Using the plastic packets in which sutures are sent could be an economical and effective method of treating serious wounds.

This is the conclusion of research published in the Equine Veterinary Journal, investigating a “novel tension relief technique to aid the primary closure of traumatic equine wounds under excessive tension”.

Study author Dylan Gorvy, a British vet based in Sweden, told H&H the “tension tile system” technique he has developed, using stitched-on small pieces of plastic around the injury, is a “game-changer for wound management”, as it relieves the tension on the surrounding skin, allowing improved healing.

Horses are susceptible to traumatic wounds, often on lower limbs, and Dr Gorvy said that if these are not managed correctly, these can mean “months and months where the horse is out of action”, often with the final result of an area of the limb that is “cosmetically poor and functionally weak, susceptible to cracking”.

He added that with traditional techniques of primary closure of wounds, the risk of dehiscence, or reopening, is high. He cited a 2002 study showing that the success rate after stitching was only 28%.

“Over the past few years, I’ve come up with this technique of using readily available material; the packs the sutures come in,” he said. “This relieves the tension on the skin – and we’ve managed to completely turn round the success rate.”

Dr Gorvy said the technique is “not rocket science”, but rather understanding the mechanics of skin. If the edges of a wound are pulled together by stitches, this puts that skin under significant tension, which decreases circulation and can lead to necrosis, and impaired healing. This tension is increased if the wound is in an area that is put under more pressure when the horse moves.

“We’re trying to take the tension away and move it away from the wound, to healthy skin,” he said, explaining that he puts foam underneath the plastic packs and stitches those on healthy skin either side of the wound, then adds more sutures through the holes in the tiles, to hold them together. The wound is stitched as normal, with the tension off.

“In a case series of 191 horses, involving three hospitals, we achieved a success rate of 69%,” he said. “Most horses were back in work after four weeks. This is really a game-changer in wound management, allowing the successful primary intention of wounds that we would never have dreamt of closing in the past.”

British Equine Veterinary Association president Roger Smith told H&H it is a “depressing reality for owners” that horses “seem to gravitate towards” objects that can wound them.

“Large wounds require closure using skin sutures or staples,” he said. “In equine lower limbs there is relatively limited skin, which means closure of larger skin defects in these regions can be challenging and can end up being under so much strain that breakdown of the repair frequently occurs.

“This study describes a simple and effective way of accommodating this tension in the surgical repair. The system was used in 22% of 860 wounds and resulted in 69% of those wounds healing without breaking down. Unfortunately it is not possible to determine whether this is better than when not using the device but its ease of use, mechanically justifiable reason, and low cost make it an attractive solution for large equine wounds.”

Dr Gorvy added: “We’ve had tremendous results. The location of the wound wasn’t relevant, the results were just as good on hocks, stifles and fetlocks, which are traditionally very difficult areas. I’ve presented on this and it’s starting to get more recognition, but it would be great for horse owners to know what’s possible.”

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The best methods for treating equine wounds

Are you up to date with the latest ideas on wound treatment? Kieran O’Brien MRCVS offers a first-aid refresher

Proud flesh in horses – dealing with tricky wounds that won’t heal

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Sharp contact between a horse’s hind hoof and foreleg can cause a significant injury, as Dr David Stack MRCVS explains

OVERREACH and strike wounds – known as interference injuries – are often self-inflicted. An overreach typically occurs when a horse steps on the heels of a forelimb with a hind foot, while a strike wound can result from the edge of the hoof or shoe making sharp contact with the fetlock or pastern region.

Similar incidents can occur when there is contact between the limbs of two horses moving in close proximity. Injuries can range from minor grazes and bruises that can be managed with routine first aid, to issues requiring veterinary attention. Some can be severe, leading to referral, hospitalisation and even surgery.

Injury can happen at any time in any horse moving actively – often at moments when the gait becomes uncoordinated, due to a lapse of concentration or a loss of fine motor control due to fatigue. Fatigue-related interference injuries can also occur in heavy ground, where horses tire quickly.

We often see interference issues with wobbler syndrome, where a horse loses the ability to know where his limbs are in space (a sense known as proprioception). This can cause an irregular and uncoordinated stride, leading to frequent overreach injuries.

Strikes or sharp, glancing blows from any other limb tend to result in lacerations, often in a horizontal plane, on the sides or back of the pastern or fetlock. Overreach injuries typically cause irregular skin tears that can penetrate other tissues of the heel, even ripping the coronary band.

Either type of injury can have serious consequences, irrespective of the size of the wound. Like other prey species, horses have very little muscle, fat or loose, connective tissue below the carpus (knee) or tarsus (hock). This evolutionary characteristic improves the speed and efficiency with which a horse moves, by reducing the weight of the lower limb, but leaves vital tissues vulnerable to trauma.

The joints and bones are relatively unprotected, as are the ligaments and cartilage and the cushioning, fluid-filled bursae. Nerves, blood vessels, tendons and tendon sheaths are also at risk.

What’s the damage

IF your horse sustains a strike or overreach injury, contact your vet. Even seemingly innocuous injuries can have serious consequences, including infection of the synovial (joint) fluid.

Wounds that are bleeding profusely should be bandaged carefully but snugly, with direct pressure over the wound. A pressure bandage should not be left in place for more than two to three hours, but can be replaced if blood flow continues.

All other wounds should be rinsed liberally with fresh tap water for five to 10 minutes, and then a clean, dry bandage applied. Avoid touching the site with ungloved fingers and remember that a poultice is not a suitable dressing for a wound.

If the skin is lacerated completely, but nothing deeper, the wound requires cleaning and suturing (stitching). Fresh wounds in the pastern and fetlock regions should be sutured wherever possible, as they are prone to the development of pink granulation tissue known as proud flesh.

The horse is likely to be sedated, and will be nerve-blocked and given pain relief, before suturing. He may then need stable rest for two to three weeks, with bandaging, to minimise movement at the wound site.

Your vet will check that your horse’s vaccination status against tetanus is current and will probably prescribe some pain medications such as phenylbutazone (known as bute). Antimicrobials are administered on a case-by-case basis and may not be necessary.

Surgical solutions

DEEPER wounds require careful veterinary assessment to establish whether any underlying structures have been involved. Investigation may include techniques such as X-rays, ultrasound scanning and synovial fluid sampling, ideally performed in a clinic setting.

Injuries to joints, tendons and synovial structures such as the digital flexor tendon sheath are the most serious and, unfortunately, are common. Those involving the cartilages of the foot and the coronary band are next in terms of severity, while other significant injuries, such as pedal and navicular bone fracture, are seen less often. In extreme cases, the whole heel including the hoof wall can be torn off or avulsed (pulled away). Thankfully, such catastrophic injuries are rare.

Wounds that involve synovial structures are potentially life-threatening, requiring hospitalisation and often surgery. Endoscopic (keyhole) surgery is performed under general anaesthesia to flush the joint or sheath, remove debris and address tendon or cartilage damage, before the wound is cleaned and closed.

Rehabilitation may be lengthy, depending on the severity of the injury and the resulting damage. Injuries of the deeper structures of the foot may need antimicrobials and anti-inflammatories.

Overreaches often result in ragged wounds with deeper ripping and bruising of the tissues. As the tissues are crushed by the weight of the hindquarters and hindlimb bearing down on the heel, these wounds are more prone to infection and potential “breakdown” of any surgical repair.

Infections of the cartilages of the foot can be slow to resolve and frustrating to treat. Overreach injuries that involve the heel bulbs and extend to the coronary band may benefit from a rigid foot cast following wound debridement and suturing, to limit movement.

Injuries to the coronary band can create ongoing issues as the new hoof wall grows from the damaged site, requiring careful farriery.

Reducing the risk

PREVENTION may be impossible, but certain measures will mitigate the risk of interference injuries or reduce their severity if they do occur.

Overreach boots will absorb some of the traumatic energy involved and may offer a degree of protection, as will tendon boots – especially those that extend below the fetlock. Consider the difference between getting stepped on by your horse while wearing sturdy leather boots, compared to flip-flops.

However, the force involved in an interference injury means that a hind hoof may slice right through the boot material. There is also the potential for boots to slip, rub or interfere with a horse’s action, so choose and use them with care.

Good farriery can address gait issues, to minimise interference risk. Hind shoes set further back on the foot and bevelled leading edges of the shoe can also help lessen the damage should an overreach occur.

About the author

Dr David Stack MRCVS is a European board specialist in equine surgery and senior lecturer in the University of Liverpool’s Philip Leverhulme Equine Hospital in Leahurst, where he leads the equine orthopaedic surgery and sports medicine service. Contact: 0151 794 6041, liverpool.ac.uk/equine

Also published in H&H magazine, on sale Thursday 18 March

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• This article has been edited and approved by Karen Coumbe MRCVS, H&H’s veterinary advisor since 1991.

While most minor wounds heal with just basic first aid, horses can have complications particularly with wounds on the lower parts of the limbs. It is not unusual for wound healing to be delayed by the development of large fleshy outgrowths known as proud flesh or more properly described as exuberant granulation tissue. Once proud flesh has developed a wound is unable to heal as effectively in the normal manner and frequently special treatments, including minor surgical procedures are required to remove the excess tissue.

Proud flesh: normal wound healing | why proud flesh forms | treatment | skin grafts | prevention

How a wound heals

As a wound heals, healing tissue provides a base upon which new skin surface cells are supported as they fill in across the wound to provide a healed surface (surface epidermal migration). Normal healing tissue looks red-pink in colour and has a flat surface. Treating horse wounds correctly helps promote healing.

While the surface skin cells are moving across the wound, they produce chemical signals that encourage the cells in the wound margins to contract. This pulls the sides of the wound towards each other. This “wound contraction” reduces the distance the cells have to move, hastens the closure of the wound and assists in expressing any dead or foreign matter.

The combination of healthy granulation tissue, epidermal migration and contraction form the main basis of wound healing. Once skin cells cover a wound, the normal granulation tissue production is switched off and the process of deeper remodelling and repair can proceed.

Why proud flesh forms

If the healing process is impaired, the delicate balance between the various processes can be upset. If contraction and the migration of skin surface cells are inhibited then the wound may get bigger because granulation tissue is the only active process happening. This results in bulging masses of tissue, which usually looks rather knobbly, pink and shiny. It may also have a yellowing tinge and may bleed easily if knocked. Sometimes the tissue can protrude out of the wound and look like a pink cauliflower.

There are many reasons why a wound doesn’t heal as expected, which include infection, foreign bodies, dead tissues or movement within the wound site, chemical applications and poor blood supply to the wound. All these factors can encourage exuberant granulation tissue and inhibit the spread of skin cells across the surface of the wound. Infection and excessive movement are the most likely reasons why horse wounds develop proud flesh.

Where proud flesh develops at sites other than the lower leg regions, there is usually another definable cause, such as a foreign body embedded deep in the wound.

Proud flesh: treatment and aftercare

Appropriate veterinary advice is required to decide on the best treatment options. Sometimes thorough wound cleaning and topical creams may resolve minor amounts of proud flesh, along with firm bandaging to reduce movement and help wound healing. Sometimes laser therapy can help and occasional caustic substances can be recommended.

A wound with an excess of granulation tissue is often most effectively managed surgically. Usually, this involves cutting back any excessive tissue. While this is invariably a very bloody business, it is usually painless because granulation tissue has minimal nerves or nerve endings.

While the removal of small amounts of proud flesh can be done in a standing sedated horse without any need for local anaesthetic, it can be applied to numb the surrounding area when necessary.

General anaesthesia is very rarely required, except possibly in cases dealing with very extensive proud flesh, where it may useful to help aid the aggressive control of the heavy bleeding that will occur.

Surgical debridement (cutting back) can serve several purposes. It reduces the bulk of the wound and, at the same time, will remove many of the “blocks” to healing. It is common practice to cut the proud flesh back to just under the skin level. This may allow the skin edges to contract and cells to migrate across the margin of the wound.

However, where proud flesh has been present for some time, the margin of the wound could be unhealthy and the sensitive edges of the wound may have to be cut back. Treatment is focused on creating a healthy wound that wants to heal.

Careful wound dressing management immediately after such surgery is vital — dressings are usually changed every 24hrs. At this stage, the vet will reassess the wound and make a decision as to the likelihood that it will heal naturally. Sometimes, immobilisation of the wound site under a firm bandage or cast is needed.

Infection may need to be controlled with antibiotics after appropriate culture and sensitivity to identify the causative bacteria and reduce the risk of antimicrobial resistance.

Skin grafting

If the wound shows evidence of healing over the next four to seven days, treatment is continued. Sometimes the process of healing can be hastened by the simple expedient of skin grafting.

The easiest form of this elegant yet simple procedure is the use of small skin pieces removed from a healthy site (often the side of the neck under the mane), which are deposited into the granulation bed.

This “imports” normal skin with a strong tendency to heal into the wound, and within a few weeks the tiny islands of new skin will be visible in the bed of granulation tissue. The grafts encourage the wound to contract and reduce the flow of new blood vessels, thus encouraging the spread of skin cells across the surface of the wound.

If skin grafting fails, the possibility of other wound healing complications must be considered.

Prevention of proud flesh

Prevention of proud flesh is easier said than done, but a healthy, uninfected, clean wound that is properly managed from the outset is less likely to develop it. As healing relies upon the migration of the delicate skin cells, repeated application of chemicals and even repeated washing and rubbing of a wound can interfere with the healing process and encourage proud flesh.

Once a wound has been cleaned, a sterile hydrogel is recommended as the best way to keep the wound moist while absorbing bacteria, damaged tissue and debris under a suitable dressing. It can be gently cleaned away and replaced when the dressing is changed.

To dress a wound, apply a sterile pad then an absorbent layer, such as cotton wool, and a clean bandage. The size, firmness and thickness of the dressing is determined by the amount of discharge from the wound and the necessity to immobilise the skin edges or adjacent structures such as joints. Daily dressings changes are normal in the early stages, reducing to every three to five days or as your vet advises.

Depending on the position of the injury, limiting the horse’s movement during the early stages of healing may help avoid the application of additional stress on the edges of a wound as it closes together.

The key thing to realise is that no two wounds are the same, and they change from day to day. If you are concerned by any delay in healing or any unexpected changes in a wound, contact your vet.

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Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

In this week’s Vet Clinic, Kieran O’Brien MRCVS offers a first-aid refresher detailing the latest advice on wound treatment...

Horses usually sustain wounds from kicks or contact with fences, and treating horse wounds is something every owner should know how to do. A recent survey of 652 owners revealed that 40% of their horses had been injured in the preceding year, with nearly 90% of these injuries occurring out at grass.

Failure to spot a wound early or to recognise one that is potentially dangerous can affect both healing time and outcome, as can the use of inappropriate treatment from the start. Treating horse wounds correctly will promote fast and effective healing.

How does a wound heal

Within minutes of a wound occurring, the healing process begins. The first stage is the inflammatory phase, when blood clots in the wound. White blood cells migrate to it from surrounding tissues and blood vessels, releasing enzymes that “digest” damaged tissues and dead cells.

This phase lasts for a variable period and is prolonged by the presence of infection, trauma or foreign material. As inflammation is a key component of healing, suppressing it by administering anti-inflammatory drugs, such as phenylbutazone (commonly termed bute), may be ill-advised unless the horse is very lame.

The repair phase can only begin once the inflammatory phase is complete, typically within 12 hours of injury. Repair requires the formation of granulation tissue, a mixture of blood vessels, fibrous tissue-forming cells and other components, which expand to “bridge” the wound. This allows surface skin cells to migrate from the wound edges and over the granulation tissue.

During the final maturation stage, the tissue strengthens and contracts to reduce the overall size of the healed wound.

Various factors, such as excess movement, can interfere with healing. Failure to treat and clean a wound soon after injury, or to administer the full course of any antibiotics prescribed, may allow infection to develop or persist. Foreign material such as hair, soil, dead tissue or bone — even wound powder or spray — will also prevent healing.

Contrary to popular belief, a moist environment in the wound is best; studies have shown that “letting the air get to it” actually delays healing.

How to assess a horse’s wound

Wound assessment requires good light and the patient to be standing still, so a horse who is very distressed may first need veterinary sedation.

In many cases, injury assessment and decisions related to treating horse wounds are best left to a vet. As a rule, evaluation starts with the size and depth of the wound: those that penetrate the full thickness of the skin are particularly vulnerable to infection.

High-risk wounds include those close to important structures, such as a joint or tendon sheath; those involving damage to and exposure of underlying tissues, especially bone; wounds with large areas of skin loss; injury to the eye or head, and penetration of the chest or abdominal cavities.

Additional “red flags” include severe lameness, irrespective of the size of the wound, and evidence of a foreign body at the injury site or any discharge from it — particularly clear, yellow, viscous (thickened) fluid that could indicate joint penetration. Any of these signs require immediate veterinary treatment.

A kick wound is essentially caused by blunt trauma, so underneath an apparently small skin wound may be a much larger, bruised area that will act as a site for inflammation, swelling and bacterial multiplication. Kick wounds to the forearm or thigh regions typically become infected if not treated promptly, resulting in a swollen leg (cellulitis) and a lame horse within 48 hours.

While you wait for the vet to arrive, try to keep the horse quiet and still. Sweep any stable bedding aside if the wound is on a lower limb, or ideally stand the horse on a clean, hard surface.

The wound can be gently flushed clean with a hosepipe, but don’t use spray or powder before the vet has seen the injury. If the horse must be transported, for example, cover the cleaned wound with a sterile pad and cotton wool, followed by a support bandage.

A bleeding wound can be alarming, yet life-threatening haemorrhage is rare and only occurs if a major artery has been damaged. In most cases, bleeding ceases either spontaneously or when light pressure is applied for a short while.

Stem bleeding with a non-stick pad, such as Melolin, and a wad of cotton wool, holding this in place with a bandage or by hand if the wound is on the horse’s trunk. If blood seeps through, place another pad on top rather than removing the first.

A tourniquet should only be used in very rare cases where the pressure pad technique fails, since severe limitation of blood flow to the limb may cause damage. Encircle the limb with a bandage, just above the wound, before inserting a pen or a twig under the bandage and twisting it until blood stops flowing. Release the tourniquet after a maximum of 10 minutes to check if bleeding has stopped, using it for the shortest period possible.

And remember the importance of clean hands and materials, to lessen the risk of wound contamination.

Treating horse wounds: how to

A good rule of thumb is never to put anything into a wound you wouldn’t be willing to put into your own eye.

Many wound powders contain old-fashioned antiseptics that are a potential irritant, and most have an inert carrier powder that the horse’s system must eliminate from the wound before it will heal. Coloured aerosol sprays that contain antiseptics (or an antibiotic, if supplied by a vet) and water-soluble dye should be reserved for superficial grazes and not used if the full thickness of the skin has been breached.

The preferred topical treatment is hydrogel, a non-irritant, soluble gel. The gel keeps the wound moist and absorbs bacteria, damaged tissue and debris, and can be rinsed away and replaced at dressing changes.

The recent appearance of bacteria resistant to common antibiotics has renewed interest in the ancient practice of using honey as a topical wound treatment. While many kinds of honey have antibacterial properties, manuka honey contains several additional elements that promote healing.

A unique manuka factor (UMF) score of 15+ is preferred for equine wounds. It’s worth investing in medical-grade manuka, from a chemist, as it’s thought that the pasteurisation of manuka honeys sold in supermarkets affects their properties. Applying manuka to bandaged wounds for more than 12 days can promote the growth of excess granulation tissue, known as proud flesh, but it can be used on unbandaged wounds for longer periods.

To dress a wound, apply a sterile pad then an absorbent layer, such as cotton wool, and a clean bandage. The size, firmness and thickness of the dressing is determined by the amount of discharge from the wound and the necessity to immobilise the skin edges or adjacent structures such as joints. Change the dressing daily in the early stages, according to the amount of discharge, reducing to every three to five days or as your vet advises.

Never use a poultice. This will delay healing, promote proud flesh and it has no role in equine wound management.

How to clean a horse’s wound

Wash your hands and be aware of the need for absolute cleanliness with equipment and technique.

Carefully clip away any overhanging hair from around the wound. Then using water and a very clean bowl, gently wash the surrounding skin with surgical scrub, such as Hibiscrub, and cotton wool. Any antiseptic you use should be very dilute.

Flush the wound with saline solution or a hosepipe, working upwards from beneath the wound and only for as long as to leave it visibly clean. Rinse away any cleansing soap or antiseptic from the surrounding skin.

A final flush with sterile saline will restore the correct salt concentration in the depths of the wound.

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Subscribe to Horse & Hound magazine today – and enjoy unlimited website access all year round

Horse & Hound magazine, out every Thursday, is packed with all the latest news and reports, as well as interviews, specials, nostalgia, vet and training advice. Find how you can enjoy the magazine delivered to your door every week, plus options to upgrade your subscription to access our online service that brings you breaking news and reports as well as other benefits.

• This article has been edited and approved by Karen Coumbe MRCVS, H&H’s veterinary advisor since 1991.

Puncture wounds in horses occur where the external damage associated with an injury is small, but the wound itself can be deep, sometimes causing damage to important internal structures.

As there is little damage to be seen on the surface, these types of injury can be easily missed. However, if dirt or bacteria has found its way into the wound, this can become a major problem as infection rapidly develops and spreads.

Puncture wounds in horses are particularly worrisome for horse owners as what appears to be a minor issue can turn out to have far more serious consequences and it can be hard to differentiate what is serious and what is not. If in doubt, it is best to seek prompt veterinary attention.

Puncture wounds in horses: Signs | Treatment | Prevention | Wounds in the foot

Signs of a puncture wound

Often the first sign that your horse has suffered a puncture wound is a swollen area. This is particularly true of horses’ legs, where the whole leg may swell as the area becomes both inflamed and infected.

In this situation you should look carefully for small wounds in any swollen area. Many are tiny and hard to see. Clues include a trickle of blood or a sensitive spot when you run your hands over the area, which may be combined with localised swelling. If you have a pair of suitable small clippers, carefully clipping the hair away from around the area will make it easier to see what is going on.Once you have located the injury, bear in mind that the damage caused is dependent on the depth of the wound, how dirty it is and whether any vital structures are involved. A puncture wound can be fatal if it reaches key internal structures, such as within the chest, abdomen or the inside of the foot. The most common complication is when a puncture wound results in infection entering a closed cavity such as joint or tendon sheath.

Many first aid manuals warn you to look out for so-called ‘joint fluid’, an oily, clear to yellow substance, and that if you see this discharging from a wound, a joint could be involved. In reality, a wound is often far too messy to spot this, and many benign superficial wounds discharge clear or yellow serum, which can appear similar.

Assess the location of the wound to see if it is near a joint or other critical structure, such as the digital flexor tendon sheath above and below the back of the fetlock. Remember that some joints, such as the elbow, are very large. An injury that seems some distance away from the bending part of the joint may still communicate with it. Equally, infection can spread towards it.

In all cases a vet should be called to assess a puncture wound, or a suspected puncture wound, as it is often more serious that it initially appears and the sooner it receives expert attention, the more likely the horse will be able to make a rapid recovery.

How do you treat a puncture wound on a horse?

• Clip the coat and carefully clean around a puncture wound ideally using saline or boiled water that has cooled with clean cotton wool.
• Do not spray the wound directly with water, or apply any chemicals such as hydrogen peroxide. This could force contamination deeper, making potential infection worse. It may be useful to hose dirt away from around the wound, but avoid hosing directly onto the wound itself.
• Use a hydrogel on the wound and apply a clean bandage with a dry poultice. This is usually more beneficial than a wet poultice.
• ALWAYS ensure your horse has been vaccinated against tetanus. These wounds provide the ideal environment for the bacteria that cause tetanus to flourish.

When should I call the vet for a puncture wound?

• If you think a foreign body might be stuck inside the wound, do not try to probe the wound – leave this to your vet
• If your horse is more lame than one would expect for the size of the wound
• If you are concerned that the injury may be deep and involve internal structures

Preventing puncture wounds in horses

While puncture wounds of all types can be difficult to prevent, checking your horse over carefully while grooming and after exercise will improve the likelihood of you spotting an injury, enabling you to take prompt action to prevent a more serious problem from developing.

Horses that have been jumping hedges out hunting should be checked very carefully on their return for wounds caused by embedded thorns.

Other simple actions such as making sure your stables and yard are swept frequently, including immediately after a farrier has been working, can reduce the chance of a loose nail or other piece of debris causing an injury.

Frequent checks of paddocks for potentially dangerous items and avoiding riding on high-risk areas such as road margins where unseen debris may be hidden in the grass can also help reduce the risk of injury.

Puncture wounds in the horse’s foot

The horse’s foot is at particular risk of puncture wounds, with a penetrating wound caused by a nail or other sharp object being typical. These injuries can be very serious and warrant emergency attention and referral. The severity of the injury will depend on how deep the foreign body has gone into the foot and what structures are damaged. Generally a wound in the middle third of the foot, near the tip of the frog is more likely to be serious.

The recommendation, which can be hard to follow, is that if you find a foreign body within the horse’s foot, leave it in place unless there is a risk of further penetration. This allows the vet to do a radiographic assessment of the direction and depth that the object has travelled.

If the foreign body must be removed, then note where it entered and which direction it went in. Keep the foreign body to show your vet. Note the depth of penetration – and mark on the object if possible.

Apply a clean dry poultice to the foot to keep dirt from entering the puncture.

A review published in the Equine Veterinary Journal in 2013 involved 95 such cases from four UK equine hospitals¹. Each had suffered a puncture wound that had penetrating structures inside the hoof capsule such as the navicular bursa, tendon sheath or coffin joint. In many cases more than one structure was damaged — so the nail might have gone through the tendon sheath, the tendon and into the joint.

Each horse was treated intensively with keyhole surgery and every possible technique to prevent infection and restore full function. Despite such efforts, the rate of return to full soundness where the bursa, tendon sheath or joint had been penetrated was only 36%. Only 56% of cases survived and a significant proportion of these were permanently lame.

The time between the discovery of the nail and referral to hospital was shown to affect outcome — emphasising the need for immediate action.

References:

• Puncture wounds: what’s the prognosis?

From nails, screws and blackthorns to a piece of deer antler and an entire stud from a pair of cricket shoes, I have encountered a remarkable range of foreign bodies lodged in horses’ hooves.

Nails from waste wood — especially if a bonfire has been held in a paddock — are the principal offenders, although nails resulting from shoe removal can be trodden on if the floor is not swept carefully afterwards.

A pointed object that is sufficiently sharp can be driven into the sole or frog if stepped on. From there, it may be dislodged or remain embedded in the hoof. Commonly, the object is deflected into the groove in the centre or on each side of the frog, which is where most penetrations occur.

The outcome very much depends on the position in which the nail lodges and both the angle and depth of penetration. Deep penetrations through the middle third of the frog, considered the “danger zone”, can have serious consequences, as the foreign object is more likely to enter the synovial structures in the foot — namely the coffin joint or the navicular bursa.

In addition, the deep digital flexor tendon (DDFT), which runs down the back of the pastern and inserts into the underside of the pedal bone at the level of the sole, may be damaged. Penetration of these structures is associated with rapid infection, a poor long-term outcome and often incurable lameness in the horse.

Infection risk

While a puncture wound to the sole may look insignificant, the potential for infection should not be underestimated.

A study in 2013 looked at 95 cases of deep penetration of the navicular bursa or coffin, treated in four UK veterinary hospitals. Sadly, these wounds can be fatal and of those horses treated in the study, only 56% survived to be discharged, with only 36% returning to their previous level of athletic activity. The outcome was worse when there was a delay in referral, or where penetration occurred through the central frog groove.

Should the offending object penetrate the danger zone, then speedy referral to a hospital enables diagnostic investigation such as MRI or radiographs (X-rays) to take place quickly. Surgical intervention can then be performed before infection becomes established. Arthroscopy (keyhole surgery) has been shown to give a better outcome than more radical open surgery and is best performed in specialist centres.

If a “safer” area of the foot is penetrated, the horse is more likely to develop a local abscess that can be dealt with without hospitalisation. Your vet can advise whether your horse should be hospitalised for investigation and intensive treatment.

What to do…

If you find a penetrating object such as a nail in the sole, this is what to do:

• Carefully clean the horse’s foot, so you can assess the location and angle of penetration.
• Resist the temptation to remove the object if it is in the danger zone. Pending the vet’s arrival, bandage small blocks of wood on the underside of the hoof, on either side of the entry site, to prevent the nail from being driven deeper.
• If the nail is removed, note carefully the precise site it entered the foot, along with the direction, angle and depth of penetration. Retain the nail for the vet to inspect.
• While waiting for the vet to arrive, verify whether the horse is vaccinated against tetanus and has had a booster injection within the past two years.

Ref Horse & Hound; 18 April 2019

An owner of a horse who was “ripped open” as she went through a partly open gate has urged others to be aware of the injuries protruding latches can cause.

Susan Bloodworth’s 12-year-old part-bred Connemara mare Fifi rushed through the field gate as she was being brought in from the field on Friday evening (22 February) when Susan’s other mare, Mary, charged at her.

Susan told H&H: “I was out at the time. Shaun Malpass who helps bring in the horses opened the gate and Mary charged at Fifi. I’ve only owned Mary since September but she has become the boss, has been bullying her sometimes in the field and will chase her away. Fifi panicked, knocked Shaun over, went through the gate which wasn’t fully open and caught herself on the latch where the pin protrudes.

*Warning: graphic image of wound before treatment *

“When Shaun saw the injury, he rang me and said we need to get the vet – I owe him a debt of gratitude for acting so quickly and phoning me straight away. Time is of the essence with wounds.”

Fifi, a former eventer who is retired following a suspensory ligament injury, avoided any damage to the muscle but required stitches.

“It was a really big area. The vet managed to stitch and staple it and put two drains in. She is on box rest and antibiotics for two weeks,” said Susan.

*Warning: graphic image of wound after treatment *

“Since retiring she has put on a bit of weight and is on restricted grazing but the fat prevented too much damage to her side – it would have been a lot worse if it had cut through the muscle. The vet warned there is always the risk of infection with these things but touch wood things are looking good and all going well, he will be back soon to take out the stitches and she can go out again.”

‘It could have been carnage’: rider injured as horse gets stuck in bridleway gate

‘A lot of people hack out and see a gate and think that’s normal, and landowners think because no one

Horse stuck on gate rescued by firefighters

The overambitious horse was winched to safety after attempting to jump the gate and becoming stuck

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Susan’s husband Walter has now adapted the gate but Susan wants others to be aware of the risks latches can cause.

“Walter has screwed a piece of wood down the side parallel to the gate post so the pin isn’t protruding anymore and can’t catch anything. I posted online what happened because I wanted others to see what can happen and how dangerous it can be,” said Susan.

“I’ve been astounded by how many people have responded about similar injuries and thanking me for making them aware. I’ve caught my jacket on the gate before but hadn’t heard of this happening to a horse, you don’t think it will. I don’t want it happening to anyone else’s horse.”

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Owners have been asked to share details of how any wounds their horses have suffered were treated for a new research project.

The Equine Wound Project launched by the British Horse Society (BHS) and scientists from Nottingham University aims to gather new evidence on the best methods of treatment.

“Owners sometimes have to deal with extremely variable wounds and we want to hear from them no matter how small the wound may be,” said Emmeline Hannelly, the BHS’s welfare education manager.

She said knowing how best to treat a wound “can be confusing as some treatments may be detrimental to healing.”

The project aims to provide answers to crucial questions such as when to call a vet, how long different wounds take to heal, when a horse will return to normal work and what the site of the wound will look like when it has healed.

Horse owners are asked to share details and photos of wounds, give an assessment and record treatment processes and healing outcomes.

Information can be submitted via Googleforms to the University of Nottingham.

Researchers want to hear about any type of equine wound regardless of whether it has had any veterinary treatment.

“There is currently a lack of research into which factors may delay or help equine wounds to heal,” said Gemma Stanford, welfare director at the BHS.

She said there was “no clear information available for owners about common wounds” and the BHS is “delighted to be to supporting the University of Nottingham with this new wound research project.”

Professor Gary England, dean of Nottingham University’s veterinary school and one of the project’s supervisors, said the evidence collected will be used to “develop high-quality education resources.”

Continues below…

Coping with wounds

Practical advice from Horse & Hound to help owners decide whether a wound needs stitching to ensure quick healing

Dealing with leg wounds

Leg wounds are an occupational hazard for working horses. However, if managed correctly, they stand a good chance of healing

Horse found with multiple stab wounds

The RSPCA is appealing for information following the brutal attack [Warning: Graphic photos]

The research is another “citizen science project” undertaken by the University following on from the previous colic research also done in collaboration with the BHS.

The closing date for the wound forms is 1 August 2019; to take part visit the BHS website.

For all the news, reports, interviews and featured, don’t miss H&H magazine, out every Thursday.

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Wounds are common in horses and most will heal well with correct management.

Smaller superficial wounds should clear up within a matter of days with little or no veterinary input.

A wound that has been stitched should heal within 10-14 days, after which the area should be dry with minimal swelling and with no signs of pain.

But wounds unsuitable for suturing, such as very large wounds with loss of skin and muscle or those already heavily infected, can take much longer to heal. In these cases, healing occurs by secondary intention.

This complex process relies on the body’s control of any infection before producing pink, fleshy-looking granulation tissue to fill the gap. The skin cells then multiply and start to migrate across the wound.

These delicate new skin cells progress across the wound bed slowly, between 0.1-0.2mm per day. They must be protected from chemical irritants, bacteria and movement, which may damage or kill them and delay healing.

Large wounds on or below the knee or hock are notoriously slow to heal — particularly in horses compared with ponies — and can require weeks to months of bandaging and ongoing veterinary care.

This is not only expensive but prevents the horse returning to his normal use for a prolonged period. In some cases, surgery to close the wound — once infection has been controlled — or skin grafting may speed up this process.

Barriers to healing

Proper initial care can enable wounds to heal as quickly and normally as possible.

Always seek veterinary advice for wounds near vital structures such as the eye, joints or tendon sheaths.

Infection within a joint or tendon sheath can be life-threatening if not identified and dealt with promptly, while wounds affecting the margins of the eyelids and nostrils can result in permanent scarring and deformity if correct treatment is delayed.

Signs that a wound is not healing properly include heat, pain, swelling or discharge from the site after it appears to have healed. A wound may also fail to show signs of sealing over.

In the case of wounds healing by secondary intention, the wound bed should be smooth, pink and shiny and should continue to shrink.

Uncontrolled bacterial infection at the wound site, failure to protect it with dressings, or too much movement — particularly over joints — can all delay healing. Other factors include death of tissue below the skin or the presence of foreign material not removed at the time of initial injury.

Proud flesh problems

Granulation tissue is normal tissue produced by the body that enables wounds not suitable for suturing to heal.

Horses tend to produce a lot of this tissue, and where it becomes excessive and billows up above the level of the surrounding skin, it is often termed proud flesh.

Proud flesh can delay movement of skin cells across the wound and indicate that the wound is being irritated — either by too much movement or from factors in the environment.

It is important to consult your vet about proud flesh. Different dressings or bandaging methods may be required, or there could be an underlying reason for its presence. This could include foreign material remaining within a wound, indicating the need for X-rays or ultrasound assessment.

Occasionally, persistent and marked proud flesh is due to sarcoid development. More rarely in the UK, it occurs because of a parasite infection called habronemiasis.

These conditions can be diagnosed by taking a sample for microscopic examination, a process termed histopathology. Appropriate treatment can then be initiated.

Scarring and skin grafts

Skin scarring is generally less of an issue cosmetically in horses than humans, due to hair covering the area. Functional healing is much more important, enabling the skin and underlying tissues to do their normal job.

This is particularly important for wounds that affect the eye, where scarring or loss of tissue can result in painful, long-term conditions such as chronic corneal ulceration. Nasal wounds may affect the normal functioning of the nostrils in allowing air to move in and out of the airways.

In general, wounds that are fresh, minimally contaminated and which can be sutured tend to heal with less scarring than those that heal by secondary intention. Some areas of the body and some horses, however, do appear more prone to scarring.

Skin grafting – where skin is taken from elsewhere in the body and placed on a wound – can speed up healing. It can also improve the cosmetic appearance and normal function of skin.

Grafting is usually delayed until any infection has resolved and the wound bed is smooth and healthy.

Simple grafting techniques can be performed with the horse sedated, using standard veterinary equipment. More complex methods requiring specialist surgical skills and equipment may be carried out under anaesthetic, usually at a referral clinic.

Ensuring that these grafts survive can be a challenge. The additional expense, however, must be weighed up against the delay in the horse’s return to normal work if grafting is not performed.

This article was first published in Horse & Hound magazine (21 August 2014)

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Horses can suffer from all sorts of wounds. But do you know how best to treat them? Professor Deborah Archer examines some commonly held wound care myths

Myth 1: the bigger the wound, the worse it is

Some wounds can look horrific. A large wound that only involves the skin, however, is often less troublesome. While it will need veterinary treatment, it is unlikely to be life threatening.

But small wounds, such as puncture wounds where a thorn has penetrated the knee, for example, can sometimes be extremely serious — especially if the puncture enters a joint or tendon sheath. Infection can soon develop in these structures unless surgery to flush out the area is performed as soon as possible.

Myth 2: powders and sprays are best for wounds

While an array of lotions and potions is available for wounds, in many instances these are not necessary.

These products can actually delay healing if applied to the delicate tissues deep below the skin and can make it difficult for a vet to assess how severe the wound is.

Superficial scrapes and grazes will heal nicely in horses in the same way they do in humans, if cleaned with warm water and kept dry and protected. There’s no need to cover them in wound powder or blue spray.

If a horse injures himself, stop any bleeding by applying a sterile wound dressing over the area and keeping pressure over the site. Alternatively, use any piece of clean, dry material such as a tea towel to stem the flow.

If bleeding persists, or if a horse has a wound that makes him severely lame, contact a vet immediately.

Once the bleeding stops, wash your hands and use cotton wool soaked in clean warm water to remove any dirt and dried blood from the area. Make a note of the wound location and how long, wide and deep it is, and look for any other wounds that might not immediately be obvious.

Grazes and small wounds with edges that do not separate should heal quickly if kept clean and dry.

If any of the following apply, contact a vet for advice:

➤ The wound is associated with lameness or is near a joint

➤ It is deeper than 1-2cm

➤ It is located anywhere around the eyes, nostrils or lips

➤ The horse is distressed or showing any other unusual signs

Myth 3: a wound should always be stitched

Stitching may sometimes be necessary and can allow a wound to heal much quicker than had it been left to its own devices.

But sometimes there may not be enough skin left to allow the wound to be stitched, as in the case of wounds caused by barbed wire or those at the hock or knee or below.

In addition, if the wound is more than around 6-8hr old and has been contaminated with dirt, infection at the site will have already started. Stitching these wounds may result in holding infection in, which will delay healing.

Another outcome is that the wound simply fails to seal, wasting the time and expense of stitching it in the first place. Your vet will determine if a wound can and should be stitched, based on these factors.

Myth 4: a nail in the foot is no big deal

There are many important structures within a horse’s foot and any object that punctures this area can have potentially serious consequences. The golden rule is to pick up any nails or plaiting needles that you see lying around the yard to prevent a horse from standing on them.

If you do find that a horse has an object stuck in his foot and is holding the leg in the air, do not make him move. This can drive the object further in, exacerbating the problem.

Ask someone to hold the horse while you remove whatever is stuck in the foot, making a note of where and in which direction the object entered and how far it penetrated (make a mark on the removed object using a marker pen to indicate how deep the object went into the foot). Then contact a vet immediately for advice.

If an object is stuck deeply within the foot and will not be driven in further if the horse stands on it, leave it in place until the vet arrives. This can help the vet determine how serious the injury is likely to be when he removes the object.

It is important that you know whether the horse is up to date with his tetanus vaccinations. The toxins responsible for this killer disease live in soil, so a foot puncture is an ideal way for the bacteria to enter the horse’s system.

Myth 5: cold tea makes a good eye wash

This is a common myth — cold tea should not be used as an eyewash.

A horse’s eyes ideally should only be bathed with commercial eye products designed not to damage the delicate tissues or allow any harmful bacteria to enter.

In an emergency, boiled water that has been allowed to cool can be used with cotton wool to wipe away any discharge.

Eye medications left lying around the yard after previous use on another horse, or human eye medications that can be purchased over the counter, must never be used. These could make the situation much worse and delay the start of correct treatment administered by a vet.

Contact your vet immediately if a horse is unable to open an eye or is holding it partially closed, or if the eye looks a strange colour.

Failure to initiate treatment with appropriate medication can make the condition deteriorate. Small eye ulcers, for example, can be treated quickly with the correct medication, but will worsen rapidly if left untreated. Infection or inflammation within the eye that becomes out of control could result in loss of the eye.

At the British Equine Veterinary Association (BEVA) congress, vets from Glasgow University looked at the question of whether honey can heal from 2 perspectives.

First, they took 20 different types of honey bought from supermarkets, small shops and beekeepers, then tested them to see if they were sterile. To their surprise, 18 contained viable pathogens — some of which were potentially nasty.

The gut of a healthy person could deal with these pathogenic bugs, but the vets concluded that putting these honeys on to a wound would be a bad idea, since they would introduce infection.

Next, the vets took swabs from infected equine wounds and grew cultures of 10 bacteria in the laboratory. They then selected 11 sterile honeys that contained absolutely no contamination and tested their effectiveness against the growth of these bacteria.

8 out of the 11 sterile honeys were effective in inhibiting the growth of all 10 bacteria in the lab — the best were heather honey and Manuka 20+ honey.

In conclusion, sterile honey does appear to have powerful antibacterial properties. The majority of honey available in the UK, however, is not sterile and should not be applied to a wound.

Horses tend to be accident prone, so it’s not uncommon as an owner to find yourself dealing with an injury of one kind or another.

Just as human first-aid techniques have progressed, however, things have changed in the veterinary world. Gone are the days of blasting every wound with powder or purple spray.

The latest products and management methods can speed up initial healing and encourage a more complete long-term recovery.

According to Kirsty Lesniak, a senior lecturer at Hartpury College who teaches equine science, appropriate and effective wound care means getting things right from the start.

Wound types

Incised: a cut with clean, straight edges which may bleed frequently but generally heals quite quickly.

Laceration or tear: the edges are torn and irregular in shape and there are often skin flaps with a limited blood flow.

Abrasion: a superficial wound such as a graze which does not fully penetrate

the skin.

Puncture: can be much more serious than it first appears, with a variable depth of soft tissue penetration but a small skin opening. Foreign material can be carried deep inside and trapped in the wound.

Penetration: where an object penetrates a body cavity with risk to the internal organs.

De-gloving: where skin has been stripped from the limb or torso.

DON’T FORGET: every equine should be vaccinated against tetanus — infection can invade the body through any wound and even tiny scratches pose a risk.

To read the full veterinary article about wound management see the current issue of H&H (18 April 2013)

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Your horse has a wound that isn’t healing — it keeps weeping, it won’t close up and it looks sore. When your vet suggests that maggots could help, you look at him incredulously.

But research has proved the maggots’ worth.

Vets in France and Mali have recently reported their use to encourage healing in chronic wounds in 41 horses.

The maggots were specially bred for this medical purpose and were guaranteed to be sterile and free of infection. This is possible because the thick capsule of fly eggs is resistant to disinfectants and the eggs can be sterilised before the maggots hatch.

Ordinary green blowfly maggots are the best species to use. The sterile maggots were either placed in a net bag within the wound or put directly on the affected area and kept in place with a covering.

The maggots remained in the wound for three days. Sometimes a second three-day treatment was necessary.

The results were astounding. The maggots helped to clean up dead and decaying tissue, secreted antiseptic enzymes and mopped up and killed bacteria. They can even fight off bugs like MRSA, which are resistant to antibiotics.

The French and Malinese vets concluded that maggot therapy for chronic or infected wounds is an excellent way of cleaning up the injuries and reducing bacterial infection.

To read all the latest veterinary research and developments see the current issue of H&H (10 January 2013)

The British government has agreed to support the development of a wound care product designed for animals and humans.

Willingsford — a small Southampton-based medical company — has received a £250,000 grant to help the development of their wound-healing product, SertaSil.

“The funding is a fabulous endorsement of SertaSil,” said Willingsford’s Dr Frank Sams-Dodd.

“It is recognition that we are developing a technically innovative product that has tremendous potential.”

A clinical study has show that SertaSil accelerates the healing process of wounds by almost 50%, when compared to antibiotic and antiseptic treatment.

The product is in a powder form, making it easy to apply to wound surfaces on animals mdash; including horses.

“We need to collect data from dogs and horses, prepare a prototype sample and develop the final product for commercialisation. The grant will be important for achieving this,” added Dr Sams-Dodd.

For more information visit www.willingsford.co.uk

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Willingsford – a small British company – is to receive government support to develop its innovative wound treatment which can accelerate the early stages of healing in humans and animals by 50%.

The small Southampton-based medical device company, has been awarded a £250,000 grant by the government-backed Technology Strategy Board. The money will support the development of the company’s wound healing product, Sertasil.

Sertasil assists the body in the cleaning of the wound surface, allowing the body to return to a healthy and optimal wound healing process. A clinical study involving more than 260 patients showed that Sertasil accelerated the early phases of wound healing by 50% for wounds and burns, leading to faster wound closure.

Subsequent studies have shown that SertaSil – a power that does not require extensive secondary dressings – has similar effects in dogs and horses. It has been used to treat conditions such as leg wounds in horses successfully.

Dr Frank Sams-Dodd, chief executive of Willingsford, said the award was a “fabulous endorsement” of a product that had “tremendous potential, both in the veterinary market and for use by healthcare professionals”.

www.willingsford.co.uk

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Read more about wounds

Find an equine vet

The debate about what to do if blood is seen around a horse’s mouth during international competition is set to rumble on into 2012. But what can we do if an oral wound does occur?

Split and cracked lips are a common problem, particularly in hard-pulling competition horses.

Using correctly fitting tack will help prevent injury in the first place, but if splits do appear, ensure they heal as quickly as possible by:

• Using a bitless bridle: a period of several weeks without a bit may be necessary for the healing process to complete, but using a bitless bridle will allow the horse to continue to be exercised.
• Applying healing lotions: lotions and potions used for the treatment of human mouth ulcers, such as antibiotic and corticosteroid ointments, as well as over-the-counter products such as tincture of myrrh or chorhexidine gel can help healing and improve the strength of the horse’s lips. Care must be taken to ensure that any creams used do not contain prohibited substances. Ask your vet for advice on this.
• Switching bits: a bit with a slightly different action may help relieve the pressure on any mouth cracks.
• Using petroleum jelly: when applied to the corners of the horse’s mouth, products like Vaseline can help reduce friction.To read the full veterinary article on treating mouth wounds see the current issue of H&H (12 January 2012)Find out more about wounds
  Do you need an equine vet?

Equimins has launched a new wound gel containing natural colloidal silver, MSM (methylsulfonylmethan), aloe vera, tea tree oil, echinacea and chamomile oil, all specifically chosen to help speed up skin repair post-injury.

David Willey, managing director of Equimins, said: “Colloidal silver is a powerful microbial agent that kills around 99% of germs.

“The other ingredients have been chosen due to their specific qualities — MSM helps promote skin recover, tea tree oil has antiseptic properties, echinacea helps activate white blood cells and chamomile is a natural analgesic.”

Equimins wound gel is available in 100ml airless dispensers and retails at £6.99.

For more information see www.equimins.com, email sales@equimins.com or call 01548 531770.

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Nurtured Pets has launched Equine Anti-LickStrip to shorten wounds’ healing time.

The cayenne pepper plaster (not shown) is placed over dressings to deter itchy or inquisitive horses from biting and chewing.

The plasters are available in packs of 10, in 10” x 2.75” strips on a strong medical grade adhesive.

This year Anti-LickStrip won Pet Product of the Year and the Pet Industry Service Innovation Award.

Also newly on the market from Nurtured Pets are dog-targeted Anti-ChewStrips.

Based on a similar idea, but infused with lemon powder, clove oil and oregano as well as cayenne pepper, these are designed to deter dogs from chewing furniture or anything else.

See www.nurturedpets.co.uk

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One of the most common problems encountered in an emergency situation is a wound: the nature of the beast means horses tend to injure themselves, either by kicking each other or somehow colliding with solid objects. Certain horses are also injury prone and seem to hurt themselves however careful you are.

Although wounds have not changed, first-aid treatment has improved. Relatively new water-soluble wound gels have replaced traditional wound powders and the various coloured sprays. Originally designed for human burns patients, these gels are also very useful in horses.

Wound hydrogels can be applied to the area of damage, helping to keep it clean and moist. It is thought hydrogels reduce the number of bacteria in the wound and can speed healing. They are a useful addition to any first-aid kit and a safe and satisfactory answer to the question: “What shall I put on a wound?”

There are various such products on the market, including Derma-gel, Vetalintex, Intrasite gel and Nugel, all of which are useful to apply to open wounds.

The healing of a wound is influenced by the way it is managed straight after an accident occurs, so your immediate action is important and should include the following:

• If possible, move the horse to a safe place so that it is not likely to injure itself further or cause injury to others
• Control any bleeding, usually by applying pressure to the wound
• Assess the injury and call the vet if necessary
• Protect the wound from contamination and further injury. Cover the wound where possible to protect it. It is important to remember that raw tissues are exposed and will be painful
• Assess whether the horse is shocked or just very sore. It helps to check how it can walk and whether it is lamer than one would expect
• Clean the wound
• Prevent or control infection
• Prevent or reduce swelling

Another essential first-aid rule is that contamination and infection prevents wound healing. If infection penetrates vital structures such as joints or tendon sheaths, a horse may be permanently crippled. Hence it is vital to check the position, depth and severity of any wound carefully. To do this properly, you must clean the wound, so you can see what is involved, provided this can be done without making it bleed further. Cold hosing can be very effective here.

Always contact your vet if:

• Any wound is bleeding profusely
• The horse is very lame, even if the wound itself is small
• Any wound is more than a couple of inches long and has gone right through the skin, so that it gapes open and may need to be stitched
• There is any suspicion of a foreign body in the wound
• There is any suspicion that a vital structure such as a joint may be involved
• The horse has NOT had an anti-tetanus vaccination

If you think a wound may need to be sutured (stitched or stapled), you should consult your vet as soon as possible, since a wound will heal more effectively if it is sutured while still fresh. This does not mean your vet has to attend instantly, as there is a 6-8hr optimum period for wound repair.

A wound may need to be sutured if:

• The edges are gaping apart, leaving a large gap for dirt to enter
• It is very large or deep
• It is in an awkward place that will scar

In most cases, deep punctures, injuries with very swollen or crushed wound edges or severely contaminated or infected wounds will not be suitable for suturing, nor will wounds that are more than 8hr old. Your vet will be able to advise you what is best for any particular wound. Many wounds that look appalling at first inspection will repair very well, given time and proper care.

Another innovation is the use of surgical skin staples, which are now often used instead of stitching for certain types of skin wounds. They can be inserted very quickly and may be ideal when a horse does not want to stand still. Staples do not work well for jagged injuries or when the wound edges are under a lot of tension, but they are often a neat and efficient way to repair clean cuts.

Large wounds often do very well, whereas small puncture wounds are frequently far more serious, since they may penetrate vital structures, introducing crippling infection.

• This veterinary focus formed part of a larger veterinary feature first published in Horse & Hound (19 January, ’06)

The term “broken knees” does not automatically refer to damage to the bones that make up the knee joint. It is commonly used to describe a condition in which one or both knees suffer serious damage as a result of impact when they are bent (flexed). This leads to the skin and tissues over the front of the knees being damaged.

Most cases of broken knees occur when the horse stumbles and goes down on the road or a hard gravel track. The full weight of the animal is taken for an instant on the flexed knee or knees in contact with the ground. Usually, it all happens quickly and the horse gets up straight away, but severe damage to the front of the knees may have occurred, even though it may not be noticed immediately.

The skin wound on a broken knee is never simple. It may appear to be a large, round graze, a semicircular flap or may even look as though an area of skin has been cored out. Whatever the nature of the damage, it will almost certainly be contaminated with gravel, stones, mud or other debris.

There are three reasons why broken knees are serious:

• The injury occurs when the tissues on the front of the knee are tightly stretched and most vulnerable
• The structures beneath the skin at this site are important and may also be damaged
• The process of healing is protracted and may leave permanent disability

Stretched tissues are always more easily damaged than flaccid ones. When the knee is flexed, the skin on the front of the joint is very tight, like a drum, and will split or tear easily. The added effect of bruising and crushing make the wounds impossible to stitch in most cases.

Even if the only layer affected is the skin, the vet will almost certainly not be able to repair the wound with sutures. It will be treated carefully to allow slow healing over many weeks. The initial injury may look worse after a week or so as further skin, damaged by the impact, dies and peels away. This may leave a large ulcer over the front of the knee, which will take weeks or months to heal.

Treating mild cases

If a horse goes down on to his knees on the road, the first thing to do is to hose the knees liberally with cold water. This flushes out debris, gravel and contamination; helps to reduce inflammation and swelling, and prevents the skin edges from drying out.

Knees with superficial grazes that do not make the horse significantly lame may be managed without veterinary assistance. They should be hosed and bandaged with a figure-of-eight bandage when the horse stands in. The horse should be returned to walking exercise within 48hr to encourage mobility and keep the swelling down.

If there is no more than a little stiffness that soon wears off and the grazes dry up in a few days, normal work can be resumed.

Treatment for more severe problems

In cases of broken knees where the skin is completely penetrated or abraded, veterinary attention must be sought to determine whether any of the underlying structures are damaged. At the very least, the vet will want to prescribe a course of antibiotics and anti-inflammatories. Open tendon sheaths or, worse, open joints will require an admission for inpatient treatment and possibly X-rays or even surgery.

Damage to the cartilage of the joint is unusual but can occur. In the very rare case of fractures resulting from a broken knee injury, the vet will want to make certain that fragments are removed and that infection is under control.

Recovery and prognosis

Recovery in any case of broken knees is potentially protracted and frustrating. Where areas of skin are lost or damaged beyond repair, there will be raw, granulating ulcers that take weeks to be covered with skin again.

Bandaging will be essential in the short-term, but knees are not easy to manage under bandages. There is a risk of pressure sores on the back and sides of the knees, where the skin is the only covering of the bony prominences. Proprietary elastic or Lycra tailored knee bandages and boots are quite helpful, but the sooner the knees can be left open the better.

Management then consists of creams and emollients to discourage excessive granulation and encourage skin regeneration. The constant flexing of the knees is a problem and reduces the success of any form of skin grafting.

Movement is essential to mobilise the underlying tissues, especially if there has been damage to tendons or joints. Any attempt to immobilise the horse for long periods to aid skin grafting invariably results in permanently stiff knees with poor flexibility. This increases the chances of the horse stumbling and sustaining the identical injury again.

We have learned to sacrifice rapid skin healing for the sake of mobility, and therefore encourage passive flexions and walking exercise as soon as the patient is able. The best possible result from a bad case of broken knees will be badly scarred but fully functional knees; in the worst case, the horse may be lost because of unresponsive joint infection and damage.

• This veterinary feature was first published in Horse & Hound (25 August, ’05)

All wounds result in scarring because although nature makes a very good attempt to restore normal tissue function as fast as possible, it cannot recreate exactly the normal anatomy at the site of an injury.

The cosmetic appearance of scars is often of concern to horse owners because this can affect the value and appearance of the horse.

Currently, it is probably impossible to avoid scarring at the site of a significant wound that damages the whole depth of the skin. It is therefore important to limit the extent of scarring through very careful wound management.

The faster a wound closes, the smaller the scar will be — wounds created surgically with a scalpel or accidental wounds that cause minimal damage to the adjacent structures heal rapidly — especially when the size of the wound is reduced by sutures.

Stitching a clean wound closed will create the minimum amount of scarring. Any delays in healing or complications arising within the wound that affect the healing process will leave a larger scar.

There are measures that can be taken to limit the severity of a scar at a healed wound site. Once the wound has healed, restoring or maintaining tissue hydration seems to be a significant benefit in ensuring that the scarring is minimised.

It is sometimes possible to limit scarring by the use of corticosteroids — these drugs reduce the inflammatory responses and so limit the scar tissue formation. Probably the commonest site for this approach is in certain eye injuries. This treatment can be applied only to a healed injury, and the exact timing of the applications is critical.

Recently there has been a major scientific focus on stem cell technology. There are several new methods that exploit this technique and the results are remarkably good. However, there is still much research needed to deliver a clinically useful response.

A second recent scientific discovery is the value of protein mediators, called growth factors, within the wound site. Manipulation of these chemicals can result in far less scarring. This technology, which is still very expensive and difficult to carry out, has been applied to some human wounds with remarkable success. It is likely that the method could eventually be applied to horses.

Can scars be removed?

There is a strong temptation to consider removing scars for cosmetic reasons, but there are significant dangers from this approach. The surgical excision will usually be far more difficult than it looks from outside and the resulting scar from the surgery may be worse than the original one.

In some cases, such as broken knees following a fall on to concrete or road surfaces, the scar can be removed surgically and the site grafted with a piece of skin taken from another site where its removal will not be noticed. While this is an attractive option, there are major risks. The graft may not “take” and the hair in the graft may not grow back in the same format, so there could be even more problems.

It is very doubtful whether the horse minds having a scar at all, so the procedures tend to be more for the owner than the horse.

This veterinary feature was first published in Horse & Hound (21 April, ’05)

All wounds result in scarring. Whether visible or not, it is the inevitable result of tissue damage in any organ. After injury, the healing process is triggered immediately and, although nature makes a very good attempt to restore normal tissue function as fast as possible, it cannot recreate exactly the normal anatomy at the site of an injury.

The cosmetic appearance of scars is often of concern to horse owners because this can affect the value and appearance of the horse. However, resultant functional problems will be much more significant for the horse. In some circumstances, scarring can be devastating and cause significant difficulties in movement or function.

The scar from a large wound over a major limb joint such as the hock or fetlock or involving the flexor tendons can severely restrict the function of the limb. A wound on the cornea of the eye results in a permanent scar — a dense white area in the normally clear cornea is the end point of a wound. This will have an effect on the horse’s vision, although in most cases this is probably not highly significant.

Over the weeks following healing of a skin wound, the amount of fibrous tissue in the wound is increased. Because accidental wounds invariably involve multiple tissues, the healing (repair) and scarring (remodelling) processes will inevitably result in scarring in all the affected tissues. During the healing process and for many months after the wound has closed, these fibrous cells become “muscular” and pull inwards. This reduces the size of the resultant scar over a long period of time.

Continuing contraction of the wound site results in a less obvious scar, but this may itself be problematic — contracting wounds will result in distortions that may be highly important for the function of the affected tissue and indeed for survival of the animal itself.

While this contraction is a benefit for the early stages of the healing process (the healing has less area to cover if the wound shrinks in size), and improves the cosmetic repair, it can also be a significant danger. The fibrous cells become much less elastic and the wound site loses natural flexibility.

Scarring also occurs at the site of surgical wounds and at sites of intended skin damage. Even though these can be “constructed” in such a way as to minimise the extent of scarring, there can be serious secondary consequences from the resulting scar. For example, intestinal surgery may save the animal’s life, but the scar may cause narrowing of the repaired gut, so a functional obstruction can develop that may necessitate repeat surgery.

Also, the repair process is sometimes not the most appropriate response. Again using an intestinal example, the natural repair process can result in loops of intestine sticking to each other or to other abdominal organs.

Scarring in any circular (or tubular) structure can be extremely dangerous. Because scars contract progressively, scarring that involves the full circumference or a greater part of the circumference may be a critical issue in the formation of a stricture. Oesophageal scarring can occur in the gullet as an ulcer that arises after an episode of choke. The nature of the injury results in a circular scar that, in common with all other scars, contracts. This creates a dense fibrous band (a stricture) that can inhibit or even totally obstruct the swallowing of food.

There are also significant problems that can affect the actual process of scarring. In some cases, the scar can be much larger than expected — the healing process is not normal and the amount of scar tissue is far in excess of normal. This is commonly referred to as a hypertrophic scar.

In other cases, the type of tissue is abnormal and the skin takes on a reptilian appearance with a thick, scaly crust over the wound site. This is known as a cheloid scar.

Individual horses may have a tendency to either of these problems, but they can occur for no apparent reason in any wound in any horse and little is understood about them.

This veterinary feature was published in full in Horse & Hound (21 April, ’05)

Horses have a horrible tendency to wound themselves so they bleed profusely. But if you are faced with an horrific-looking injury, before panicking, remember: wounds heal from side to side, not end to end, so even if there is a nasty big hole, it can heal surprisingly well.

Before any wound can be dealt with, however, the bleeding must be stopped. It is exceedingly rare for a horse to bleed to death when a single artery or vein is cut, but severe bleeding must be controlled. However, a small amount of initial bleeding may be beneficial, as it can flush out any dirt.

Always contact your vet if:

• Any wound is bleeding profusely.
• The horse is very lame, even if the wound itself is small.
• The wound is more than 10cm long and has gone right through the skin into the tissue beneath.
• There may be a foreign body in the wound.
• A vital structure such as a joint may be involved in the injury.
• The horse has NOT been vaccinated against tetanus.

Be aware that a little bit of blood will go a long way. An average Thoroughbred-sized horse normally has more than 50 litres of blood inside its body and has to lose more than 10 litres before the situation becomes life-threatening. If it is your horse that is bleeding, however, even a litre can look like a huge amount.

Profuse bleeding comes from two sources. Arterial blood, coming directly from the heart, is bright red and spurts in rhythm with the heartbeat, which can look very alarming. Severing a major artery is critical, but this would involve a big blood vessel near the heart, not a small artery on the lower limb.

The loss of large amounts of venous blood can be of concern, too. This is on its way back to the heart, so is darker in colour and oozes continuously.

The volume of blood lost depends upon many factors, particularly the size of the injured vessel and the extent of the wound. A clean cut will bleed far more than a jagged tear: if the skin is torn, the blood vessels are stretched, so are less liable to bleed extensively.

Stopping the bleeding

Clotting is essential to stop bleeding and this is a natural process that you can assist by applying pressure. Before any wound can repair the bleeding must be stopped, so whatever the source, it is essential to keep both yourself and the injured horse calm, and then try to stop the bleeding by firmly applying pressure to the wound.

Ideally, you should make a pressure pad from a thick cloth, or use gamgee from your

first-aid kit, with a non-stick dressing underneath. In an emergency, however, use whatever is to hand, such as a T-shirt, large handkerchief or towel. Press the pad against the wound and hold it there as tightly as possible.

Most such wounds are on the lower limb, so usually a thick pressure bandage over the area will control bleeding. If the blood soaks through, simply put more padding over the top and apply more pressure. You must keep a pressure pad in place for at least five minutes. Do not be tempted to take it off to look underneath, as that may well restart the bleeding.

Talk to the horse reassuringly as you keep pressure on the wound, encouraging him to stand still, so you can keep the pressure pad in place. If he is excited, the heart pumps faster and blood will run faster too. If you keep him calm and still, the blood will clot more easily. An injured horse or pony will often stand more quietly in a familiar environment, so unless the wound is enormous or the distance particularly great, it is usually best to lead a horse back to the yard and deal with the injury there.

If you estimate that the wound is bleeding more than about a teacupful per minute, do not move the horse until you have got a firm and effective pressure pad in place. It can also help to give a horse or pony a small amount to eat to settle them. If possible, ask someone else to steady the horse’s head, talk calmly and maybe feed the odd titbit.

Once the dressing is in place, apply a bandage using several moderately tight turns. This will provide sufficient pressure to greatly reduce the blood supply to the lower leg. Do not apply a tourniquet – a pressure bandage is much more practical in a crisis. Such a tight dressing should be safe for up to two hours. Once you have got a firm, comfortable pressure bandage controlling the bleeding, it is best to leave it in place until your vet can treat the injury.

This first-aid feature was first published in HORSE magazine (January ’05)

Of all the species vets deal with, horses seem especially prone to wounds. And, after colic, wounds are the most common group of emergency conditions in horses.

When we compete horses we present them with unnatural hazards, increasing their potential for injury. Yet the majority of wounds occur at home. It is a sad fact that many horses sustaining fractured limbs from a kick by another horse do so within a few days of being introduced to the new group, while the pecking order is being rearranged.

Dos and don’ts

• Don’t panic. Most wounds do incredibly well whatever the circumstances and no matter how awful they look originally, as long as they receive the appropriate treatment. Even a horse with a fractured limb will appear to be uncannily calm and will not be helped by people panicking.
• Do bring the horse in from the field and on to the stable yard if it will walk. Then wash the wound with clean running water from a hose (not under pressure), assuming that the horse will tolerate this.
• Do try to assess the extent of the damage before calling a vet. The vet will want to know when the wound occurred, how it happened, how big it is and which part of the body is affected. How lame is the horse? If the wound is recent, is it still bleeding heavily? If the wound is old, is there much swelling or pain around it? Is it discharging pus?
• Don’t apply anything to the wound other than a clean, dry dressing —resist the temptation to apply wound powder, purple spray or green oils unless you are sure that the wound will not require vet attention.
• Do check the tetanus vaccination status.
• Do not give the horse any bute unless specifically advised to do so by your vet.When to call the vetWhen assessing a wound, the first priority is to determine whether veterinary attention is required. Generally speaking, if the wound is less than 8hr old and the edges can be pulled apart, suturing may be of benefit.Simple skin wounds are not usually very painful. If the degree of lameness is disproportionate to the size of the wound, this may suggest a penetration of a synovial structure, ie a joint, bursa or tendon sheath.Similarly, if there is an unexpected degree and persistence of lameness where a wound occurs as a result of a kick to a region of the limb that has little flesh overlying the bone, a hairline fracture could be involved. But absence of obvious lameness does not rule out penetration of a synovial structure or bone damage.HealingThere are many things that influence a wound’s ability to heal. These include the age of the horse, healing ability and the time of year, with conditions associated with the summer months, principally the heat and flies, combining to interfere with healing.
  But the two most significant factors are the extent of the blood supply to the region involved and the degree of contamination.Due to the generally poor circulation in the lower limbs of the horse, wounds in that area tend to be challenging to treat and suturing may be of little help. Limb wounds are also more likely to be contaminated with visible dirt and debris as well as invisible bacteria.It is pointless to suture an infected wound. The time it takes for the bacterial population to multiply to an unacceptable level ranges from 4-8hr depending on the degree and type of contamination. Unfortunately, failure to close the wound adequately with skin suturing can often result in overzealous healing and the formation of excess granulation tissue or “proud flesh”.The fundamental approach to treating wounds is to provide the best environment to allow nature time to do what it does best. The wound should be kept moist and sterile while allowing for removal of excess discharge and providing a barrier to external contaminants.In the early stages this can be achieved through bandaging or the use of a topical treatment. The most commonly prescribed treatment used to be an antibiotic and steroid combination cream. However, after license expiry in May of this year, this is no longer available. Luckily medical and herbal hydrogels are proving to be equally as effective and remain widely available.Studies have shown that unpasteurised honey also has valid medical benefits in the treatment of wounds. As well as providing a viscous barrier, honey contains some enzymes that promote tissue formation and others that break down into hydrogen peroxide, generating highly reactive free radicals. Renewed interest is being shown in the use of honey, as MRSA, E coli, and other “superbugs” have been shown to be controlled by it where all else has failed.A new injury will also benefit from being cold-hosed for about 20min at a time, as many times a day as possible. Shorter periods aren’t as beneficial, as they don’t give the blood vessels enough time to react fully. Applying cold temperatures can encourage blood flow and help reduce inflammation.Other benefits of cold-hosing include cleansing of the wound and relieving pain by acting like a topical analgesic. Purpose-built equine cold water spas have been developed to optimise this treatment approach and are gaining in popularity.In conclusion, a skin wound wants to heal. There is much that we can do to assist this process by creating the right environment. However, if it is not healing it is either because we have failed to do this or there is some other structure (eg tendon or bone) or tissue involved and further investigation is required.

This feature was first published in Horse & Hound (21 October ’04)

All horses have a tendency to damage themselves, often on their limbs and some times their injuries bleed profusely.

The sight of a bleeding horse can be alarming, but it is important not to panic. An average-sized Thoroughbred has to lose 10 to 15 litres of blood before there is a serious problem.

The first thing to do is to assess the type of bleeding:

• Arterial blood will be bright red and will spurt out under pressure from every heartbeat. A common site for this type of injury is the side of the fetlock, where there is a large artery that is easily knocked
• Bleeding from a vein is slower and tends to drip, rather than squirt, from a wound, in a steady flow. The blood is usually dark red or purple in colour
• Bleeding from the small vessels known as capillaries will result in blood oozing from a wound. Usually, this will clot naturally within a few minutes, but applying a cold compress or ice pack can help

Significant blood loss only occurs when bleeding from a large vein or artery is left unchecked. Most small wounds will eventually stop bleeding without interference, as the blood clots, shutting down the damaged vessels.

Stop the bleeding

Any bleeding must be stopped before the wound can be treated. Although a small amount can be beneficial, as it will flush dirt and debris from the cut, but severe bleeding needs to be controlled.

Stem the flow by applying pressure firmly to the wound. Make a pressure pad from thick cloth, or use gamgee with a non-stick dressing underneath. In an emergency, use whatever is to hand, such as a clean T-shirt, large handkerchief or towel. Press the pad against the wound, and hold it there as tightly as possible. It is often easiest to tape it in place.

A thick pressure bandage can be used to control bleeding from wounds on the lower limbs. If the blood soaks through, put extra padding over the top and apply more pressure. You must keep a pressure pad in place for at least five minutes. Don’t be tempted to check it before then, as the bleeding may restart.

An injury involving blood loss is the one occasion when a relatively tight bandage is recommended. A bandage wrapped in several fairly tight turns provides enough pressure to reduce, but not stop, the blood supply to the horse’s lower leg and is also easy to apply in a crisis. A tight dressing should be safe for up to two hours, while awaiting professional help.

In the case of an arterial bleed, pressing the skin firmly a couple of centimetres above the vessel may help to stop the blood flow. This can be done while the first aid kit is fetched. As you apply pressure, compress the area of the wound and also the region just above it, to reduce blood flow towards the wound.

Talk to your horse or pony reassuringly as you do this, encouraging him to stand still, so you can keep the pad in place. If the horse becomes excited, its heart will pump more quickly and blood will run faster. If you keep him calm and still, the blood will clot more easily.

Assessing the horse

It is important to check the horse over for other wounds and to inspect its gums, which should still be a healthy pink colour. If a horse has lost a significant amount of blood, the gums will be pale pink to white and the pulse will be fast. The horse may also look uncomfortable or anxious, or be sweaty and trembling.

Always contact your vet if:

• The horse has lost a large volume of blood
• A wound is bleeding profusely and you cannot stop it
• The horse has not had an anti-tetanus vaccination
• You think the wound may need to be stitched
• This article was first published in HORSE magazine. Don’t miss the new issue of HORSE, on sale this Thursday (1 April 04).

Exactly where an injury is sustained on the horse’s body is a major factor in its severity and the speed at which it heals.

When cuts heal, a delicate layer grows over the wound, forming a new surface layer. Cuts heal by primary intention, where the edges stick together and are healed within a couple of weeks, and by secondary intention, where the wound gapes open and is not stitched, so granulation tissue forms from the inside out, over which the new layer grows.

Head wounds tend to bleed excessively, and were previously considered best left to heal on their own. A more recent trend towards stitching this area has proved very successful. Gaping body wounds can looks serious, but with care and delicate needlework from a vet, can heal exceptionally well.

As a rule, stitching injuries below the knee can be difficult, and will be considered with caution as the close proximity to the ground exposes the wound to infection, the skin is tight and there is a lot of movement.

To obtain the optiumum benefit from stitching, a wound needs to be fresh and clean, and in a place where the skin is not too tight. Anything over 12 hours old is likely to be contaminated, the surface layer may be damaged and the surrounding tissue deteriorating, making it difficult for the stitches to hold.

Essential Wound Care

When cleaning a wound, be aware that:

• Bathing with cotton wool can introduce contamination
• Strong antiseptics can kill cells as wells as bacteria – use very mild solutions or salt water
• Coloured sprays and wound powders can act as foreign body and be caustic to cells; use creams and moist wound dressings as recommended by a vet
• Avoid “second skin” sprays, as they can seal in infection
• To avoid damaging delicate tissues when flushing out or bathing wounds use a light water mist from a garden spray, such as a hand-held trigger variety on a soft setting

An average 500kg horse will have more than 50 litres of blood and, when it bleeds, even one litre can appear to be a huge amount, even though this level of blood loss is not life threatening.

Severe bleeding can come from two sources — an artery or a vein.

Arterial blood, coming directly from the heart, is bright red and spurts in rhythm with the heart beat.

Venous blood, on its way back to the heart, is darker in colour and oozes continuously. The amount of blood lost depends on many factors including the size of the injured vessel.

Vet Karen Coumbe, from Bell Equine Veterinary Clinic, says: “A pint of milk spilled on the floor looks like a gallon, and a litre of blood from a horse will do the same. Don’t panic over profuse bleeding — apply pressure and padding and consult your vet.”

Treating bleeding

First aid kits should contain clean, dry “non fluffy” dressings, which can be applied directly to the wound, than padded with gamgee or a clean towel and held firmly in place.

If the injury is to a leg, tape the padding into place and leave it alone.

Do not be tempted to lift the dressing for at least five minutes. If the blood seeps through, add another level of padding and keep the pressure on.

Depending on the site, depth and type of wound, most small arteries will have stopped bleeding before the vet arrives

If the horse has been impaled and the object is still in place, do not pull it out. Although the vet will have to remove it, leaving the object in place will at least give more idea of the direction and depth of the injury.

Types of injury

Bruising and haematomas

These are very common following kicks over muscular regions such as the rump (gluteal muscles), thigh muscles (quadriceps), or forearms. The overlying skin is often undamaged, but blood vessels are ruptured by the hoof’s impact.

Bleeding into the surrounding tissue may be mild, forming bruises, or in some cases more severe, resulting in large fluid swellings under the skin called haematomas. Mild bruising can be treated with cold hosing and compresses, but large haematomas deserve veterinary attention.

Skin lacerations

Trauma from kicks often only causes small skin wounds. However, these should be carefully examined as they often lead to pockets under the skin where the connective tissue has been separated by the blow, leaving atunnel into deeper tissue for bacteria to travel along.

Small superficial wounds away from joints, which do not appear to be causing marked lameness, can be treated by poulticing, followed by twice-daily cleaning and application of a suitable wound ointment.

Deeper puncture-type wounds require veterinary attention, as the skin has been broken and bruised tissue is prone to infection. The wound will need flushing and the horse will require antibiotics and tetanus prophylaxis.

Large skin wounds may need stitching, and these must be seen straight away, as bacteria multiply rapidly and, after six hours, most wounds will be too infected to close.

Wounds that need stitching should be cleaned with saltwater (half a teaspoon of table salt into a litre of water) and bandaged to prevent contamination while waiting for the vet.

Infected or heavily contaminated wounds should not be stitched. Instead, they should be managed with antibiotics, bandaging and water-soluble wound ointments.

Kicks onto joints

Joints are particularly dangerous sites for a horse to sustain a kick. If the skin is broken there is a serious risk of joint-capsule penetration. Any puncture-type skin wound over a joint should receive veterinary care.

If infection gets into a joint, it will rapidly become septic. This is extremely serious and can lead to permanent lameness or even necessitate euthanasia.

Kicks onto bone

In many cases, the bone will just be bruised and will heal quickly, leaving only a splint-type bony swelling. These cases respond well to a week’s cold hosing and kaolin poulticing, combined with box rest.

Sometimes, however, the kick wound is deep or traumatic enough toaffect underlying bone, resulting in a ‘sequestrum’, a fragment of bone that has broken off with the initial impact or has become devitalized due to reduced blood supply as a result of infection.

The wound may heal initially, only to break open again. A chronic drainage tract will persist until the sequestrum is surgically removed.

Any kick wound which refuses to heal should be X-rayed to rule out bone chips, fractures or sequestra. Some kicks onto bone are so powerful they fracture the bone.

Many fractures can be repaired, though sadly some cannot, necessitating euthanasia.

Recognition of non-displaced ‘hairline’ fractures is essential for, as the horse gets sounder and starts to bear weight, the bone may suddenlygive way.

Any kick wound resulting in severe lameness deserves urgent veterinary attention.

Call the vet if:

• the wound is pouring or pumping blood
• the skin over a joint or tendon sheath has been penetrated
• the horse is lame
• a large haematoma has developed
• the wound is infected, highly contaminated or doesn’t show signs of healing
• your horse’s tetanus jab isn’t up-to-date
• the wound is deep or large enough to require stitching.

Alternative treatments

There are a number of alternative therapies that can be helpful with kick injuries and worth keeping in your first aid kit. Before using them, check with your vet that they won’t interfere with any other treatment your horse is receiving.

• Arnica: useful for treating bruises.
• Calendula lotion: used to flush out wounds, Calendula has antiseptic qualities and stimulates healing.
• Hypericum: eases pain – useful when an area is very painful but there’s not much damage.
• Hepar sulph: if a wound is infected and oozing pus, Hepar sulph will help stimulate healing.

Many lower leg wounds can be described as over-reaches but the first aid each requires will differ depending on the precise cause.

Horses can injur themselves by:

• The hind foot striking into the front heel – an overreach
• Wounds on the inside of the leg, below the knee or hock, caused by the inside of the oppositeleg’s hoof – speedicut
• The hind foot striking into the front leg anywhere above the heel, including causing damage to the flexor tendons – a strike injury
• Wounds around the coronet that are the result of a horse treading on himself, often while travelling – treads

Such wounds can range from trivial scrapes requiring a minor clean-up to crippling injuries that damage the vital tissues of the lower limb and can end a horse’s career.

First aid

• Assess the degree of lameness. With any trauma, the horse can be sore, but persistent lameness implies serious damage. Call your vet.
• Stop bleeding. If there is major bleeding, encourage clotting by applying a clean pressure bandage over the wound. Tape a pad in place for at least five minutes.
• Clean the wound. Low-pressure cold-hosing is a good method, as it numbs pain. Blood and dirt should be wiped away with moist swabs.
• Assess the damage. A small skin wound is not trivial if the horse is very lame: serious damage is likely, especially with strike injuries in which the leg was bent when it was struck. There may be underlying tissue damage away from the wound site.
• Cover the wound. Use a gel to start wound repair. These can be applied directly to the injury, which should then be dressed. Most wounds will be too bruised to suture, but your vet can advise.

Danger areas

• Deep wounds at the back of the pastern that may involve the tendon sheath
• Wounds around the coronary band, which can indicate coffin joint damage
• Wounds around the back of the cannon bone may mean tendon damage
• In each of these cases, or if the horse is lamer than you would expect, consult your vet.

It is natural for groups of horses to have a ‘pecking order’, and this minimises fighting and injury in the long run. Unfortunately, the establishment of this dominance hierarchy requires each horse to recognise his companions as individuals and determine through initial aggressive behaviour (biting or kicking) and submissive acts (such as moving away) which of the horses is dominant and which submissive.

It’s at this time that injuries are most likely to occur. Once the hierarchy has formed, fighting is usually minimal.

The seriousness of a kick injury varies greatly depending on its site, and the amount and type of tissue damaged.

Serious wounds can result in permanent disability or even death and should receive prompt veterinary care. Many less severe wounds can be treated by the owners.

Avoiding injury

Understanding the social interactions of horses allows us to use certain husbandry practices to help prevent kick injuries.

• First, avoid over-crowding. Crowding increases aggressiveness and decreases the subordinate horse’s ability to escape. Consequently, the weaker individual may be kicked and bitten repeatedly.
• Allow new horses a period of acquaintance – separate them with a safe fencein adjacent paddocks before turning them out together. This is often an effective way of minimising the initial fighting that occurs when a new horse is introduced to the herd.
• When feeding a group of pastured horses, it’s best if the most dominant equine is fed first. Feeds should be placed more than 15m apart and be well away from fences, especially corners.
• Some horses are habitually aggressive and are best removed from the group or should at least have their hind shoes removed.
• Kick injuries commonly occur when mares are in season. Geldings and mares should be turned out separately where it is possible to do so, and double fencing placed between particularly “flirty” mares and “riggy” geldings is a sensible idea.

First aid

Staunch any bleeding. Direct pressure with a pad, either hand-held or bandaged firmly in place, will stop even severe haemorrhage until the vet arrives.

If bleeding continues beneath the bandage, apply a second one firmly over the top of the first.

• In the absence of marked bleeding, shave or clip the hair from around the wound.
• Clean the wound with saltwater.
• Apply a non-adhesive dressing or poultice.
• Bandage to prevent further contamination.
• Ensure your horse’s tetanus vaccination is up to date.
• Contact your veterinary surgeon.
• Do not apply any wound ointment to a wound requiring stitching.

Call the vet if:

• the wound is pouring or pumping blood
• the skin over a joint or tendon sheath has been penetrated
• the horse is lame
• a large haematoma has developed
• the wound is infected, highly contaminated or doesn’t show signs of healing
• your horse’s tetanus jab isn’t up-to-date
• the wound is deep or large enough to require stitching.

Expert advice on stemming bleeding after injury or accident

Horses tend to produce injuries, which bleed profusely. Wounds heal from side to side, not end to end, so even if you’re faced with a big hole, it can heal well.

Before any wound can be treated, the bleeding must be stopped, although a little bleeding may help as it will flush out dirt and debris.

Keep your horse calm. If he is unsettled, the heart will pump faster and his blood will run faster.

Taking action

If an artery is severed, bright red blood will be spurting from the wound. If so, or for any wound bleeding profusely, try to stop the flow with a pressure pad made from a thick cloth pad or gamgee, with a clean non-stick dressing underneath, pressed against the wound as tightly as possible. Failing that, use a towel or T-shirt or handkerchief.

Most such wounds are on the lower limb, so usually a thick pressure bandage over the area will control bleeding. If the blood soaks through, put more padding over the top and apply even more pressure.

Keep the pressure pad in place for at least five minutes. Do not be tempted to take it off as that may well restart the bleeding.

If the bleeding continues, a bandage wrapped in several fairly tight turns over a bandage pad will reduce bleeding and should be safe for up to two hours while you wait for help.

Your vet may choose to apply a tournique instead.

Always contact your vet if:

• A wound is bleeding profusely.
• The horse that is wounded has NOT had an anti-tetanus vaccination, or he is overduefor one.

Read more about wounds:

• Treating leg wounds
• Coping with wounds
• Microscopic bleeding and breathing innovations

Wounds of all sizes located close to joints or tendons should always be treated seriously because ofthe risk of infection. You should call the vet immediately as the sooner treatment begins, the better the prognosis.

Examining the wound

When you find a wound, clip away the surrounding hair and wash it thoroughly before assessing thedamage. What may appear to be a small scratch can be more extensive once “uncovered”. While a puncture wound may appear fairly innocuous, it must be treated as serious because it may introduce infection into the joint itself.

Washing is best done with a gentle hose starting from below the wound and progressing upwards. If you think that a joint or tendon is involved, call your vet immediately. Apply pressure to the wound with a clean, preferably sterile, dressing if there is extensive bleeding.

Exposed joints

Some wounds are so extensive that the joint is visibly exposed. A puncture may be more difficult to assess, although you may see joint fluid oozing from the injury if the joint capsule has been damaged.

Your vet may take a sample of the fluid to test for any infection and to establish which antibiotic to use. X-rays can also provide important information about any additional bony damage.

If the vet thinks there is a chance that the joint has been penetrated, the horse may be referred to the vet college for further examination and to have the wound flushed through under general anaesthetic.

Natural healing

The wound is usually left open to heal naturally by granulation – the growthof blood vessels and connective tissue behind the scab. Prolonged box rest and repeated sterile bandaging will be necessary. The vet may apply a cast if extensive tissue has been loss or extra support is needed.

An antibiotic course should be started as close to the time of injury as possible and may need to be continued for four to six weeks. The vet may also prescribe pain killers, but these must be used intermittently in low doses to avoid masking complications, such as septic arthritis.

If the vet needs to reassess the wound, he may need to take more synovial fluid samples and follow-up X-rays.

Out hunting, kicks are par for the course and if they involve the fleshy part of the horse are likely to be of little significance.

However, if there is an open, deep wound or the injury is near a joint, you must seek veterinary guidance, as antibiotics will be essential.

If there is no obvious open wound to the leg and the horse remains lame the next day, a precautionary X-ray may be necessary.

Dealing with fractures

Fractures are rare out hunting. A fracture does not mean your horse has to be put down. It may just be a crack in the bone which, although causing severe lameness, will heal with adequate box rest.

If the hindleg hits a hunt fence and your horse is hopping on three legs with a tender stifle, beware ofa damaged patella (knee-cap). If in any doubt, contact your vet, who may advise an X-ray.

Stake damage

Stake wounds are more common and often involve the brisket and groin. Such wounds must be flushed out thoroughly in the manner already described ¨ do not be afraid to use a hosepipe initially.

Because these wounds often involve extensive damage to tissues under the skin, air is sucked in and the horse may take on the appearance of a Michelin man, with a crackling feel under theskin.

Do not despair – this air soon disperses if your horse is box rested and the wound is sutured, commonly with drains inserted. Penrose drains resemble ribbon-like tapeworms and allow excess fluid to track down them to the outside.

Antibiotics, in such cases, are essential and fairly expensive and special drugs may be needed to fight the type of anaerobic bacteria which prosper in deep injured tissues.

It is essential in such injuries to make sure no foreign material is still present. This is commonly wood, which is not visible on X-rays.

Blackthorn is a foreign body particularly attracted to the legs of a horse attempting to clear a hedge. If a puncture wound in the cannon area or on the knee persists in discharging, suspect a blackthorn and if vigorous poulticing does not produce the desired result, your vet may have to investigate the wound with forceps.

Taking the strain

If your horse goes lame in front and there is localised heat, pain and swelling at the back of the leg, between the knee and the fetlock, suspect a strained tendon or ligament. It may turn out not to be, but you cannot play too safe on this one.

Initial cold hosing and ice-packing is essential and, as such luxurious commodities are not often available to us on the hunting field, it is worth carrying a special “cool pack” with you. These packs are bandaged on to the affected limb and are magically activated by squeezing. Apply a well-padded pressure bandage and keep your horse in a box until your vet can examine it.

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A cornered horse will kick out as its prime means of defence, so, if several horses are kept together, kick injuries are inevitable. Where the kick has broken the skin, the type of injury is usually fairly obvious, but if the skin has not been marked, it may be difficult to recognise what has happened.

Kick injuries are localised. You may see little reaction as you feel over the horse’s body, but when you press on the exact spot that was kicked, the horse will respond immediately. Therefore, any examination must be thorough.

Kick injuries are often worse the day after they have occurred. This is the equivalent of a human black eye appearing the day after an injury. Owners often say that their horse was well when they brought it in the previous evening, but after a night in the stable it has suddenly become lame. In many cases, the injury was a kick inflicted the previous day.

If the kick hits a fleshy part of the body, such as the quarters, little, if any, swelling will be visible. If, however, a bony area is kicked, such as the side of the hock, a hard swelling may appear. But even though the lump feels as hard as bone, it is not necessarily a permanent blemish. Initially, these lumps are a fibrous reaction on the bone surface and, as such, they can disappear completely. Only if they persist for about a week will that fibrous tissue become calcified and turn into permanent bone.

Because they are localised injuries, kicks respond best to localised treatment. Cold compresses are the most suitable. They reduce the blood supply to the affected area and so reduce the number of inflammatory cells being brought in – it is these inflammatory cells that cause fluid to leak into the surrounding tissues and cause swelling.The cold compress must be pressed firmly against the area rather than held on the surface. The pressure not only increases the effect of the cold, but also helps prevent further swelling.

Kicks often cause a visible wound. The problem is that a small, insignificant-looking break in the skin may be surrounded by a larger area of inflammation from the kick. You should expect kick wounds to be infected – the foot that caused the wound was in contact with the ground only a second earlier. Expect the wound to be quite deep – the kick compresses all the tissues and punctures through to the deepest extent that the hoof reaches.

Infections usually find it easier to multiply in bruised tissue, so an infected kick wound will incubate infection. When that infection includes anaerobic bacteria, which are able to multiply without oxygen, then the deep puncture wound with only a small surface hole provides ideal conditions.

The best known anaerobe is tetanus. Therefore, it is vital that you keep your horse fully vaccinated, as even the smallest kick wound could prove fatal.

You might also like:

Equine first-aid kit essentials: what you really need

The best methods for treating equine wounds

Are you up to date with the latest ideas on wound treatment? Kieran O’Brien MRCVS offers a first-aid refresher

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Horses have long, relatively unprotected legs, with only a thin skin covering them. Often leg wounds heal relatively quickly, with an excellent cosmetic result. However, although these injuries may take months to heal, an unsightly blemish could remain.

A recent study in Holland has also shown that ponies with wounds on their lower limbs heal better than larger horses.The inside story

Below the horse’s hock and knee there is no underlying muscle, so any wound below those sites goes directly on to a bone, joint or tendon.

Underlying muscle is important in wound healing, as cells, which are needed to close the wound, come from the muscle itself. Wounds over big muscle masses on the upper limb heal relatively well, while wounds directly on to bone or tendon often heal slowly.

Fighting infection

Wounds on the lower leg can be full of dirt or bacteria, which will often lead to infection that slows or even stops healing. It is important that the area is cleaned meticulously – ask your vet about the best way to do this. Some traditional and widely-used remedies can often delay healing and should no longer be used.If the wound becomes infected, antibiotics will almost certainly be needed.

Foreign bodies

IT is not uncommon to find foreign material – such as tiny blackthorns or wood splinters – left in wounds. They should be identified and removed quickly. If they are left in, the wound will not heal and infection will persist. Your vet may take X-rays, or use diagnostic ultrasound to try to identify any foreign bodies.

Dead tissue

When a wound is present, there is considerable damage to the surrounding skin and underlying tissues and these injured tissues can lose their blood supply and die. Dead tissue attracts infection, so it has to be removed along with the weakened tissue. The process of removing such tissue is known as wound debridement. Your vet may do this surgically by cutting away the dead tissue; alternatively, it can be done using specialised ointments which can digest the dead tissue.If the bone forms a sequestrum – a fragment of dead bone that becomes separated from the surrounding bone – this can often delay healing. It can occur anywhere, but is common on the front of the cannon bone. An X-ray will show up a bone sequestrum. Some will resolve without treatment, but the majority require surgical removal of the infected fragment.

Movement delays healing. Wounds over joints can take months to heal, often with a poor cosmetic result.Examples include wounds to the horse’s heels, the front of the fetlock and hock, or overlying the tendons at the back of the leg. Your vet may attempt to immobilise the limb as much as possible using bandages. Casts to rigidly immobilise the leg for up to three weeks are now used frequently to treat severe wounds to the lower leg.

To stitch or not not to stitch

There is no doubt that if a wound can be sutured by your vet, then it heals rapidly in most cases. There are, though, a substantial number of wounds which cannot be stitched.These include:

• loss of too much skin so there is no base for the stitches
• the wound is too contaminated or infected
• there is going to be too much movement, leading to excess tension of stitches and failure of the repair.Wounds that are not sutured have to heal by producing granulation tissue (pink proud flesh), followed by skin healing over the top. The production of excess amounts of proud flesh and the failure of the skin to heal over the top often complicates healing in these cases.Healing can be aided in such situations by keeping the granulation tissue under control, either by trimming it back surgically, the addition of caustic chemicals, or the use of steroid creams. For healing to continue, the proud flesh should be kept at a level which is lower than that of the surrounding skin.In some cases, where there is a large wound present, yourvet may consider skin grafts to accelerate the healing. This is relatively straightforward and has a good success rate.Another technique is not to suture a wound initially and leave it until all the infection and contamination have been removed.The vet will then suture the wound closed several days or weeks later.

Horses’ natural instinct is to move rapidly away from anything that alarms them, often disregarding obstacles such as fences, people or vehicles in their way, which makes them vulnerable to injuring themselves.Typically, they also damage themselves when they become cast in their box, or when they paw at a door or fence .

On the mend

If you think a wound may need to be stitched, speak to your vet as soon as possible, since wounds will heal more effectively if they are sutured while still fresh. Wounds heal from side to side, not from end to end so, even if there is a huge hole, it can heal well.

Also, a little bit of a blood will look like a lot. However, a small amount of bleeding may be beneficial as it will flush out dirt and debris from a wound – severe bleeding must be controlled.

If your horse has severed an artery, bright red blood will spurt out, which can look alarming. Try to stop the bleeding by firmly applying pressure to the wound. Hold a pad of material,such as gamgee, over the wound. As most of these wounds are on the lower limb, a bandage can usually be fastened over the area. If the blood soaks through, put on more padding and apply more pressure.

Cohesive elastic bandages wrapped in several tight turns provide sufficient pressure to reduce the blood supply to the lower leg. This is more practical than the old-fashioned rubber or rope tourniquets and is one occasion when I recommend applying a relatively tight bandage. It should be safe for upto two hours, by which time you should have been able to contact your vet.

Small but serious

The wounds with the most serious consequences tend to be the smallest. The damage caused depends on the wound depth, how dirty it is and whether vital parts of the body are involved. Many first aid manuals tell you to look out for “joint fluid”, and if you see this oily, clear-to-yellow fluid discharging from a wound, you will know that a joint is involved. In reality, a wound is often far too dirty to distinguish this among the blood and muck.

Critical position

The position of the wound may indicate whether it is near a joint or anything else critical, such as the digital tendon sheath at the back of the pastern. Some joints, such as the elbow, are large, so an injury that seems far from the bending part of the joint can still harm it, and infection will spread easily.

If your horse is more lame than you would expect for the size of the wound, suspect serious damage and contact your vet immediately.

Trapped infection

Vital parts of the body, such as tendon sheaths and joints, are poorly designed to cope with infection. All small puncture wounds can cause complications as the infection becomes trapped inside and cannot drain away. If this damage involves a joint, the infection will damage its delicate cartilage lining, producing a septic arthritis and permanent lameness unless it is treated immediately.

Infection within a tendon sheath produces inflammation and scarring which will prevent the limb from bending properly and cause permanent lameness.

Treatment

Aggressive treatment is needed for an effective cure. This usually involves a general anaesthetic and flushing large volumes of fluid through the infected area to clear out the bacteria. The vet may need to do this several times. He may use an arthroscope (a small telescope-like instrument) to visualise and treat the wound. Treatment must be started without delay to ensure a return to soundness.

Foreign bodies

The only advantage of wounds with foreign bodies is that in the majority of cases they are visible, so you know what is wrong. The problem is what to do. In the horrific circumstance of something large, such as the piece of wood in Fujyama’s case being stuck in a wound, it is best left there until the vet arrives, unless it is loose.

In the majority of cases, particularly with wood in the foot, it can be wedged in hard and be difficult and potentially painful to remove. It is better for the vet to remove it as he can give the horse painkillers and sedatives and check the injury properly. The exception is when a nail becomes stuck in the sole of the foot. Remove it to prevent the nail penetrating more deeply and keep the nail. Contact your vet immediately since a deep puncture wound in the foot can have life-threatening consequences.

Leaping back from the brink

A piece of wood lodged in the foot of Tina Fletcher’s mare Fuyjama almost destroyed the show jumper’s successful career. Liz Benwell finds out how quick thinking prevented a catastrophe

Only one word describes how show jumper Tina Fletcher felt when she found her Grade A mare with a foot-long piece of wood embedded in her coronary band – “sick”.

And, when the pair jumped a good clear round at Olympia last December, Tina was still amazed that Andy Doyle’s Finchpalm Fujyama had survived such a horrific injury to be completely sound.

“Unbelievably, she was never lame throughout the whole thing. It just shows how tough she is,” says Tina, who is based in Berkshire with her husband Graham, Horse & Hound’s show jumping columnist.The accident happened when nine-year-old Fujyama was waiting, tacked up, in temporary wooden stabling during the Festival of Show Jumping at Stafford.

“The groom who was looking after her ran to fetch me from the lorry. The mare just stood there with her leg hanging and a piece of wood, about an inch and a half wide and a foot long, going straight down into her foot.”She must have pawed at the door, which didn’t fit well, got her foot under it, pulled back and brought part of it with her. The worst part of it all was deciding whether to try to pull the wood out or call for the vet.”She called for the show vet, who arrived, removed the wood and dressed the wound.Tina then drove Fujyama, who was third in the 1996 Grade C Championship at the Horse of the Year Show, the two hours to her own vets, O’Gorman, Slater and Main in Newbury, Berks.

As soon as Tina arrived, vet Andrew McGonnell flushed out the mare’s wound with a saline solution which produced fragments of wood.

“We X-rayed the foot to make sure that the wood had not damaged the pedal bone or pastern bone,” explains Andrew. “We also took a sample of fluid from the coffin joint to see if the wood had penetrated that. If it had, it would have been catastrophic, but the joint fluid was normal.”

A scan taken while Fujyama was at the surgery, revealed that the piece of wood had missed entering the coffin joint capsule by millimetres.

Andrew describes it as “like something leaning on a piece of cellophane without quite breaking it – it was as close as that”.Had the wood entered the joint capsule, complicated surgery would have been needed. “Treating these things as quickly as possible is an advantage. Tina did the right thing in bringing her mare straight here,” adds the vet.

Sent home with a poulticed foot, the mare was on antibiotics for a week.

“We used an Animalintex poultice and kept replacing it,” says Tina. “After two days, five large splinters came out.”A month’s box rest, followed by a couple of months in the field and Fujyama was back in work – jumping as well as ever.