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  Discussion on Nine months later, what next?
Author Message
New Member:
Lcsmith

Posted on Tuesday, Dec 3, 2002 - 2:41 pm:

My horse injured himself in the pasture in February 2002. His hind legs got caught on the fencing and he scraped the front of his right hock extensively. The wound appeared to heal, but three weeks later, we learned that interior tissue had necroticized and abcessed, and blew a hole 4" by 8" in his leg. We have been wrapping and hosing and the wound finally closed three weeks ago. Much to our dismay, it popped open shortly thereafter, and now has to heal again, although it is much smaller (1"x2"). What is the best way to thicken or toughen the skin once it heals again, and what is the best way to wean him off the cast-like compression bandaging we have been using to encourage healing? We are riding now walk-trot about three times a week, and he is in private turnout about four hours a day.
Moderator:
DrO

Posted on Wednesday, Dec 4, 2002 - 4:26 am:

Hello Laura,
Once healed there is very little you can do other than surgery / grafting to improve the quality of the tissue though it will continue to improve with time. There is a lot you can do before it heals however to improve the quality of the healing and it is good basic wound care. See the articles associated with this forum for our recommendations.

I presume when you quit bandaging the extra-articular tissue's swelling returns (and not the tibiotarsals joint capsule). If so you must continue to bandage for as long as it fills when not wrapped. This is very important, my experience is that such swelling can granulate in, fibrose, and trap the tendons that run through the front of the hock. Because of the motion in the area, the fibrosed areas re-tear causing more fluid to form and the hard swelling from the fibrosis continues to grow bigger eventually causing a lameness that can only be repaired by surgical removal of the fibrosis.

If the filling is caused by tissues that have not healed completely you may be bandaging for several months or more and you should not be riding at this time. If the filling is caused by healed tissues that have lost there elasticity you may be always bandaging the hock but riding is OK. I like the neoprene hock boots for treating this problem, they are easy to remove, pressure points can be cut out, and areas that need a little extra pressure can be filled in. Just get a couple so you can always have a clean one.
DrO
Member:
Lcsmith

Posted on Wednesday, Dec 4, 2002 - 2:50 pm:

Thank you for this advice. The healing wound looks beautiful in terms of scar tissue and granulation. You are correct in assuming that the swelling is around soft tissue, and not the joint capsule. How can we determine whether the filling is caused by insufficient healing or inelasticity? In a "free lunge" situation without any bandaging, the horse exhibits only a very minor asymmetry of stride, which my vet attributes more to the nine months of wrapping than any permanent damage. Is this a reasonable conclusion?

How long should we expect the tissue to fully "heal" once the wound itself closes? And can you help me understand why light work under saddle is detrimental? Lastly, are there other forms of exercise that will help this horse regain strength that would be less stressful on the healing wound?

Many thanks for your helpful response.
Moderator:
DrO

Posted on Thursday, Dec 5, 2002 - 4:44 pm:

I have wrapped a hock for as long as 6 months and basically wrappped until the swelling did not return when left unwrapped. I would check it by leaving it off every few weeks. How long would I go....I don't know but I was getting pretty discouraged at 6 months. Light work may be detrimental if the damaged tissues are not strong enough to support the work: more damgage than repair occurs. Damage and repair occur even with healthy tissues, damaged tissues both tear more easily and repair less slowly.
DrO
Member:
Lcsmith

Posted on Friday, Dec 6, 2002 - 3:45 pm:

Thanks so much. Your opinion is greatly appreciated.
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