Wound management overview

Wound evaluation overview – podcast (8 min)

Approximately 20% of after hours equine visits in the UK were due to wounds. Horses are accident prone and there is not much owners  can do to prevent injury. [However, shipping boots and horse helmets do probably help more than bubble wrap.]

The most common horse wounds are limb degloving injuries (the horse kicks through something and the skin is pulled away as the limb is pulled back through the glass/wood/metal) and puncture wounds.

Puncture wounds are easy to miss and can immediately penetrate deeper structures and lead to life threatening infection. Owners may consider them unimportant and not call you.

Degloving injuries can readily traumatize joints, bones, tendons, ligaments and vessels due to the limited soft tissue covering of horse limbs. Skin injury can prolong healing for months. Many of these injuries are manageable but require extensive time and money. Giving clients appropriate information from the beginning helps everyone fully understand the treatment needs and make informed decisions.

Wounds to the thorax, shoulder and abdomen usually occur as animals run through fences, gates and in wooded areas. Solid structures tear skin and muscle as the animal passes through. Occasionally bony prominences are also removed form the parent bone (eg point of hip).

Triage plan for emergency care:

• ABC assessment – Airway, breathing, circulation+
  • Any involvement of the chest cavity, airway or vessels?
  • Any involvement of the abdominal cavity?
  • Significant blood loss?
  • Loss of blood supply to the limb?
  • Significant lameness?
• Any risk of joint or tendon sheath involvement?
  • Wounds near tendon sheaths or the “bendy bits” of the limb?
• Any risk of flexor tendon involvement?
  • Does the wound affect the palmar/plantar surface of the lower limb?
• Any risk of long bone fractures?
  • Is there any abnormal angulation or instability?

Complicating non-urgent factors:

• Is the wound below the hock or carpus or involve eyelids?
  • Distal limb wounds are prone to proud flesh
  • Eyelid lacerations can lead to exposure keratitis if not managed appropriately
• Is the horse knuckling over?
  • Stabilization will be needed
• Is there skin loss in a wound on the distal limb?
  • Predisposed to proud flesh
• Is bone exposed or damaged?
  • Predisposed to sequestrum and/or infection
• Is there muscle injury to the hindlimbs?
  • At risk of fibrotic myopathy

• Sharp or blunt trauma?
  • Blunt trauma will lead to delayed damage to the tissues
• How heavily contaminated?
  • Closure may not be recommended
• Horse factors
  • Will the horse allow treatment standing? tolerate bandage changes?
  • Intended use and timeline for performance, if any?
  • Adequate BCS and nutrition?
• Chronicity
  • How long has it been going on and has it been treated appropriately?

Resources

Managing degloving wounds – Malone, Comp Cont Educ 1996