Ask the Vet: Wound Care (bandaging)

Join us in January as we return from the holidays to answer your questions concerning wound care in the winter and bandaging techniques with January's AAEP expert, Dr. Erin Denney-Jones.

1
Question: I have a 3-year-old Warmblood that cut himself on a stray wire when he was 9 months old. The wound was on a hind cannon bone and showed about 2 square inches of bone, though managed to miss all supportive structures and he never took a lame step. The wound healed over after about 6 months of constant pressure bandages. However, he has a very thick pad of scar tissue over the injury site that may interfere when working/jumping and when palpated still seems to be painful. Are there any treatments that would effectively reduce the scar tissue and/or continue the healing process?
Answer: 
An old wound like that would have little chance in reduction of size or removing the scar. Immediate therapies would give you an increased chance of size reduction or minimizing scars. Some of these therapies are laser, estim, and therapeutic ultrasound as well as passive flexions of the site and/or massage of the site. Other medicines that can be used are DMSO with or without steroid. 

Becasue the wound is over two years old, possibly reconstructive surgery would be best recommended, but a surgeon's opinion is warranted. There may not be enough skin to remove and reconstruct the site.
2
Question: I have an 8-year-old OTTB gelding that I've owned for over a year. As far as I know, he has never had any major injuries of any kind. He's been in training at a friend's house for the last two weeks, which she last rode him on Thursday (Jan 12) and said he worked very well. She did notice he stumbled at the trot once or twice (she was thinking it was because he was using his shoulders more), but cooled out well and looked fine afterwards. He got the day off Friday (Jan 13). On Saturday (Jan 14) when I arrived, he looked a bit off when I brought him up from the pasture. He had a smidge of swelling only on his left front, just above the fetlock/ankle area (on the backside of the leg). I should note, when I say smudge of swelling, I mean VERY little, as it would not have been visibly noticeable to most people I'd imagine. It was just by feeling the leg and the fact that he had a "head bob" when on the lunge line that I noticed a bit of swelling. We slathered the fetlock/ swollen area with MagPaste, loosely covered it with plastic wrap, then put on a pillow quilt and standing wrap and just a standing wrap with pillow quilt on the RF leg. I also gave him 2 grams of Bute and turned him back out with his buddy (a quiet 22-year-old gelding). 

I then left only to return the next day Sun. Jan. 15. My friend also left to go with a friend to a H/J awards banquet (she was gone overnight). I returned the next day and pulled my horse out of the pasture, the wraps looked good/ still intact/ had not slid down, and my horse was walking well - better than the day before (he had been wrapped for ~24 hrs). I unwrapped and hosed both front legs. The LF looked better, the fetlock swelling/heat had gone down, both front legs looked totally normal and felt cold. I put him back out on pasture bare legged until my friend got home a couple hours later. My horse had been quiet (i.e. not running around) during that time, so it was quite a surprise when we brought him back out of the pasture a couple hours later, and BOTH front legs had a large amount of swelling (pretty much all the way from the knee to just above the ankle) on the FRONT of both cannon bones (his legs looked like he had bowed a tendon, but on the front of the leg)! No heat, no pain (we both palpated his legs/ the swellings and there no reaction from him) and he didn't take a lame step on the lunge at the walk and trot. Since he wasn't lame and there was no pain/heat, we put him back out last evening (~5 pm) bare legged. This morning at 7 am, Mon., Jan.16, the swelling is greatly reduced (i.e. a non-horseperson probably wouldn't notice) but there is still a slightly noticeable "curve"/ swelling on the front of each cannon bone. He was not lame (not with palpation nor on the lunge at walk nor trot), still no heat/ pain. He trailered home just fine, got off the trailer sound and happy. 

The only thing we can think is that maybe she put the wraps on a too tight and it irritated the common digital extensor tendon? (She's a knowledablge horse person who's wrapped horses legs hundreds of times, as have I, and I had no qualms with how she had wrapped him). 

Is this CDET swelling just a one off thing? Or should I be concerned that it could be a chronic thing? Should I worry about wrapping him again? Should I have a vet ultrasound or? After 30+ years riding and working with OTTBs, I've never seen anything like this.
Answer:
I always say, when in doubt have your veterinarian check him out. Regarding the fact that this all started with a lameness, an exam by your veterinarian should be done to rule out a primary ligament or tendon injury. With that said, and your wonderful description of your bandaging procedure, (I would say you did a fantastic job with your wraps on both front limbs), the pillow wraps certainly make it very hard to damage the tendons and ligaments of the limbs when used with a standing wrap. Without looking at the horse, I would have to guess it was possibly due to the original injury, some sort of dermatitis under the wrap on both forelimbs that was aggravated by the wraps, or that the skin was more sensitive to dew, bugs, or something in the pasture after wrapping especially if your horse is not regularly wrapped while stalled then turned out without wraps.
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Question: My horse has two open, gaping wounds on the front of his hind ankles from being hit by a truck several weeks ago. They are not healing well and since he is a show horse, I would like to care for them in a way to achieve the best possible results and minimal scarring. What is the best product/procedure to promote healing and minimize scarring?
Answer: 
This is a good topic to discuss all of the over-the-counter wound medications that are available. We veterinarians receive, almost on a weekly basis, flyers for those medications. They all advertise that they speed healing and decrease scarring. The bottom line is that it depends on where the wound is located, what vital structures were involved, if there is a foreign body in the wound or not, and what bacteria and/or fungal elements are involved.

Any wound on the front of a joint such as the ankle (fetlock) would be reason enough to have your veterinarian determine that the joint or the structures in the joint are not involved. Also, wounds over joints are in an area of motion constantly pulling on the skins edges of the wound making it difficult to heal well. I would not be able to offer a suggestion for a product for you without evaluating the wounds - again looking for the structures involved etc. Since this is a show horse and scarring is a concern, possibly a visit to your local equine hospital may be your best possibility for repair under gas anesthesia rather than injectable anesthesia in the field where time is limited. Some medicated products are available to put on the wound from your veterinarian as well that would be better than your over-the-counter ones.
4
Question: My horse wears a cribbing collar. What is the best way to prevent and/or treat an open sore that he keeps getting on his neck from the collar rubbing when he attempts to suck air?
Answer: 
This is a challenge as all those owners with cribbers knows. I suggest that while he does not have the collar on, for example while you are riding, clean the wound up and place antibiotic ointment on it. My favorite cleaning product for open wounds is a dilute chlorhexidine solution (sky blue in color when diluted in water). As for antibiotic you can use neosporin or nolvasan ointment. There are some spray liquid bandages you can use as well that are found in the feed stores. 

To prevent future sores, you may want to place a fleece wrap on the leather where the sores are consistently occuring.
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Question: How do you keep a bandage on a hock area laceration?
Answer: 
A figure eight type bandage is recommended for the hock area (it is similar to an ankle wrap on a person). Proper care of the laceration, either a nonstick pad or pad with antibiotic over the wound area is recommended with a 4-inch gauze roll to hold the pad in place. Again, the 4-inch roll gauze will need to be in a figure eight fashion possibly to hold the gauze over the wound. Always use a padded material, either roll cotton or a quilt on top of the gauze pad, and roll, under your vetrap. This will allow you to make a SNUG fit to your vetrap when wrapping it. Allow a small portion of the quilt or cotton roll to be showing under the vetrap at the top of your wrap and the bottom. Holes will need to be cut out over the point of the hock in the cotton roll or quilt so hock sores are avoided. Your vetrap's final wrap should either be the circumference above or below the hock joint itself. This allows the vetrap to stick to itself more securely when the horse moves. Finally, less movement of the horse (possibly stalled) will keep the bandage on better. The more a horse moves around the looser the bandage becomes. A stacking bandage can be placed under the hock bandage to hold it in place depending on the site and size of the laceration, but a hock bandage, if done properly, will stay in place over the hock - again snug fit is recommended. Practice does make perfect when it comes to hock bandaging.

Below, is a direct link to a video (available courtesy of AAEP Media Partner, The Horse) of these types of bandages explained above being done.

http://www.thehorse.com/Video.aspx?n=how-to-wrap-a-horses-legs&vID=550
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Question: What is the best way to care for an open sore caused by Pigeon disease?
Answer: 
If the horse has truly been diagnosed with "Pigeon Breast", contamination is a concern for the rest of the horses on your property. The wound heals by second intention usually. What that means is the body will create granulation tissue (scar tissue) to fill in the wound and allow the skin to heal over the opening. Pigeon Breast is lanced by your veterinarian and drained and cultured. The opening is lavaged with a dilute antibacterial solution by the owner or by assistants at a clinic on a daily basis. At home, you can capture the discharge in a bucket and dispose of it in your garbage as well as the shavings from the stall to prevent contamination. If your horse is pastured, do not have other horses on the same pasture. Antibiotics may or may not be used, that is the discretion of your veterinarian on the case.