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  Discussion on Stocking up after surgery?
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New Member:
Vboese

Posted on Tuesday, Jun 6, 2006 - 11:42 am:

Hello,

I am new to HA and have enjoyed reading all of the articles and postings. However, I cannot find anything that relates to my topic.

Here goes: Smokey 10 yo QH/Arab cross. In March 15 of this year, he wrapped his foot in a tree branch resulting in a substantial puncture wound to his coronet band and heel. Attached are pics of initial injury. To make an extremely long story short, he went lame 3 weeks later (was not initially lame from injury). The wound never closed and kept draining for weeks. The vet was out several times for xrays and ultrasounds thinking joint involvement or foreign body. No such luck. Then they thought it was Quittor which is an infection of the lateral cartilage since there was swelling and drainage. They had me soak in epsom and wrap with ichammol. I did this for almost 2 weeks. He finally had something else erupt from the coronet band about 1/2 inch from original wound. It was a draining tract, not cartilage. My vet referred me to Cornell where he went for surgery 2 days later. After 5 days, they finally operated on him and let him go the very next day. The vet there told me they sutured the 2 draining tracts and then drilled a hole in the bottom of his foot the size of a quarter to allow drainage since there was a subsolar abscess. (He was negative with hoof testers when initially tested first day of ultrasound, xrays)It has been almost 3 weeks since the initial surgery and the hole in the bottom of his foot is still not closed up and there is considerable swelling in his fetlock. The vet was out here last Thursday to remove the stitches which became embedded in the skin since they were left in for 14 days (what they told me) and she really had to dig to get them out. The leg swelled up the next day. He also was on SMZ for 14 days which I stopped the day she removed the stitches. He is on stall rest except for 30 minutes twice a day in which I hand graze. The bandage has gotten wet a couple of times from urine even though his stall is cleaned every 2 hours or so. I have been changing every 2-3 days. What I would like to know is how long until that hole closes, do I still need to worry about infection, what about the swelling? He has some edema in his sheath since he is a very active horse that is now having to be stuck inside. Could the swelling be related to edema? I am just beside myself after this entire ordeal, being new to horseownership and all, it has been really stressful to say the least. Any help is greatly appreciated!!!!!!!!!!!
Moderator:
DrO

Posted on Wednesday, Jun 7, 2006 - 7:56 am:

Welcome Steve,
All of these questions are best answered by your veterinarian who examined your horse, what did she say about these? The most important piece of information is whether the horse is still lame and if so how is it changing?

The increased swelling in the fetlock suggests there are unresolved issues but it may be related to the traumatic suture removal. Pared holes in the sole heal from the inside out and may take 3 months to fill in completely. However the horse is generally usable well before that and if the area is protected by a shoe may be used 3 weeks after having the hole pared. Lastly yes reinfection is a possibility so vigilance with clean bandaging is important.
DrO
New Member:
Vboese

Posted on Wednesday, Jun 7, 2006 - 3:25 pm:

Hi,

My vet is not concerned with the swelling in the sheath. She wasn't aware of the swelling in the leg as of yet (I have a message in for her). I think it is pitted edema since it yields to finger pressure and fills back up slowly. He is not lame. I talked to another vet in the practice last night and she told me that it very well could be stocking up from standing in the stall all day and night. He really doesn't move much while he is in there. He only gets hand grazed for 30 minutes twice a day in which he eats as much grass as he possibly can so he is not moving much there either. He has swelling all over him, like his veins are all filled up, but again, I think that is from not moving very much. This week I am able to let him out for 1 1/2 hour twice a day so I am hopeful the swelling will go down once he can move around on his own. My vet told me the same thing about the shoes. How long before infection is no longer an issue??
Moderator:
DrO

Posted on Wednesday, Jun 7, 2006 - 8:03 pm:

You have to remember that infection can occur anytime and if there is a defect in the horn there is an increase chance of it. However infection is not present as long as the horse is sound.
DrO
New Member:
Vboese

Posted on Wednesday, Jun 14, 2006 - 11:13 am:

Yesterday, Smokey's bandage came apart at the top and shavings got packed into the giant hole that has been healing on the bottom of his foot. I picked out what I could and then flushed out with a syringe of betadine and water. Do you think this may cause infection? Will the body flush out any shavings that may still be packed in the hole? When I saw it yesterday, I panicked. It has been just about 4 weeks since the surgery but I do know the hole is pretty deep. I have a call in to my vet but I was wondering if you have any opinions??
Moderator:
DrO

Posted on Wednesday, Jun 14, 2006 - 9:24 pm:

My Opinion is, Cool Steve, this is OK. If you think infection is not present in any open wound you have a misunderstanding of infection. Pick any antibiotic or antiseptic and there are organisms that will get around it. The important point always in 99.9 percent of the cases is can it drain. If it drains infection will resolve.

If there is a piece of wood up there it needs to be removed but this is OK. I think better than the antimicrobial betadine is the pressure of a full force hose: flush it out with pressure. For more on this see Diseases of Horses » Skin Diseases » Wounds / Burns » Long Term Deep Wound.
DrO
New Member:
Vboese

Posted on Thursday, Jun 22, 2006 - 9:30 am:

Hi again,

My vet told me she would rather see me soak it in betadine and water since the hole was so deep, that she didn't want me to forcefully flush anything that shouldn't be going up there. So I soaked in warm water and betadine for about 15 minuteson June 15. All is well then.....Yesterday I changed the bandage and noticed a funny odor. I use a gauze pad for the hole, then I cover that with brown gauze to keep pad in place, then I wrap that with elastikon, then I reinforce the bottom with a duct tape covering. I can't tell if it is from the heat (85+ degrees here), the elastikon (which has a strong smell anyway)or the duct tape over the bottom of the hoof and keeping everything hot. I change every other day and usually the gauze pad is a little damp and has a urine smell (since the bandage wears through at the toe by the end of the second day and I do keep the stall very clean). There is dark brown discharge and the gauze pad was stuck to the bottom of his foot and I noticed a small blood clot. Is this what I should expect to see? It has been 1 1/2 months since the surgery. I called my vet but she has today off. I am wondering what you think? If that hole were to get infected, what would I be seeing? Someone told me that around the hole would be red and inflamed. When you look in the hole, all you can see is dark black tissue. I am wondering if the blood clot may be some of that tissue sloughing off to make room for healthy hoof tissue? Any thoughts?
Member:
Hwood

Posted on Thursday, Jun 22, 2006 - 10:18 am:

I would flush it out with a syringe and disinfectant, Steve, and then pack some icthammol and gauze on it. Icthammol is pretty gooey, but is a good drawing agent and has antiseptic properties, as far as I understand. If Dr. O. isn't able to respond right away, is there another vet or another experienced equine owner you can call?
Moderator:
DrO

Posted on Thursday, Jun 22, 2006 - 11:13 am:

The first signs of ascending infection steve would be increased lameness. The problem with soaking a open wound on the foot, in my opinion, is all the stuff on the rest of the foot now comes into contact with the wound. I soak to open abscesses that are not draining well but if all is healthy I tend to flush and rebandage. If it all is going very well I just rebandage packing the hole with betadine soaked cotton, like a cotton ball. Often I have lost a bandage to find my cotton ball remains in the hole protecting the wound.

We have a less expensive bandaging technique that might provide more protection at Diseases of Horses » Lameness » Diseases of the Hoof » First Aid for Foot Disease in Horses.
DrO
Member:
Vboese

Posted on Thursday, Jun 22, 2006 - 3:24 pm:

Thanks Dr. O for the quick response. Smokey is not lame at all. But I am not sure if I smell a funny smell or not. I just changed it again to check and (also changed yesterday), and the wound is still draining dark brown, sticky substance. Is this normal? Prior to having the bandage slip and packing the hole with shavings, it was draining light pink substance and now it has changed to dark brown. I wondered if this is just the progression of the wound healing or something starting to go awry?

They never told me to put anything wet in the wound, it would make sense to put a cotton ball in there and not let those stray shavings in. I also do need a less expensive wrapping method which I will try the one you referred me to. When I turn him out, I put a couple of strips of duct tape on the bottom of a diaper and then put the diaper over the "good wrapping" and let him wear that down. When I bring him in for the day, I just take off diaper and throw away. I just worry about the bandaging gaping at the back of the foot and letting in shavings. Oh the saga......
Moderator:
DrO

Posted on Friday, Jun 23, 2006 - 9:25 am:

It might be Steve but I would have to look at it to know for sure. Again, without lameness things cannot be too bad. Best is to wet that cotton with betadine before packing however.
DrO
Member:
Vboese

Posted on Thursday, Jun 29, 2006 - 1:58 pm:

Hello,

My vet was out yesterday and she told me not to worry about the funny odor, that it was funk in the bottom of his foot and to start putting betadine gauze in the hole and then wrap it. Since I have done so, the smell is not as bad. She recommended that I put a pad and shoe (I am assuming that I need to do all 4 since this is a hind foot?) and start riding him. He is not lame, a bit stiff perhaps, but not lame. I was going to put a hospital plate on the foot but I didn't want to pound and nail a shoe into a sore foot. It has been 6 weeks since surgery. Are pads and shoes safe for a deep hole in the sole that we are waiting to fill in? She said all of the tissue was hardened.
Moderator:
DrO

Posted on Friday, Jun 30, 2006 - 7:47 am:

Foul odor is a sign that either I am not keeping it dry enough or the bandage needs more frequent changes. Shoes are Ok but I would not cover over this until it is well on its way to healing unless my number one goal was to get on and ride at a risk it may worsen. Once a pad is on you cannot control moisture and it may become thrushy and reinfected.
DrO
Member:
Vboese

Posted on Wednesday, Jul 12, 2006 - 2:29 pm:

Hi Again,

Yesterday I was looking in the hole in the bottom of his foot with a flashlight and I noticed that there is still no tissue up along his hoof wall. the hole is right on the whiteline area closer to the edge of the foot. The farrier said he could probably use a rim pad and the vet cleared the way for me to do so. There is tissue on one side but not on the side going up the wall. There is a tunnel leading to who knows where that runs right along the wall. Also, big chunks of his hoof are flaking off right around the hole, actually all over his sole. I believe since the foot is constantly wrapped this is what will happen??? Then, the other day he was racing around his pasture (a sure sign he feels better) bucking and galloping and he broke through the bandage on the toe and then the entire bottom came off and he stepped in a big pile of manure. It jammed right up in the hole. I picked out what I could and syringed with Betadine and water and rewrapped. My question: Since it has been almost 8 weeks since the original surgery (May 15), are my chances of infection decreasing? In your opinion is it safe to use a rim pad and shoe and let this hole go for a while? I know I read somewhere that the hole could take up to 3 months to completely fill in, but the way it looks now after 8 weeks, it could take another 3 months to fill in and he is getting fatter by the day - and really needs some good exercise. Help!!!!!
Moderator:
DrO

Posted on Thursday, Jul 13, 2006 - 6:57 am:

The problem with your post Steve is I don't understand what you mean with the word "tissue". Do you mean there is still exposed bleeding, sensitive, tissue? This would be very unusual at 8 weeks post surgery. I normally get horn, albeit soft easily dislodged horn, within 2 or 3 weeks that by 8 weeks is a firm thick patch. However holes in the horn do not fill in, they grow out. If you have a deep hole that runs up the wall it has to grow out the bottom of the foot. While a hole in the sole may grow out is 3 months, a deep hole up the wall has much further to go. If the horse is sound and there is no exposed sensitive tissue, by all means stick a shoe on this horse and ride. I am uncertain about the need of a pad but let your farrier/vet decide this.
DrO
Member:
Vboese

Posted on Thursday, Jul 13, 2006 - 8:58 am:

Hi,

Oh no, there is no exposed bleeding, sensitive tissue. When I say tissue, I mean that dark black, hard stuff that has filled in part of the hole. I guess this is what you refer to as the horn. I guess I was expecting it to be the same color as his hoof (whitish/yellowish?) But I assume it will turn the same color as his hoof eventually? It makes sense that it will have to grow out with the hoof. Yes, they did drill up the wall to make connection with the wounds on the coronet band so it is pretty deep. He has a defect on the outside of his hoof due to the wound on the coronet band, now it is about 1 inch below the hairline. They told me this will take about 1 year to grow out completely and then he should have a normal looking hoof. Are my chances of infection gone with this new horn growth on the bottom of his foot? That is my main concern. My fear is to put on a shoe and a pad then have the hole get infected somehow and then I am back to where I started. Forgive me for sounding so niave, I have never dealt with such a thing as an abscess with a huge hole in the foot and I don't know if I get worried for nothing.....My vet told me it was fine for a pad and a shoe but I was skeptical because I don't know enough about the nature of this type of injury, new horn growth, etc.
Moderator:
DrO

Posted on Friday, Jul 14, 2006 - 8:18 am:

The chance of infection is not gone, they are never completely gone as a completely normal foot can abscess, but it is considerably less.
DrO
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