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Discussion on Hock wound hair not growing back
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Member:
ceceb
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Posted on Wednesday, May 20, 2015 - 1:59 pm:
Dr. O, my horse got hung up in a wire fence 11 months ago on the front of his hock. It's been a long process but my concern is the hair is not growing back. I have to keep it bandaged or it swells up and it has split open a couple of times when left unbandaged. He is totally sound and X-rays showed no damage. I'm concerned about the hair not coming back.
I had someone suggest cold laser, another doing grafts, or shock wave. Or insulin containing ointments. I've just switched from Thermezene and I'm trying Equiderma which contains neem and caledula.
Any advice is greatly appreciated!
 
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Moderator:
DrO
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Posted on Monday, May 25, 2015 - 2:39 pm:
Hello Cece,
Your wound has not healed to the point that the horse can be safely freely exercised. He needs a longer period of rest and healing so that the tissues that are holding the edges together, probably maturing granulation and immature scar tissue, can advance to a higher quality scar, a type of connective tissue. The areas that are re-epithealeated will grow hair, the areas where scar tissue predominate will not. There are no ointments that are going to promote more hair growth and keeping the wound clean and free of infection are the number one goals.
If you allow this to heal properly the scar tissue, as it strengthens, will contract down to a much smaller area. The more times you push this wound to reopen the less attractive is going to be the result.
DrO
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Member:
ceceb
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Posted on Wednesday, May 27, 2015 - 6:24 pm:
Thanks, Dr.O. I've had 2 different Vets check it recently and one said to keep bandage off, but he bites at it. 2nd vet suggested ultrasound to see if there's anything in there. She also suggested laser therapy. Would that be helpful? I normally would use h2o and keep it unbandaged but with the location, I've kept it bandaged and lately leaving it uncovered. One suggested keeping it dry, the other keeping it moist, using Thermazene or steroid cream. What do you suggest? Thanks!
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Moderator:
DrO
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Posted on Thursday, May 28, 2015 - 7:22 pm:
Hi Cece,
I am uncertain how lasers might help and not being able to examine the wound I cannot make any specific recommendations. A pretty good rule of thumb is that moist wound should be dried and dry wounds moistened but there will be exceptions.
DrO
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Member:
ceceb
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Posted on Wednesday, Feb 3, 2016 - 9:10 am:
Hi Dr O, ongoing with this one. . I'm at my wits end. There is no lameness. . There is a little heat and it appears to be getting larger recently.
From what I'm getting from different vets, there's improvement with the bone remodeling. One is telling me to not exercise him, another is saying to keep him moving. My issue is the scar tissue and how to deal with that. Shockwave? Laser? Steroid treatment? Will it go away on its own? Any advice?
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Member:
ceceb
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Posted on Wednesday, Feb 3, 2016 - 9:17 am:
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Member:
lucyc1
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Posted on Wednesday, Feb 3, 2016 - 9:38 am:
Hello Cece,
I notice that one of the vets suggested doing an ultrasound to "see if there is anything in there". Was that done? I'm no vet, but it seems logical that if the swelling is continuing, your horse's body is responding to something abnormal......
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Moderator:
DrO
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Posted on Wednesday, Feb 3, 2016 - 2:25 pm:
Hello Cece,
As scars mature they do not go away but they can get smaller. You think it has been enlarging recently which suggest ongoing damage and further rest. On the other hand you don't want the tendons to scar down which suggests movement. If the swelling has a fluid component a neoprene hock wrap will help. As you can see the answer depends. A ultrasound may be helpful if only to get a baseline for future changes. Since you are getting different advice from those who can examine the wound you need to explore their advice deeper to understand why they recommend what they are recommending and see who makes the most sense. A good step would be referral to a experienced soft tissue surgeon who is willing to enlist a dermatologist to help.
Surgery including laser often ends us with the scar growing back however I have managed a few horses with similar problems by surgically debulking the scar and through rigorous bandaging and limited exercise and a long time of daily care have improved the outcome. Their scars were not as wide as yours is at the base but stuck out much further. I do not have any experience with ultrasound therapy of large scars.
I went looking for research on keloids and was surprised that neither veterinary or human medicine have a good grasp of effective treatments. Here is an example of what I found:
Arch Dermatol Res. 2015 Aug;307(6):461-77.
A comprehensive evidence-based review on the role of topicals and dressings in the management of skin scarring.
Sidgwick GP1, McGeorge D, Bayat A.
Author information
Abstract
Wound healing after dermal injury is an imperfect process, inevitably leading to scar formation as the skin re-establishes its integrity. The resulting scars have different characteristics to normal skin, ranging from fine-line asymptomatic scars to problematic scarring including hypertrophic and keloid scars. Scars appear as a different colour to the surrounding skin and can be flat, stretched, depressed or raised, manifesting a range of symptoms including inflammation, erythema, dryness and pruritus, which can result in significant psychosocial impact on patients and their quality of life. In this paper, a comprehensive literature review coupled with an analysis of levels of evidence (LOE) for each published treatment type was conducted. Topical treatments identified include imiquimod, mitomycin C and plant extracts such as onion extract, green tea, Aloe vera, vitamin E and D, applied to healing wounds, mature scar tissue or fibrotic scars following revision surgery, or in combination with other more established treatments such as steroid injections and silicone. In total, 39 articles were included, involving 1703 patients. There was limited clinical evidence to support their efficacy; the majority of articles (n = 23) were ranked as category 4 LOE, being of limited quality with individual flaws, including low patient numbers, poor randomisation, blinding, and short follow-up periods. As trials were performed in different settings, they were difficult to compare. In conclusion, there is an unmet clinical need for effective solutions to skin scarring, more robust long-term randomised trials and a consensus on a standardised treatment regime to address all aspects of scarring.
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