Wounds: Nightmare or Nuisance?

You go to catch your horse for a ride and there it is?a big, ugly laceration right in the middle of his chest. You panic when you see blood running down his leg, and it looks like he’s cut right down through the muscle. Now what?

Illustration by Kip Carter

Breathe. Relax. Believe it or not, even a big, deep laceration in your horse’s chest is likely to heal quickly, and without much trouble. Why? Because it’s an area with large muscles, good blood flow, and few critical structures at risk of being damaged. But if you find a tiny little puncture at the back of your horse’s pastern, that’s another story. Even the smallest, most benign-looking wound in that area could mean trouble.

In this article, I’m going to help you understand what makes a wound more serious, and why. First, I’ll give you a quick rundown of the five critical factors to evaluate when faced with any wound. Then, I’ll give you some real-life scenarios so you can decide whether that wound is a nightmare or a nuisance?and what you should do about it.

Factor 1
Location, location, location. The location of a wound is one of the most important factors in determining its severity. If it’s over a well-muscled area of the upper body like the chest or croup, you’re in luck. There’s good blood supply and few critical structures to complicate healing. It’s likely to heal well, even if it’s big and deep.

The same is true for wounds on the head. They often heal quickly and well with few complications, even if they look horrifying at the start.

Wounds on the lower legs, especially those below the hocks and knees, are typically more difficult. Blood supply may be limited, and there’s little extra tissue between the skin and the more critical underlying structures. A wound that’s directly over a joint or tendon sheath is the scariest of all because penetration risks infection of one of those critical, closed-off structures?a potentially life-threatening complication.

Factor 2
Other signs. Is it “just a wound,” or is there some other symptom that could mean something more? Most commonly, excessive bleeding may be cause for concern, and might happen any time a large vessel is disrupted. If blood is bright red and spurts in pulses, that’s the most concerning of all, as it means a high-pressure artery is likely to be involved.

Lameness is another sign that a wound might be serious. If your horse is lame with a wound, a critical structure such as a joint, tendon, or ligament might have been damaged. Severe lameness might also mean a more serious injury, such as a broken bone.

Finally, if the wound is on your horse’s face, signs such as squinting or tearing might mean his eye’s been damaged. Blood from his mouth, or difficulty chewing, could point toward an injury to his teeth or jaws. Anytime a wound is accompanied by another problem, it’s likely to be more serious, and to require special care.

Factor 3
How deep? The depth of a wound is important for helping you decide just how serious it is, and whether it needs sutures.

To determine just how deep it is, try to separate the edges by putting pressure on either side. (It helps to clean the wound with cold water from a hose before this step.)

If the wound is fresh and you can pull the edges apart, it’s likely to have penetrated the full thickness of the skin and would heal best with sutures (unless it’s a puncture wound; see page 2). If you can’t pull the edges apart, chances are it’s just an abrasion and sutures won’t be necessary.

Keep in mind there are areas on your horse’s body where the skin is up to one-quarter-inch thick, meaning a deep abrasion can look much more frightening than it is. Most non-full-thickness injuries will heal without much trouble.

Finally, a very deep wound, even if it’s small, might end up as the most nightmarish of all, due to risk of penetration of more important deeper structures?taking us back to location as a crucial factor. A tiny but deep wound over a joint may turn out to be a much bigger issue than a huge abrasion over a well-muscled area.

Factor 4
How big? If all other factors are equal, size does matter. A wound that’s less than one-half inch in length typically won’t need sutures, even if it’s a full-thickness deep through the skin. A wound that’s between one-half and one inch might heal better with a stitch or two, and a wound that’s longer than an inch will almost always heal better if it’s sutured.

Again, though, location plays a role in this decision. A longer wound on the well-muscled upper body is likely to heal even if it isn’t sutured, while a shorter wound on the lower legs will be much more problematic if left to heal on its own. As a general rule, a call to the vet is an important step for any full-thickness lower-leg wound.

Factor 5
How old? It’s always best if you discover a wound immediately so that you’re able to make a treatment decision right away, while the damage is fresh. Fresh wounds that are attended to immediately are much less likely to become nightmares than are wounds that are days or even hours old.

Excessive swelling or drainage of yellowish/brownish thick fluid are two signs that a wound is older and possibly in need of special care. However, contrary to popular belief, even a wound that’s a day or two old may often still be sutured, and will heal much better as a result.

Now that you know the five basic factors to evaluate on any wound, let’s take a look at some common wound scenarios and whether the wound in each will become a nightmare or a nuisance.

T-Post in the Chest
You see: Your horse meanders in from pasture with a six-inch-long gash in the center of his chest. There’s blood dripping down his legs and a flap of skin hanging loosely from one side of the wound. You see shredded muscle underneath the skin, but the horse seems happy. He’s not lame, and he is noisily demanding dinner.

Your assessment: There’s bleeding, but not a lot, which means the wound is likely fresh but no major vessels have been cut. It’s deep, but because your horse isn’t expressing serious pain, it’s unlikely any significant deeper structures have been injured. What to do: Call your vet, as this wound will heal best with sutures. While you wait, you can clean the wound with a gentle spray of cold water. And if your vet is several hours out because of another emergency, there’s no need to panic. The wound most likely looks much scarier than it really is.

What to expect: Your vet will clean the wound, explore its depth, and confirm that no important deeper structures have been penetrated. He or she will likely perform a deep layer of sutures to hold the muscles together before repairing the skin over the top. The vet also might place a rubber drain inside the wound to encourage drainage. Your horse will be given antibiotics to prevent infection, and an anti-inflammatory to minimize pain and swelling, and you’ll probably be asked to flush the wound daily to keep it draining. Either

> you or your vet probably will remove the drain after three to five days.

Some sutures may pull out as the wound heals, but in general it will heal well, typically within two to three weeks. This wound is more a nuisance than a nightmare.

Head Gash Near Eye
You see: You arrive at the barn to see a beautiful?and bloody?face peering out of a stall. On closer inspection, you see the horse’s eye is swollen shut, and there’s a two-inch-long gaping wound on the side of his head.

Your assessment: The wound is big and gaping open?the skin edges are easily separated. It’ll need sutures. The swelling is worrisome because it might indicate the eye’s been injured.

What to do: Call your vet. If the horse will let you ice the eye area, the swelling might go down, but there’s probably not much you can do to clean the wound until your vet arrives.

What to expect: Your vet will do a thorough exam of the eye, including applying a stain to the cornea (the clear, outer covering of the eye) to make sure it hasn’t been scratched or ulcerated. He or she will also carefully palpate the bones around the eye socket to look for possible fractures. If the eye appears normal, and no likely fractures are detected, the vet will clean and suture the wound. Your horse will be given antibiotics and an anti-inflammatory. This wound will probably be completely healed within two weeks, and with minimal scarring. Although scary at first, the fact that the eye wasn’t damaged turns this potential nightmare into a simple nuisance.

Fetlock Cut
You see: A horse comes hobbling in from the pasture with a hugely swollen fetlock joint. You clean it up, and all you can find is a half-inch wound at the back of the joint. There’s no bleeding, but there’s a goopy-looking discharge coming from the wound.

Your assessment: The wound itself doesn’t look too bad, but it’s located over the fetlock joint, and the horse is very lame. It’s possible the joint or tendon sheath has been penetrated, or that there’s an accompanying injury such as a fracture. The swelling and discharge means the wound most likely happened a day or two ago.

What to do: Call your vet right away. Even though the wound is small, the location and other signs are serious cause for concern. Cold-hose the area while you wait.

What to expect: Your vet will begin by cleaning and exploring the wound to determine whether the joint or tendon sheath appear to have been damaged. Due to the degree of lameness, he or she might decide to take radiographs (X-rays) to rule out a fracture, and/or to place a needle in the joint and flush it with fluid to help determine whether there’s joint penetration. If the joint’s involved, the vet is likely to suggest transporting your horse to a surgical facility where the joint can be thoroughly flushed under anesthesia. Your horse will be on “big gun” antibiotics, and his long-term prognosis could be dicey. This one is a definite nightmare.

Cannon-Bone Gash
You see: Your horse shows up for feeding time, and you see a wide gash all the way down the length of his cannon bone. There’s not much blood, but it looks like a really deep wound.

Your assessment: The horse appears to be completely sound. The wound starts just below his knee, and runs about six inches along the front of his cannon bone. The edges of the wound look like they’re separated by about one-half inch, but when you explore further, you discover that you can’t pull them any farther apart.

What to do: You can probably manage this deep abrasion without a vet call, as long as you’re comfortable with basic first-aid. The wound won’t need sutures if the full thickness of the skin hasn’t been penetrated and if it’s not close to any joints. Cold-hose the area to clean the abrasion and help control swelling. Dress the wound with a basic antibiotic ointment such as Neosporin, and apply a stable bandage.

What to expect: It could take a couple of weeks for this wound to completely heal, but your horse should have little down-time because of it. This deep abrasion is just a nuisance.

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