Lacerations and cuts will happen in almost every horse. In part one of this article, I discussed key points to evaluate when dealing with a cut or laceration. After a thorough evaluation, you are often then left with many options regarding how to manage that cut or laceration in your horse. These options can be endless, but with some simple approaches, healing can be acquired quickly!
Cuts and lacerations will happen, if you own a horse. There is no level of protection that can be provided that will completely eliminate this ongoing threat. Some of these wounds are very superficial, while others can appear minor but create a lot of headaches and worries over time.
In part one of this article, I discussed the 5 key points that should be evaluated with every wound, cut, or laceration. You can do this simple evaluation, even on a basic level, as a horse owner and with it, gain a pretty good idea as to the severity of the situation.
The Laceration in the Horse and Warning Signs
Lacerations or cuts can be very minor, but some can indicate that there is more severe damage. Signs that there is more damage present or a definite need for veterinary intervention include:
- Ongoing blood loss or bleeding
- Leakage of clear-amber colored fluid
- Ability to visualize or see deeper structure such as blood vessels, muscle, or bone
- Penetration of a body cavity with leakage of fat, other tissue, or organs
- Involvement of the eye, neck, or face
- Involvement of the lower limb (fore or rear)
- Acute lameness associated with the laceration or wound
- Foreign object embedded within the wound or severe contamination of the wound bed
If your horses wound falls into any of these categories, it is best to contact your veterinarian immediately.
Lacerations and Cuts in the Horse; Why Time is of Essence!
In my days as a student learning surgical skills, one thing was ingrained into our minds. Time=Trash=Trauma. This means that with more time, there is more contamination to a wound, and often with that, there is more tissue trauma or damage. All three of these then equate to the ability of that wound to heal properly.
When it comes to even the simplest of lacerations, there is a golden period of time that stitches or sutures can be placed for closure. That period of time is generally less than 6 hours. That means that if your horse cut themselves at 3 pm, you have about 6 hours to make a decision to contact your veterinarian for purposes of primary or stitch closure. The more time that goes by, even with the best of hygiene, bacteria in the wound and from the environment contaminate the wound and increase in number. Given this fact, if you decide to stitch a wound closed after this period of time, the risk of infection and breakdown of the stitches (dehiscence) is much higher.
This decision making process, regarding time, generally is not an issue unless a few circumstances occur. If the wound is severe enough, in most cases, your veterinarian is alerted immediately, so time is not a factor. However, if the laceration appears minor and you put it in the back of your mind, meaning to tend to it later, time may become a factor. If your horse lacerates himself overnight, while in a stall or in a paddock, and you discover it at 10 AM the next morning, likely time has become a factor.
The key point here is remember that time is a critical factor with any wound, cut or laceration!
Cleaning and Protecting a Laceration in the Horse
No matter what the circumstances, you as the owner, can and should take measures to protect and clean the wound. Your veterinarian may be called, but they may also be delayed, so protection can go a long way. What are some things you can do as an owner to clean up and protect that wound?
This is really dependent on the location of the wound. In most cases, I think it is generally safe to try to clean the wound, especially if it is readily contaminated. Ideally, take some photos of the wound before you clean it so your veterinarian can assess the original nature prior to cleaning. In simple cases, application of a cold stream of water to briefly remove surface debris is helpful. One has to be cautious though in their attempts as first, you don’t want to use a forceful stream of water as this can drive debris deeper into the skin and tissue layers. Second, you don’t want to overdo the water application. If you apply water continuously, you can create tissue edema or essentially water log the tissue, which is not a good thing. Use a good clean water source, briefly apply to the wound to remove surface debris. Nothing more, nothing less.
Then, after a gentle cleaning, if you are waiting on your veterinarian, it may be wise to apply a bandage, if this is possible. This is especially helpful when the wounds involve the limbs or if there is moderate bleeding. The bandage material should be clean, usually gauze with an elastic outer layer, applied in a semi-tight manner, but not too tight! This bandage will help to keep the wound protected and clean until your veterinarian arrives.
If the wound is very minor and you are going to tackle it on your own, after a gentle flushing with water, it is advisable to clean the wound with an antiseptic to aid in reducing bacterial contamination. In most cases, we will use dilute iodine solutions (1:25) or chlorhexidine. Both can reduce bacterial levels rather quickly, but both need to be diluted in order to reduce irritation to the skin. When using these agents, generally you soak some gauze pads with the solution and then gently cleanse the wound a few times, using different pads with each wipe or pass. After a few passes, you can then rinse the wound once again using a clean water source. In cases of minor wounds, you can then apply a triple antibiotic type of cream once to twice daily, which will aid in managing bacterial contamination. Most superficial wounds will quickly scab over and heal in a matter of days. Other therapies that can be applied to superficial wounds or cuts include raw honey or Aloe gel when prepared properly. Both have anti-bacterial properties and can speed the healing of a wound.
Primary, Secondary Closure, and Second Intention Healing of Lacerations
There are many factors involved with cuts, scrapes, and lacerations in the horse. One of the biggest questions is whether or not sutures or stitches are needed. This can be determined based on the factors mentioned above and in our other article. Ideally, in any wound, we desire quick and uncomplicated healing.
Primary closure is the medical term applied to closing a wound with sutures. This is the fastest means to an end, closes the wound, speeds the healing process and reduces bacterial exposure. However, this primary closure is going to be dependent on the time frame involved and also the aspects of the wound. If the wound is rather small or minor, it may not require primary closure and may heal on its own. In smaller wounds, it is also possible to achieve primary closure without sutures. This is commonly done using medical grade ‘super’ glues to close the wound, if small enough, after a wound prep.
Secondary closure or delayed primary closure, are terms used to refer to a wound or laceration that was closed with sutures, but not immediately. Many wounds should be closed with sutures, but often time is a problem. In many instances, the laceration occurred overnight and you have no idea on time frame or the wound is heavily contaminated with dirt or feces. In those cases, primary closure immediately is not desired, as often it will just open with infection. So, here we opt for a delayed primary closure or secondary closure. This is achieved by cleaning up the wound, applying topical medication if warranted to support granulation, oral antibiotics to help reduce bacterial infection, and topical dressing to keep the wound bed clean. Then, usually 2-4 days down the road, the wound can be cleaned again, debrided, and closed with sutures. The chances of success are better than just immediately putting in sutures. This delayed time frame allows us a chance to clean up the wound and allow the body to initiate the healing process.
Second intention healing is a method that is chosen due to lack of ability to put in sutures, or maybe the wound is missing skin sections due to trauma and cannot be closed. In other cases, there may be so much contamination that closing the wound with sutures is not an option. Sometimes, the wound may penetrate another organ system, a tendon, or a joint, where you don’t want to close it but allow it too heal from the inside to out. Second intention healing basically means we manage the wound open, meaning no sutures, and allow the body to heal it over time. This does not mean the wound is open to the environment, but more so topical and oral therapies are given to encourage and support healing. This healing process can be brief or severely prolonged, dependent on the size and nature of the wound.
Proud Flesh or Exuberant Granulation Tissue and the Horse
The term ‘proud flesh‘ is used to describe excess granulation or healing tissue that occurs on wound beds in the horse. In most cases of proud flesh, it is involving a wound lower down on the leg, from the carpus or hock down. In those areas, the skin tissue is rather tight, and if a wound is allowed to heal on its own, there will be a constant battle between healing or granulation tissue and the skin epidermis.
Picture a wound as a pothole in an asphalt road. The skin want to cover the wound or hole at the surface level, but this takes time when the skin is tight. In the mean time, the body is trying to fill in the hole with granulation tissue, which it keeps filling over and over. The only restrictor to this granulation tissue is the skin. If the skin were covering it, the granulation tissue would slow down, but considering the tight skin, the skin is rather slow to cover the wound. Thus, the granulation tissue keeps filling it, exceeding the wound margins like water overflowing the hole in the road. This is proud flesh.
Once the proud flesh forms, it becomes a vicious cycle. As the granulation tissue builds, it will impair the ability of the skin to form over top, thus more and more develops. The only way to impede the granulation tissue is by getting that skin to close. Thus, primary closure in all leg wounds is ideal. In open wound cases, it can be a battle back and forth using topical medications and wraps to keep things under control while the skin migrates in to cover the wound.
Lacerations in the Horse, Making the Right Decisions
Lacerations are very common in the horse, with most being rather benign and harmless. However, some can become serious very quickly. Being able to determine the situation with your horse can make all of the difference and understanding what factors are involved can help to make the process less frustrating. The good news is that most lacerations heal uneventfully, and with stitches, that healing takes place within 7-10 days.
When in doubt about any laceration of wound, it is always best to seek out your veterinarian’s input to ensure that the best therapy approach can be utilized.
Author: Tom Schell, D.V.M., CVCH, CHN