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  Discussion on About wound care
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New Member:
Zilpha

Posted on Wednesday, Dec 14, 2005 - 5:03 pm:

Hi Folks! As a registered nurse since 86 and horse owner since 76, this is the conclusion
I have come to regarding caring for wounds on
humans and horses. While they are different patients, the technique remains the same.
1. A balance in moisture must exist. If a wound
is VERY dry, then an ointment or other moisturizing agent should be considered and applied, like Neosporin ointment or other approved, anti-infective ointments. This is especially true around areas of high mobility such as joints, knees, etc.
2. A very wet or draining wound should then be encouraged to drain and the goal is to pull the excessive moisture/drainage away and out. In the human setting, various absorbing-types of dressings are used such as alginates, abd pads, etc. Infection must be treated if present. Maybe
consider a poultice that is safe for open
wounds to pull away drainage/infection.

3. In addition, I have found that wounds that
need to fill-in should be kept moist with an
antibiotic ointment until the granulation tissue
is almost level with the surface of the skin.
Premature drying in these wounds will cause a
crater. Basically, if I want a wound to fill in,
I use Neosporin ointment after I have cleansed
the wound with sterile saline solution which can
be made at home with the proper measurements
and technique. With very, very deep wounds
they must heal from the inside out and your
vet will advise you on these. I agree that
a scabbed wound without drainage should not
be disturbed. The scab is a physical barrier to
contamination. However, if it is draining or the
scab isn't level with the surface of the skin,
it should be removed and treated as above till
granulation tissue has reached the level of
the outside skin. Also, the best cleansing agent
to date without damaging healthy tissue is 0.9
saline solution. I use a large syringe with a}
large bore needle to flush wounds. I don't touch the wound with the needle but I get good pressure from using a large syringe and 18g. needle. Not too much force but good enough to get a good cleansing action to clean the wound.
Be careful when doing this and get someone to
hold your horse as working with the needle
can by tricky. You may just be able to use
a large 60 cc syringe without the needle if your
horse isn't cooperative. It's the mechanical aspect of the flush that cleanses the wound.
Hope this helps.

Sheryl McGrath
Member:
Warwick

Posted on Wednesday, Dec 14, 2005 - 5:53 pm:

Hi Sheryl

Many thanks for the good advice. One of my horses injured himself quite severely on November 11 (conveniently at exactly the same time that I had 10 people arriving for my husband's birthday dinner) and I had to take him to our local leg specialist/surgeon for surgery and a cast as the wound was very deep and involved a joint. Basically he degloved his leg from mid pastern to half way up the cannon bone on his near foreleg, and exposed the tendons. It was a nasty injury.

Anyway, to initially clean out the wound, the surgeon used an oral Waterpik device. It has a good sized reservoir to hold the cleansing solution and the Waterpik head is attached by a long flexible tube to the reservoir. The jet spray from the Waterpik head worked incredibly well in eliminating debris and getting into all the hard to reach areas. Very much along the same lines as you suggest with a syringe but with a finer and stronger spray and a larger capacity for solution.

I guess necessity really is the mother of invention.

Cheers
Sue
Member:
Christel

Posted on Wednesday, Dec 14, 2005 - 6:35 pm:

This is a good subject.
On wounds I like to use hyDrO therapy (spraying w/ water) when ever the weather allows. I use a horse bathing wand, homemade out of pvc pipe. I will hyDrO for 10 minutes then w/ a 60 cc syringe will mix water and betadine 3:1, without a needle, as I would kill myself, will spray the wound, then put neopredef (a dry, pain relieving antibiotic powder) on top of that, early in wound especially if it needs to fill in, will spray w/ derma glo, or scarlet oil to encourage granulation.
I use furozone gel early on the wound edges and will progress to corona or an aloe vera wound dressing when there is no sign of infection, to keep it moist on the edges.
I really like the hyDrO therapy on wounds, they seem to heal faster and w/ minimal scarring.
Moderator:
DrO

Posted on Thursday, Dec 15, 2005 - 6:26 am:

Hello Michael,
Though your advice is sound, daily cleansing and debriding a large wound with a 60 cc syringe with needle and saline can be very tedious and the important debriding action inadequate without a needle. Also trying to keep Neosporin on large wounds, particularly when it is cold outside and where bandaging is not practical, can be difficult. It sticks poorly to open moist wounds. Also, one important difference between human wounds and equine wounds is the ease with which horses form granulation tissue which effects some of our optimum choices for treatment.

Our articles on wound care present alternative methods that have given consistently good results in thousands of wounds, some of them gapped many inches wide, 8 inches deep, several feet long, and having long expanses of bone exposed.
DrO
New Member:
Zilpha

Posted on Thursday, Dec 15, 2005 - 11:16 am:

Thanks Dr. O. for the tips. I will make sure I always use a needle to irrigate/flush wounds. I read the article that you have posted on wound care and suggested maybe the furacin spray on the wounds that drain and can't be bandaged. I do feel that the ointments are a problem when you have a
draining wound especially in the cold but I feel they do provide some protection from the cold/elements and infection. After all, the swimmers that swam the frigid, English Channel used vaseline to cover their bodies to prevent heat loss and provide protection to their skin. Do ointments do the same in the cold as far as protecting the horse's skin/wounds from the elements? Weird analogy but they do contain a petroleum base similar to vaseline that those swimmers used all over their body.

Anyway, I am currently treating my mare that
has two kick wounds near her left upper elbow. One is almost near the point of the elbow. I am
irrigating daily with saline solution under
high pressure and applying neosporin ointment.
I did give her a tetanus toxoid booster.
There is a moderate amout serous/yellow drainage
and maybe the ointment isn't best used here. I will try to post some pictures so we can all see the progress. I am thinking about switching to maybe furacin spray after the article I read due to the drainage and the fact the the ointment
has minimal contact with the wound due to the
drainage. I have always used ointments on my wounds but this is somewhat deep and large hole with moderate drainage. I do have her on SMZ/TMP tablets twice a days since the one wound is close to the elbow joint. I initially gave her some bute paste for inflammation and pain.

Wound is down to first layer of muscle. I can
see fatty tissue and red muscle. I do know that using ointments on a draining wound goes against the balance in moisture rule above. What would you suggest? Would the furacin spray be approp.
here?
Do the sprays also get washed away by a draining
wound? Will the tissue still fill in with
irrigation and furacin spray? Also, I thought
that any solution that was used for irrigation
into a deep cavity or wound had to be sterile?
Maybe it's because I work as a nurse but I don't think on horses it's acceptable to use tap
water on deep wounds unless it has been sterilized by boiling or microwaving. Even in
home health we did use tap water to reduce the
patients cost but always sterilized tap water by microwaving before using on wounds. Why shouldn't horses be treated the
same. I would avoid using water from a hydrant
that was uncovered in a barn due to the contamination from birds, dirt, etc. The health
dept. before they took water samples to check
for contamination in my new well fired the nozzle of the hydrant to make sure they didn't pick up dirt and bacteria with the water sample.
So you know that junk can be picked up on barn
hydrants. I understand and agree that tap water is fine for superficial wounds but it goes against all my teaching to use tap water on a deep/severe wound, even in a horse.


Thanks,

Sheryl

PS. Thanks Sue for the great tip on irrigation.
Member:
Miamoo

Posted on Thursday, Dec 15, 2005 - 11:38 am:

Oh my goodness Sue G.,

The worst wound my horse ever got was a bad wire cut on Nov. 10 a few years back (only one day off yours). I remember the date because I had a house full of people arriving for my husband's birthday dinner. The mare had to go to the clinic and go into surgery to have the leg stitched back together. I arrived home half way through the evening to all the people there. My husband had had to cook dinner for everyone.

How much of a coincidence is that!

Ella :-)
Member:
Warwick

Posted on Thursday, Dec 15, 2005 - 12:31 pm:

Wow, Ella, that is totally bizarre! Just like yours, my poor husband had to serve up his birthday dinner too. Although I'd prepared the majority of it earlier in the day, he ended up being chief cook and bottle washer until I dragged myself back from the vet clinic too!

This was a really nasty injury. The surgery was done under general anesthetic as Warwick was impossible to treat under even very heavy standing sedation. He continuously flicked and pawed on the leg and at one point caught the poor surgeon on the side of the head opening up his eyebrow. Luckily for me he's a very tough 3-day event rider and brushed off the cut by saying "well, it was my fault as I shouldn't have put my head so close" but it still made me feel awful. So the surgeon, my vet and I all agreed that a general was best as safety was the number one priority for all, especially when dealing with a 1700+ lb horse that was being anything but a model patient.

So long story short, Warwick underwent surgery, had 2 separate casts applied (the first one appeared to be rubbing him after a few days) and has been on stall rest for the past 5 weeks. His cast was removed last Thursday night and he's been heavily bandaged ever since. But the good news is that the leg looks wonderful and he has full mobility. As of this coming weekend I have the green light to start him on a 30-day rehab work program and turn him out in a small paddock (initially under a bit of tranq).

Bad news is we will have a Charles Dickens' Christmas this year as the bank account is now the one that needs serious medical attention!

Sue
Member:
Christel

Posted on Thursday, Dec 15, 2005 - 1:19 pm:

Sheryl, I have used tap water for many bad wounds. It debrides the wound well when coming out of a water hose. I always end these treatments by irrigating w/ a betadine solution, so I would think that would kill any of the germs the tap water may have left behind. My tap water is city water which of course has had chlorine added to it.
I have never caused a secondary infection that I know of anyway doing this.

What are SMZ/TB's? I use a pill form antibiotic called Tribriserin- is that the same thing?
Member:
Zilpha

Posted on Thursday, Dec 15, 2005 - 3:27 pm:

Christella,

Thanks for the info. Glad to hear there were
no problems with you using tap water on your
horse for a deep wounds. Maybe I'll try it
since Dr. O and others like you say it's ok. The SMZ/TMP tablets are Sulphamethoxazole/Trimethoprim(generic name).
Anyway, today I flushed her wounds out with
the saline solution that I made using a
needle and large syringe. It was unreal what flushed out. I guess I wasn't using enough force before but now there is a clean, healthy bed and I can
now see the base of it where before I couldn't
see the base due to all the slough/drainage that
was present. Dr. O was right, the needle was
needed to get the pressure. What a big difference
from yesterday.

Today, I let my horse exercise outside for a bit as she was starting to swell and stock up in her
lower leg. I didn't see this yesterday but
the swelling has moved from the elbow area down to her knee now and I know
she didn't hurt that. I'm keeping
her stalled to prevent contamination of the
wound but the exercise is also what she needed
to help with the dependent edema/promote drainage.

So now I just time my flush after I let her
exercise outside for a bit. The area in which
she has her wound is in constant mobility so
sutures wouldn't of worked there anyway. When it
was just snowy outside, I kept her out
but now we have wet weather with rain and mud so
I am stalling her with exercise periods followed
by flushing to immed. cleanse anything she
may pick up in the paddock. Impossible to
bandage the area or I would do so.

Thanks,

Sheryl
Member:
Dyduroc

Posted on Thursday, Dec 15, 2005 - 8:14 pm:

Sue G., I'm so sorry to hear about Warwick! How did I miss this news?

Please keep us posted on his progress! You're in my prayers!

D.
Moderator:
DrO

Posted on Friday, Dec 16, 2005 - 9:02 am:

Hello All,
What a great discussion. Michael I certainly can understand how a human health professional can be reticent about the use of tap water on deep wounds. Certainly I cannot vouch for everyones water from the tap as being safe but I would contend that if it is safe for drinking it can be one of the best tools you have for treating wounds.

The key to wound care, in the highly contaminated environment of a barn, is one that requires an idea of balance. The notion that you are going to keep a wound aseptic is an illusion. The instant clean or sterile bandage material is opened or the wound exposed to the air it is covered with hundreds to thousands of dust particles each one covered with millions of bacteria. So the real question is not how do keep bacteria off the wound, as this is impossible, but how do you minimize this effect. And more importantly, how do you best remove the bacteria, exudate, and necrotic material from the wound itself.

We both agree that water, under pressure, has marvelous cleansing and debriding properties. We also both agree that isotonic saline is the ideal flushing solution from the tissue damage perspective. So when we look at our 2 systems of wound care a question arrises: does the much greater amount of flushing solution that I can do with a hose give a cleaner wound with healthier tissue than you can achieve with your set up. Obviously your set up will be more tissue friendly, but by how much? Obviously my set up will result in a better debrided wound but by how much? My experience strongly suggest in the ying and yang of the above equation, in the hands of the average horse owner, the hose situation is much better and the larger and deeper the wound the better the hose is at prevent infection. I think it is because the clearly better debriding action is more important than the minimal amount of tissue damage done by using plain water.

The amount of bacteria introduced into the system by a hose and clean water (and it is important the this the hose, nozzle, and water be kept clean) is tiny compared to the environmental contamination and that growing on the wound itself. In fact I might be able to contend that (assuming you reuse your equipment, the syringe, and saline solution) it may become more contaminated with significant pathogens than my system. After all where do the very worse infections, those pathogens that are the most aggressive and difficult to treat, often come from? It is those difficult to treat noscomal (hospital origin) infections. Partially this is due to the selection from high antibiotic exposure but I also believe the very antiseptic environment selects for these pathogens by reducing the non-pathogen background that competes for space. This is particularly true with Pseudomonas infections. I think there is work suggesting that the regular use of heavy antibacterial hand soaps results in a marked increase in pathogens.
DrO
Member:
Christel

Posted on Friday, Dec 16, 2005 - 9:50 am:

Dr O, very interesting and great explanation, only a few of the 'big' words went over my head, but was able to get the jest of it.
I have a question I have been wondering about the last few weeks. I saw on RFD-tv a boot type apperatus that went on the whole leg, and would hyDrO the leg for a few seconds then not hyDrO for say 45 seconds to a minute. The reason for this was to let blood fill the capillary's after being briskly hit w/ the water. The filling back of the cappillary's was the most healing part of the treatment. This made perfect sense to me and I hope I explained this to where you understand.
So my question is when hyDrOing w/ a water hose, should I hydrate for a minute and back for off for a minute then repeat this thru the whole treatment? Do you see any benefit of doing this way? I did try this on my filly that has a large wound across her chest, it seemed to be better than what I had been doing (hyDrOing the whole time), but this particular wound is almost healed and I don't think this is a true test.
Also you mentioned in above post about reusing the syringe, needle each time could lead to contamination of the syringe and needle. If one used betadine in the syringe wouldn't that kill whatever had landed there?
Gosh I love this site, thank you so much Dr. O.
Chris
Member:
Christel

Posted on Friday, Dec 16, 2005 - 10:03 am:

I keep forgetting to mention, another reason I like hyDrOing w/ the hose is for swelling also. Many times when doing this treatment, will aim the water not so much on the wound itself but on the outlying areas that are swollen, I have actually noticed the swelling going down while doing so. I may only be accomplishing moving the inflamation to another place-lol- but it seems to work, often times the swelling does not come back.
Member:
Warwick

Posted on Friday, Dec 16, 2005 - 12:23 pm:

Thanks for the good wishes, D. They are much appreciated.

I spoke to the surgeon last night and he's very happy with Warwick's leg. Sure has stressed the heck out of me though! I sure didn't need all those extra grey hairs...

Wish me luck over the weekend as I summon the courage to climb back on an 18+ hand immature goofball that's been locked up for 5 weeks and I'm not allowed to lunge! And wouldn't you just know it, in total contrast to our normally damp, grey and just plain dreary West Coast weather where it requires a supreme effort to even get out of bed in the morning, it's crisp and frosty right now so he's feeling extra peppy! Big fat rats...
Member:
Dyduroc

Posted on Friday, Dec 16, 2005 - 3:17 pm:

Sue, are you certain you want to get on a goofball that's been locked up for 5 weeks a mere 7 days before the holiday? Wow! You've got a lot of gumption!

I can't imagine the stress you've been under for the past month! Forget about those extra grey hairs! In the grand scheme of things they don't amount to a hill of beans.

Take care of yourself and PLEASE let us know you're OK after your ride. BTW--why aren't you allowed to lunge?

D.
Member:
Jgordo03

Posted on Friday, Dec 16, 2005 - 3:23 pm:

Sue,
Look at it this way at least you have him caught.Good Luck with your outing. Let us know how it goes. I have a quick question about wound care. My neighbor just bought a beautiful dapple gray Missouri Foxtrotter, she ran through a fence the first night, and somehow cut herself from her shoulder across her elbow down into her barrel. The stitches are very loose and there are almost a hundred of them, I offered to help her with the care in the evening, can I use the irrigation method you are talking about here on this wound? The vet said to irrigate it but nothing about flushing it out.
Member:
Warwick

Posted on Friday, Dec 16, 2005 - 4:42 pm:

Hi D

I can't lunge him as this rehab exercise program is supposed to be controlled. If I put him on a lunge line at this stage, he'd be higher than a kite and leaping and bouncing all over the place. Vet said there's just too much risk of banging his injury with his other front foot and opening it up.

Plus unlike the other young horses I've trained, I've never made a point of lunging him as I don't have a round pen and he was just so large that if he ever decided to take off or pull on the lunge line like youngsters do on occasion, I knew I'd be no match for him. Since he's always been on full turnout, it's never been a problem to just get on him - until now!
Member:
Dres

Posted on Friday, Dec 16, 2005 - 6:54 pm:

Sue, your welfare is far more important then his soundness.... BE-CAREFUL... I say this cus I have rehabbed a young horse and was told not to lunge but to ride at walk and light trot.. HA!~ I am more valuable .. and if I can't let the horse let off steam before I mount .. well then, I guess I won't... YOU are the valuable one here...

** Just visited a friend at home, the day before Thanksgiven she was tossed by a young horse, that she was trying to be careful with.. she CRUSHED her hip and femur... won't be doing ANYTHING for a very long time...


On the first day God created horses, on the second day he painted them with SPOTS..
Moderator:
DrO

Posted on Saturday, Dec 17, 2005 - 8:40 am:

Hello Christella,
The boot would not be suitable for open wounds because of the contamination factor. Contamination from the boot, contamination from the rest of the leg, particularly the hoof.

Concerning its use for massage I would have to see the design. No I don't think stopping and starting is necessary and am uncertain that the action as you describe and the potential for reflex vasodialation is an important part of the wound cleaning and healing process.

The betadine should not be relied upon to prevent contamination, there are organisms with persistent exposure that can become resistant to it. Instead you should depend on the utmost cleanliness, cleaning all exposed surfaces with warm soap and water, and storage in a clean dust free environment. Just prior to insertion of the needle in the bag you should wipe the rubber stopper and if you are reusing the needle it too with a alcohol swab.
DrO
Member:
Christel

Posted on Saturday, Dec 17, 2005 - 9:36 am:

Thank you Dr O. I think the boot was more for strains etc, not open wounds- sorry for giving the wrong impression. Im not much on gadgets, would rather spend my money elsewhere, (good feed etc.), but the way this particular item worked got me to thinking about my hyDrOing practices and wondering if I should change after all these years. In the back of my mind, cant remember where I got this info, but another reason for hyDrOing besides the debriding action was that the pounding of water on the wound caused more blood to go to the wound, thus accelerating the healing. I will admit the few times I did try the stop and start hyDrOing it was tedious trying to count the seconds in between.
I can't thank you enough for this site. Once one figures out how to get around here, it is very convenient. I found the dictionary yesterday-wooo hooo- after the holidays I plan on going back to some posts I remember thinking, what the heck are they talking about-lol.
Merry Christmas all,
Chris
Member:
Imogen

Posted on Sunday, Dec 18, 2005 - 3:41 am:

I'd like to second Dr O's point about knowing the quality of your tap water in a rural area. My own is fine and our specialist horse vet with similar experience to Dr O alway advises hose wounds under pressure BUT my horse was recently at a friend's barn when she got cut requiring 4 staples. I had happily cleaned out the wound with a hose before trailering her to the vet when I remembered that my friend has bugs in her water and cannot drink it at the moment...

All the best

Imogen
Member:
Warwick

Posted on Sunday, Dec 18, 2005 - 7:30 pm:

Thanks for the kind words, Ann!

We got too cold here over the weekend and the ground was too hard to work him so I had a reprieve. Until tomorrow that is, when we are expecting rain and everything should soften up.

I was allowed to let him out in a small paddock yesterday and today. I gave him a bit of tranq yesterday to take the edge off and he was fairly well behaved apart from the odd leap here and there. Didn't tranq him today and he just walked out into the paddock, rolled, and when off and ate hay. Hopefully this pattern will continue!

Cheers
Sue
Member:
Christel

Posted on Sunday, Dec 18, 2005 - 10:00 pm:

Sue, had to laugh, I think the horses are as tired of this crappy weather as we are. We didn't get above freezing today, ice stayed on the trees, my horses sombered up at pm feeding like it was a 90* day. None of that 'yeee hawww' 'I feel good today' stuff.
I am so ready for spring!!
Chris
Member:
Warwick

Posted on Tuesday, Dec 20, 2005 - 11:01 am:

Chris, the worst part is that it's not even the first day of winter until tomorrow! Ugh...
Member:
Warwick

Posted on Sunday, Jan 8, 2006 - 7:32 pm:

Hi Everyone

Just an update - and a rather late one at that. We finally got some good weather and I clambered back up on the big guy. He was perfect and never put a foot wrong although I did have my husband stand guard the first day in case we needed to call 911. I have to count my blessings that Warwick has the temperament that he does. I think he was happy to finally be doing something other than standing around. He walked up to the mounting block, stood like a gentleman and immediately walked forward stretching down and into the bit.

Boy it's good to be back in the swing of things!

Cheers to all
Sue
Moderator:
DrO

Posted on Monday, Jan 9, 2006 - 7:54 am:

Good to hear of the outcome Sue.
DrO
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