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Discussion on Anterior hock laceration
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Posted on Thursday, Jun 27, 2002 - 5:22 pm:
3-1/2 weeks ago my 9yo TB jumped through/over wire fencing and lacerated his hock. The cut itself is about 8" long (straightened) and is in a smile/half moon shape. It is not directly in front of the point of hock, but more like 3" below - which is a bandaging nightmare! Initially it was stitched closed, but the stitches tore through the skin edges at about one week post injury. The site is now about 6" long, with about a 2-1/2" to 3" gap between skin edges at its widest point, and about 1-1/2" deep.
I rinse/hose the site daily with cold water, apply - alternating daily- Panalog and Schreiner's Wound Spray (per vet orders), and wrap with women's maxi pads, polos, vetrap, and a human knee brace to help hold it up. The wound itself has started to close on the outermost edges, working in, but it's a constant battle against proud flesh forming, as the cut was almost 3" deep (but filling). Should I alter anything that I'm doing, or just keep at it? I'm worried I might be leaving out an important step. I do have (poor quality) digital pictures if needed.
PS - Besides being a little stiff, which he will walk out of, he weights and walks on the leg just fine.
Thank you in advance!
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Posted on Friday, Jun 28, 2002 - 7:16 am:
Hello Liz,
Our specific recommendations for wound care, both first aid and long term, are found in the articles associated with this forum. You should compare what you are doing to what we suggest and talk about it with your vet.
Schriener's wound spray is an interesting choice for wound care. It is a rather complicated mixture of herbs inclusing aloe vera and cayenne pepper. I cannot find any research or clinical study information on its effectiveness.
DrO
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Posted on Saturday, Jun 29, 2002 - 5:32 pm:
Liz - we are currently treating my gelding for a kick to the top of the splint bone just below the anterior hock - we had to remove the shattered splint bone - he has an incision about 8" long and the bandages would keep slipping overnight - he was not kicking or stomping (apparently when people were around) but made the mistake of stomping on a Friday night just when the vet was ready to head home from a long day - we put a kick chain on him and can now keep the bandage on for at least 2 days - flushing with water with every bandage change - do you have a picture of the knee brace and how you have it on - I will be bringing him home soon and will be fighting the bandage problem myself - thanks Janet Schmidt
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Posted on Monday, Jul 1, 2002 - 11:45 am:
Hi Liz
My horse had a very similar injury last October - if you check posts with my name in the date range Oct 2001 to Jan 2002 you should find the thread. I can report that it healed beautifully leaving a small scar in about 11 weeks and the horse's movement and jumping are unaffected, so have faith, it will be worth all the effort. Cost me a fortune in vet bills, bandages and livery though!
I wish I'd thought of the knee brace idea - all I can tell you is every time the vet did it the blasted bandage stayed up, and every time I or my friend, both experienced bandagers, did it, the pad tended to slip... do keep a good eye out for infection, we had to go back on antibiotics at one stage for a few days.
Good luck, persevere, I know it doesn't look like it now but barring disasters the wound will grow together and will be OK.
All the best
Imogen
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Posted on Monday, Jul 1, 2002 - 12:40 pm:
My gelding had a laceration to his hock last winter, and I secured the bandage (at the top) with duct tape to his winter coat... not sure if that strategy will be as successful on a summer coat. It made his fur a little gummy, but kept the bandage in place.
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Posted on Monday, Jul 1, 2002 - 7:05 pm:
Janet-
It's a neoprene knee brace made by Ace...black with two straps w/ velcro. It's helped alot. I put it on backward...this seems to help keep it in place (why I have no idea!). I've switched lately to layering the wrap as so:
maxi pads (down to one!)
regular leg pillow wrap folded in half
vetrap
knee brace
Much easier than the first version! I was using Elastikon to seal the top & help hold it up, but it's irritated his skin too much (where it pulls out the hair - ouch!), so I've discontinued it. I do have pix that I'm taking weekly to monitor progress if anyone is interested...just let me know!
Liz
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Posted on Tuesday, Jul 2, 2002 - 6:46 am:
By all means Liz, post the pictures here, see "Formatting Messages" for help. Did you find any differences between our recommendations and what you were doing and did you discuss them with your vet and what was the results?
DrO
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Posted on Tuesday, Jul 2, 2002 - 2:46 pm:
Hi DrO - Yes, I've compared your's and my vet's advice and they are very similar...we still have to keep it bandaged as my horse loves to roll..and in the dirtiest part of his stall I might add. 
I'm going to try to post some pix, taken last Thursday the 28th of June. Since then, I think it's contracted, as it's much smaller now, and pinker. Still not closed enough to treat open, though...maybe a week or two more. You can see (hopefully!) where it's already closed on the right-hand side. I'm not computer savvy at all, so here goes...
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Posted on Tuesday, Jul 2, 2002 - 2:51 pm:
Hi DrO - Yes, I've compared your's and my vet's advice and they are very similar...we still have to keep it bandaged as my horse loves to roll..and in the dirtiest part of his stall I might add.
I was going to try to post some pix, but the smallest I can zip them to is 83k (grrr). I'll try and reformat my camera tonight and take new ones. Looking at it last night, I think it's contracted, as it's much smaller now, and pinker. Still not closed enough to treat open, though...maybe a week or two more. I'll post again as soon as I can get some smaller pictures...
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Posted on Wednesday, Jul 3, 2002 - 3:55 am:
Liz,
Most photographic software has a method for reducing the file size of gif or jpeg photos so you will not have to retake the pictures.
DrO
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Posted on Wednesday, Jul 10, 2002 - 2:40 pm:
Sorry for the delay in updating (and in double-posting before - my computer crashed as I hit POST! - ack!). This picture was taken 6/23...I'm still trying to get a decent one more recent. Lately, it's been covered with a thick skin-like tissue, yellow in color, that sloughs off quite easily. It comes off when I cleanse the cut - is this the right thing to do, or should I try to leave it "on"?
BTW, it's closing fast...at its closest, the skin edges are only about 1/2" apart now- yah!
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Posted on Wednesday, Jul 10, 2002 - 9:58 pm:
Oh, Liz, how horrible! And in such a bad spot! I'd love to see how you make out with it. Thank you for the picture.
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Posted on Thursday, Jul 11, 2002 - 2:42 am:
A most excellent looking wound: well granulated in but no pround flesh and the skin is attempting to reepithelate the granulation bed. Considering the age of the wound you are doing great and yes you continue to clean and bandage.
This is a tough spot as frequent flexion of the granulation bed results in excessive granulation production. The result can be some pretty big and ugly scars called keloids, but you look like you are doing very well.
DrO
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Posted on Thursday, Jul 11, 2002 - 1:18 pm:
Thanks for the complement, Dr.O...but I really think it should go to my horse! (He's a fast healer, even for an equine) So it looks ok for a 4 week-old injury? That's so good to hear! I'm an old pro at bandaging, after nursing him back after his fetlock surgery last year (for DJD).
I took some more pix last night, as it really has started to close. BTW, I started leaving it unbandaged on July 3rd (about a week after the posted picture was taken), as it had stopped draining. It's quite "shrunken" now, and the skin is really growing over fast...most of the entire wound is very smooth, with the exception of the very middle, but that area is shrinking daily. I will post the pix as soon as my husband transfers them to disk. Thanks to everyone for their support!
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Posted on Sunday, Jul 14, 2002 - 10:37 pm:
Ok, here's some more pictures, to show our progress...I apologize for the darkness/blurriness/general ineptitude of the pictures...
This first one is from July 3rd, the day I stopped wrapping and leaving it open:
And this one (sorry it's so dark!!) is from a week later.
It's getting smaller each day, and I'm even considering turning him out again...
Here's the patient, BTW..
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Posted on Sunday, Jul 14, 2002 - 10:46 pm:
Ok, I'm getting tired of this camera stuff...
I'll try again tomorrow...grrr.
Actually, I think I'll just go take better pictures!!
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Posted on Wednesday, Jul 17, 2002 - 1:52 pm:
Ok, sorry to everyone for being a complete idiot about the pictures... but here's one from a few days ago.
Dr.O - I know it'd be hard to judge, but at this stage of healing, would it be ok to put him back on full (12hr/day) turnout? We don't have many flies here, due to excellent barn management, and it doesn't attract many anyway. It feels very hard & dry, like a scab, so I've been trying to keep it moist with nitrafurazone (sp?) ointment. I think I'm still on the right track, since it seems to be getting better every day. Thoughts/suggestions?
Thanks for all your help!
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Posted on Thursday, Jul 18, 2002 - 10:01 am:
Hello Liz,
I think increased exercise will increase scar and keloid formation. Best to wait. I would still be using a spray on dry form rather than the ointment: the wound will heal under the scab where it still is moist.
DrO
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Posted on Friday, Jul 19, 2002 - 7:22 pm:
Is there anything else besides restricting movement that I can do to help prevent a keloid from forming? Are keloids cosmetic only, or would they restrict movement also?
Thanks!
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Posted on Sunday, Jul 21, 2002 - 3:34 pm:
Just good wound care.
DrO
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Posted on Monday, Aug 5, 2002 - 5:15 pm:
Update on Hi-Oc...here's a new picture from the 26th of July. It seems that the healing is slowing down, but that could just be from me watching it all the time! His leg beneath the cut is swollen, but only to the inside...the outside is completely normal. Wound is only a little warm, and no discharge still. He has no problem moving (at all!), and will finally let me pick up that hoof. This picture was taken the 8th week post-injury...I'm hoping it looks to be on course to you guys!
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Posted on Tuesday, Aug 6, 2002 - 6:50 am:
It was the contraction phase that seemed to go fast and now you must wait for the skin the cover the wound a much slower process. However it does seem to be healing slowly, I would have expected more new skin in the last 20 days. If it contines to go this slow, I would discuss with the vet about freshening the granulation bed: this consists of removing or scrapping away the upper 1/2 of the older granulation tissue. This allows new more vascular granulation tissue to reform. I think this encourages faster reepitliation and you might get a second contraction out of it.
DrO
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Posted on Tuesday, Aug 6, 2002 - 11:25 am:
Thanks Dr.O...Hmmm...could I be cleaning it too much/hard? I'm lightly scrubbing it w/ Betadine every other day now - should I back off on the cleansing? It's not getting very "dirty", in fact it seems that all that comes off is what looks to me like a loose scab. Maybe just hose it instead of scrubbing?? Thanks for all your help, Dr. O!!
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Posted on Wednesday, Aug 7, 2002 - 12:06 am:
Hosing it is what we recommend in the article Liz.
DrO
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Posted on Saturday, Aug 17, 2002 - 1:13 am:
Hi all, just an update (again)...the swelling below the cut is starting to go down, as is the swelling around the cut itself. Although this picture is pretty dark and blurry (sorry!), it does look a little better. I'm still searching for furazone spray around here - grrr - but will start using it as soon as I get my hands on some!
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Posted on Saturday, Aug 17, 2002 - 12:19 pm:
Thats a little better the granualtion bed appears fresher (redder) the wound is continuing to contract a little and the epithealeal layer has grown a touch.
DrO
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