|
|
Discussion on Severed extensor tendon, large wound, need advice/suggestions (graphic photos)
|
| Author |
Message |
New Member:
suznhopf
|
Posted on Sunday, Aug 30, 2009 - 5:52 pm:
I would like some advice regarding one of the worst injuries I have ever had to manage.
About two weeks ago a two year old Irish colt got caught in electrobraid, which of course was hot. He managed to wrap the braid around his hind leg (I think he pulled the braid forward trying to get away, and stepped back and wrapped it around his leg). I sure wish the end connectors had broken, but they did not. Because he was getting shocked, he eventually ran down the fence line with the braid wrapped around his hind leg, severing all soft tissue on the front of his hind leg from the ligaments on the inside to the outside of the leg. Ligaments and bone remained intact, but the extensor was severed completely. When he got the end of the line the braid held, and he went down, his leg still wrapped. This pulled his all soft tissue down about two to three inches exposing the cannon bone. I was about 200 feet away when this happened and got the line cut as fast as I could, but the damage was done.
I have a wonderful practical vet, and he says the horse will never be riding sound. I considered euthanasia but could not bring myself to do it, and decided if the colt made it he could stay with me as a pasture ornament. This fellow has a fantastic disposition and showed tremendous promise with his natural jump. Since the injury about 16 days ago this is the history regarding how the colt and I are managing through the ordeal. I would like advice and suggestions regarding anything that folks who have lived through this kind of injury might suggest:
Day one: Swelling of lower leg about 10% over normal, can put weight on hind leg, some knuckling over, about every six or seven steps. Can put weight on injured leg when walking, but is very careful in movement and placing of weight.
Vet attended to injury about four hours after it occurred, he was in surgery that morning and came as soon as surgery was finished.
Way before the vet came I immediately IV’d 10 cc banamine. That night we started the colt on a course of Tucoprim (3 scoops once a day as recommended by vet) and ½ gram bute, twice a day. Tetanus shot since I got the horse in spring 09, and am not 100% sure what his vaccination schedule was when I got him.
Twice daily change of wrap. Generic Novalsan used, diaper padding and vetwrap to secure wrap, washing injury with water (no hose) to clean. Within a few days I switched the diaper to a “diaper undergarment” that is a 30”X36” diaper pad which is folded in thirds and used like a cotton wrap to pad under the vetwrap (a great disposable and economical alternative to regular cotton padding).
Day two: Same care as day one less the banamine. Swelling 15% over normal. Can put weight on leg, knuckling over about every 15 steps. Some blood and putrid smelling pus when wrap changes.
Day three: Same care as day two. 15% swelling, some heat. Very few steps knuckling over. Some blood and putrid pus. Can bear weight on hind leg.
Day four: Same care as prior day. 15% swelling, some heat. No steps knuckling over and appears fairly normal in mobility. Some blood, small amount of pus, very clean smelling.
Day five: No change
Day six: No change
Day seven: Some apparent discomfort to horse. Same care, but increased Bute to 1 gram morning, ½ gram at night. Started hosing leg. Looks like some granulation may be starting.
Day eight: Discomfort to horse increased slightly. Horse flexes hock trying to keep weight off leg, not wanting leg to touch ground. Hock is slightly swollen and hot. HyDrOtherapy for leg.
Day nine: Discomfort to horse increasing, hock still slightly swollen and hot. Some blood and pus, but all smells good. Increased bute to 1 gram morning, one gram night. Stopped the hose therapy and went back to using disposable shop cloths to clean wound.
Day ten: Discomfort to horse increasing, heat in hock. Puts very little weight on leg, does not want the sole of the hoof to rest on the ground. Will bear some weight on leg, but props the hoof on the toe, not letting the sole touch the ground. Bute at 1 gram morning and night.
Day eleven: More discomfort to horse, appearing lethargic, a little dull in the eye and he is sweating on the side of this body where the injury is more than the other side (it was hot and many of the horses were stall sweating some this week). Concerns due to the uneven sweat pattern. Changed analgesic to 6 cc of banamine IV twice a day.
Day twelve: Horse almost never rests hoof on ground, hock and pastern are constantly flexed. Lethargic, dull, laying down during the day more. Still sweating disproportionately on the left side of body (side of injury). Still on 6 cc banamine IV twice a day.
Day thirteen: Great discomfort to horse, rarely will even put his toe on the ground, and wont bear any weight on leg. Most of the time literally hops on the other leg to get around. 6 cc banamine twice a day.
Day fourteen: Lots of blood when I change wrap, but the horse is now resting his toe on the ground at times, though he puts very little weight on it when walks and tends to walk on toe. Some sweating, but less than the past 3 days. Seems a little more bright eyed. Put back on 1 gram bute morning and night. I switched the wrapping to diapers secured at top and bottom with vetrap, and a polo wrap over the top. I am trying to keep pressure off the wound but it is very hard to secure it without some pressure.
Day fifteen: Can place sole of hoof on ground when he walks, but puts very little weight on it, and is severely lame walking in his stall. But is more bright eyed, and more interested in what is going on around him. No sweating (and the weather cooled down). Won’t rest sole of hoof on ground when standing. 1 gram bute morning and night.
Day sixteen: Bright eyed, appears quite normal, and can rest sole of hoof on ground when he stands (and I am almost ecstatic over this). Pain level appears to have abated. However, I still have him on 1 gram bute morning and night with plans to try and lower the dose in the next few days.
I will try to attach some photos of the injury at day 6 in a separate post.
During all this the horse’s appetite has been very good, and his water intake is normal, if not slightly high. He is on free choice hay and six lbs a day of low starch (14%) grain.
I have several questions regarding his continued care:
HYDrOTHERAPY?: I know the mild pressure hosing is good for normal wound cleaning. However, I am afraid that the water will literally run down the front of his cannon bone and be a potential problem. Clearly, there is reduced circulation to the lower leg right now. There is no way to express water from the wound if it runs down his leg. I thought that careful light scrubbing with clean shop paper towels (disposables) would be best. These wont tear apart into little bits and get caught down inside the leg. If SHOULD use hyDrOtherapy with a hose, please tell me so. Dr. O, I would really value your advice here.
MEDICATIONS?: I’m not sure when to take the horse off of bute. I would like to try him on naproxen sodium, but am not sure this is the time to go that route.
FEED SUPPLEMENTS?: I am not a fan of feed supplements. We feed large amounts of good quality hay in combination with just enough grain to keep weight where we want it, and quality free choice minerals. We use ADM products, which I have a high confidence level in my horses getting proper nutrition from. I am not a fan of feed supplements since I think for the most part they are a waste of money if the horse has good quality hay and grain. However, I heard some rave reviews about a product called RECOVERY EQ. I’m not big on spending $60-100 a month on supplements, but would consider it to help my boy recover. Would a feed supplement be worth investing in, and if so, what supplement would be best?
|
New Member:
djrn55
|
Posted on Sunday, Aug 30, 2009 - 6:36 pm:
wow Suzanne,I feel for you.First,that's a very long time for the colt to be on bute.probiotics are very important to be given when on any medicine and you didn't mention this.So I would get that started right away or you going to possibly have an ulcer to treat next. I also would recommend getting some vetrycn for the would as soon as you can. It's a product thats been talked about quite a bit on the RFDTV channel and they have amazing results.I would also take the colt to a university hospital if your near one. I was taking my horse back and forth for 3 months to one and what an experience.They have all the necessary equipment and their fees were better than my local vets!
I wish you all the best and will keep the 2 of you in my prayers.Kudos to you for being so dedicated,he's a very lucky boy..
|
Member:
juliem
|
Posted on Sunday, Aug 30, 2009 - 7:14 pm:
Welcome to the site and so sorry it's such a serious issue that brings you. What a horrific accident and thank goodness you were able to end the torment of the electric fence quickly. Dr. O will respond by early tomorrow I'm sure. There is an article on long term wound care that will give you a good overview. Wish I had some wisdom to impart, but the best I can do is offer encouragement. The young ones do seem to have remarkable healing powers. Be prepared for a long ordeal and try not to get discouraged. Not to cause unnecessary alarm, but supporting limb laminitis should probably be on your radar screen if he continues to be non weight bearing on the injured leg. Best of luck and kudos for giving him a chance. Julie
|
New Member:
rein
|
Posted on Sunday, Aug 30, 2009 - 7:17 pm:
Hey Suzanne, sorry to hear of this happening. I too have delt with severed tendons. The mare was great after 6 months. Has a huge ugly scar, but is 100% sound!! When she came up the hill her hoof out behind her while walking on her ankle, I knew I was in for some time of doctoring...
So what about the bone, was it clean and free from trauma? I know Sizzy was good that first week..I was so amazed to see little to no pain. Then into that second/third week, that was when the bandages were bloody and the pain began. So at that point the vet had to re expose the bone and scrape it. After that it was up hill from there. For the life of me right now I can not remember the name of bone bruising??? But anyway just a thought.
Wishing you the best recovery!
|
New Member:
rein
|
Posted on Sunday, Aug 30, 2009 - 7:19 pm:
Oh ya, I never did use the hose as I too was worried about what may pool in the bottom. I would just swab it out with warm water with betadine. Then would spray colloidal(sp) silver on it. Then I used green wound cream (a pen/cortizone cream)
|
New Member:
suznhopf
|
Posted on Monday, Aug 31, 2009 - 4:09 am:
Thanks so far for all the advice.
I had not thought of the probiotics, that is a good suggestion. I have some in the barn for the horses that need weight gain (which are NONE right now) so can start that. I thought of taking him in to a medical facility. I am about 1-2 hours from the Bluegrass region in KY. However, I felt that the colt could not load in the trailer, he had only ever loaded once before. With the trauma of the injury and his mobility issues, I felt he could easily be hurt worse trying to load him. And to be entirely up front, I also realize that the medical facilities in Bluegrass are quite expensive, and would anticipate 8-10K bill and hospitalization. So I weighed the options and opted to keep him at home and retire the colt if he could not come out of this sound.
The bone appears quite clean and there is no bruising that I can see. I don't know what a bone bruise would look like, so I can only guess.
I also want to say that seeing other's posts on here regarding the same kind of injury was very reassuring. Knowing that there is at least a chance the colt could have a somewhat normal life (ie not be in danger of further injury if he is a pasture ornament) was reassuring.
|
Moderator:
DrO
|
Posted on Monday, Aug 31, 2009 - 4:30 am:
Welcome Back Suzanne,
First let me say there is nothing in the description above that would lead me to give a poor prognosis for a complete return to soundness. Maybe I don't understand what your veterinarian is seeing for such a pronouncement.
I have aggressively hosed wounds, as described in the article on Long Term Wound Care, with large amounts of exposed cannon bone with good results. I am uncertain about your concern of the water "running down" the front of the bone.
You should take the horse off bute when the degree of benefit is no longer greater than the risk of continuing. If there is lots of pain and swelling present, then you are getting a lot of benefit and 1/2 gram twice daily in a horse this size a small, but not zero risk.
If the colt continues to eat a good quality forage well I see no need for a supplement Suzanne. If the feeling is the hay is less than it should be a good quality vitamin supplement may be of benefit. For more on this see the Nutrition section for the article on Vitamins.
DrO
|
New Member:
suznhopf
|
Posted on Monday, Aug 31, 2009 - 4:54 am:
Thanks Dr. O, I'll start the hosing this afternoon.
There is pain, but very little swelling or heat now. A remarkable change from week 2, where I think blood was clotting and perhaps adhesions were causing some pain. So it may be time to come off the bute.
The vet said that his experience with this kind of injury was that the horse would not be able to pull his toe up and place it forward under himself with weight on his back, that horses would have to learn to swing the leg to the outside to get weight on the hoof. However, the colt appeared to improve greatly (no knuckling over) after about three days. I am unsure of the level of post-injury care the vet's prior equine patients had, so perhaps that may make a difference.
|
Member:
dres
|
Posted on Monday, Aug 31, 2009 - 6:52 am:
Don't give up follow the rules to the letter.. i have a post on this site with a grave injury as well .. no she will never be Olympic mount but she is sound today and am riding her 1st- 2nd level in dressage.. it took over 2 years of treating and a slow very slow rehab..
good luck..
On the first day God created horses, on the second day he painted them with spots..
|
Member:
dustee
|
Posted on Monday, Aug 31, 2009 - 4:30 pm:
Well, you certainly seem to have all your priorities in order. I am so sorry this happened to the both of you. It just wrenches our emotions when something like this happens. Best of luck getting through this. One day at a time, and know others are hoping for the best for you.
|
Moderator:
DrO
|
Posted on Tuesday, Sep 1, 2009 - 5:12 am:
Suzanne, I presume you have read the extensor laceration section of the article associated with this discussion area. Here is a review of many cases of complete extensor transection that gives excellent prognostic information. I would note that while suturing the skin wound was an important determing factor this has not been true is a number of case I have attended. Good long term wound care also can prevent the scarring that caused so many of the horses to not return to athletic function.
Vet Comp Orthop Traumatol. 2008;21(4):358-64. Links
Factors affecting outcome of extensor tendon lacerations in the distal limb of horses. A retrospective study of 156 cases (1994-2003).
Mespoulhès-Rivière C, Martens A, Bogaert L, Wilderjans H.
Dierenkliniek De Morette, Asse, Belgium. cmespoulhes@vet-alfort.fr
Distal limb lacerations are common injuries in horses, with a better prognosis reported for extensor tendons lacerations compared to flexor tendons lacerations. The objective of the present study was to determine the influence of type and location of injury, modalities of treatment and post surgical complications on the outcome of extensor tendon lacerations. The medical records of 156 horses surgically treated for extensor tendon lacerations over a 10-year period were analysed retrospectively. Information was obtained for 124 horses with a minimum of 18 months follow-up. Statistical analysis was performed on 129 horses (five horses were euthanatized during hospitalization) in order to determine factors affecting outcome. Seventy-four percent of the horses returned to soundness, 17% had moderate gait impairment and 9% remained lame. Approximately 60% of the sports horses returned to an equal or higher level of performance, and 17.5% returned to a lower level. In the multivariate statistical analysis, the only significant factor that favourably influenced outcome was complete suture of the wound. A significant association could not be detected between outcome and absence of a functional extensor tendon, The most important post-surgical complication was extensive scarring of the wound. The present results report outcome of extensor tendon lacerations in a large number of horses and outline the importance of primary wound healing in order to avoid major scarring with potential functional consequences.
|
New Member:
suznhopf
|
Posted on Tuesday, Sep 1, 2009 - 8:21 am:
Thanks Dr. O for the info you posted regarding prognosis. I did read the article on wound care and am following all the advice.
I wish we had tried sutering the wound, but I am not sure it would have held, there was a good 2-3" gap due to the action of the braid pulling all his soft tissue down. The colt is a willing patient so we are keeping the wound very clean. The downside is that the location of the injury makes it almost impossible to keep a wrap on without some pressure on the tissue that needs to heal, which I think is contributing to adhesions.
The flesh on the edges of the wound looks quite good, though I am still getting a good deal of yellowish fluid/goo that I clean twice a day when I change the wrap. It smells clean, no bad odor. I am noticing that there is some growth from the top of the wound down between the flesh and the bone, it is dark grayish in color, and I would assume that is the tendon? I will try to get some photos and post.
I gave him 1/2 gram of bute last night, and he was not very comfortable this morning. I think he needs 1 gram morning and night to feel ok, but I know that is not good for him long term. Would I be better off giving him IV banamine? Banamine is not very expensive if you dont give the oral. I know anything in higher rather than lower dosages is not good for the kidneys. But I do like to see the colt more comfortable if at all possible. What about Naproxin Sodium? Is that worth trying? I bought 300 220 mg tabs at Walmart the other day. If I dont give them to him, I can use them for my arthritis in my back
|
Moderator:
DrO
|
Posted on Tuesday, Sep 1, 2009 - 2:09 pm:
Susanne,
I disagree about the pressure bandaging be detrimental. There is little that will help as much at keeping the swelling down and support the torn tissues. If you are having problems with the bandage adhering to the wound use a Telfa Pad or other nonadherent dressing. However usually such wounds have remarkable exudate and cotton gauze bandaging makes an excellent debriding tool when removed.
As to bute versus other NSAIDs you should review the article Treatments and Medications for Horses » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx) » NSAID's, Nonsteroidal Antiinflammatory Drugs, Overview. For more on bute toxicity see Treatments and Medications for Horses » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx) » Phenylbutazone (Bute).
DrO
|
Member:
simonem
|
Posted on Tuesday, Sep 1, 2009 - 2:21 pm:
Suzanne,
As far as a supplement is concerned, have you looked into SmartTendon by SmartPak? My own gelding caught his leg in a fence about 4 months ago, straining his suspensory and partially rupturing an extensor tendon, and I immediately put him on this product, figuring it couldn't hurt. The general consensus I seem to get from vets (including my own) is "it can't hurt and it might help." The main ingredients are MSM, lysine, hyDrOlyzed collagen and silica. I also followed my vet's advice to a tee. I had another ultrasound done very recently, and it showed a complete and (most importantly) correct heal of all damaged tissue, this only 4 months after the initial wound. My vet has commented several times how good he looks after so little time. I obviously can't say whether the supplement really helped, but I have heard many other stories like my own about this product, and it's only about $20/month before shipping. My two cents worth
Good luck!!
Simone
|
New Member:
suznhopf
|
Posted on Tuesday, Sep 1, 2009 - 4:38 pm:
Well, Dr. O, that make me feel better, regarding the pressure. I have to say the flesh looks good, it is pink and almost looks like very healthy flesh now, sans skin. Then of course there is the cannon bone that I still see, alas, I think it will be some time before it is covered with flesh.
As for the NSAIDs, I did read your article, and of course there is a good deal to ponder. It is so much easier to have someone just tell me what to do... rather than to try and determine the best route myself.
Simone - I will try the Smart Tendon, it makes sense. Much less expensive than the RecoveryEQ.
Thank you for the advice. I had seen it when looking for the RecoveryEQ and wondered about it. What is $ 20 a month after what I have invested in the little fellow at this point!
|
Member:
simonem
|
Posted on Tuesday, Sep 1, 2009 - 5:05 pm:
That's pretty much the way I feel about my boy too- "what's an extra $20/mo?"..lol. I'm very interested to hear what you think about it and how this story ends up- keep us updated!
Simone
|
Member:
ajudson1
|
Posted on Tuesday, Sep 1, 2009 - 5:16 pm:
Here's a link to some info & feedback on the Smart Tendon, along with a recipe to make your own.
I am not 100% sure, but I think I have a bucket of it in the barn. My horse that I bought it for won't eat it no way, no how.
https://www.chronicleforums.com/Forum/showthread.php?t=175845
If that is what I have, and you want to try it, I'll send it to you UPS, I could ship it out Thursday.
Email me at fancy4j@gmail.com.
|
Member:
txgf
|
Posted on Tuesday, Sep 1, 2009 - 8:15 pm:
Suzanne,
Very sorry to hear of your colts injury.
From reading the description of your colts injury, it reminded me of a recent traumatic injury case we treated at my work.
Saying that, I am not a vet and don't pretend to play one in my spare time . Just trying to help.
We had a serious degloving/drag injury in a dog. Both hind legs, all tendons, ligaments, bone exposed. Much with soft tissue completely absent. I honestly thought we'd lose her and/or be forced to amputate or euthanize. ONe of the worst things I'd seen in a long while.
Anyway, on the recommendations of a specialist, we started using a product called "Collasate". It's a post-operative collagen dressing. Has the consistancy of honey. A little went a long way.
We did daily brief hyDrO-therapy on the area, applied the dressing, then non-stick telfa pads, topped with lots of supportive wrapping.
The entire area granulated perfectly. We were all shocked at the level of healing. It was remarkable and in 4 weeks time, this animal went from open bone on 75% of both hind legs to minor surface wounds.
I'm not sure of the availability of the product or even if it would adviseable for your horse. But, it might be worth looking into.
|
Moderator:
DrO
|
Posted on Wednesday, Sep 2, 2009 - 2:30 am:
Please, there is nothing that has been shown to be either clinically or nutritionally useful in the Smart Tendon Pak, don't waste your money on this or other supplements with no scientific support. If you must spend extra money on something find a better quality hay if possible.
DrO
|
Member:
suznhopf
|
Posted on Sunday, Sep 6, 2009 - 3:49 pm:
Just wanted to update anyone who is following the thread on my injured horse. It is about day 24 and he is looking well. Physically, he is bright eyed and alert. He can put weight on the leg walking, but is obviously lame on it. He no longer keeps the leg hitched up underneath himself, as he did during week two and three. The wound is healing nicely, the bone is completely covered with new flesh (ie no bone is exposed) though it has far from filled in the area where he lost so much tissue. He appears to be healing quickly now. Much thanks to all the words of encouragement here. This is a tough course to steer, seeing the animal in pain for a period of time. It is much easier with words of encouragement from an optimistic vet and others that have gone through this.
|
Member:
ajudson1
|
Posted on Sunday, Sep 6, 2009 - 5:08 pm:
Nice to hear good news; I hope he continues to heal!
|
Member:
simonem
|
Posted on Sunday, Sep 6, 2009 - 6:37 pm:
Suzanne,
It is really rough to have an injured horse. Your horse's injuries are far worse than mine were, and yet I felt so bad for him I can only imagine how you feel about it. Glad to hear he's doing well. Is he stalled 24/7? How's he handling that?
|
Moderator:
DrO
|
Posted on Monday, Sep 7, 2009 - 4:50 am:
Sound good Suzanne, it always feels better once the wound has granulated over the bone. Now your job is to keep the proud flesh to a minimum to avoid a big scar here.
DrO
|
Member:
suznhopf
|
Posted on Tuesday, Sep 8, 2009 - 5:39 pm:
He is handling the layup fine. This is guy is SO easygoing and wonderful to handle. You would never know he is a two year old. Precisely why I could not bear to put him down. I am cleaning the wound twice a day with water pressure and a light coating of Chlorohexadine and then the wrap. I have to reset the wrap (diaper pad, vetwrap with a polo wrap over it all) twice a day. If I try to go 24 hours it slips and the wound is not protected. I will reread the articles on proud flesh to be sure that I am doing what I should.
|
Moderator:
DrO
|
Posted on Wednesday, Sep 9, 2009 - 5:24 am:
That continues to sound good Suzanne. Somewhere in the future there is a point where the tissues are all supported or "held together" and protected by the granulation bed and then bandaging may become counterproductive as it promotes continued growth of the granulation bed.
DrO
|
|
|
