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  Discussion on Scar tissue repeatedly tears open
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Member:
mleeb

Posted on Monday, Jan 11, 2010 - 9:45 pm:

I have an 18 month filly who sustained a smooth wire cut on the right inside hind leg, approx 3" above the fetlock. She did this last May.

The original cut was very shallow and healed well. It was kept clean and unbandaged. Three weeks later the wound broke open and eroded quite badly. What was originally not much more than a 5" long scratch, turned into a swollen mess 5" long and 1" wide. She was doctored with penicillin, bute, cold hosing twice a day, and topical ointment, Hibitaine. The wound healed slowly, but finally closed up again. The leg is larger (deep scar tissue?) in this location than the opposite leg, but the scar was neat and clean, a thin grey line.

The problem is that the scar tissue is not strong, and any amount of activity beyond a trot rips it open again. She never favors the leg, but I still can't think it's a good thing to be constantly tearing it open. In September the local vet recommended DermaGel, and I again doctored her for several weeks. It appeared to heal well again, and stayed intact until December this time. She's now ripping it open again, and it is covered in an old scab, with a spot at the top of the wound, about dime sized, open and raw.

What do I do next? Is there any way to protect this area, or strengthen it? I can't see starting her under saddle when any amount of stress tears open the leg.
Member:
juliem

Posted on Monday, Jan 11, 2010 - 10:49 pm:

Michelle, what breed is she? I'm sure she'd have had other signs by now if she has HERDA. It's a genetic disorder, to my knowledge only in quarter horses with a lot of foundation breeding (Poco Bueno and Traveler among others.) By the age of 18 months you'd have seen other signs of poor healing and loss of skin integrity, so don't get alarmed--it could be many things or a combination of things.
Member:
mleeb

Posted on Tuesday, Jan 12, 2010 - 7:33 am:

She IS quarter horse, lots of cowhorse breeding, and does share a common ancestor with Poco Beuno, however, I don't suspect HERDA as of yet. At the moment I'm just thinking scar tissue = less elasticity, add to that a lower leg wound and movement, and *tada* - we have what we have. The question is, what do I do about it?
Moderator:
DrO

Posted on Tuesday, Jan 12, 2010 - 7:33 am:

Hello Michelle,
The wound you describe should not be having the healing problems you are having, so I am wondering if something else might be going on. Is it possible the horse interferes with (strikes) this area with the hoof of the other leg when walking, trotting, or cantering?

Can we have more details on how you are treating this wound since the initial episode? Following opening up how long have you tried enforced rest in order to try and get this well healed?
DrO
Member:
mleeb

Posted on Tuesday, Jan 12, 2010 - 8:22 am:

I can't rule out striking, but I have never witnessed it.

As for treatment, the first incident would have been the initial wound, and the second would be when it broke open and eroded quite badly. That's covered above.

The third time it tore open (August), it didn't develop into the huge wound as it did before, but I began doctoring it very quickly since I was concerned that the previous erosion was because I wasn't concerned enough the last time and left it a day or two. I doctored it by cold hosing once a day and an application of DermaGel. The vet instructed that it be applied well up onto the hair surrounding the wound to give complete coverage. She was not confined, but left on pasture. I treated with the cold hosing for several days until the wound scabbed over nicely, and continued with the daily DermaGel for about 3 weeks, well after the scab was gone, and healthy tissue was showing.

So, the fourth time is now. A week or two ago I noticed it looked crusty, but couldn't tell if it was ice (she had a lot of it on her legs), or the wound itself. I didn't supervise it too closely as I recently broke a bone in my foot and just got out of my cast, so my mobility is not very good yet. I checked again just this weekend, and the wound has definitely opened again, and scabbed over. The scab is not clean and tidy, but rough and irregular. Without having seen the wound open, I would assume this is again a simple tear, not very deep at all. It always tears the length of the scar tissue, no where else. It was open at the top of the wound, but I don't know it was because she peeled off the scab, or if it hadn't healed over in the first place. I put on a layer of DermaGel and put a call in to the vet. I'm waiting to here back from him now.
Moderator:
DrO

Posted on Tuesday, Jan 12, 2010 - 6:40 pm:

Michele, what is in the DermaGel? Can we have some good images of the current wound?
DrO
Member:
mleeb

Posted on Tuesday, Jan 12, 2010 - 7:54 pm:

I can take pictures, but not until Saturday. It's too dark when I leave for work, and when I get home, and not nearly bright enough in the barn. I wish I still had the original photos I took last May.

I found a website for Derma Gel. www.derma-gel.com

Here's some info:
Ingredients:
Titr. Polysaccharides (Pyrus Sorbus extr.) ; Centella Asiatica (titr. extr.) ; Calendula Officinalis (titr. extr.) ; Salvia Officinalis extr. ; Thymus Vulgaris extr. ; Origanum Majorana extr. ; Lavandula Officinalis extr. ; Propylene Glycol ; HyDrOgenated Castor Oil ; Sodium Bicarbonate ; Glycerin ; Alcohol ; Aqua Purificata ; Carbomer (for the gel form).

Indications:
Veterinus Derma GeL® is an isotonic formulation available in gel or fluid form indicated for intensive and rapid skin care. Veterinus Derma GeL® ensures a uniform porous barrier of protection against bacterial attack, foreign contaminants, avoiding desiccation and maintaining an ideal percentage of moisture. Bandaging the affected area is therefore not required.
Certified non-mutagenic and devoid of cytogenotoxicity or irritant and sensitizing effect on epithelial cells, Veterinus Derma GeL® maintains cell viability to a very high rate and consequently favors a rapid hair regrowth in the original color. Staying where it is applied, Veterinus Derma GeL® in gel form will not run off the treated surface.
Moderator:
DrO

Posted on Wednesday, Jan 13, 2010 - 6:45 am:

I look forward to the picture but in the mean time if you believe exercise is responsible for it opening you will have to restrict it until the wound heals strong enough to take exercise then add exercise back slowly to strengthen the tissues. I do think daily hand walking will help it heal stronger Michele.

I do not have any experience with the wound treatment product but have had good results on wounds like this using the recommendations in the long term wound care article.
DrO
Member:
mleeb

Posted on Wednesday, Jan 13, 2010 - 8:10 am:

I just looked it up, and it turns out that that is the article I was referencing when she initially injured herself. It was very helpful, and gave me a lot of detail that I didn't get in conversation with my vet.

The problem I have with confining her to limit her activity is that this wound is reopening itself each time at longer and longer intervals. The first time was quite short, the next time was 6 weeks, the next time was 3-4 months. With a time period like that to deal with, and a wound/scar that by appearance does not give any indication of being unstable, it's going to be a guessing game for me as to when to decide she's alright and turn her out.

I checked her in the dark last night, and by feel the leg was improving. The scab is decreased in size, and there was no weeping felt. I applied the Derma Gel again. I expect that Saturday's photo will be relatively unremarkable.
Member:
mjq1

Posted on Wednesday, Jan 13, 2010 - 9:13 am:

Michelle, How about after the wound heals, put polo wraps, or boots on her legs when you exercise her. If it is interference, the wraps will stop it from reoccurring. Something I found that works really well on wounds, and scar tissue is plain old Aloe Vera gel. It even dissolves really old scars anywhere on the body. I use the clear kind without any color.
Member:
mleeb

Posted on Wednesday, Jan 13, 2010 - 9:04 pm:

I have certainly considered using boots or wraps when I exercise her (and I do plan to do this)-- only I NEVER exercise her. At 18 months she's only gotten basic groundwork, handling and manners. I didn't teach her to lunge because the cut was either open, or too recently healed for me to want to try it. She's never torn it open while I was doing anything with her, just turns up with it bleeding again. If booting her 24/7 for protection was a safe option, I'd try it. If the darn thing would stay closed just a little longer, I might actually get some training on her. Aloe vera is something I've considered as well, but haven't tried yet. Still hoping the local vet phones me back...guess it's time to leave him another message.
Member:
stek

Posted on Thursday, Jan 14, 2010 - 6:54 pm:

Very odd. I wonder if using some kind of butterfly bandage to help hold the wound together while it heals would help?
Member:
rtrotter

Posted on Thursday, Jan 14, 2010 - 7:51 pm:

Michelle,

I have two possibilities as to why this seems to be reopening without, you seeing her do it.

I have a race mare with very good tight legs that has to wear polo wraps outside in the field. I could never figure out why she was getting cuts on her inside left rear cannon bone. If you can, watch your mare when she rolls. My mare when she rolls always goes down on the same side, and as she rolls she hits the inside of her left leg with the right rear hoof, its like a routine with her, then instead of getting up or rolling all the way over, she sits up like a dog, switches sides and does the same thing on the other side, but she does not hit the cannon bone on the right side, she misses it entirely.

The other possibility is that she's doing it when she comes in heat. I had a very slutty mare that would try and mate with the fence. She would rub her butt on the fence and in some cases get her back leg over the bottom board on the fence and she was perfectly happy to stand there like that until someone saw her and got her out of it( Sometimes requiring pulling the nails out of the fence boards to get the board off, when she wedged herself into it).

I had very good luck with a product called alumisol when my mare was recovering from a racing accident where she had really bad cuts on her knees. Its a silver spray that acts like a second skin, like a bandageless bandage. I used it after following Dr. O's recommendations for long term wound care, when I felt it was safe to go back to turning her out.

Just my experiences.
Rachelle
Member:
mleeb

Posted on Thursday, Jan 14, 2010 - 10:09 pm:

The alumisol sounds interesting. What do you think, Dr. O? Would it be worth considering in this situation?

I'll also watch her whenever she rolls and see if she is striking herself. Thanks for the tip.
Moderator:
DrO

Posted on Friday, Jan 15, 2010 - 11:50 am:

I am confused Michele, in your first you say The problem is that the scar tissue is not strong, and any amount of activity beyond a trot rips it open again. But then in a more recent post you say it did not open up for 3 to 4 months. Was your horse confined for 3 to 4 months and then open it up on the first day out when he presumably trotted?
DrO
Member:
mleeb

Posted on Friday, Jan 15, 2010 - 7:35 pm:

Sorry that was unclear. I'll try to clarify.

My horses ARE pastured, and so is this filly. She has not been confined due to the injury. Had she been ripping around all over the place, I would have confined her in the ponies' dry lot pen.

However, I can clearly observe all 6 horses in the pasture from my house, and she was pretty quiet throughout her healing stages, grazing and walking, the ocassional trot, nothing more. I generally check her up close every day to check the leg, and to feed her and get hands on with her. The leg would be steadily improving each day, but, maybe just coincidence, on the day I would witness her running around in the pasture at top speed, the next check would reveal that her wound had re-opened.

Now, obviously I cannot know what she's up to 24/7, and I assume that she MUST run when I'm not looking, but this is how it's worked out so far, without fail. Maybe it's not one good run, but two or three that does the trick. Regardless, based on the fact that I observe her increased speed etc all within 24 hours of seeing the leg opened up again, I am assuming that the two are related. Once it has become an open wound again, she doesn't run anymore. She doesn't favor it either, but she's much quieter.

I spoke to the vet today. I explained what was still going on, and he said he doesn't believe he can do anything helpful. His best advice is to moisturize with Vaseline to keep the scar tissue supple, and hopeful increase it's flexibility while it gains some strength. However, he doesn't believe appying Vaseline in the winter is such a good idea, and says I should wait for spring, and hope for the best in the meantime. Vaseline is a petroleum product, which I believe is not helpful to healing tissues. Could it also be detrimental to scar tissue?

Honestly, this is so frustrating! This is not a life threatening wound by any stretch of the imagination, and aside from the initial infection that was truly a disgusting site to behold, the re-injuries don't appear severe. I'm just concerned that they keep re-appearing, that I am unable to prevent them, that I cannot in good conscience work a filly with an open leg wound, and that I possibly will never be able to work her even when it is closed, for fear or reopening it. What does this mean for her future? I have no desire to turn her into a brood mare simply due to injury, not quality and proven skills. Could this be a permanent situation, or do ALL wounds heal eventually, just like all kids are eventually potty trained?
Member:
paul303

Posted on Saturday, Jan 16, 2010 - 1:42 am:

I've used the Dermagel on some deep wounds ( one that was stitched )on the rump, and the chest. It worked well as far as protecting the wound. But I hesitate to treat leg wounds where the skin is stretched thin and tight....and is stressed with every movement. The movement of the lower legs is almost constant. Sometimes, these cuts need to be allowed to dry up and shrink...just daily wound care and disinfecting, then patting gently dry. I have used alumisol spray on your type of leg wound. It goes on quite dry, and doesn't seem to slow the healing on constantly stressed and moving tissue. The ointments and flexible gel bandages seem to slow healing sometimes, due to an almost "over softening" of the wound tissue.

Any chance of a picture? I'm surprised, with all the re-openings of the wound, that proud flesh is not a problem.

Good luck, but as long as the "Poco Bueno" genetic factors are not involved, you should get this cleared up.
Moderator:
DrO

Posted on Sunday, Jan 17, 2010 - 12:20 pm:

Michelle, this is sounding more and more like reinjury and not exercise causing the reopening Michele. Maybe protective boots while out would prevent reinjury?
DrO
Member:
mleeb

Posted on Sunday, Jan 17, 2010 - 4:02 pm:

I'm certainly willing to consider this and use boots. I have in my tack room both polo wraps, standing bandages, and SMB boots. However, turnout for her is 24/7 in a currently snowy pasture, with some trees and bush. What is the best way to go about booting her? Could she safely go with boots on for 24 hours at a time before checking and changing them out? (I'm at work and leave quite early in the a.m.) What about snow, ice and debris? Please give me your recommendations, and I'll go out and get started right now.
Member:
mleeb

Posted on Sunday, Jan 17, 2010 - 8:49 pm:

Took pictures today. It is healing quite nicely, as always. The full length of the scar tissue is about 5", some of which is covered by hair in this photo, sorry.
Member:
mleeb

Posted on Sunday, Jan 17, 2010 - 8:51 pm:

And here's the close up.
Member:
mjq1

Posted on Sunday, Jan 17, 2010 - 10:02 pm:

Michelle, I would be really careful about using SMB boots on her while turned out. They limit circulation and are not intended to be used 'long term' on a horses legs. I have a friend who caused a pressure/bandage bow of her horses tendons by leaving them on 12 hrs a day. By the photo it looks like her off hoof is striking her inner leg. I would try rubber bell boots over her hoofs to protect the leg, rather than wrapping the leg..just a thought.
Moderator:
DrO

Posted on Monday, Jan 18, 2010 - 7:58 am:

No Michele, if the horses is out 24/7 a boot will not be a good solution. The same would be true of any bandage you could come up with also. They should only be used in a situation where the horse is monitored during the day and when brought in removed.
DrO
Member:
mleeb

Posted on Monday, Jan 18, 2010 - 9:58 pm:

That's what I suspected. I guess I have to continue on as I have been already and hope for the best. I'll boot her whenever she can be supervised or when training, and cross my fingers the rest of the time.
Moderator:
DrO

Posted on Tuesday, Jan 19, 2010 - 6:27 pm:

I think the history or the tears getting further apart and smaller in encouraging.
DrO
Member:
mleeb

Posted on Sunday, Feb 14, 2010 - 1:20 pm:

Well, she's done it again. It was a long scabbed crack a week ago, and yesterday it was open. The diameter is approx 1 1/2". I haven't treated it at all this time.
Leg wound
Moderator:
DrO

Posted on Monday, Feb 15, 2010 - 8:57 am:

It does look like the rather fragile dried "scar" covering the healed wound wound has been abraded off the top. That does not lead me to any other suggestions than has already been made. If it is to be 24 hrs out, largely unmonitored, this is going to happen from time to time when she interferes or hits it on something. The hope continues to be that over time she will get a good firm healing that is less susceptible to healing.
DrO
Member:
mleeb

Posted on Monday, Feb 15, 2010 - 8:19 pm:

Good enough. I'll continue to cross my fingers and hope for the best. AT least she's not lame on it.
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