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Discussion on Lacerated knee
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Member:
frances
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Posted on Monday, May 5, 2008 - 3:19 pm:
Hi DrO and others
My horse somehow slipped/fell under the rails around the paddock in the early hours of this morning and thrashed around, injuring herself.
All four legs showed laceration and were cold-hosed and cleaned, and the horse injected with bute. The left knee looked really bad.
The vet was called at once but was not able to arrive until about 6 or 7 hours later. He said that the wound in the left knee was not too deep, but that the tissue underneath was not normal but scar tisue, due to her having been blistered long ago when she was at the racetrack.
He sedated the mare and injected local anaesthetic around the wound, then stitched, stapled and finally bandaged it.
We're to change the bandage every other day, and she's to have penicillin and bute injections for 3 days. On Friday the vet will come back to see the wound when we change the bandage, as he said that's when it's most likely to take a turn for the worse if it's going to.
She's to be on box rest for 3 weeks with 10 minutes handwalking twice a day (maybe he'll want to increase the time after Friday).
The vet was concerned about the wound opening if my horse lies down, and mentioned that ideally she should be tied up 24/7 to prevent this, but he didn't really push the idea, saying that he knows it's a very difficult thing. I would really be worried that she might panic at some point (i.e. the middle of the night)and injure herself further.
DrO, could you please tell me what you think of the wound, whether you agree with the treatment, and your opinion re the need to tie a horse with a knee wound up?
I'll try to post pictures of the wound before and after stitching/stapling separately.
Many thanks as ever.
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Member:
frances
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Posted on Monday, May 5, 2008 - 3:41 pm:
Sorry, I should have put "lacerated knee" as the photo titles too. They're also rather small 
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Member:
mysi
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Posted on Monday, May 5, 2008 - 9:15 pm:
LL,
You should probably post the pictures under this posting instead of two others. It was kid of confused.
My horse fell on the gravel road and busted both of his knees open, to the joint. My vet did not stitch up the wounds because of the mobility of the joint. I thoroughly wrapped him daily, hosing the wounds, placing antibiotic ointment, and re-wrapping. He was on stall rest and hand walked daily for about 3 months. He did lay down every night to sleep and it probably took longer to close up because of that but it did heal. I have attached a pic of how he was wrapped, it kept mobility to a minimum. The bandaging took forever and the materials were super expensive (about $30 a day, using 2x elastikon, stretch gauze, brown gauze, roll of cotton, square sponge and vet wrap ), but I was a pro within days.
He healed up great and went back to work and fell again busting one back open and it was all scar tissue, but it healed up just fine. Never did grow back hair on the wound areas though!
Good Luck!
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Member:
frances
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Posted on Tuesday, May 6, 2008 - 1:40 am:
Hi Melissa - I know, I was sort of stressed about the whole thing, not used to posting pictures here and somehow, because I was sending them separately, I started new discussions. Realised immediately afterwards that I'd made a mess of it. Maybe DrO can move them under the same discussion.
Thanks for all the info - it's very encouraging to hear that although Moose lay down at night, his knees still healed. I wondered about the stitching too, although there was a large flap to reattach - maybe that was the reason the vet chose to do it.
Also good to hear of healing despite scar tissue.
Thanks a lot.
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Member:
frances
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Posted on Monday, May 5, 2008 - 3:30 pm:
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Member:
frances
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Posted on Monday, May 5, 2008 - 3:38 pm:
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Moderator:
DrO
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Posted on Tuesday, May 6, 2008 - 6:59 am:
I think the treatment plan looks reasonable LL and what I would be doing. A laceration caused by a sharp edge and a wound created by gravel abraiding the skin open would receive different care. Going down on the road creates so much blunt trauma and contamination that it would be hard to successfully get stitches to hold.
DrO
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Member:
frances
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Posted on Tuesday, May 6, 2008 - 8:24 am:
DrO: thank you for kindly reposting the images for me - I was experiencing several senior moments at the time!
Thank you too for your comments. I was starting to worry about whether the vet was right to stitch the wound, so it's a HUGE relief to hear that it's what you would do under the same circumstances.
Two more questions (sorry):
1) Do you ever recommend that a horse in this situation should be tied up for 2 or 3 weeks to prevent it from lying down? To me it's a horrifying thought ... but then of course so is that of the wound breaking open...
2) Are 3 days of antibiotics and (injected) bute going to be enough? The BO and I both feel that 5 days would be more usual. We are concerned that the swelling will come back with a vengeance if we stop the bute so soon, and that 2 days more might just make the difference.
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Member:
kathleen
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Posted on Tuesday, May 6, 2008 - 12:18 pm:
LL, We had to keep our two yr old arab filly up like you are describing. We rigged a very stiff rope (used for steer roping) going across the stall diagonally, above her head. We put a lunging halter on her, the type with rings on the noseband, attached one end of a trailer tie to the top ring on the halter and the other end to the rope so that the one on the rope would slide so she could walk back and forth across the diagonal; then put her water at one end of the diagonal and her hay at the other end of the diagonal. That way she could walk, but not lay down. She was like this for at least a couple of months as she had had stifle surgery and had opened the stitches and exposed the stifle joint and we had to keep her this way until the wound healed from the inside out. She came out of it just fine, especially when you consider that she was only two years old. Don't know if this is something you can use or not. If you want more information, let me know.
Kathleen
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Member:
frances
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Posted on Tuesday, May 6, 2008 - 1:33 pm:
Hi Kathleen,
That's really interesting. If it turns out that I have to tie her, that's definitely a far better way to do it. Of course I'll be happier if I don't have to....
I'll see how bad DrO thinks lying down and getting up are in these cases. Last night the stable guy told me she was pawing as she does when she's getting ready to go down, but she couldn't manage it; no doubt as time goes by she'll try harder.
Many thanks for your help!
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Moderator:
DrO
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Posted on Wednesday, May 7, 2008 - 7:43 am:
Both of these questions should be answered by the veterinarian who did the surgery LL and depends on several factors like contamination level, degree of swelling, tension on the sutures, etc..
In general I do not tie up such wounds but then again I usually have several mattress sutures in to help relieve pressure at the suture line. I do normally bandage heavily enough to create a splint like effect that makes bending the leg difficult for the horse.
Because of these variable these questions are best answered by your veterinarian.
DrO
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Member:
frances
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Posted on Monday, May 12, 2008 - 4:31 am:
Thanks DrO. Vet did not object to continuation of shots through Friday. Wound did not blow up after that, nor does it appear at all infected so far.
It is rather soggy though, and one or two stitches towards the medial side have pulled through the skin. It has granulated in there though.
Vet saw it yesterday and felt it was ok. We're to apply Lotagen concentrate, which apparently is an astringent/antiseptic/anti-proud flesh agent much used in Australia and Ireland, and continue to bandage with gamgee roll and vetwrap.
He said it's essential that the stitches come out on Thursday before they disappear completely - are absorbed I suppose he means.
I see my first pic has vanished into cyper space - I'll try to take another one next time we change the bandage .
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Member:
frances
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Posted on Monday, May 12, 2008 - 4:33 am:
Oh - now the first pic is back! What's going on here!
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Moderator:
DrO
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Posted on Monday, May 12, 2008 - 7:51 am:
It sounds like the image did not load on to your browser previously LL. Everything from burps on the internet, including our server, to settings on your browser can effect connectivity. Opps almost forgot, I would love to see an new image of the knee.
DrO
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Member:
frances
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Posted on Tuesday, May 13, 2008 - 10:20 am:
Took my camera with me today, but BO had already changed bandage. Will have another go at getting a picture to post tomorrow.
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Member:
frances
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Posted on Thursday, May 15, 2008 - 10:21 am:
Hi DrO. Stitches were removed today, 10 days from the time of injury. The first image was taken immediately after, the the second a few minutes later after the vet had cleaned it up a bit and applied Lotagen.
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Member:
frances
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Posted on Thursday, May 15, 2008 - 10:33 am:
The Lotagen gives a slightly brownish color.
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Moderator:
DrO
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Posted on Friday, May 16, 2008 - 3:51 pm:
Hello LL,
What appears to be the reason for the suture line dehiscence. I was very interested when I saw all the staple because I have quit using staples for such high tension situations. The reason is the brands that I can find on the market don't hold well is such situation. I typically would put in multiple heavy mattress sutures then simple interrupted sutures to closely oppose the edges. What are the current plans for treatment of the open wound?
DrO
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Member:
frances
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Posted on Saturday, May 17, 2008 - 10:39 am:
Hello DrO,
I'm not sure why the wound opened up again - it may have happened on the two nights when she seems to have lain down (shavings evidence). Since then I don't believe she has.
The current plans are daily cleaning with Lotagen on gauze, Lotagen-impregnated gauze left on wound, then gamgee and vetwrap.
I will post more pics from Friday morning and this morning: it does seem to have contracted I think - do you agree?
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Member:
frances
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Posted on Sunday, May 18, 2008 - 1:28 pm:
Day 11
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Member:
frances
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Posted on Sunday, May 18, 2008 - 2:37 pm:
Day 12
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Moderator:
DrO
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Posted on Sunday, May 18, 2008 - 2:46 pm:
Well not appreciably LL but then again I would not expect it to have at this time, see the long term care article for a time line for wound healing.
DrO
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Member:
frances
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Posted on Monday, Jun 2, 2008 - 6:32 am:
This was taken on Sunday, 28 days from the initial injury. Any comments, DrO, and would you think that the mare can be shod (carefully) tomorrow? The vet hasn't seen her for about 10 days but at that time thought she could be shod in a week's time. I'm a little concerned that the flexing might break the wound open, but she certainly does need a farrier - toes pretty long by now.
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Moderator:
DrO
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Posted on Monday, Jun 2, 2008 - 5:43 pm:
I would assess this by seeing how firmly the margins of the wound are attached down with the granulation tissue. It looks pretty good LL but manipulate the edges and make a decision and if you feel ok go slow and easy but these things are usually tougher than you think.
DrO
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Member:
frances
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Posted on Tuesday, Jun 3, 2008 - 12:29 pm:
Many thanks DrO for your very helpful response.
I had a slight reprieve today as the farrier is behind schedule, and can't come until Friday after all.
The BO had also spoken to the vet, who said as long as the hoof was raised at no more than a 30 - 40 degree angle it would be ok, so I suppose it's the farrier's call as to whether he can trim/shoe like this. Of course you never know whether a horse will suddenly snatch its leg up higher ....
The edges of the wound feel fairly firmly attached except for that in the lower right corner, which feels as if it COULD lift off like a scab if picked at. Will this hardened dark red area which remains in the middle (and looks like blood under glass) in fact come away when it's ready, or just shrink until the whole area is healed?
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Moderator:
DrO
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Posted on Wednesday, Jun 4, 2008 - 8:50 am:
That would appear to be a scab LL covering a deep defect. It can remain in place as long as there is no purulence under it. If it becomes infected it should be hosed away exposing the underlying granulation bed. It will appear to shrink around the margins until healed.
DrO
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Member:
frances
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Posted on Wednesday, Jun 4, 2008 - 11:37 am:
Thank you DrO. The centre section of this scab came off with the dressing this morning. (This was before I had received your last post - time differences.)
At first it seemed like a bit of a setback to me, but after I had rubbed the whole area lightly with Lotagen and then blotted it (this is per the vet's demonstration) with the same Lotagen-impregnated gauze, it looked quite healthy (I think). No sign of infection.
If the scab is covering a DEEP defect, does this change your advice re trimming/shoeing on Friday? I'm getting a bit nervous about this!
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Moderator:
DrO
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Posted on Thursday, Jun 5, 2008 - 8:16 am:
No LL, my advice remains for you to carefully assess the stability of the wound margins and make the decision as to whether it will tolerate the flexion required to trim.
DrO
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Member:
mdelton
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Posted on Friday, Dec 18, 2015 - 2:56 pm:
Hi LL,
Just read this post because my horse tore open his knee similar to what yours did. My questions to you are - Did the knee have much swelling? And if so how long did it take to come back to a normal sized knee?
Thanks,
Mary
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