Wounds and Lacerations (Book Excerpt)

Editor's Note: This is an excerpt from Understanding Equine First Aid by Michael A. Ball, DVM. This book is available from www.ExclusivelyEquine.com.

One of the most important facts regarding severe wounds is that the sooner they are noticed and repaired the better the patient's prognosis, both functionally and cosmetically. Another aspect of wounds is that they bleed, some significantly more than others. Blood loss will be considered in a separate chapter in this book, but will be discussed here in the context of wounds.

Good horse management and wound management begins with a routine vaccination program for protection from tetanus. The once-dreaded disease, also called lockjaw, still claims many horses' lives each year. It is caused by the toxin from Clostridium tetani, which produces an endless spasm of the muscles in the jaw followed by severe contractions in all other muscles. It ends in a horrible death. Such an end is easily preventable.

Healthy horses should receive a first vaccination when they are weaned. It should be followed by annual booster shots of tetanus toxoid. If a wound might have become contaminated with soil, or if the immunization record for the wounded horse is unknown, the veterinarian will probably inject the horse with tetanus anti-toxin to give it a short-term measure of protection lasting a week or two. Vaccination records should be well-documented in writing and easily accessible for all of your horses. While your veterinarian keeps such records, you should also keep a set of records that travel with the horse.

A fresh limb wound that is bleeding profusely will need a pressure bandage applied as soon as possible. Try to stay calm. A relatively small, and non-life threatening quantity of blood can look like a much greater quantity than it really is. The bandage serves to apply pressure on the hemorrhaging blood vessels and helps to promote blood clotting.

If a large artery is severed, it will be difficult to apply enough pressure, especially if the laceration is any place other than the lower limb, but an attempt to apply a pressure bandage should still be made. The bandage should not be too thick, as this will limit the ability to apply an adequate degree of pressure for bleeding control. Using any one of the following wrappings will work: three sheets of sheet cotton, a quilted shipping bandage, a bath towel appropriately folded, or several layers of roll cotton. Hold the pressure bandage in place with several rolls of an elastic bandage material.

The elastic bandage material should be applied in a smooth, even, and firm manner--there must be adequate pressure if it is to be effective at controlling hemorrhage. This kind of bandage might be too tight for long periods of time, but it can be used at first to staunch the flow of blood. The bandage can be left in place for 20 to 30 minutes, at which time it can be replaced with less blood-soaked material. Or if the bleeding has subsided, it can be replaced with a clean and more loosely applied support bandage.

If the laceration involves the flexor tendons or suspensory ligament, an effort should be made to provide more significant support and immobilization. A Robert Jones bandage and splinting should be applied to the leg while waiting for the veterinarian or before transporting the horse to a veterinary clinic. This sort of support and immobilization can help prevent further damage if the horse attempts to put its weight down on the injured leg. The horse should be moved as little as possible until its injury has been evaluated and repairs have been made.

If the wound is older, bleeding might have subsided or have slowed substantially, but in such a case there might be significant contamination by dirt, debris, and bacteria. With respect to wound repair, there is what is known as a "golden period." The golden period is considered to be the first six hours after the wound was created. If the wound is appropriately cleansed and repaired during this time frame, the chances of complications from infection are reduced. Therefore, it is important to have wounds evaluated and repaired as soon as possible. To decrease the amount of contamination and reduce the risk of complications, cleanse the wound with warm water while waiting for the veterinarian and paint the area with an iodine-based surgical scrub.

In addition to cleansing, the application of a sterile dressing and support bandage can be of great benefit, especially if the horse cannot be seen by a veterinarian right away. If the wound is very old (noted by dried-out skin edges or the presence of pus) and has a great degree of swelling and inflammation associated with it, the use of cold hydrotherapy can be helpful. Use a garden hose to spray cold water on the wound site and swollen tissues. Cold hydrotherapy can reduce some of the inflammation and aid in the clean-up process until a veterinarian can debride the wound properly.

About the Author

Michael Ball, DVM

Michael A. Ball, DVM, completed an internship in medicine and surgery and an internship in anesthesia at the University of Georgia in 1994, a residency in internal medicine, and graduate work in pharmacology at Cornell University in 1997, and was on staff at Cornell before starting Early Winter Equine Medicine & Surgery located in Ithaca, N.Y. He is also an FEI veterinarian and works internationally with the United States Equestrian Team.

Ball authored Understanding The Equine Eye, Understanding Basic Horse Care, and Understanding Equine First Aid, published by Eclipse Press and available at www.exclusivelyequine.com or by calling 800/582-5604.

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