Wound Care

Over the weekend Elle was injured, and so there are some graphic photos in this blog post as I detail her wound care, rehab, and recovery.  She is an approximately 10 y/o chestnut warmblood mare with some underlying proprioceptive issues, who incurred a large wound over the mid to ventral aspect of her right pectoral muscle.  It required suturing to close, but will likely not heal without some sloughing of tissue.  Her owner sent her here for wound care and dressing as the injury heals.  

When I get these types of cases for PT/rehab, I do quite a bit of documentation to ensure that any veterinarians involved are kept abreast of the status of the patient as well as keeping the owners informed.  This also lets me keep detailed information on how the wound is healing, including the horse's vital signs which can indicate something may be going awry before the horse starts behaving oddly. 

Here is the treatment sheet I use for large laceration cases:

This chart has a spot for me to track all kinds of pertinent details about the horse, and the last column on the right is where I make additional notes on the horse and wound treatment.  I also take a photo at each treatment to document progress visually.

This first photo is from when the wound was found, on Sun 8/8.

 

This second photo is from today, after I brought Elle to Bit of Honey and after I lavaged the wound with saline solution.  I have a weed sprayer, which I fill with a salt water solution of 2 tsp salt /1 L water, and it does a great job rinsing the wound without debriding too much tissue.  Spraying the wound with salt water inhibits bacterial growth, as most bacteria doesn't like to live in salty environments.  I don't use disinfectant like betadine or chlorhexidine at this stage in the wound healing, because those solutions, while excellent for killing bacteria, also decrease regrowth of healthy tissue.

Once the wound was thoroughly rinsed with the saline solution I gently removed crusted material from surrounding healthy tissue.  Too much serum or exudate left on the healthy surrounding skin can irritate the skin and cause secondary issues, so I like to keep the rest of the leg clean by rinsing with water then soaking the hair with laser sheen hair polish to help any dripping to slide off the hair rather than stick.  

Once everything was clean, I applied honey to the wound.  Honey is a great natural antibacterial substance.  It's inexpensive, works well to help prevent infection, and doesn't sting when applied to the wound.  Because we are in the middle of August and despite detailed manure management and liberal use of fly predators there are some flies around.  I applied some swat fly repellent ointment to the healthy skin surrounding the wound, which helps to minimize flies on the injury.  If necessary I'll assemble a cover for the wound using a shoulder guard, but I wanted to give this a try first to minimize friction on the sutures from fabric rubbing.

Elle also had a treatment with the laser.  This works well to reduce inflammation and pain, as well as stimulate growth of new healthy granulation tissue.  She seemed to like the laser, she nuzzled it a couple times when I was moving it over the actual wound.  If the setting is incorrect the horse will almost always tell me by acting uncomfortable, either pawing or leaning away from me.  When they lean into the laser or nuzzle it with their noses it's usually because it feels good to them.

Elle was set up in the stall with fresh shavings, water buckets, and her evening grain including bute for pain management and oral antibiotics to prevent infection.  I'll continue to monitor her and treat the wound twice daily for at least two weeks, and we'll see how healing comes along!