that claims to kill bacteria, stop proud flesh, and and turn your OTTB into a world class eventer overnight. Contrary to the claims associated with these products, they can and frequently do, hinder wound healing rather than help it.
Daily wound cleansing with dilute betadine solution (mix 10ml of betadine solution with 1L of water or sterile saline or make it up until it resembles the colour of tea) followed by cold hosing for ten to fifteen minutes will help reduce any debris or infection present in the wound bed.
We encourage the use of honey on wounds. Ideally medical grade Jarrah or Marri honey is a good option to have on hand. Honey has excellent antibacterial properties and is best applied during the first 2-3wks of wound healing.
Bandaging is a crucial part of wound therapy. Wounds need to be bandaged to keep the exposed tissue clean and protected from the environment while the granulation tissue fills the wound gap. However if the bandage is kept on for a prolonged period of time, it can promote the production of exuberant granulation tissue (proud flesh). Bandages should be changed every 24-72hrs, or sooner if there is a lot of discharge and there is ‘strikethrough’ (the presence of discharge appearing to seep through to the outer layer of the bandage). This allows for the wound to be examined and any “biofilm” to be washed off. Biofilm slows wound healing and is caused when bacteria colonize the surface of wounds, producing a protective matrix that encases the bacteria and prevents antimicrobials from penetrating the wound bed.
Once the wound is completely covered by a layer of granulation tissue, bandaging can be discontinued. The granulation tissue is a natural barrier to bacteria and debris that keeps everything underneath this layer healthy and clean. If left alone, a scab will form over the granulation tissue and the skin will move across the granulation bed at a rate of approximately 1 millimeter a day.
Despite our best efforts proud flesh can rear its ugly head. In simple terms, proud flesh is granulation tissue that protrudes above the level of the skin and prevents the skin from moving across the wound bed. Wounds that occur in areas of high motion (i.e. the legs) are more prone to developing proud flesh. This occurs because every time the leg moves, the granulation tissue develops microscopic cracks. The body responds to these cracks by filling them in with more granulation tissue, and with time, this produces proud flesh. The best treatment for proud flesh is frequent debridement (tissue removal) by your veterinarian. Be wary of topical ointments which claim to “cure proud flesh”. These frequently contain very caustic substances which do not discriminate between healthy tissue and proud flesh.
Fun fact #1 :
Ponies heal better than horses due to horses mounting a weaker but more prolonged inflammatory stage. This inefficient inflammatory stage is believed to make the wound more susceptible to infection as well as contribute to a prolonged proliferative stage of healing.
Fun fact #2 :
The rate of wound healing varies by the location of wounds. Upper body wounds heal more quickly than distal limb wounds.
Fun fact #3 :
The 3 Layer Bandaging Rule
1. The primary layer is the one in contact with the wound and should be a non-adherent dressing. We use a product called Paranet (paraffin gauze) and apply the honey to this layer before placing over the wound.
2. The secondary layer is an absorptive layer and adds protection to the wound. This layer absorbs a lot of the discharge. We use cotton wool or Gamgee or a poultice pad for this layer.
3. The tertiary layer is the holding layer of the bandage. We use things like vetwrap or vetplast to offer rigid support the wound, whilst still allowing the wound to “breathe”. A tight tertiary layer without adequate padding from the secondary layer will cause tissue damage to the skin and underlying tendons.
To achieve the best cosmetic and functional results, all wounds should be receive veterinary attention asap. Wounds near joints, tendon sheaths and around the eye are ABSOLUTELY veterinary emergencies and you should contact us immediately. Wounds near synovial structures can be very difficult to deal with and may sometimes lead to a life threatening infection.