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| Discussion on Deep Wound above Knee- Exposed Tendon and Bone. | |
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| New Member: katiev |
Posted on Thursday, Nov 4, 2010 - 1:19 pm: My sweet old gelding Kit Carson got tangled up in a fence on October 4th. Most of the cuts were superficial, but one above his front left knee was pretty deep and exposed some tendon and a little bit of bone. He wasn't lame at all, there was some swelling. He is one tough horse and has been through some serious injuries, he has some major willpower and a zest for life!He has been moving on it really well. He is not a horse that is use to being stalled, thankfully our stalls are 20 x 30, and hand walked daily, recently upgrading to a few hours turn out in a small paddock on pretty days. The wound exposed a tiny bit of bone (vet was able to poke her index finger in the hole to touch the bone, but you can no longer see that area as granulation flesh has filled in. You can see some of the exposed tendon in the first two pics which are from about a week ago, but as you can see there is granulation flesh attaching TO THE TENDON, which moves up and down with it when he walks. Is that normal?? The G. flesh has filled in pretty quickly and everything seems to be going along as it should. My questions pertain to what I've seen happening the past few days... On Sunday night I went down to the barn to blanket him and close the barn doors up. I found him outside the barn happily munching on grass. His wound was bleeding quite a bit, but he wasn't lame at all and didn't seem to mind me spraying it out. From what I can determine... he actually fell OUT of his stall! He is prone to lean on things..he LOVES having his butt rubbed and massaged (will back it right up to your face like a dog) and I think he backed his butt up to the gate and leaned/rubbed it so hard it bent the nails holding the chain and the gate fell open. (BTW he is NOT scratching his tail like a horse with worms, just loves to rub his butt muscles) So I cleaned him up, put him back in his stall and left. The next morning (Monday) he once again had a lot of blood on the wound and what looked like a clot/blood blob kinda hanging down on top of the tendon area, it seemed to come out of the area between the tendon and the encasing flesh. I sprayed most of the blood off, but decided not to pick at the clot until I could examine better and had more time. That evening I did notice that he was sorer and stiffer and the clot thingy had grown (to about the size of the tip of my thumb.) It was dark black and sticking out and seemed to make it harder for the tendon to move up and down, so I thought I might should trim it off, vet agreed it probably needed to go- talked to her on the phone- though she seemed to think it was dying tendon that might has been jarred down and slothed out. I cut a little bit of it to see, didn't hurt him a bit and was obviously solid congealed blood, so I trimmed it off as best I could and it seemed to make it easier for him to move. The next morning, the darker black areas of the blood clot that I wasn't able to get without being to invasive (and that didn't seem to be to hinder the tendon movement) has disappeared or been reabsorbed or whatever by his body. Things were looking pretty good. Still seeing more blood than I had previously been seeing... but he wasn't lame in that leg. He did still seem a little stiff in his back end (he's and old man and has trouble getting up and down sometimes, and after that fall I think he had, was to be expected.) Last night (Wend.) I decided to turn him out in the paddock for an hour or two while I went to church. As far as bandaging goes, been using a pantyhose attached to Velcro to keep flies out but let wound breath. This seems to bug him more than anything else (I think it pulls his hairs) so I leave it off at night, or on cold days when there is no fly problem) Since I was turning out, i wanted to put it on to keep any dirt out of it. I had soaked it in alcohol to loosen up the gunk and dried blood on it and then I spray it off. In hindsight I might not have sprayed it off long enough to get all the alcohol out, i noticed it still has that "alcohol smell" when I came back after church and found him standing at the gate and holding the leg up like it was hurting. He was suddenly sort of lame in it (from one hour to next) Took the bandage off and cleaned it out again, LOTS of fresh blood (especially for just an hour or two), and a new little clot looking thing forming on the top of the tendon. After I washed it off it didn't seem to hurt anymore, so I think it was probably just stinging from alcohol that might have still been in the pantyhose cover. I didn't put the pantyhose cover back on it. Also, I think he might have rolled by the look of part of his coat... and he might have once against tweaked/stressed it when climbing back to his feet. This was last night. The little clot looking thingy wasn't as dark black as the one I had seen before. On close examination it actually looked like it might have granulation flesh forming OVER it... it was sort of purple blue... rubbery. I could pull part of it up and look under it and it seemed to have some tendon fiber attached to it so I decided to leave it alone and look at it again this morning. This morning it was now the dark black color of dried blood, I could still pull it up and look under it from the front and see fresh blood and tendon or fleshy fibers... What I want to know, is should this be trimmed off?? I read in the article how a wound like this has to bleed to heal, the vet said the same thing when she first came out, but what about these clot things? Will those turn into granulation flesh? Will the be reabsorbed? Should they be trimmed off? The vet can't come out again for probably two weeks... in talking to her on the phone she seems to think it's dying/dead tendon coming out. I don't know. The first one I know was solid blood. It looked like blood pudding when I cut it up.. but this second one.. I don't know, it seems to have other elements to it besides congealed blood. But even if it IS dying tendon, should it come off? I mean, we don't want necrotic flesh hanging around...? I just can't figure out it this is something his body is doing to proactively heal, or if this is a consequence of two much movement in the joint and should be cleaned/trimmed off?? Also I have noticed that on the other side of the wound where the granulation flesh has started to fill in more and the skin is growing back over the surface, where it bends as he moves the skin and G. flesh tear and bleed. In one of the pictures I pointed to this "crack" area and you can see the dried black blood in it. Will the bleeding in the area help it heal/fill in with G. flesh quicker? I'm not too concerned about that area, it's this blood clot on the tendon that is worrying me. He seems to be walking on it fine today, walks faster than me, so it's not hindering the up and down sliding of the tendon the way the first clot seemed to...? I'm leaving him in his stall right now to restrict movement, but he has a huge 20 x 30 stall. Sorry this is so long, I'm just trying to be diligent. This horse is my darling, I've had him since I was 10 years old and we've been through a lot together. Everything seems to be going well, flesh filling in the way it should, it's just these blood clots/blobs that are throwing me for a loop! It does seem to bleed more when i put the pantyhose cover over it, maybe it irritates the skin... or maybe it just traps the blood for me to see as one big gooey mess when I pull it off, whereas it normally just drains. Oh as far as wound care- twice a day I clean with betadine scrub, then treat with biozide gel (betadine based) I have used vetricyn spray gel at times as well- like after I wash put that on and hand walk/graze... it sort of evaporates/dissolves and then put the biozide on nice and thick. Only oral meds are SMZ (we are doing a second 10-day round of SMZ just to be safe), with occasional bute the past few days for soreness/stiffness from either standing around or possibly his fall and then rolling. Any advice/suggestions would really help! I wish I had taken more pictures, the first two are the wound about a week ago.. same pic, but the second one I added "labels" to explain. The next few pics are the ones I took this morning are not the best. (I'll try to take some more this evening of the new blood clot in question... it at least doesn't seem to be growing the way the first did.) Thanks again for reading all this and for any advice. Even if it's just to tell me to chill out and let his body to it's thing... the last picture is one I put together in photoshop to show the wound progression from last week to this morning. This morning pictures are blurry, but you can tell the flesh has filled in around edges skin is growing, it just doesn't LOOK as "pretty" I guess with that dried black blood...     
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