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  Discussion on Sedation during bandage change
Author Message
New Member:
Chitty

Posted on Saturday, Jun 26, 2004 - 2:37 pm:

Hi, It is so wonderful to have this resource for horses health. My question involves my 3 yr. old filly that has a severe cut on the back of her hind leg between hock and fetlock(no tendons,etc. involved-just gaping flesh that is filling in). The vet is out two to three times a week to clean and wash with betadine, put what I believe is an antibiotic salve on and rebandage. We did 5 days of antibiotics and about a week of bute. The wound seems to be doing o.k. My problem and question envolves the fact the he sedates her every time he changes the bandage. The owner of the stable cleaned and bandaged the wound the first time without any problem and I have removed the bandage without her moving a muscle and I am just wondering if it is normal to use sedation this much (it is an injection-not sure which med.,and lasts about 45 min. or more)for just washing and changing the bandage. There is some concern over a bulging out of tissue and some formulation of proud flesh that he wants to sedate her and lay her down and trim. He has also used Neo-Predef powder and we left it unbandaged for the first time yesterday for about 7 hours. Any thoughts or advice would certainly be welcome.
Thanks,
Mary
Moderator:
DrO

Posted on Saturday, Jun 26, 2004 - 6:00 pm:

No Mary this is not routine to sedate to bandage a well behaved horse. Light surgery like you describe is usually done under sedation and local. If it is proud flesh it does not even require local as there are no nerves present.
DrO
Member:
Chitty

Posted on Saturday, Jun 26, 2004 - 8:33 pm:

Thank you so much, Dr. O. I certainly did not think so, but I have not dealt with an injury this bad in all the years I've owned horses, so I was justifying it as keeping her out of pain while he washed it and proded it. Should have followed my instincts. Does the treatment thus far sound valid? I am faced, I guess, with either treating it myself, as we do not have another large animal vet, or taking her to another city.
Thanks, again,
Mary
Member:
Chitty

Posted on Sunday, Jun 27, 2004 - 1:40 pm:

I have just got to ask one more thing, please. I asked the vet when this cut first happened about "water treatment" as I had read about it on your site and heard good things about it from others with horses--his answer was "well, on some injuries"--which left me thinking "not this one". I am just wondering if I should begin this now. I have found out about another vet, who is highly recommended, and comes here several times a week and I think I will call him, but I am worried about the protocal of bringing in another vet without bad feelings, or worse. Any suggestions? The main thing is I just want to do what is best for this baby and I don't feel the sedation and treatment are what is best, but I truly would like any input I can get, as tomorrow he is supposed to come out again, sedate her again, and I just want to have as much information as possible to help her. The bulge from the wound is my greatest concern. It was only bad while the bandage was off on Fri. He says the bandage has kept it from doing that and wants to trim it. I don't know if it is proud flesh or not (can't find a picture of proud flesh, so far) but from the descriptions I guess it could be. I am just a WEEEE bit stressed as I feel I am at a cross-roads with this healing process and want to make the best decision about her treatment as I realize we are probably at about the place where this will be contracting and our best chance to get it right.
Thanks,
Mary
Member:
Dres

Posted on Sunday, Jun 27, 2004 - 2:20 pm:

Mary, i had a weanling that had a very nasty cut on a hind leg, deep, no tendons, outside on the cannon bone slightly on top of the fetlock.. anyway the first time the vet came out we had to sedate her, to really clean and dress the wound.. we wrapped it with some special wrap and left it on for two days.. i then had to redo it.. NO COLD HOSING at this point.. just wiping off the slime and redressing.. after two weeks it did develop the 'lump' proud flesh, the vet came back out again and cut that off.. we did not sedate her for this, as she was getting used to me fussing with that leg.. again i had to keep it wrapped for a few days changing the dressing but NO WATER TREATMENTs.. just wiping the slime off and re wrapping..

anyway this lasted for a month ? give a few days here or there.. then we left the wrap off .. she has a slightly raised scar there, but nothing like it could have been...

so i can't answer the water treatment question.. but in our case we were NOT to ...

Ann
Member:
Chitty

Posted on Sunday, Jun 27, 2004 - 2:44 pm:

Thanks so much for your input. It helps so much to compare notes. I guess I am becoming a little more comfortable with the treatment he is giving and I think I will just tell him I don't want her sedated and I will do the bandage changing under his direction so he won't have to put himself at risk. Not to sound down on him, if it wasn't my horse and that was my livlihood I might do the same thing-I just don't like it unless absolutely necessary. How did you keep your horse still while trimming the wound. He wants to sedate her enough to lay her down to do this, which REALLY upsets me. Thanks again for you input and I hope your baby healed without any problem.
Mary
Moderator:
DrO

Posted on Sunday, Jun 27, 2004 - 6:40 pm:

Without examing the wound I really cannot judge the treatment, and treatment changes in response to how the wound is doing.

The advantage of water under pressure is that it does a wonderful job of debriding a wound: removing the bacteria and gunk that accumulate. When a wound is wiped both bacteria resistant to the treatment you are using and inflammatory products are left behind. Removing them minimizes the amount of inflammation so that minimal excessive granulation tissue (proud flesh) forms and skin more rapidly can repopulate the granulation bed. With diligent care in small to medium size deep wounds there is no need for proud flesh removal and no scar forms as skin completely covers the wound. You should ask your vet why they do not recommend hosing with water under pressure, wounds really do wonderfully when treated this way.
DrO
Member:
Dres

Posted on Sunday, Jun 27, 2004 - 7:09 pm:

i think Dr. O in my fillies case ,no cold hosing was becus the flesh would then continue to flap open.. i had to keep it clean and wrapped for several weeks.. after the proud flesh removal and more wrapping i was then alowed to hose it if neccessary...

as far as sedation.. and laying down the horse.. i haven't a clue why.. my filly was used to the process of me 'playing' with the sore and the proud flesh has no feeling, so it was an easy process standing up......

Ann
Moderator:
DrO

Posted on Monday, Jun 28, 2004 - 7:01 am:

I have seen others make this argument Ann and it is without merit. In fact just the opposite is true, not cleaning under the flap delays its closure as the granulation tissue forming under the veneer of inflammatory exudate but the exudate prevents it from attaching to the dermis of the overlying skin. Thoroughly cleaning the wound then bandaging the flap down firmly once daily will get the flap down quicker. When real healing has occured the water under pressure will not disrupt the tissues.
DrO
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