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Scott Bayerl : MHWF
 #1 

This is something we have wanted to share for quite sometime...how to treat large open wounds. Recently, Karen's 38 year old QH, Clancy had a run-in with a tree branch and we had the opportunity to photograph his wound and its progress as it healed.

In this case, Clancy was standing by a tree with a few low branches (which have since been trimmed off). Another horse backed up to Clancy to kick or warn him and when he backed up, he broke a small branch off of the tree, leaving a sharp, pointed branch, which went deep into his muscle tissue.  Of course, Clancy panicked when the branch went into his rear end and he tore the skin and flesh around it even worse.

This is the kind of wound which we have been wanting to talk about on the forum for quite some time. While this wound is large and was not pretty, it does not affect any joints or vital organs and is not near any tendons or ligaments. This is treatment for large muscular wounds only. If there are joints, organs, tendons or ligaments involved, don't mess around...call your vet.

Many people will see this and just and automatically say they need the vet out to stitch it up. The opposite is true. Not only can you treat these wounds on your own, but you do not want to stitch these kinds of cuts up, trapping dirt and bacteria in them and giving them no place to drain.   If you stitch it up, eventually the stitches will tear out and you will increase your chances for an infection.

1. For open wounds like the one pictured below, give your horse some pain meds, Bute is the standard. You are also going to want to give antibiotics, Pen G is the preferred antibiotic for this kind of wound. In this case, Clancy got 25ccs of Pen G, once per day, for 10 days. That was given with a syringe and an 18 gauge needle, which is a little larger and makes it easier to push thick Pen G through.

2. Cold hose the wound at least once per day, twice is even better, for a solid 5 minutes. Do not use pressure, simply let the water flow into the wound and let it run for the full 5 minutes. This will clean the wound, keep it open and able to drain, and over time will cause the flesh to look granulated. This is exactly what you want. When you are done cold hosing the wound, squirt in one full tube of Dry Cow (Cephapirin Benzathine) treatment into and around the wound.

3. Do not bandage the wound, simply turn the horse back out or put it back into its stall or paddock. This is key. Bandaging the wound will only keep bacteria trapped in the wound and will prevent it from draining.

4. Repeat the same steps every day until the wound is healed. If you look at the photos below, you will notice that after only a couple of days, the wound already looks much cleaner and like it is starting to heal. Eventually you will notice the wound getting smaller and smaller, healing from the inside out, building new healthy flesh to fill in the hole or cut created by the injury. Eventually this will heal completely and often with little or no scarring.  The key is to never skip a day in these treatments and never let the wound close up before it is healed all the way. Use the water from the hose to not only keep the wound clean, but also to keep it open and draining.

The photos below are being posted in order, from the day after the injury until the day we stopped treatment. A week or so after we stopped treatments, and stopped taking photos, the wound healed the rest of the way and new hair is now growing where the wound once was.

We hope this helps some of you the next time you see a similar injury.

 

 

 

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doreen
 #2 

Thanks for posting this information.  Did you wrap Clancy's tail just for the hosing and treating portion? The wound healed really nicely, much faster from viewing the photos than I would have thought.

Denise S - WW
 #3 
WOW, great info & great pictures! Now if it happens to one of my horses I won't panic quite as much! Thank you for sharing!!
Karen-MHWF
 #4 
I kept his tail wrapped for the duration of healing because the tail hair was getting in the wound.  (I took that first picture right away to document the wound, before I even got his tail wrapped that morning)   At his age we are extremely happy this healed so well and so fast. Scott wanted to share the photos as we went but I wanted to wait until it was fully healed.

Jenn-WI
 #5 

Ouch!  It is very impressive that the wound healed up so nicely, given Clancy's age.  Thanks for showing us the progression of his healing.  

doreen
 #6 

Thanks, Karen.  That is what I was thinking, the hair might have been a constant problem.  I agree, even not thinking about Clancy's age, the wound healed really quick and neatly...add in his age, and it is very impressive.

John B.
 #7 
Ouch!  Good info that I hope we do not need to use any time soon or ever.

Question; if it was mid-summer would you do anything different due to flies / infection?

Thanks for documenting this along with your treatment.  Also nice to see how ole Clancy healed so well, what a great trooper he is.
 
John B.
Karen-MHWF
 #8 
Denise, this didn't come without some panic on my part.  ;)  Clancy would not walk without assistance; he had a kick mark on his front leg and then this wound on the back-end, and he has the lowest pain threshold I've ever seen on an animal (I've had him for about 11 years now and know him pretty well). 
When I first saw this wound that morning I actually thought someone had shot my horse at first and I was ready to load for bear, so to speak. 

John, there wouldn't have been much different to do if there were flies, other than apply some type of fly repellent around the area as well and probably be sure to wash it out at least 3 times per day then.  With a wound this bad I may have kept him stalled for a day or two at first with a fan and in a fly-free zone in the barn.  The timing of it was lucky that there were no flies, as those stinkers can cause more complications.  We dealt with a bad wound similar to this on Mary (don't know if most of you remember Mary or not).  She was blind in one eye and had run very strongly into a metal eyelet on her blind side with her shoulder on the side of the barn and tore her shoulder open (it was not a sharp object, but it tore her open with the amount of force she hit it with).  That was mid summer in full bug season, and we just made sure to wash it at least twice a day and the outcome was the same, except she had no scar (she was black), whereas I think this is going to leave a bit of a scar on Clancy. 

One thing that Scott didn't add is the fact that I had to explore that wound to be sure that there was nothing in it.  Had there been something in it (some type of foreign body such as stick or bark) I would have called the vet out for anesthesia and a more thorough wound debridement than I would have been comfortable doing to be sure there was nothing left in there.  This wound was deep, the length of my index finger in, but thank goodness it was a fairly clean wound. 

Oh yes, and one more thing...that skin flap.  That skin flap was giving me fits and I really thought I'd have to have the vet out to have that removed, but it did wind up re-attaching eventually without any infection in there, but again got lucky with that. 

Faye - WI
 #9 
Just a comment on the importance of keeping them vaccinated for Tetanus too.
Some folks never vaccinate their horses, and this type of thing could go really bad without it.
Not an issue for MHWF horses.

Karen-MHWF
 #10 
Faye, that is an excellent point that we forgot to mention.  Funny thing, on the walk getting Clancy up from the pasture when this first happened we were discussing the exact time it had been since his tetanus and discussing that we were safe in that respect. 
About 3 years ago I saw someone's horse get tetanus and have to be put down for an injury much less severe than this one, and it is an image I will never forget.  Something so simple and avoidable.  Keeping your horse up-to-date on tetanus is so important; they hurt themselves so easily. 
Wendy W - WI
 #11 
Amazing.  I get the heebie jeebies thinking about putting a finger in the "hole", but know you (Karen) with your medical background would do such a thing.  We all see the pictures of how this or that medicine will help this or that, but to see it progress is really something.  Myself, I would probably still panic about something like this.  That's just me.  Thank you for sharing this as it is very educational for all of us.  
Sherri N.
 #12 
Really appreciate your posting this information with the photos of progress!
Karen-MHWF
 #13 
I did snap a picture of Clancy's scar a couple of days ago and thought I'd share what it looks like now in case anyone was interested.  It has a little lumpiness with scar tissue there, but in time I don't think it will be a very big scar at all. 

Clancy's healed wound from 4/7/2012 when it first happened, and then from 6/8/2012 on the bottom of it healed. 

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Wendy W - WI
 #14 
It looks so great!  Thanks for the picture update.  Just goes to show that things like this can be healed properly if done correctly.  And I must add.........having had a gold dun in the past....gold duns and buckskins have the cutest cheeks of all!  Sending much love to Clancy.  
Val
 #15 
Wow.....amazing recovery. I have now added Dry Cow to my shopping list. Never heard of it so not sure if I have to order on-line or can get it at one of my local stores.

Wondering if you have ever heard of Underwoods Horse Medicine (http://www.underwoodhorsemedicine.com/)? My Appy/Friesian mare got hung-up in a manure spreader at a trainers and ripped her chest and both forelegs wide open. One leg was down to the bone (I think my vet called it ungloved). I was a wreck just over the fact that someone who has been in the horse business would have a spreader anywhere near where a horse could get to it lone enough the devastating wounds it inflicted. Two vets said it would scar and due to the leg wound she would never be ridden again. I had used the Underwoods on a horse that took off a fourth of a his hoof getting great results so decided to try it on my mare. Today she does not have so much as a scar from the ordeal. It sounds like it works the same way as the Dry Cow does. You spray it on, sprinkle baking powder over it and leave it. Repeat two to three times a day depending how bad the wound is. When I get home from work I will have to send you some pictures.
Val
 #16 

Found a picture of the wound to my mare mentioned in my previous note. This was taken about two months after the initial injury. Her chest wounds were completely healed and this picture is of the worst of her injuries.

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Jenn-WI
 #17 

Oh my...that is a nasty wound!  Glad to hear she's healed up well, that must have really took some determination and time to treat.  On a side note my farrier also recommends Dry Cow for treating thrush.  It works great and can be purchased at Fleet Farm. 

MHWF
 #18 
We wanted to share this with our readers as it was in line with what this thread was originally about.

The wound pictured below was on an adoption horse in her home and happened when a very nasty wind storm blew over a 3 sided shelter that she just happened to be standing in at the time.

The treatment for her wound was exactly the same as mentioned in the previous posts.....cold hosing at least once per day for at least 5 minutes and Dry Cow squirted into the wound after cold hosing. As you can see, over the days and now weeks, the wound healed. In a few more weeks the lump in the wound will go down and there will be just a little scar left on her neck.

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Emma Casanova
 #19 
Hello Scott,
I am writing to you from France, Europe.
I read your story with great interest and well done for looking after so well your horse.
My horse had a cist removed from under his right front leg 7 days ago. Two night ago the stitches split and the wound is now open. It is about 1"x 1" (1 inch). Not very large compard to the wound on your horses rear. There is not possibility to stitch again because the skin has torn where stitches came out.
So, I wash the wound out with cold water everyday to keep it clean and now I am wondering where I can buy this Dry Cow cream you talk about. I wonder what the equivalent is in France because it sounds like really miracle open-wound healer. 
Are you able to give me any other specifications about this cream or where I may be able to order some to send to my home in France?
Thank you so much for any help you can lind me.
Kind regards,
Emma Casanova
Karen-MHWF
 #20 

Hi Emma,

The Dry Cow has a brand name of Tomorrow, I believe. 
Here are a couple of links that I could find on where to get it and what it is: 
http://www.jefferspet.com/tomorrow-dry-cow/camid/liv/cp/16618/

http://phalenhorseshoeingsupply.com/PhalenNew/Phalen/catalog/index.php?main_page=product_info&products_id=192

http://www.valleyvet.com/ct_detail.html?pgguid=30e079bc-7b6a-11d5-a192-00b0d0204ae5

Good luck Emma! 

 

I just saw an interesting article on how wounds heal: 

http://www.thehorse.com/articles/31764/how-horse-wounds-heal?utm_source=Newsletter&utm_medium=health-news&utm_campaign=04-30-2013

Whether large or small, serious or innocuous, all wounds follow a distinct and complex healing process. During the 2013 Western Veterinary Conference, held Feb. 17-21 in Las Vegas, Nev., one veterinarian reviewed how wounds heal and how owners can help facilitate healing.

"(Wounds are) a fascinating topic; you never know what you're going to come across," said Bimbo Welker, DVM, MS, a clinical associate professor in the Ohio State University (OSU) College of Veterinary Medicine Department of Veterinary Preventive Medicine and a practitioner at OSU's Large Animal Services, in Marysville, Ohio.

Welker first reviewed some basic wound management steps. Although there's been "a tremendous amount of research on wound healing, we still can't speed wound healing up," he explained. We can, however, ensure wounds have an optimum environment in which to heal.

He also reminded veterinarians that skin is a complex organ that can't regenerate. Instead, wound defects are replaced with fibrous tissue covered by surface epithelium, which reestablishes continuity, he explained.

"Healing always progresses in the same way," he said. "Wounds heal in stages, and each is dependent on the stage before it."

Welker then discussed the stages of wound healing, noting that while each of these stages must occur, many overlap and take place at the same time.

The Inflammatory Phase

The horse's body begins reacting as soon as an injury occurs with the inflammatory phase, Welker said. The skin around the wound begins retracting due to tension; immobilizing the wound can help reduce this effect, he said. Skin retraction can continue for up to 15 days post-injury, he said.

Within five to 10 minutes after the horse sustains a wound, Welker said, a vessel response occurs. During this response, "intense vasoconstriction" (narrowing of the blood vessels) occurs at the wound site, followed by vasodilation. It's during this response that fibrin—an insoluble protein that forms the nucleus of a blood clot—arrives at the wound site.

Within 30 minutes of injury, the body's cellular response kicks in, Welker said. Blood platelets and leukocytes (white blood cells) "line up" at the wound site to begin cleaning it. These cells are required for healing, he said, and their presence activates the fibrin, allowing clotting to begin.

And finally, within an hour of injury, the localization response takes place. At this point, a fibrin clot has localized damage to just the affected area; the clot also prevents contaminants from getting into the horse's bloodstream or surrounding undamaged tissues, Welker said, and forms the framework needed to repair the defect.

Unfortunately, the localization response comes with a downside, Welker said. Because the contaminants have been localized to one central area, inflammation (including swelling, redness, heat, and pain) develops. Excessive inflammation delays healing, Welker said, and can lead to pressure necrosis, pain, scarring, and bacteria development.

The Debridement Phase

The next phase is debridement, which is critical for all wounds and injury healing, Welker said: "Healing cannot proceed without the completion of this stage," he said.

The debridement phase takes place when neutrophils (a type of white blood cell capable of engulfing and destroying bacteria and other disease agents, immune complexes, and cell debris) enter the wound defect and kill bacteria, break down debris, and enhance the inflammatory response; unfortunately, when too many neutrophils enter the wound, the healing process slows, Welker said. At that point, pus develops, which further slows the healing process by breaking down fibrin working to fill the defect. To prevent excessive neutrophils from inhibiting healing, he said, keep the wound clean and administer antibiotics.

Some inflammation is good, Welker added, but excessive inflammation slows healing.

Epithelialization—which Welker described as the first sign of defect repair—begins between eight and 10 hours after a wound occurs. During this stage epithelial cells "migrate" under the scab at a rate of 0.2 millimeters per day on the horse's upper body and 0.09 millimeters per day on the animal's limbs or lower body, Welker said. Factors that inhibit or delay epithelialization, he said, include infection, excessive granulation tissue (commonly known as proud flesh), repeated bandage changes, extreme hypothermia, and dessication (the wound drying out).

The Repair Phase

By the fourth or fifth day after a wound occur, fibroblasts (cells responsible for forming connective tissues) move into the area and begin tying the wound edges together to fill the defect. The fibroblasts will continue moving over the defect until they contact other fibroblasts. Welker explained that fibroblasts produce a substance that enhances the fibrin matrix before producing collagen, which essentially serves as a glue holding the layers of skin (or in this case, new epithelial tissue) together.

In the third to sixth day post-injury, Welker said, granulation tissue begins to form and subsequently allows wound contraction to occur (more on that in a moment). Welker said granulation tissue is an important part of wound healing: It provides a surface for the epithelial cells to migrate over, it's resistant to infection, wound contraction centers around it, and it carries the fibroblasts responsible for collagen formation. But granulation tissue can cause problems in some cases.

"Horses are overachievers and can keep producing excessive granulation tissue," Welker said. "This is when it becomes a problem."

He said he considers granulation tissue that rises above the skin level to be excessive.

Next, Welker discussed wound contraction, the process by which open skin wounds reduce in size due to the movement of surrounding full-thickness skin. Welker said special cells on the surface of the granulation tissue bed--modified fibroblasts called myofibroblasts--draw the full-thickness skin toward the center of the wound.

"Wound contraction works best in areas where the skin is relatively loose (upper body), but where skin is relatively tight (lower limb) contraction is much less efficient and will result in wider scars," Welker said.

The Maturation Stage

The final stage in wound healing is maturation, Welker said, and it can last for months to a year or more, depending on wound severity. In this phase, the number of fibroblasts in the area decreases while collagen production and lysis (decomposition) continue, he said. Also in this phase, the wound's tensile strength increases. Welker cautioned that once a wound heals fully, the defect's tensile strength will always be 15-20% weaker than the surrounding areas.

Keys to Consider

As Welker mentioned, we can't speed wound healing, but we can provide an environment to help facilitate it. Some factors that negatively impact healing include age, disease status, malnutrition, and multiple trauma sites. However, there are options veterinarians and owners can employ to help facilitate healing including non-steroidal anti-inflammatory drug administration, steroid administration, wound lavage, wound debridement, and bandaging.

Welker stressed that a veterinarian should examine any full-thickness wound and treat each wound individually.

Kara W.
 #21 
I'm am in the process of healing a large open spot from an abscess on Cassie's neck from a Vaccination shot. I am documenting it every day and once its healed up I will post the pictures on here as well... The cold hose and dry cow is working VERY well :)
Donna M
 #22 
I've heard about this method before but it's great to see the photos.

Question: How do you get a horse to stand still for 5 minutes of cold water flushing daily?
Scott: MHWF
 #23 
Hi Donna,

Horses do know when you are trying to help them and they know when they are hurt. In all the years I have used this method for treating large open wounds, I can honestly say that after a day or two, every horse has learned to stand still for the cold hosing. We do also have a vetting stock here, but I cannot remember the last time we used it. The only reason we even have it is because the Dept. of Ag. requires that we have one.

We even had a semi-wild horse about 10 years ago that tore a giant flap of muscle off her front right shoulder. After a day or two of treatments she learned that we were trying to help her and she stood like a champ for the rest of her treatments. In the end her injury was a blessing to her because getting her treatments taught her to trust people and look to them for security.

Now your adopted horse, I would think she would stand like a pro for her treatments after the initial dancing around.

Start with a slow flow of water on the ground, slowing working toward the hoof, then progressing slowly toward the wound. They will get it pretty quickly.
Karen-MHWF
 #24 
Yes, I have to admit I was stumped at how to answer "how to get a horse to stand still for the cold hosing of the wound" too.  :)  I've had this rolling around in my head from the time I read it, and I'll be darned if I can think of how to explain how to get a horse to stand still for the cold hosing.  Scott is right, after some initial dancing around, they all generally do really well with it, but again, I'll be darned if I can figure out HOW to explain HOW to get them to stand still.  Like Scott said, work with them...go slow, start from low and go up with the hose...and I just can't come up with the words on how to explain that.  I think maybe you would figure that out if you did it?  I tend to think each horse is a little different and individual, so you go with you instincts on what works with each horse.  I can't believe that is a tough question and am laughing at myself, but I seriously cannot figure out how to explain that.  Kudos to the teachers. 

I did use the vetting stock for Clancy when he had his wound, but the reason that I did is because he had little to no teeth and ate a mash that took him an hour, so at meal time it was just easier to put him in there and give him his food and cold hose while he was eating.  Convenience and time saving, and it became a very easy little routine for him.  I did cold hose his wound and get him used to that before putting him in the vetting stock. 
John
 #25 
Is it just me but I had a very big smile seeing a woman from France seeking info here.
Pretty cool in itself and even cooler what great info was given.
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