Wound Care and What to Expect When the Vet Arrives

1. I recently had an 18-year-old gelding wrap a 2-3" diameter grape vine around his back hips and then on around the left leg at the knee joint. The more he pulled the tighter it got until he had broken the tissue and to the bone. Based on our best educated guess, we believe him to have endured this between 2-3 days total. We discovered the injury two weeks ago tomorrow. Against the grain of odds, he has been doing remarkable until about two days ago. Our veterinarian ran out of antibiotics and because we had been giving him four grams of Bute per day (2 am/2 pm), she had us to not give him anything for a minimum of 48 hours. After about 72 hours, she called a prescription of antibiotics into our pharmacy until she could come out. Now, I am seeing blood clots and extensive swelling that we had not been seeing before. He is now off his food/water intake. I believe mostly due do to the pain. The wound itself was making progress, even though the area kept getting wider. I soak his leg with the water hose daily (we have well water and it is very cold) flushing out as much exudate as possible. I then let it air dry a little (not all the way) before applying a layer of alumnashield. I wrap with several gauze bandages including putting some large feminine pads over the wound before wrapping in gauze wrap and then elastic wrap. Could you provide advice on other treatment options? Also, what would you recommend to include in his diet for weight gain as he is losing weight, including muscle mass pretty rapid. I have numerous photos. Some the day after discovery up to and including this past week. Your expertise would be greatly appreciated. (View Answer)

   From your good description of events, it sounds like you, your horse and your veterinarian find yourself in a very challenging situation. Few of us would be experienced or comfortable dealing with such extensive injuries that potentially involve a lot of tissue damage, infection, open wounds, and something that is likely to be very painful for the horse. It sounds like what you have done so far has helped considerably, yet I doubt there is a clear path forward to outline. The same principles that apply to all wound management are still your best options. Those include infection control with antibiotics, which means using a drug that is cost effective, safe for long term administration and appropriate for the likely range of bacteria involved. Common ones include penicillin, sulfa trimethoprim combinations, and perhaps one of the long acting ceftiofurs such as Excede. Your veterinarian must consult on this selection. 

   The second principle is wound management, which includes protecting tissues that are still viable (those that bleed), removing dead or necrotic tissue, promoting drainage if needed and preventing further tissue damage from long term exposure to air or the use of chemicals that are toxic to tissues. Alumashield products are very popular but may not be the most tissue friendly in the early stages of healing. Saline soaked pads are very helpful to keep the tissue moist and there are recipes available to make your own saline solution.

   Finally, you need to address pain management. Non-steroid anti-inflammatory drugs (NSAID) do have side effects but can be used for long periods at safe doses. For Bute, that is probably 2 grams or less daily. There are newer NSAID's such as Equioxx that have a better safety profile. There are also other drugs available, including published doses for acetaminophen (Tylenol) that can be used alone or in combination.

   Regarding a choice of feed, the primary goal is to provide conditions in which the horse's appetite is maintained (pain control) and select a highly nutritious food with good palatability. Alfalfa hay generally meets those criteria and you can also use formulated diets that are higher in fat content for added calories.

   Don't give up on your horse and follow your veterinarian's advice on care. Keep in mind, long term quality of life always needs to be on your mind. Gary Hanes, DVM, Woodside, CA

2. Do you recommend using DMSO gel on a foot wound that occurred three months ago? The horse continues to be lame and the foot has a thick ring of scar tissue that goes around the top of the hoof that feels soft when palpated. I have been told that the DMSO gel will help with inflammation. I also think he may have harmed a tendon upon injury as it was severe. (View Answer)

   I'm sorry to hear that your horse suffered a severe wound three months ago and is still lame.  Scar tissue, which is what you now describe, is almost always going to result from an open wound that is not amenable to closure (suturing) at the time of injury and this is often the case with lower leg wounds in horses.  DMSO has been around for at least 40 years and credited with having all sorts of medical uses, including reduction of inflammation.  The fact is there is virtually no scientific proof that DMSO is medically useful beyond treating non-infectious bladder inflammation and perhaps when used very early in acute neurologic trauma and inflammation.  It is a solvent that penetrates the skin and can serve to carry other drugs through the skin barrier, but even this usage is limited.

   What you need to focus on now is finding out what is causing the lameness and if anything can be done to alleviate it in order to have a riding horse again.  A severed tendon can take up to a year to fully heal if that was part of the original injury, but without investigating other possibilities, you simply will not know what to expect in the end.  In my opinion, DMSO treatment would be a waste of time and money and only further delay your understanding of the actual cause of his problem.

   I wish you all the best in getting him better. Gary Hanes, DVM, Woodside, CA