DIARY OF A WOUND
Assisting the healing of wound will be part of
every horse owner's experience, eventually.
Here's a journal of one owner's nursing
routine for a fairly common injury,
by Nicole Kitchener
From "Horse Canada" - Nov/Dec 2009
One afternoon in mid-July, my Mother's Arabian mare came to the gate of the field where she was turned out for the day with the herd. Sunny nickered and I could see by the look in her eyes that she wanted to tell me something. I went to the gate to see what was up. That's when I saw a flash of red on her right hind. Grabbing a lead, I took her to her stall and told Mom first, not to freak out, and second, that Sunny had a huge wound on her hind leg.
Located above Sunny's right hock, we're certain it was a kick. The leg was fairly swollen from just above the wound down to her hoof.
Over the phone, our veterinarian told us that there really wasn't much she could do, as the wound would be too big to stitch. We were to keep it clean, cold hose at least twice a day and apply nitrofurazone, an antibacterial ointment. Otherwise, we were to keep it uncovered. Luckily, the wound was fairly clean to start with. We began cold hosing immediately.
Treating this extremely sensitive, hot-tempered mare was interesting to say the least. Due to past abuse issues, she's deathly afraid of restraint and barn aisles. She doesn't always like being touched on the legs and can be very quick to kick, rear or spin.
We decided treatments would take place with her on a lead in front of the barns. Within a few minutes of her first hosing treatment and after some tap dancing, snorts and kicks, Sunny realized the cold water was moderately okay and she settled to graze intermittently. However, to actually get in and touch the wound to apply ointment would be taking our lives in our hands. I essentially threw some glops of nitrofurazone at the leg, but knew that wasn't going to work long term.
After the first evening's cold hosing session, we decided to switch from nitrofurazone to our favourite old standby - a wound dust product (although we'd never used it on such a large area before). That way, we could stay well out of the way of Sunny's flailing leg as we puffed the medication out of the bottle onto the wound.
The powder "stuck" to the wound's ooze better than nitrofurazone, gave excellent coverage and kept the flies at bay.
This picture was taken after a night and part of a day with the wound dust applied. The black, crusty bits are scabs starting to form, combined with the wound dust. You can already see healing was beginning at the wound's edges.
Day two after the evening's cold hosing. There was still some swelling, mainly above the wound, which gradually, over the course of treatment, worked its way down the leg.
It wasn't looking half bad the next day. Our main concern was the flap of skin on the top of the wound, as we weren't sure if it might harbour infection. During hosing, we directed water up and under the flap to flush it out as best we could. If Sunny allowed us to get close enough, we would puff the wound dust up there too.
The wound started to close over just a few days after the incident. During hosing sessions, we tried to pick off dead skin, especially from around the edges as the water ran over the wound, which Sunny didn't mind too much, particularly if she had carrots in front of her. Pressure from the hose helped remove skin as well.
The majority of the loose flap of skin at the top of the wound dried up and we were able to pick off the dead tissue. At this point, however, we started to worry about proud flesh forming. Proud flesh is excessive granulation tissue caused when a wound's normal healing process goes into overdrive. It has a cauliflower-like appearance and can be difficult to control.
The vet came to examine the leg. She said we needed to scrub the wound raw, particularly at the edges at least once a day to help prevent proud flesh. I knew that was what she was going to tell us and cringed at the thought, wondering how we were going to explain it to Sunny.
The vet left us with scrub sponges impregnated with chlorhexadine along with a tube of Vulketan (ketanserin), a topical preparation for proud flesh prevention and promotion of healing.
I tried the scrubbies with decent success - and a lot of snarling from Sunny.
The Vulketan ointment was another matter. We rubbed it into the wound a few times but it seemed to make the wound even more inflamed and proud fleshy. So, we went back to wound dust, which, according to the label, has properties to thwart proud flesh, but is more caustic in nature.
We were pleased with how things had progressed and were no longer worried about proud flesh. Our repeated hosing, as well as picking off dead skin, mainly with our fingers as the water flowed out of the hose, a practice that Sunny tolerated (for the most part), was working.
There was a huge difference in the wound's appearance at this point. We were still hosing, without fail, twice daily. The edges were closing in and the tissue was healthy.
Overall, we're pretty happy with how the wound healed. We tapered off on hosing in early September, doing it just once a day with an application of wound dust. A couple of times, when the leg swelled a bit, we upped hosing treatments for a day or so. Other than that, it was pretty low maintenance at this point. Hosing stopped completely mid-September with an occasional dusting of wound powder, if necessary.
Would we have done anything differently? Not much except perhaps having our vet remove the flap of skin right off the bat. I think that would have helped initial healing at the top of the wound and prevented the remaining pucker (although, we feel this will diminish overtime).
I believe the regular water treatments, constant application of wound dust and diligent daily observation was critical to the wound's healing (as well as many, many carrots for Sunny who was as patient as a hot Arab mare can be).
PERSONALLY I WOULD HAVE ENDED THE COLD WATER HOSING WAY BEFORE EARLY SEPTEMBER. CERTAINLY WOULD HAVE DONE EVERYTHING TO KEEP THE WOUND CLEAN, OBSERVING IT OFTEN EACH DAY. THE AIR AND NATURE IS ONE OF THE BEST HEALERS OF ALL [IF THE WOUND IS CLEAN] FOR THIS TYPE OF WOUND. JUST HAVING SOMEONE SPEND A NUMBER OF HOURS EACH DAY FOR THE FIRST WEEK OR MORE, WITH THE HORSE, IN THE OPEN AIR. IT IS AMAZING WHAT OPEN AIR CAN DO FOR A WOUND - Keith Hunt