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Discussion on To Bandage or Not to Bandage...
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Member:
Heidih
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Posted on Monday, May 22, 2006 - 11:51 pm:
I guess "That is the question" is how I should finish that statement. 
History:
My 4 YO mare cut her left anterior hock on high tensile wire over 2 weeks ago. The evening feeding help saw her get hurt and gave me a call right away. The vet came out and stitched it that night. She didn't have much hope that the stitches would hold. The cut was through the skin and muscle but didn't hit the tendon (Thank goodness). The stitches held, I cold hosed her daily, for up to 20 minutes a day while she was swollen, only to get the wound clean after that. She got a dose of Gentamycin and a dose of Pen G that night and was put on Tucoprim for 6 days. She also got 2 gr. Bute 2x a day until the swelling was gone. She was placed on stall rest for 10 days and then in a small run after that.
Fast forward 2 weeks:
At 14 days the wound started draining profusely, bleeding and swelling a bit. I think she got to bucking and kicking in her run and ripped it under the stitches. I called the vet and she told me to take the stitches out and heal the wound open (no bandaging), with hosing and nitrofuricin ointment. She was headed out on vacation, so told me to call into her partner the next day (Sat.)and give him an update. Sat.the wound looked worse (as usual) and I called in and spoke to the other vet and he told me to keep the leg wrapped. And to use Novalsan ointment one it. Today the original vet called me back for an update. I told her the leg was wrapped per the 2nd vet's instructions and she told me to take the wrap off and heal the wound open.
Now I don't know what to do. The wound is granulating (there was no granulation when I pulled the stitches). I have it wrapped and I'm changing the bandage daily, hosing with pressure to clean it up. There is a fair amount of drainage but no puss. My mare is confined to her stall again and handling it fairly well. Here are a couple of pictures.
The first one is of the morning after she got stitches. The 2nd one was taken last night, with the bandage off.
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Moderator:
DrO
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Posted on Tuesday, May 23, 2006 - 8:43 am:
If you can keep it clean and the mare stalled I would probably not bandage at this time. Infection is not much worry at this stage. If you could build a bandage that would limit the motion of the leg in the stall, it might help heal a little but considering the expense and time and the good outcome you should expect without bandaging, I would not opt to.
DrO
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Member:
Heidih
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Posted on Tuesday, May 23, 2006 - 9:09 am:
Thanks Dr.O, I knew I could count on you to break the tie. It's hard when you have 2 different vets telling you to do 2 different things. I'll take the wrap off and start using the Furicin spray tonight instead of the novalsan ointment.
PS. Why didn't my pictures turn out right?
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Moderator:
DrO
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Posted on Wednesday, May 24, 2006 - 7:18 am:
If you click on them they do show but usually they display without the extra step. Did you hand code the images instead of using the Upload Attachment button? Or did you edit the code once it was in your post?
No, I think I got it: the combined size. They are under the attachment limit of 64k but together over both the attachment limit and the 100k message limit. I think the program made a decision to allow your post but to link to the the images to keep the post within proscribed limits.
DrO
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Moderator:
DrO
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Posted on Thursday, May 25, 2006 - 8:25 am:
My last thought was incorrect about the image, I have found where others have posted multiple photos that together exceeded both limits and they posted fine. I remain uncertain why your photos linked instead of displayed.
DrO
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Member:
Heidih
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Posted on Thursday, May 25, 2006 - 9:10 am:
Thanks for checking.
Oh well, the way my last few days have been going, technology (especially computer related technology) hates me. I have an unusual error on an instrument at work and not even the upper IT folks can figure it out.
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Member:
Heidih
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Posted on Friday, May 26, 2006 - 9:56 am:
Good Morning Dr.O, I have additional questions and since my regular vet is out of town for the long weekend, I thought I'd ask here.
Since removing the wrap from my mare's leg on Tuesday, I've started to see increased swelling or edema in the hock and lower leg, with no heat or excess drainage (I do see some clear/yellowish drainage, but not excessive). Is this normal? Could it be caused by her stomping at at the flies? I have been hosing off the wound daily and spraying furicin spray on it. I also surround the wound with SWAT. I've been flyspraying her over the rest of her body, including the lower leg below the wound. I'm waiting for a refill on my automatic fly control dispenser, but it's backordered, so I'll try to find it locally this weekend.
Should I think about re-wrapping her because of the stocking up? or should I just let it be? The wound does not look infected. I can take some pictures this weekend to show the difference between this weekend and last weekend.
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Moderator:
DrO
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Posted on Friday, May 26, 2006 - 11:14 pm:
Since the increase swelling is associated with not wrapping and if you were doing a good job of pressure wrapping this is not surprising. It is always best to minimize swelling, if only to prevent future stocking up problems, but it will heal either way. If it was significantly infected you would see increase lameness.
DrO
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Member:
Heidih
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Posted on Wednesday, Jun 7, 2006 - 10:27 pm:
Well I'm back with more questions
It's been almost 3 weeks since my girl opened up the wound, almost 5 weeks since the original injury. Today she got away from the barn owner and had a good romp. From what I hear it was full of bucking and kicking and lots of running. I guess she was only free for about 5 minutes and wasn't in too large of an area.
Anyway the wound is bleeding really good again and the swelling is back. I've also been concerned (before today)that the skin doesn't seem to be growing over the center area of the wound. She's been cold hosed with pressure every day and the wound is sprayed with furall and then I put swat around the edges. I took a couple of pictures tonight after I cold hosed her.
Does it look like it's healing? Or is it time to have the vet come excise some of the tissue in the top center of the wound?
My pictures aren't showing again, so I'll try in different posts.
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Member:
Heidih
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Posted on Wednesday, Jun 7, 2006 - 10:34 pm:
Trying again. The leg from the front.
I give up. You'll have to click on the picture.
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Member:
Heidih
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Posted on Thursday, Jun 8, 2006 - 9:43 am:
I'm trying the pictures again from my work computer. I'm wondering if it has something to do with my fire wall at home.
So here's a try.
Wow that worked. I noticed that the coding in the post is different. At home it says "\popattach" or something like that and here is says"\popjpeg"
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Moderator:
DrO
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Posted on Thursday, Jun 8, 2006 - 10:43 am:
Looks very good Heidi. The main change is that all the edges have granulated down so that contraction and regrowth on new skin can occur. There appears to be no excessive granulation tissue. With good care, in the next 3 weeks the wound will contract to about 1/2 this size (it will seem to happen all in one day) then it will slowly grow skin over the rest of the wound. It would be unusual to not have to trim a bit of proud flesh, but right now it looks great!
DrO
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Member:
Heidih
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Posted on Friday, Jun 9, 2006 - 2:34 pm:
Thanks Dr.O. I'm just feeling depressed that I finally have a riding horse for the trail riding season and she had to go do that to her leg. Now I won't have her most of the season. Thanks for the words of encouragement that it really doesn't look as bad as I think it does.
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Member:
Heidih
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Posted on Sunday, Jul 2, 2006 - 12:38 pm:
Well I'm trying this again. I messed up and lost my first message.
Here are some pictures from yesterday. 6 weeks after she ripped out the stitches, 8 weeks after she injured herself initially. I was hoping the wound would be smaller by now. What do you think Dr. O? Is it still healing as it should be?
A friend (not a vet) recommended a powder containing alum to help shrink it. I nodded politely and took the powder she offered. I haven't used it and with the long holiday weekend, I can't call the vet until Wednesday, since it's not an emergency. What do you think?
There's obviously a problem somewhere on my computer. I still can't post the pictures where they will show up as pictures. I can't figure it out.
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Moderator:
DrO
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Posted on Sunday, Jul 2, 2006 - 9:58 pm:
Looks fine Heidi. Alum is a caustic so the points in the article on proud flesh apply.
DrO
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Member:
Ginny
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Posted on Monday, Jul 3, 2006 - 9:00 pm:
Hi Heidi,
I know what you are going through because last year at this time my mare had a confrontation with a culvert and the culvert won. After a week at UGA vet clinic,she came home and the vets there told me to keep a Robert Jones bandage on her, that is, one of those bandages from forearm to fetlock. Well, those bandages were costing me a small fortune but I figured I was in it for the long haul. One week later, the wound was doing well but after a while she was developing proud flesh and it really looked bad. I did some searching on the internet and came across an equine vet who has done extensive research on wounds and healing. His name is Dr. Jolly and he is located in Hot Springs, Ark. He suggested that I keep the wound covered with paper toweling to absorb the fluid from the wound and cover that with panty hose. I decided to give it a try. I used his cream made with equine stem cells and the wound healed great. Hair started growing in places that I didn't think would grow. My mare still has a scar but it could have been much much worse. If you are interested you can e-mail Dr.Jolly at stepaheadfarm@yahoo.com
He is a super guy and willing to help anyone heal their horse.
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Member:
Heidih
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Posted on Wednesday, Jul 5, 2006 - 11:29 am:
Dr.0, thanks for the encouragement. I wasn't sure where alum fell in the treatment range. Thanks for the clarification.
At what point will it be safe to let her go outside into her small run (Approximately 20 ft x 50 ft)? Should I wait until it's completely healed, or is it OK for her to come and go now? She's doing well with being stalled, but she is getting bored.
Virginia, thanks for the information. I may contact him and see if there's anything else I can do speed healing. I have a trail ride scheduled for early August. I'd really like her to be ready for it.
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Moderator:
DrO
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Posted on Wednesday, Jul 5, 2006 - 11:53 am:
Hello All,
Virginia I do not know of a stem cell cream that is likely to be of any benefit over other good care so I think it was all the other good recommendations Dr. Jolly gave you that saw you through.
She could go out now but because of the location it will heal quicker and will a smaller scar with stall rest at least until past the contraction phase.
DrO
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Member:
Corinne
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Posted on Thursday, Jul 6, 2006 - 1:43 am:
Virginia...Just curious. What would the pantyhose do? Provide a sorta pressure bandage? Do you apply a dressing first? Or just the hose?
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Member:
Heidih
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Posted on Wednesday, Aug 9, 2006 - 10:56 am:
I'm back again. It's been nearly 14 weeks since the original injury, nearly 12 weeks since she opened it up. I must say that I think it's healing well. It's just taking so long. I'm very happy with how the sides of her hock look, I'm still waiting for the wound to close in the middle.
Here are some updated pictures.
DrO, Do you think there may be some exuberant granulation that could be slowing the healing? Is it time to have some tissue removed? Or should I continue to be patient and wait a few more weeks to see what happens.
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Moderator:
DrO
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Posted on Thursday, Aug 10, 2006 - 10:29 am:
From the side view I would say wait a little but I think one more trimming is in your future. Comparing to where you were on Jun 8th and that this is a anterior hock injury, this is not bad progress.
DrO
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Member:
Heidih
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Posted on Friday, Aug 11, 2006 - 8:10 am:
Thanks Dr. O. One last question. Do you think turnout in her run would be OK. She's now in a 12 x 12 stall. The run is 20ft x 80 ft. I'll admit I've let her out there a little bit when I clean her stall. She mostly just puts her head down and munches on the grass that's grown up there this summer. So I haven't been too worried, but it's just a short time. I'd like to be able to leave her stall door open all the time, if I can, to cut down on the stall cleaning. But I don't want to slow down the healing.
Thanks again.
Heidi
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Moderator:
DrO
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Posted on Saturday, Aug 12, 2006 - 11:44 am:
Increased motion in the joint will cause more tearing of the granulation bed, more granulation tissue forming, and increase the size of the scar tissue both on the surface and deep to the surface where adhesions form. Hand walking is good to prevent adhesions but I would discourage free running till healed. Where the turnout figures in this I am uncertain.
DrO
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Member:
Heidih
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Posted on Tuesday, Aug 15, 2006 - 9:52 am:
Thanks DrO. I think I will continue with my current schedule. She's not running or playing in her run right now. I leave her out for a couple of hours while I'm there cleaning stalls. If she gets too active, I'll pull her into her stall. She's really been a good girl through all of this and seems to look forward to her outside time.
Thanks again.
Heidi
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Member:
Heidih
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Posted on Tuesday, Oct 3, 2006 - 7:57 am:
Hi again DrO and everyone. I have good news and bad news about my mare Tootsie. The good news is that her hock wound is almost closed now. Just a very narrow space still needs skin, it almost looks like a scrape. Here are a couple of pictures I took last night.
The bad news is that she got to running and playing on Thursday night or Friday sometime and did a number on her left front pastern coronet and hoof wall. It looks like she caught herself. The wound on the pastern doesn't bother me too much. I'm keeping it wrapped and clean. What worries me is the slice out of her hoof wall, right at the coronet band. That seems to bother her the most too, she's fairly lame on it. I talked to my vet, who didn't come out, but did prescribe Tucoprim for 5 days. She said that the hoof would just have to grow out. What I'm wondering is whether or not I should have her out and take off the bit of hoof that is sliced? Or should I just leave it. Once the wrapping is off, it's going to pack with dirt either way. Should I just plan to leave it wrapped until it grows all the way out? Or can my shoer put something in the defect to protect the sensitive tissue? Here's a picture of the injury. What do you think?
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Moderator:
DrO
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Posted on Tuesday, Oct 3, 2006 - 10:02 pm:
Could we have a photo of the hoof Heidi? Until then there is no reason that I can see not to treat this as recommended in our articles on wound care.
DrO
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Member:
Heidih
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Posted on Wednesday, Oct 4, 2006 - 5:58 am:
Hi Dr O.
Right in the middle of the circle is where the hoof is sliced. I wouldn't be worried, except that she is pretty lame considering the size of the slice.
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Member:
Heidih
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Posted on Wednesday, Oct 4, 2006 - 7:39 am:
Sorry Dr. O, I got interrupted by a power outage at home. I'm posting again from work with hopefully a more clear picture. The first one has a circle around the slice in the hoof wall, the 2nd one is a closer up view. I was having a hard time getting a good picture since I was working indoors under fluorescent lamps. What isn't evident in these pictures is that the flap of hoof wall is detached and can be lifted up. She is quite sore.
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Moderator:
DrO
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Posted on Thursday, Oct 5, 2006 - 9:46 am:
That is quite a quarter crack Heidi and will be sore until it recornifies which may take several weeks. The question in my mind is whether to remove the loose horn, or stabilize it with a hoof patch, or just leave it alone. I would be prone to sedation, local, and removal. If it gets caught on something it might avulse a even bigger piece. Stabilization and infection possible.
DrO
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Member:
Heidih
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Posted on Friday, Oct 6, 2006 - 8:50 am:
Thanks Dr.O. I was thinking of pulling the hoof piece off. It's definitely more than a crack, it's an actual slice. The red line on the picture below shows the extent. It goes right through the coronet band. Last night while I was spraying the pastern, the flap on the hoof came up and it appears to only be attached by a piece of hoof wall. I was able to bend it back and look at it. My mare showed no signs of pain, so I think it's only attached by wall, no soft tissue. I plan to pull (or cut) it off tonight when I change the bandage.
I have a call in to my farrier to see if he thinks there's a way to patch the area so I don't have to keep it wrapped until it grows out. Does that sound like a reasonable plan? I'd like to be able to turn this girl out to pasture for the winter.
Right now I have a pressure bandage on with duct tape holding the wrap to the hoof wall. I hate to leave the tape on the hoof, but I don't know what else to do right now. Any suggestions?
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Member:
Heidih
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Posted on Tuesday, Oct 10, 2006 - 8:08 am:
Well it looks like we lucked out on this injury. I had the farrier out over the weekend to take a look at how much damage was done to the hoof. It appears that the "slice" was actually a gouge and she didn't go all the way through the hoof wall. She was probably sore because of a small cut at the coronet band. The farrier recommended that we do nothing right now. He said that the gouge will grow out and that there will be a little bit of management as it grows to make sure no splitting or cracking occurs at it gets closer to the ground.
She is almost 100% sound right now and the wound on her pastern is starting to granulate. I have it covered and am doing just about the same things for it as I did for the hock. Hopefully it will heal much faster.
Thanks again for your help.
Heidi
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