|
Giving Mother Nature a Helping Hand: Healing Leg Wounds
Lacerations on your horse's leg can be alarming, especially when there is considerable bleeding and a large flap of torn skin. Cuts on the leg are very common, but even severe wounds can have an excellent outcome when attended to quickly and diligently.
The 12 year old Trakehner cross gelding in this case study caught his left hind leg on the fence while turned out in his paddock. He suffered a very serious laceration close to the hock. Fortunately, the wound did not enter the joint, and the main tendon that runs down the front of the leg was intact. However, a large amount of skin was torn off just below the hock, exposing the cannon bone. The wound was so large that it could not be sutured. All the veterinarian could do was clean up the tissue and remove a dangling flap of skin. The horse was left with a gaping hole in the top of his leg. What to do?
 | |
On the day of trauma the vet has cleaned the wound and applied hemostats to the blood vessels to control bleeding. |
Mother Nature has an efficient way of fixing many things, including large wounds, as long as there is a good blood supply. This wound bled a lot during the cleaning process, so that was a positive sign, but leg wounds in horses often develop "proud flesh" as they try to heal. Proud flesh, also known as exuberant granulation tissue, is a "cells gone wild" situation that occurs only in wounds on or below the knee and hock, and most commonly in high motion areas. It can form when there is an over-proliferation of granulation tissue, and results in a red, cauliflower-like mass growing in the center of the wound bed that prevents the skin from healing together. Unchecked, proud flesh can reach tumor-like dimensions. It was imperative to prevent proud flesh in this leg.
 | | Leg wound on another horse that did develop considerable proud flesh. (Photo courtesy of Dr. Richard Hackett, Cornell University.) |
In days past, the veterinarian would have bandaged the leg with a snug bandage and applied topical steroids. This would have reduced proud flesh growth, but not eliminated it. Bandaging would have gone on for several months, and proud flesh trimming would have been necessary every few weeks.
That was then.....but this is now! A product called Cica-Care, used to treat scar tissue formation in people, is often effective in preventing proud flesh in horses. We opted to give it a try.
Cica-Care looks like a transparent, flexible computer mouse pad. The way it works is simple: the material blocks oxygen supply to blood vessels on the surface of the wound, restricting their growth. This allows deeper blood vessels to deliver repair cells to the wound site in order to build healthy new tissue while restricting proud flesh on the surface.
First, the gelding was put on antibiotics and anti-inflammatory medication, and a very snug bandage was applied to his left hind leg. Over the first few days, infection was controlled and the wound bed reorganized. White blood cells infiltrated the damaged area, killing bacterial contaminants and digesting debris, and new blood vessels began to grow in from surrounding healthy tissue. Knowing that proud flesh starts to develop in about a week, the Cica-Care product was used as a dressing under the bandage at that point.
The owners treated the horse every other day. They took off the bandage, washed the reusable Cica-Care dressing pad, and hosed the leg. They scraped the surface of the wound a little to stimulate exposure of new blood vessels and keep the wound bed level with the surface. The Cica-Care pad was then reapplied under a new bandage. Exercise was limited while the bandage was in place.
At every bandage change the leg looked better.
 | | Wound after 1 week |
 | | Wound at 2 weeks. |
The deep hole filled in and by 3 1/2 weeks the wound bed was level with the surrounding skin.
 | | Wound at 3 weeks. |
 | | Wound at 4 weeks. |
 | | Wound at 6 weeks. |
Sequential photos show the bed getting smaller and smaller from weeks 1 to 6. By week 9 the owners were able to stop bandaging.
 | | Wound at 9 weeks. |
These photos demonstrate an important concept in wound healing: CONTRACTURE. As a wound like this matures, the edges shrink towards one another. Sometimes contracture allows two haired skin edges to rejoin. Other times, as in this case, there is a hairless area left that will toughen up to form a scar. It will take over 6 months for the scar on this wound to mature completely. The scar will lack hair but will fade to a light color that will blend in with the surrounding white stocking. The horse should not be lame.
 | | After 3 months the wound is resolving nicely. |
Mother Nature deserves most of the credit for this amazing repair job, but modern science (Cica-Care) and a LOT of skilled bandaging by some very dedicated caretakers really helped her along!
Thank you to Michelle Mercier and Luen Lowrey of Park Place Farms in Honeoye Falls for letting us use these photos. They did a wonderful job of taking care of this serious injury.
| 
