Wound Management

Wounds in horses are unfortunately extremely common and every horse owner should be aware of how to deal with them. Whilst many wounds are small and require little more than cleaning and monitoring closely, some inconspicuous looking wounds can have far more serious consequences than might first appear.  

Assessing the wound

If the horse is out in the field, bring it in to the yard or onto a hard surface where the wound isn’t going to become more contaminated. If the horse is distressed or in pain, don’t take risks trying to examine the horse yourself; call a vet who can sedate the horse in order to assess the wound in a safe manner. It is important to restrain and calm the horse and stem any bleeding with direct pressure and apply a thick gamgee/lint dressing held in place with an elasticated bandage. Assess how comfortable your horse is; if it is lame, call a vet.

Types of wounds

There are 4 main types of wounds:  

Puncture wounds - these may look small on the surface, but there may be significant damage beneath the skin surface. These may be complicated by infection, as contamination is introduced deep into the wound. Often, the skin heals before the underlying tissue. These wounds should be cleaned, lavaged, and encouraged to drain and remain unsutured. 

Incised (slicing) wounds - these normally have smooth edges and are suitable for repair by suturing, stapling or gluing.

Lacerations - wounds that usually leave jagged edges and may cause underlying soft tissue damage and infection.  These wounds may require some debridement (removal of damaged tissue or foreign objects) and are often best managed as open wounds, depending on severity and location.

Abrasions - these are generally minor wounds that require cleaning and can be treated topically.

What are the most common equine wounds?

The most common wounds occur on horse's limbs and are caused by foreign objects such as fences, gates, farm implements and building materials. Wounds on the distal (lower) limbs of horses can be especially difficult to manage because of poor circulation, joint movement and minimal soft tissue between skin and bone. There is also always the risk of contamination from the environment. The smallest most innocuous looking cut or puncture wound can sometimes present a serious problem that may require surgery. Conversely, a wound that initially looks large and severe may require little veterinary attention.  Eye injuries (eyelid tears, pus in the eye, clouding of the eye, the horse holding the eye shut) will require immediate veterinary attention. 

Wash the wound thoroughly with cold water. This will also help reduce any swelling. Mild antiseptic solutions such as Hibiscrub are often used to clean the wound edges, but not deep wounds. Copious lavage or irrigation of the wound will wash away visible and microscopic debris and organisms. The best solution for irrigation is sterile saline with or without dilute antiseptics.  If you can do it safely without further injuring the horse, or yourself, clip the hair around the wound. This will help to assess the wound and keep it clean. Vets will often administer Intrasite® gel into the wound before clipping to avoid contaminating the wound with hair.  It is important to ensure the wound doesn’t involve a synovial cavity - a joint, tendon sheath or bursa. If the wound is large or deep, call the vet; it may require stitching.

If the wound looks simple, you are confident that it doesn’t overlie an important structure and the horse is not lame, you can apply a clean dressing. If in doubt, ask your vet to show you how to apply a dressing. Ideally the dressing should be applied with firm pressure, but not too tightly as this can cause serious complications such as bowed tendons, constriction of the blood supply or restricting return of blood from the area. If it is too loose, it may not stay in place and could cause rubs.

For minor eye wounds, clean with water or a salt solution and apply a cold compress if there is swelling.  More severe eye wounds will require veterinary attention.  

Monitor the wound until it heals fully. If the wound doesn’t seem to be healing well or quickly, there may be a more serious underlying issue which is preventing the wound from healing. If the horse appears to be getting more lame, call a vet; it may be more serious than you first thought.

Allow the wound time to heal if it is large, or if it is obviously being affected by exercise - movement will delay wound healing, so it will take longer to heal completely which in turn will increase the cost of dressing materials etc.

When to call a vet

• If the wound is large or deep or if it is bleeding profusely.
• If the eye is injured - eye injuries can be extremely painful.
• If the wound is near a joint or tendon sheath. Wounds that involve joints or tendon sheaths require surgery to flush the joint or sheath with fluids. If you think it’s close to any of these structures; it is better to be safe than to run the risk of a long-standing infection in a joint which can have serious consequences and will be expensive to treat. If there is a clear, sticky discharge coming from the wound call your vet immediately; it could be synovial fluid from a joint or sheath.
  
  Don’t be fooled into thinking that the wound can’t involve a joint, sheath or bursa as your horse is not very lame. An important point with septic joints or tendon sheaths is that it is commonly the swelling (increased intrasynovial pressure) within the joint, tendon sheath or bursa that causes lameness. Therefore, if there is an open wound communicating with a joint, for example, fluid will be leaking out and there will not be any swelling. Once the synovial lining closes, the joint will swell and the increased pressure will cause the severe lameness expected with a septic joint.
• If something has penetrated the sole of the hoof.  Mark the spot where an object has penetrated the sole for the vet to explore.
• If your horse is lame - the wound might involve a joint or other important structure that will require veterinary attention. There may also be damage to the underlying bone which will be much more serious than the small cut that a kick often leaves on the skin.
• If the horse has been kicked.  There are several area on horses’ legs which are covered with little more than a thin layer of skin. If a horse is kicked in one of these areas, there may be a fracture of the underlying bone.
• If the lameness worsens. 
• If the wound isn’t healing or worsens. 
• If 'proud flesh' appears within or around the healing wound.