Wounds are inevitable when keeping horses. Luckily, they’re not all as bad. A lot of wounds can be treated by you, the horse owner.
When a your horse wounds itself, always assess the wound properly. A superficial scrape or cut may be managed relatively easily. However, iIf the skin has been cut through-and-through, always have a vet assess it to see how deep it goes, what deeper structures are involved and whether it needs veterinary treatment. During movement, the horse's skin slightly moves over the underlying tissues, which means that a puncture wound might look superficial, while in truth it runs much deeper only a few centimeters next to the skin cut. For that reason, a wound close to any joint or tendon sheath should always be evaluated. An infected joint or tendon sheath can often mean the end of a horse. If a joint or tendon sheath has been compromised, it needs to be treated immediately and appropriately to improve prognosis. A vet will be able to assess whether a wound needs to be stitched or bandaged with specific dressings. Even if you would prefer doing much of the work yourself and the wound allows that, your vet can set you and the wound up for success.
In general, wounds on legs take longer to heal and develop complications more often than wounds overlying muscle. To name only a few reasons: there’s more tension on the skin of the lower limbs; there’s more movement in the legs around the high-motion joints; wounds are closer to the ground and can therefore catch a lot of bad bacteria; a horse's legs often bump into objects (lying down, getting up, pawing, knocking into things, playing with other horses, etc) which is why wounds on legs more often get mechanically disrupted. We advise you to always have wounds on the lower legs where the skin has been cut through-and-through evaluated by a vet.
Mudfever gone bad: Mudfever causes scabs. These scabs can open up and become tiny wounds. Once they do, they often get infected with the bacteria that cause the mudfever, mud and other debris, which can lead to inflammation, infection and cellulitis. Especially if the mudfever is being treated with oily creams without being properly washed and bandaged, there can be a lot of aggressive bacteria on the surface. With mudfever, the key words are clean & dry. If your horse is developing cellulitis, becoming lame or the mudfever just seems to spread, give us a call so we can help you tip the balance towards healing.
As vets, we still regularly get called out to wounds that have “gone bad” and should have been seen earlier. Often there’s a combination of good intentions, a restricted budget and not enough know-how to properly evaluate the wound to make an informed decision. This is understandable, but can result in having to spend even more money, keeping your horse out of training for longer and a bad cosmetic result.
The wound healing process
The body has certain tools to aid healing. Inflammation is an important one. Mind you, inflammation is not the same as infection. Where infection is a bad thing involving bacteria or other pathogens, inflammation is actually a good thing that is necessary for wound healing, as long as it doesn’t spin out of control.
When wound healing begins, the body starts the process of inflammation. The body has to determine which tissue cells are dead or alive, kill any bacteria, and get rid of these things together with any debris that’s been left in the wound (sand, dust particles, etc.). The body produces wound fluid to achieve these things. When the wound has been cleaned out by this process, the inflammation should go down. Local inflammation in the area of the wound/bruise causes swelling, heat and may cause pain. It is not until inflammation becomes systemic (often due to infection) that a horse develops a fever. Make sure you take your horse's temperature twice daily for a week to make sure your horse isn’t developing an infection.
The next step is tissue repair. This can either be the mending of wound edges in a stitched wound, or when a wound is not stitched the body will first try to fill up the defect with granulation tissue and then grow new skin to cover the gap. When a wound is not stitched, this tissue repair process obviously takes much longer (months), depending on the size of the wound. Also, wounds usually become bigger first, because dead tissue gets cleaned out and tension on the wound edges pulls them apart - especially on legs!
When the wound has just closed up, the new tissue is still fragile. Therefore, the last phase in wound healing is strengthening of the new tissue. In tendon injuries (which is like an internal wound), this is actually quite an important phase. A tendon defect may seem “filled in” on ultrasound, but this tissue is not immediately functional tendon tissue. The new tendon fibres are still fragile and not aligned properly. This tissue is very fragile and could easily get torn again if the horse moves too much or missteps. To make sure you don’t do too much too soon, it’s important to check the tendon and keep to a good schedule while the tendon adjusts and strengthens. This means that we have to use ultrasound to estimate what level of activity the horse can do, and check regularly whether the fibres have adjusted themselves properly. If so, we go up a level, then check again and so on, until a horse is fully back into work. Factors like work-load/intensity, duration and training surface are all taken into account. The process of strengthening also happens when other tissue (for instance skin or muscle) heals, but we don't usually notice it as much.
In reality these three phases of wound healing overlap a little in time, so several processes can sometimes be going on at the same time. A wound can also linger in the inflammatory phase or relapse into it if the wound is irritated too much. For example, when a wound becomes too dry, or when a wound can’t settle because there’s too much movement in that body-part, or when the wound isn’t bandaged. When a wound isn’t bandaged it gets daily insults from its environment causing new micro-trauma, and new debris (sand, dust particles, etc.) and bacteria will also cause a continuous stimulus for the body to create inflammation to clean the wound out. Ongoing irritation and inflammation cause tissue repair of lesser quality and less tensile capacities, proud flesh, delayed wound healing, more scarring and an end result that’s just less pretty.
What can a vet do for me?
A wound that can be stitched should be stitched. It saves a lot of healing time (stitches can usually come out in 2 weeks) and therefore may save a lot of costs on bandaging. It usually has the best cosmetic result (minimal scarring). However, not every wound can be stitched. This depends on many things, such as how long the wound has been there, the location of the wound, the level of contamination or infection, the patient and the whether the property offers a good space for the procedure.
When we treat a wound that’s not being stitched, we first assess which phase the wound is in at that time. Then by using either medicine or special veterinary wound dressings, we can influence the process of inflammation and tissue repair. That way we can reduce healing time, prevent complications and achieve a better cosmetic result
If you have any questions about this article or about a wound, please don’t hestitate to contact us. Our vets would love to help you out.