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  Discussion on Correct wound care for road rash ( stone dust racetrack) injury
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Member:
rtrotter

Posted on Sunday, Oct 19, 2008 - 4:30 pm:

Dr. O,

This is a unique situation that I could not find covered under the wound care topic. So I am posting this here. If it needs to be moved please feel free to do so.

On Thursday of this week, one of my racehorses was involved in an accident during a race. It was a really freak thing as the horse that caused the accident hit three pylons, the third pylon cracked and went flying backwards and scared the horse in front of my horse causing that horse to break stride and basically stop in my horse's path. This caused my horse to take up sharply and she wound up falling down on the stonedust track. The driver saved her from more severe injuries because he basically bounced up and made sure she stood still even with the racebike still attached to her. It happened right in front of where we were sitting and watching the race so we were able to get to her quickly. To her credit she seemed to know everyone was there to help and managed to stay calm even when the horses were coming past her as she was walking off the track.

Both her knees and her right shoulder seemed to take the brunt of the fall, but she was not unsound, walked back up to the race paddock and seemed like she took it all in stride. I was amazed at her coolheadedness ( She can be a pistol sometimes).

The vet washed out all the injuries and flushed them with saline solution, gave her a shot of bute and banamine for pain and a shot of Naxcell ( Intramuscular) as an antibiotic and bandaged her up with nolvasan. I followed up with my own vet the next day. He gave her bute and changed the antibiotic to Tetracyclaline. One knee there was very little fill, the other knee was only slightly swollen. The shoulder seemed ok.

She towed three miles (Saturday) with her knees covered, all looked well. The vet looked at her, said she was ok and to keep doing what I was doing.

Today, I did the same thing, only the bandage slid down so her knees were not covered up. I washed them with diluted betadine and let them dry. The vet was there to treat her right after she towed and at that time her knees looked good ( No bute,today Sunday. I left her open for about an hour and when I went back, one of her knees had blown up, the other one was fine. I did her up the same way with Nolvasan.The vet gave me two bottles of sulphur pills to use for the next 10 days.

I am afraid of a staph infection, will the sulphur pills be sufficient to treat this type of infection or should I ask the vet to treat her with something else?

She still seems to be in good spirits, has no temperature, is eating well and does not appear to be sore or unsound at all. The only thing she is mad about is that she can't go outside because she is bandaged 3/4's of the way up her front legs to keep her knees clean.

I just want to know if we are appropriately caring for her wounds or is there something else, I should or shouldn't do?

Thanks
Rachelle
Member:
corinne

Posted on Sunday, Oct 19, 2008 - 7:14 pm:

Rachelle...sorry to hear about your mare's accident. I am glad there were no other injuries to the drivers or horses and that she stayed calm while attached to the bike.
From what I gather the antibiotics were started prophylactically due to the dirty nature of the wounds. In the subsequent visits from the vets did they culture so they can make a precise determination about what spectrum antibiotics to put your mare on? Is that an option?
In my experience and from reading about others in similar situations who had horses with serious wounds on or near joints it has been recommended that they be left open to air to drain, with water lavage up to three times daily to keep the wound moist to facilitate drainage. Is there a reason the vet is keeping these wounds covered? Especially since they are not clean due to the nature of the track debris? I would be curious to hear.
Hopefully Dr. O will get back soon. Keep up your diligent care!

v/r
Corinne
Member:
rtrotter

Posted on Sunday, Oct 19, 2008 - 7:59 pm:

Hi Corinne,

No, my vet has not cultured. When he has looked at the wounds they have not looked infected, although there is some serum coming out of one knee. I got concerned today because I did leave the knee open and it was very swollen. He gave me some red salve to put on her shoulder and that seems to be healing up well, but he wanted me to wait before I started applying it to her knees. The red salve is furacin paste and iodine. The knees are draining into the gauze and cling wrap I put on under the sheet cotton.

I am going back to the barn in a few minutes and depending on what I see may rewrap it. I just hope it looks better then it did when I wrapped it earlier today.

As far as water therapy. I have been giving her a bath with Nolvasan scrub, mostly for her shoulder, but her knees get it too just from the water dripping down her. She gets cold water hosed for 15 minutes on each knee, but I've only been doing it once a day.

I've been bandaging her because that's what the track vet said to do, but tomorrow is the last day. I'll check with my vet and see if he thinks I should leave her open. She really wants to go out, but I am afraid she'll roll and then I will really have a problem.

Thanks for your advice.
Rachelle
Member:
corinne

Posted on Sunday, Oct 19, 2008 - 8:29 pm:

Rachelle,
Yes I would be curious to hear what your vet says about the wrapping and perhaps it was indicated in this case due to the surface area.
Having had multiple wounds on knees with my horse and others in the barn (one horse ripped off all his knee flesh in barbed wire) risk of infection being trapped in by the bandage which could then travel to the joint outweighed risk of the wound getting dirty at least in those cases.
As always you need to follow your vet's advice. I personally sware by the wound care articles here which have served many severely injured animals with wonderful results.
Once again good luck with the antibiotics and wound care! Please keep us informed as to her progress. You never know when you are going to need to treat a different type of wound such as the one you describe.

Have a good night. Give her a carrot from me!

v/r
Corinne
Member:
corinne

Posted on Sunday, Oct 19, 2008 - 8:33 pm:

PS None of the barns I board at use Barbed wire!
Member:
rtrotter

Posted on Sunday, Oct 19, 2008 - 10:02 pm:

Corinne,

The day the accident happened, the knee that looks the best now looked the worst. It appears to be healing nicely and I can probably not bandage it tomorrow and start the red salve treatment. The other one I will wait and see what it looks like. I was going to redo it tonight, but I did not have another roll of vet wrap, so I will wait until tomorrow morning to check it out.

The one that is the most swollen does have more road rash surface area to deal with plus a hole at the very top of the scrape. I think the reason the vet had me keep her bandaged using the nolvasan was to keep the wound moist and draining at the same time.

I think what I'll do with her tomorrow, assuming the knee comes down by itself is after she jogs, I'll do her up without the big sheet cotton put some elastoplast on her and turn her out. After she does her little routine which includes a roll in a sand pit, I'll take the bandage off and put the red salve on. She usually doesn't roll a second time, so I feel relatively safe leaving her outside. The cold air will do her good and her buddy misses her.

I'll give her your good thoughts and an extra carrot from you.

take care
Rachelle
Moderator:
DrO

Posted on Monday, Oct 20, 2008 - 8:01 am:

Hello Rachelle,
Concerning the antibiotic I see no problem starting with potentiated sulfa drug for such a wound unless you have known resistance problems on your farm. Prevention of infection will be more dependent on the wound care than the antibiotic used. Not having examined the wounds I really cannot comment on the appropriateness of what you are doing. A deep skin scrape I would be treating like a open wound in our recommendations in Diseases of Horses » Skin Diseases, Wounds, and Swellings » Wounds / Burns » Long Term Deep Wound Care. As to the swelling in the knee, treatment would depend on whether this was in the joint or subcutaneous.
DrO
Member:
rtrotter

Posted on Monday, Oct 20, 2008 - 10:30 am:

Dr. O,

After I read Corrinne's posts and read the article on Deep wound care, it appears I have been doing everything right. Her knee that was swollen from yesterday was down quite a bit this morning and they were left open for about 2 hours, so I could tow her. I did put nolvasan on before I went out to tow(5 miles today, no soreness or stiffness) and the fill came out a bit more by the time I came back in. She got a bath and I hosed her knees as per the article with a little more force than I had been doing. The crud started to come off and I can see pinkish skin after most of this washed off. So, I think I am going in the right direction. I put Nolvasan on both her knees and lightly bandaged them with a gauze pad, a cling roll of gauze and a very lightly wrapped vetwrap. As soon as she is cooled out, I am going to turn her out and hope after 5 days of being stall bound and only jogging, she won't be too much of a nut. I'd leave the bandages off, but I do not want her to roll and get more dirt in an already compromised situation.

I'll post an update as the days go on.
Moderator:
DrO

Posted on Tuesday, Oct 21, 2008 - 5:48 am:

Sounds good Rachelle,
Swelling that returns in the stall might be best dealt with by pressure wraps while up.
DrO
Member:
rtrotter

Posted on Monday, Oct 27, 2008 - 7:44 pm:

**Update** 10/27/2008
Knees blew up significantly a few days ago. Filly is now on sulphur pills and penicillin. She is still towing 5 miles a day is in good spirits, has normal vital signs. I have gone back to cleaning wounds once daily ( per vet) with antibacterial soap and water and after several attempts at finding something that doesn't bother her knees, I have returned to nolvasan twice a day. I think she likes it because its cool. Everything else just seemed to irritate her ( and her knees more). She is on 2 gr. bute morning and night and I intend to keep her on it until I see significant healing. She is also on a probiotic( per the vet) to maintain her gut.

I think this is going to be a longer process than I anticipated. I do not like the fact that every time the vet takes her off the bute her knees swell up.

How long can a horse stay on bute?

Rachelle
Moderator:
DrO

Posted on Tuesday, Oct 28, 2008 - 7:22 am:

Hello Rachelle,
You will find a discussion on the long term use of bute in the article on the drug. Considering the nature of the injury and that it has only been 10 days still having trouble with edema is not surprising, this may be something you are dealing with NSAIDS as long as there are any open sores causing a active edema and then for months with wraps to control the passive edema. For a better understanding of active and passive edema see Diseases of Horses » Skin Diseases, Wounds, and Swellings » Swellings / Localized Infection / Abscesses » Diagnosing and Assessing Swellings in Horses.
DrO
Member:
rtrotter

Posted on Tuesday, Oct 28, 2008 - 3:27 pm:

Dr. O,

I sure hope its not months, although when I raced another horse last Friday, I was right next to a horse that fell down going to the track back in August. His knee still had a hole in it and it looked like it was still swollen. so I guess it might be months for me too.

As far as long term use of bute for this particular horse. First, she is young ( 3 ), second, prior to this accident she had only gotten injectable bute once before for another cut on her hock and that was only for a day or two. She has never had oral bute, except for the last few days. If her knees continue to look as they did today, I am going to start weaning her off the 2 gr. twice a day. and get her down to a lower dose, partly because she is on sulfur/ trimethoprim pills ( she is on her 2nd 10 day treatment).

Her wounds right now, look to be closing up. The left knee has gone from a nickel size hole to smaller than a dime and there does not appear to me much stuff coming out of it at all.

The right knee which is the one I am most concerned about and is the one with the most edema, still has a hole the size of about 1/2 a quarter, but that is getting smaller as well. It still has some stuff coming out of it but not as much as it did.

Now that I am at this point, what should be my next step? I saw in the article on bandaging that poultice is a good choice. I purchased some Equisportz Hoof poultice ( for the shape of it, it looks like it will conform well to the front of her knee). Each layered pad contains 0.39 Tragacanth and 1.12g Boric acid. It can be used wet (hot or cold) or dry. I'd like to use it wet cold.

Now the questions: Can I apply this directly onto her knees hold it in place with a rolled gauze pad and a pressure wrap. (Yes, I am experienced with how to do this properly) or should I put something between the poultice and the knee (another roll of gauze)and then wrap with a pressure bandage?

Can I still put nolvasan on under everything or will the poultice be enough?

Should I sweat over the poultice with plastic wrap? ( Which may keep the wrap in place a lot better)

I am hoping that by putting the pressure bandages and poultice on it will significantly lower the amount of bute I need to keep her on and it will enable me to discontinue the bute much more quickly. I also hope that the edema will eventually resolve itself

Thanks in advance for your advice.
Rachelle
Moderator:
DrO

Posted on Tuesday, Oct 28, 2008 - 8:43 pm:

As to the question of what to do now, I cannot answer this question without examining the wound and your next step should be following your veterinarians recommendations. Of course we think you should use our articles to educate yourself and if the recommendation differs I would like to know why.

I think it always a good idea to cover all open wounds whether under a poltice of not with a good antibiotic ointment as described in the article on long term wound care. I cannot think of a good reason for sweating an open wound, you have more success keeping active edema out by keeping it cool. You can probably think of times that acute edema turned into a chronic problem. This is usually because it was not properly controlled during the acute phase and stretched the tissues. This process is explained in the article on swelling I reference above.
DrO
Member:
rtrotter

Posted on Wednesday, Oct 29, 2008 - 5:29 pm:

Dr. O,

What a difference a day makes. After I posted my update and my questions. I went back and wrapped the bad knee, first with the poultice pad cold and wet, I held this in place with the rolled gauze cling wrap and then vet wrapped the entire thing including the top part of the bandage, so it would not fall down during the night.

It worked, the knee looked great this morning, the poultice got quite a bit of the fill out, not much gunk at all coming out and I can see the hole starting to close up. I redid it again after she towed. I think I need to do this as soon as she comes in and not let it fill up by leaving it open for even an hour.

I did talk to my vet and he says what I am using is fine to use over an open cut (the hole in her knee)and to continue pressure wrapping it.

Today was her last day of penicillin, so lets hope this keeps on healing and I do not get any residual infection down the road.

Your articles and advice were very helpful through all of this. Thank you!

I'll keep you posted.

Rachelle
Member:
vickiann

Posted on Thursday, Oct 30, 2008 - 11:02 am:

Great news, Rachelle. Keep up the good work.
Moderator:
DrO

Posted on Thursday, Oct 30, 2008 - 6:28 pm:

Good to hear Rachelle.
DrO
Member:
rtrotter

Posted on Tuesday, Nov 11, 2008 - 9:05 pm:

**Update**

Filly is doing great, she's just ornery when I wash her knees. The hair has started to grow back on her shoulders and on her knees. The holes are closing nicely and the swelling in both knees has gone down considerably. I do not yet see any proud flesh forming.

Her knees do not bother her ( except when I bother them to wash them) She flexes sound and jogs sound. If all goes well she will start training back Saturday and will probably be ready to qualify by the end of the month. She really had no down time during this whole ordeal, never missed a day of jogging until a few days ago when I turned her out for the first time (I thought she and I both needed a break).

I am very proud at the way she has handled everything(from the accident to the recovery and rehab process),she showed her true colors and her great standardbred stoicism and breeding. And no matter what happens down the road there will always be a place in my heart for her.
Rachelle
Moderator:
DrO

Posted on Wednesday, Nov 12, 2008 - 8:26 am:

Sounds good Rachelle,
DrO
Member:
vickiann

Posted on Wednesday, Nov 12, 2008 - 4:45 pm:

Great news, Rachelle.

You did a good job.
Member:
rtrotter

Posted on Thursday, Dec 4, 2008 - 10:07 pm:

** Road rash update**

My road rash filly qualified today and finished 3rd. Driver said she was good. Not on any lines and if he hadn't been the one driving her when she was in the accident and saw what her knees looked like, he wouldn't have believed it was the same horse. He didn't even pop out her earplugs.

Almost all of the swelling has left, she is only a little fussy about her knees, but I think thats more because I paid so much attention to them when she was rehabbing. I was very pleased with her both today and throughout this whole process.

Thanks to everyone and especially you Dr. O. I'll post a win photo of her the next time she wins a race. That may be a while, she needs a few races to get her back into shape.

Rachelle
Member:
scooter

Posted on Friday, Dec 5, 2008 - 6:44 pm:

Great Rachelle, and Congrats on the 3rd place, looking forward to the win photo
Moderator:
DrO

Posted on Sunday, Dec 7, 2008 - 3:38 am:

Great to hear Rachelle.
DrO
Member:
rtrotter

Posted on Thursday, Dec 18, 2008 - 6:33 pm:

Well folks,

It took a lot less time then I thought to get that win I talked about in an earlier post.

My road rash filly was a monster today winning by open lengths over a sloppy track.

I will probably get the win picture after Christmas and I will post it then.

Thanks all
Rachelle
Member:
warthog

Posted on Thursday, Dec 18, 2008 - 7:39 pm:

we had an experience with a horse next door that emphasized just how essential it is to get a wound clean when it happens. The horse was injured on a fence - part of the the skin on the knee was ripped off. The wound was hosed down, the vet sutured it and gave the horse antibiotics. The owners requested that the vet put in a drain but the vet refused.

The wound got worse and worse and worse despite hosing three times a day, culture, antibiotic, wrapping and a lot of expense. Finally the owner had to get a surgeon to go into the wound and clean it out, open the top and install a drain. The wound has finally healed and the horse is now sound although the knee is still swollen. The surgeon expects the swelling to continue to diminish but this has been horrendous and to the point where the owner almost had the horse put down she was in so much pain despite the bute and antibiotics.

So when you get road rash or any injury where there is a remote possibility that it is dirty, clean, clean clean that wound and get a surgeon in a few days if you aren't satisfied with how it's healing. It'll save you money in the long run and it'll save the horse a lot of pain.

So glad your horse had rapid and complete healing!
Member:
jowidner

Posted on Thursday, Dec 18, 2008 - 8:31 pm:

Congratulations Rachelle. Looking forward to the winning pic!
Member:
canter

Posted on Friday, Dec 19, 2008 - 7:32 am:

Great news, Rachelle, and a testiment to the great care you gave your filly.
Member:
rtrotter

Posted on Saturday, Dec 27, 2008 - 7:33 pm:

As promised here is Wicked Persuasion's win photo from December 18, 2008. almost exactly 2 months from the date of the accident. That's hubby in the picture, next to the driver.

This is also my first attempt at using Picasa to resize the photo, so I hope it comes out well.

WP win photo 12/18/2008


Rachelle
Member:
ekaufman

Posted on Saturday, Dec 27, 2008 - 9:18 pm:

Thanks so much Rachelle! Nice photo, and beautiful condition on that filly. Not a hair out of place for her victory photo.
Member:
juliem

Posted on Saturday, Dec 27, 2008 - 9:44 pm:

Ahh, sweet, sweet victory!
Member:
scooter

Posted on Saturday, Dec 27, 2008 - 10:02 pm:

Great pic Rachelle, beautiful filly...congratulations
Member:
frances

Posted on Sunday, Dec 28, 2008 - 5:41 am:

Very nice - well done!
Moderator:
DrO

Posted on Sunday, Dec 28, 2008 - 9:18 am:

I agree a very nice looking filly.
DrO
Member:
maggienm

Posted on Sunday, Dec 28, 2008 - 9:40 am:

Wonderful picture, congratulations.
Member:
lilo

Posted on Sunday, Dec 28, 2008 - 11:38 am:

Congratulations! I just love happy endings! Lilo
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