Let's face it - horses love finding creative ways to injure themselves.  These injuries often result in some sort of laceration or abrasion and many times, we never find the item that they did it on.  Whatever it was, you now have to deal with the wound and there are several things you have to keep in mind. 

First off, where is the wound located?  Is it near the eye?  Could the eye be affected?  If so, then we need to treat two issues simulataneously.  (Remember, eye injuries in horses are always emergencies which require at least a call to the vet.)

While this looks like just a cut with some swelling, it could be affecting the fetlock joint or digital tendon sheath.

Lacerations which are on the limbs can sometimes seem like a small issue, but there are many structures that are easily affected even by the smallest of cuts.  If the wound is near or over a joint, it is possible that the joint has been penetrated.  Infections can easily set up in joints and, if severe enough, can be life threatening.  Surgery to flush these infected joints is often necessary in these instances.  Are any tendons or ligaments affected?  Damage to any significant soft tissue structures could mean a long layup while it heals.  We also have the tendon sheaths (synovial structures similar to joints that lubricate the tendons) to deal with.  Infected tendon sheaths are just as dangerous (and hard to treat) as infected joints. 

How severe is the bleeding?  Is there a small amount of blood or is it gushing?  It can be hard to remember sometimes that horses have much more blood than a human, so what seems like a lot of blood may not necessarily be so.  That doesn't mean that a horse can lose GALLONS without having a problem, of course.  If there is blood spurting out of the wound, you're likely dealing with an arterial bleed, and you need veterinary support ASAP.  While waiting for the vet, apply compression to the bleeding wound - with a clean towel, a pillow wrap, your hand... whatever is available.  If you can wrap the area in a snug pressure wrap, do so.  If the bleeding seeps through the bandage, do NOT remove it - apply additional absorbant material over top, and more pressure.  We don't, however, recommend that you apply a tourniquet - leave that one to a veterinarian. 

Finally, consider when the last tetanus vaccine was given.  Horses are very prone to tetanus and if a booster has not been administered in the last six months, it will be important to give one soon after the injury occurs.   Tetanus (and other bacteria) thrive in puncture wounds, so if you suspect that the wound is deeper than it is wide, call a veterinarian to probe the wound and potentially place a drain to aid healing.

There are many options out there for topical wound care, but you should remember that not all of them are appropriate to use in all circumstances.  Always check the active ingredients and consult with your veterinarian prior to applying something new to a wound.   Also, if your vet is coming to look at the injury, avoid using any ointments, at least until we can look at it.  Topicals can make it more difficult for us to clean and assess a wound.

As vets, we often hear of things that get used on wounds that make us cringe inside.  One of the more common ones is hydrogen peroxide.  Everyone has this sitting on their shelf at home, but it is actually horrible for wound care (ask your physician - they will tell you the same thing, we promise!).  Yes, it makes bubbles and looks like it's doing something - and it is!  Peroxide is very good at killing cells, but it's not selective in the cells that it kills.  So while it's taking care of the bacteria, it's also affecting the fibroblasts and cells that are trying to heal the wound.  It actually slows wound healing and by doing this can lead to scar formation, as the cells can never come together correctly.  Save the peroxide for removing the blood from non-injured areas (and clothes!), or flushing out hoof abscesses. 

Instead, we often recommend a dilute betadine solution - not concentrated betadine, which can be just as irritating as hydrogen peroxide.  To make dilute betadine, mix a small amount of the straight solution with clean water or saline, to make a solution that looks like "weak tea".  If you don't have betadine solution available, an alternative is gentle soap (we like plain liquid Ivory) and water.  Be sure to mix the soap with water to gently clean, and rinse well with plain water (or saline solution). These alternatives are more gentle on the wound itself and remove debris as well as bacteria. 

For treatment, there are many options.  One that we often see used (and do NOT recommend over wounds) is SWAT.  SWAT is labeled as a fly repellent and also states that it can be used on wounds.  The ingredient list does not include any antiseptics or antibiotics - only products similar to dog flea and tick medications.  Treating an open wound with this product would be akin to squirting Frontline into the injury (and I can say from personal experience that that burns!).  While SWAT is great as a fly repellant AROUND wounds (and on faces, ears, etc), we recommend avoiding it for wound care.

So what do we recommend? Topical treatment with good old triple antibiotic ointment is often your best bet for minor scrapes.  Triple antibiotic ointment, as its name states, has 3 different products in it to cover the various types of bacteria that could be affecting the wound.  It's a petroleum based, clear ointment, so it has some emmolient properties as well.  We find that it is gentle and effective at treating minor wounds.  We often apply this ointment, covered with a nonstick pad secured with cling gauze and covered in a standing wrap (see below) for superifical scrapes on lower limbs.

Another good option for superficial wounds which have some swelling associated (like mild tick bite reactions) is Nitrofurazone ointment.  That's the thick, yellow ointment that comes in the black container (usually).   This ointment has some good antiseptic, antibiotic and antifungal properties, as well as an osmotic "drawing" effect.  This helps to remove subcutaneous swelling when applied topically.  For infected tick bites, we often recommend applying a warm compress for 10 minutes, then a thin layer of Nitrofurazone once daily - this usually does the trick in a few days!

Bandaging
 

 While not all wounds can be bandaged (and sometimes we have to get a little creative!), wounds on the lower limbs often benefit from a simple "standing" bandage to keep dressings in place and apply compression. 

Keep in mind that if you've never been trained to place a standing bandage, you can do more harm than good.  If you have questions, or would like to go over this technique with us, just ask!  We never mind taking a few minutes to go over this simple bandage, to help prevent issues in the future. 

The first layer in a bandage covering a wound is obviously the treatment layer.  This layer is in place to hold any dressing or ointment over the wound.  Ideally, it consists of a sterile non-stick pad or clean gauze, and clean "cling" rolled gauze applied snugly, but not too tight.  Resist the urge to apply Vetrap or other stretchy pressure bandage material over this layer - this often creates too much pressure, especially if the bandage becomes wet with sweat or drainage.

The next layer is the padding layer.  Typically, reusable "pillow" wraps are used, but other options include sheet cotton (B B Satin), or disposable absorbant Gamgee padding.  Rolled "pound" cotton  will also work, but tend to be a bit harder to apply smoothly.  Apply the padding layer in the same direction you'll be wrapping the compression layer: front to back from outside to inside.  (Remember, PULL across the front, PUSH across the back.  This decreases the pressure on the sensitive tendons and ligaments at the back of the limb.)  Wrap as smoothly and evenly as possible, avoiding wrinkles, and applying snug uniform pressure.  Brown, non-stretch gauze can help in keeping the padding layer in place and smooth while you're getting your compression layer on. 

The outer layer is a compression layer.  Vetrap or reusable thin "track" wraps are the best options.  Fluffy polo wraps will work in a pinch, but are not ideal because of their bulk.  Wrap this over the padding layer, leaving 1/2-1" of padding free at the top and bottom.  Apply snug, uniform pressure evenly through the entire bandage.  Overlap each pass by about half the width of the bandaging material, and spiral the wrap down and back up the limb.  This is the trickiest part, and where you should get help if you're not sure.

A completed standing bandage should be snug enough to stay in place and apply some compression, but not so tight as to cut off circulation.  It should also be uniform in pressure - one area of extreme pressure in an otherwise loose bandage is a recipe for a damaged tendon.  To test your bandage, flick your finger along the length of it - you should hear a uniform "thump" sound throughout.  Grab the bandage and try to move it up and down - the skin should move with the bandage, and the bandage should stay in place. 

We believe that every horse owner should have a first aid kit on hand.  We are often asked, "Doc, what should be in that there first aid kit?"  Here's a good list of supplies to keep on hand.  It's best to keep them all in a waterproof box which can easily be moved to a stall or field.  Go through the kit at least once a year to replace expired or damaged items.