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  Discussion on Deep lower leg wound with exposed bone
Author Message
New Member:
jer216

Posted on Wednesday, Nov 28, 2012 - 2:03 pm:

Hello,
This is my first post here. Two and a half weeks ago I found my mare lame in the pasture. We have a lot of pasture so from afar I only noticed the lameness. When I went to get her she had a huge gaping wound with about 6 inches of exposed bone. I still don't know what she cut it on. Part of the pasture is wooded so possibly a protruding or fallen tree branch, but could have been anything. The wound looked like it was a couple days old. I had seen her in the pasture in the days leading up to this, but she was standing and eating with the other horses so I did not catch the lameness.
Anyway, the vet came out and removed "flappy" flesh, cleaned the area with a chlorhexadine scrub, wrapped it and put her on antibiotics and bute. He applied furazone to the wound, covered in 4x4 gauze pads with a non stick gauze wrap over that, then sheet cotton and Vetrap for the top layer.
I've been doing this every day and today is day 18. About 7 days ago he said to taperher off bute since she was completely sound. 9 days ago she finished the antibiotics. So, two days after she was done with the antibiotics her bute was lowered. I noticed some swelling the next day but assumed it was because of less bute. She was still sound. Over the last few days her swelling has gotten progressively worse and she now has a large edema on the lower left abdomen. I spoke with the vet and upped her bute again last night, and am starting the antibiotics again today. Ill post some pictures of the progression along with the current swelling.
In the last two days the wound has been bleeding a lot more. The vet said not to worry too much as the granulation tissue is very vascular and it means the wound is healing.
I'm hoping there's nothing in the wound that is causing the infection, but I don't know enough about it to really know either way. The vet said he didn't think she would have needed more antibiotics at this point but said to start them up again. Anyway, I don't have any specific question, but any advice would be appreciated!
PS - cant upload pics from phone so will upload when I'm on a computer
Moderator:
DrO

Posted on Wednesday, Nov 28, 2012 - 3:47 pm:

Welcome Jane,
Let me help you out with our specific recommendations on long term wound care for deep wounds like yours. I have use these recommendations on many legs wounds with exposed bone successfully. See the article at HorseAdvice.com » Diseases of Horses » Skin Diseases, Wounds, and Swellings » Wounds / Burns » Long Term Deep Wound Care.
DrO
New Member:
jer216

Posted on Wednesday, Nov 28, 2012 - 4:17 pm:

Thanks for your response, I will check out these recommendations. What do you think of furazone? I've read it promotes granulation (which she needs now) but also inhibits wound contraction. The vet said to keep using it until the bone is covered and then use something else to prevent proudflesh. He suggested a caustic powder, but I'm wondering if that will also damage the good tissue.
Also, with the wound being so open, how much do they usually close up? Or I guess how much of that swelling from the wound goes down until it's at a permanent state?
Thanks
Jane
New Member:
jer216

Posted on Wednesday, Nov 28, 2012 - 7:58 pm:

New Member:
jer216

Posted on Wednesday, Nov 28, 2012 - 7:59 pm:

day 5, day 9
New Member:
jer216

Posted on Wednesday, Nov 28, 2012 - 8:19 pm:

Member:
jer216

Posted on Wednesday, Nov 28, 2012 - 8:20 pm:

Member:
jer216

Posted on Wednesday, Nov 28, 2012 - 8:20 pm:

day 14
Member:
jer216

Posted on Wednesday, Nov 28, 2012 - 8:21 pm:

last two pictures are day 14 and 17
Member:
cathy33

Posted on Thursday, Nov 29, 2012 - 7:24 am:

Hi Jane, when my horse has a very nasty, open over reach injury this year, after the initial stages of using antibiotics and antibiotic creams, I used a product called Equaide which is a paste that is brushed on the wound then bandaged over. It has antibacterial properties but most importantly promotes healing without the formation of proud flesh. The results were really good and he only has minimal scarring. Obviously you have a very large area to cover so it might be costly to use but I think it would be worth you visiting their website as there are case study examples not disimilar to yours. I can't remember the web address but if you google the name and run a search you should find it. I am from the UK but the product is made in America so should be cheaper there. My vet also likes the product as it is not caustic.

I wish you all the best success with his recovery.

Cathy
Member:
jer216

Posted on Thursday, Nov 29, 2012 - 12:53 pm:

Hi Cathy,
Thanks for the suggestion. I actually ordered a sample size of Equaide I try out when the vet suggested applying something different to the top few inches of the wound as it's at skin level already and if we wait until the bone is covered the top part might already have developed proud flesh. I applied it for one day but after her leg swelled up I went back to furazone until te leg swelling goes down. I don't know if that will help at all (waiting until the infection is resolved) though.
Also I think I forgot to mention that she has been sound throughout the whole process with the exception of the day I found her. With the recent swelling the leg has been sensitive (and hot) to the touch but she's still sound. The vet said there was no tendon damage so that's good news.
Dr. O, what are your thoughts on regular gauze pads versus Telfa pads?
Thanks,
Jane
Moderator:
DrO

Posted on Friday, Nov 30, 2012 - 7:39 am:

Hello Jane,
I would note that Equaide will not tell you what is in it's product. We strongly recommend you do not use any product that does not list its ingredients.

I think most your questions are answered in that article (Furacin ointment is a nitrofuran in a propylene glycol base). I like gauze instead of telfa because it helps keep a wound debrided when it is removed. And it is much cheaper.

Why are the exposed tissues in the first image above blackened? As the photo series goes on things get to looking much healthier but the swelling up the leg is much more than I would have expected.
DrO
Member:
jer216

Posted on Friday, Nov 30, 2012 - 9:31 am:

Hi Dr. O,
Thanks for directing me to the article, it was really helpful.
The wound was black because it was 2-3 days old. On Thursday morning I took hay out and she was fine. I saw her Friday and Saturday as well but from a distance and as she was standing (not walking) I didn't notice anything. Sunday morning is when I noticed she was lame so went out to get her and that's when I saw the wound. So it potentially could have happened any time after Thursday morning. They are on about 5 acres of land so I really didnt see anything until the obvious lameness. That picture was taken when the vet was on his way so before it was cleaned. I've been changing the bandaging daily since. I was going to switch to every other day (per vets instructions) once she finished the first round of antibiotics but then it swelled up again so I've been doing it daily still.
How long does it usually take for the antibiotics to work? We started the second round Wednesday, so she's had doses on Wednesday afternoon, Thursday morning and now this morning. I haven't noticed any decrease in swelling, tightness or heat.
Thanks,

Jane
Member:
jer216

Posted on Friday, Nov 30, 2012 - 10:13 am:

Sorry, another question. In your article you noted that foreign bodies can cause infection. Since I don't know what she injured herself on I can't speculate as to what could be in the leg, but is it possible for a foreign body to cause swelling two weeks after the initial injury? Or would it be right away?
Also, the vet thoroughly cleaned the area, but if something was missed (and now that a lot of granulation tissue has formed) how would you be able to tell if there is actually something in there that needs to come out?
Thanks,
Jane
Member:
jer216

Posted on Friday, Nov 30, 2012 - 1:58 pm:

Full body picture at day 19, here you can see the full leg and also the profile of the edema under her stomach
Member:
paul303

Posted on Saturday, Dec 1, 2012 - 12:23 am:

Jane, has the vet been back out yet to see the new areas of swelling and edema? I, myself, and many others on this site have dealt with similar injuries and have found the recommendation in Dr.O's articles invaluable. The dailey cold hosing under gentle pressure seems to be the most help. It would probably be good to extend the hosing up the leg to above the area where the swelling has extended. Make sure you don't skimp on the hosing...a few minutes won't do (although it's better than nothing). Besides cleansing, look at it as hyDrOtherapy, and take your time. Wish you much luck and patience in treating this wound. There is a long road ahead.

Now, I have a question: There are some antibiotic sprays out, like neosporin, would they have any place in treating a wound like this?
Member:
jer216

Posted on Wednesday, Dec 5, 2012 - 11:14 am:

The vet came out Monday to take a look. He said he really didn't think it was an infection because of the healing progress but said to finish the antibiotics anyway. He also mentioned that, although unlikely, she could be reacting to the chlorhexadine scrub (the day he had me start using the scrub is the day the swelling started). I started using the more-diluted solution and the swelling on the upper leg has come down, although she still has the edema and lower leg swelling. He said to either keep using the solution or switch to Betadine in case it actually is a reaction. She is really sensitive (full body hives every spring, strong reaction to vaccinations every spring) so hopefully it is a reaction and can be fixed with switching to Betadine. I've started hosing too so we will see if the swelling starts to come down more -
Jane
Member:
jer216

Posted on Wednesday, Dec 5, 2012 - 11:17 am:

day 24

Moderator:
DrO

Posted on Wednesday, Dec 5, 2012 - 6:57 pm:

You definately do not want to use scrub (chlorhexidine or povidone) daily on such a wound. The soap is to irritating and unnecessary. Discuss with him the recommendations we give as a alternative. I also recommend the use of antibiotics until all the tissues are covered with a solid layer of granulation tissue including bone.
DrO
Member:
jer216

Posted on Saturday, Dec 15, 2012 - 4:40 pm:

Updated pictures, day 24 and day 33 to compare. Still no change in the swelling


Member:
juliem

Posted on Saturday, Dec 15, 2012 - 8:10 pm:

Looks like you're diligent care is making progress
Member:
jer216

Posted on Monday, Dec 31, 2012 - 12:27 pm:

Update: All bone is completely covered. The wound is healing nicely but the leg is still extremely swollen. Our vet said he just doesn't know why. We switched the antibiotic to penicillin (started Saturday) and are adding dexomethasone with it (10 CCs for two days, skip third day, 10 CCs on fourth day) to see if that will help at all. At a loss as to what to do if this doesn't work. Thoughts?
Member:
chrism

Posted on Tuesday, Jan 1, 2013 - 4:46 pm:

Hi,

I have been nursing my mare through 3 similar wounds to the bone on either side of her cannon and on the inside of her tibia.

She was hurt in April and one of the wounds is not completely healed.

So, perhaps your expectations for healing are a bit, er, ambitious?

My mare did have a sequestrum in two of the three wounds. One was resorbed by her body. The other had to be surgically removed in August. Then in November, that wound showed some signs of bone infection and it was trimmed and we changed topicals, and put her on a fairly long course of oral antibiotics.

My vet used radiographs several times to check the bones for sequstra, infection, etc. The first signs of sequestrum were about 6 weeks after the accident and one wound was slower to develop a sequestrum.

We also wrapped for quite some time, which may have helped with the swelling. She was on stall rest, then stall and paddock and is still restricted from turnout with other horses.

We used different things topically, depending on the stage. SSD was great for promoting granulation and as an antibiotic.

When I was wrapping, I used an 8" telfa, cling gauze, the BB satin star white gauze wraps, generic vet wrap and generic elasticon. I put whatever topical I needed on the telfa. It was tricky getting two telfas on opposite sides, but you learn. I found most of my supplies for a good price at www.shopmedvet.com

When the granulation was good, my vet gave me a topical that was a mix to discourage proud flesh and infection. It was something he mixed up and I know there was a steroid in it, too.

After the wrapping phase, we graduated to tube socks with the toes cut off to cover the wound from insects. These were held up with the elasticon tape.

Right now, only one wound is still on the mend and it basically needs the hide to grow over - epithiliation, I think. We are applying Animax to it daily, sometimes after a spray rinse with warm water in a spray bottle and then lightly dry.

I use some wooden popsicle sticks from the Dollar Store to dip meds to avoid contamination.

Once this wound closes, we will do like we did for the other two wounds and apply, of all things, Preparation H. This is supposed to tighten the tissue and reduce scarring.

We think my horse's leg was pinched in the stall between two thick/large oak boards when the channel failed as she tried to right herself from being cast. She managed to extract her leg on her own and did not have any tendon, ligament or joint damage. She was at our local vet school for 18 days and then at the vet's clinic hospital for another couple of weeks. Her survival has been deemed somewhat miraculous.

I tell her story to give you hope/ideas/encouragement. Let me know if you want to see her photos and I can send you a link showing the progress.
Member:
chrism

Posted on Tuesday, Jan 1, 2013 - 5:01 pm:

An addendum:

We only rinsed with bottled saline, initially. Eventually we rinsed with regular water. I never used chlorhexidine or provadine/Betadine. If I needed to clean crusty areas around the wound, I first used saline soaked gauze squares. After the wound had filled in a lot and I was rinsing with tap water, I used antibiotic hand soap. I also used this on my hands to try to keep them clean.
New Member:
kahanson

Posted on Thursday, Apr 4, 2013 - 10:44 am:

Jane, I had a foal with an identical injury last August and I have been fighting it ever since. Turns out there was a sequestrum which was removed in December 2012, back to the wrapping and antibiotics again! Now, a couple weeks ago the leg started to swell so we are back on Uniprim and Animax daily. NO wrapping for the last few weeks. He is not lame, never was, and it doesn't seem to bother him at all. Did the swelling ever go away in your horse?
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