General Wound Care

Get familiar with basic equine wound care before you hit the trails and shows 

by R. Paul Schwab, DVM 

Everybody has a wound spray, ointment, powder, or miracle paint to sell to treat wounds. In fact, the more strange the product, the more people think it works (especially if it’s blue, smells like turpentine, and was made in a jar in someone’s garage). Do these products work? Maybe. Who says? The neighbor, the vet, the feed store? Probably not the FDA. What is the best way to treat a wound? Is there a best way? In this article I hope to cover some basic wound care concepts. 

When to Call the Vet

Obviously, anything that looks like it requires suturing (i.e., gaping wounds, visible bone, excessive bleeding, etc.), has loss of function or excessive swelling should be seen by a veterinarian. Wounds that require sutures should be looked at within 12 hours to have the best outcome. Also, horses that are acting sick or running a fever (temperature greater than 101 degrees) should be seen. Other cases that may warrant veterinary attention are wounds that are slow to heal or have excessive granulation tissue, known commonly as proud flesh.

What Can You Do?

General wound cleaning and irrigation goes a long way. One of the first things we like to do, especially on a deep wound, is clip the hair around the wound to keep it from matting up with serum, blood and other debris. Clipping all wounds is a good idea because it often reveals a much larger wound than was seen without clipping. Gentle scrubbing with warm water and a mild soap such as Ivory liquid soap is helpful for removing debris. Povidone-iodine scrubs are excellent for cleaning and disinfecting the skin, but might be a bit too strong for inside a deep wound. Please, no peroxide! Hydrogen peroxide damages healthy tissue.

Wound irrigation is best done with saline solution. You can buy bags or bottles of sterile saline solution from your veterinarian (not a bad thing to have in a first aid kit). You can also make your own saline solution by adding two teaspoons of salt to one liter of water. Obviously, the cleaner the water is, the better. For small wounds, a 35-60cc syringe fitted with an 18 gauge needle works well to spray the saline over the wound. (Don’t inject the wound, spray it...yes, it has happened.)  Clean spray bottles also work well as saline wound irrigators. For larger wounds, a garden sprayer used to spray weeds (a new one, or at least a really clean one) makes an excellent large volume irrigator, as well as a good giant water pick for your horse’s mouth.

After the wound is thoroughly cleaned, it should be bandaged if possible. Keeping a wound covered helps keep the skin supple and elastic. Wounds that are not covered can be treated with triple antibiotic ointment to help with infection and to keep the skin edges soft. 

Special Considerations

Puncture wounds can be especially problematic. They appear small on the surface but often have deep pockets under the skin that can become infected. They will look fine for 24 hours or so, and then swell up with infection under the skin. These wounds typically need to be opened at the bottom to allow drainage.

Tetanus should be a consideration with any wound. If the horse has not had a tetanus vaccination within six months, it should get a booster.

Healing wounds should be monitored carefully for proud flesh. When a deep wound is healing, it fills with granulation tissue. This is the pink, lumpy tissue that quickly fills in the gap between the separated skin edges. The skin then slowly contracts over this granulation tissue until it is healed. Occasionally the granulation tissue keeps growing higher than the skin edges, preventing the skin from coming together. We call this "exuberant granulation tissue" or "proud flesh." Lower leg wounds in horses are especially prone to proud flesh formation because of poor blood perfusion and high motion. There are numerous ointments that claim to prevent proud flesh formation, but once it has developed, it has to be trimmed off to the level of the skin. You should get your veterinarian involved at this point; it can be dangerous, and granulation tissue bleeds heavily when cut.

In general, wound care is basic. Keep it clean, flush with saline, and monitor the whole horse (i.e., temperature, attitude, swelling, etc.). Worry more about what not to put on a wound, rather than what to put on it. If you wouldn’t put it on your own wound, don’t put it on your horse’s wound. Above all, keep in touch with your veterinarian regarding wounds on your horse. Every horse is different, and every wound is different.