First Aid & Wound Management
Types of wounds
- Puncture wound
- Incised wound
It is very important to us to have some information about the injury before we attend your horse, so here are some tips on how to assess the situation and deal with it correctly before the vet comes:
DO NOT PANIC
- Is the horse in a safe place?
- Is the wound bleeding profusely?
- Where is the wound and which structures are potentially involved?
- Can the horse be moved to a stable (Is the horse lame?)
- How old is the wound?
Horse trapped in wire/fencing
- Try and keep horse calm (Feed if standing)
- Sit on neck (away from legs) to keep down if on the floor
- Cut fencing to free horse ASAP
• Do not remove foreign bodies from wounds prior to the vet arriving unless specifically instructed to do so by your vet
- Is the blood jetting from wound (arterial bleeding)?
- Apply tourniquet (towel, jumper, shirt) ABOVE the wound and /or dressing over the wound.
- Ice might help if available
- Venous bleeding is slower and darker in colour.
- Apply direct pressure on wound.
- Do not hose.
Where is the wound?
- Proximity to joints/ tendons (beware of puncture wounds!)
- Penetrating wound on the sole (nails)
Wounds (often puncture wounds) that penetrate synovial structures (joints/tendon sheath/bursa) require immediate veterinary attention. Straw coloured, sticky fluid (synovial fluid) oozing from the wound would be indicative of this. These need to be treated aggressively (surgical flush) ASAP to ensure the best possible chance of a successful outcome.
Horses become very lame within 24-48 hours (or sooner if foreign body involved) of original wound and the affected joint/tendon sheath will be distended. Horses can quite often be pyrexic (fever) and exhibit general malaise.
If a wound is superficial and away from “dangerous” locations (i.e. Joints, tendon sheaths) clean with water, being careful not to drive foreign material into the depth of the wound.
A slight swelling around wound is to be expected.
If lameness/ more severe swelling develops, call the vet!
- Primary closure (suturing)
- Delayed primary closure
- Second intention healing
Primary Closure (suturing)
Incision sites and lacerations. To achieve primary closure, the wound must be no more than 6 hours old and must be ‘clean’ or able to become ‘clean’.
Sutures can breakdown due to infection, excessive tension on the sutures or swelling. The skin on the lower limbs is under a great deal of tension so wounds in this area are not often closed by primary closure.
Drains may be left inside the wound to relieve the tension on the area or to help with drainage of fluid and reduce any swelling. This drain will normally be removed after 10 days.
Delayed primary closure
Delayed primary closure is used to close wounds which are clean or clean-contaminated but have extensive tissue damage. Initially the wound is left open, or partially open to aid removal of contamination/infection within the wound or until the wound is free of necrotic tissue. The wound is then sutured once it is clean and healthy.
Second intention healing
Second intention wound healing is used for wounds which are over six hours old and/or unclean and therefore cannot be closed by stitches. The wound is left open and granulation tissue fills the wound from the base upwards. Once the granulation tissue has reached the margins of the wound, the wound begins to contract. The contraction process in the lower limbs is often poor, particularly in horses.
Excessive granulation tissue (proud flesh)
Excessive granulation tissue occurs when the body continues to produce granulation tissue beyond what is required. This tissue can form a ‘mound’/’hill’ of tissue which must be removed in order for the wound to be able to close. Excessive granulation tissue usually occurs due to the wound becoming infected or if there is necrotic tissue present.
Cleaning a Wound
- Diluted antiseptic (Hibiscrub/iodine) , especially if wound old or grossly contaminated.
- Shave if appropriate (hydrogel/swab to prevent wound contamination with hair).
- Sterile saline solution.
Creams, Ointments and Sprays
Your vet may dispense a product to apply to the wound as a barrier or to use under a dressing.
- CLEAN WOUNDS – Sterile hydrogel or manuka honey may be used under a dressing
- INFECTED WOUNDS – These may require debriding and/or a cream which contains an antiseptic or antibiotic
- GRAZES/SORES – Once clean, these usually only require a barrier cream/spray in order to protect the area from flies and dirt from getting in. Barrier sprays such as silver spray are useful to keep in your first aid kit for these types of wounds.
- EXCESSIVE GRANULATION TISSIE – If your horse’s wound has developed excessive granulation tissue, the vet may prescribe a cream to help reduce this.
**If you require a vet to examine a wound on your horse, please DO NOT apply creams prior to the visit, e.g. Sudocrem is a good barrier cream however, it is a very challenging substance to remove from a wound and could adversely affect the healing especially if the wound was to be sutured**
Below are the layers of a lower limb bandage, starting from the layer nearest to the wound:
- Ointment (if required) – usually hydrogel or manuka honey
- Dressing material – Melolin / Allevyn / Primapore (depending on the type of wound)
- Orthopaedic paddingg. Soffban (10cm for ponies 12.2HH or under, 15cm for ponies/horses over 12.2HH)
- Padding layer – Cotton wool or gamgee (30cm long gamgee for ponies, 45cm long gamgee for horses)
- Conforming bandageg. knitfirm (10cm for ponies 12.2HH or under, 15cm for ponies/horses over 12.2HH)
- Cohesive bandageg. Vetrap (10cm for all horses)
- You can seal the top and bottom of the bandage using cohesive bandage tape if required (e.g. Elastoplast) however, please note that this is difficult to remove so should not be applied unless required.
Other bandaging materials can be useful for bandaging difficult areas such as presage boots for bandaging around the hocks or hoods for bandaging neck wounds.
Sometimes, your horse will need systemic medications to assist with managing their wound. This may include a course of antibiotics, pain relief, anti-inflammatories and tetanus anti-toxin if they are not vaccinated against tetanus.
Wounds Involving Eyes
Wounds involving eyes are always treated as a priority and we would always encourage early treatment to prevent further damage to an eye. Always call your vet as an emergency if the eye appears painful, closed or the colour or shape of the eye appears unusual.
The vet will examine the eye and apply fluorescein stain to check if the cornea is damaged. The vet might prescribe some medicated eye drops for your horse to help with healing.