Podiatry proficiency - initial hoof wound assessment can require anesthesia, antibiotics, wire probe and radiographs - DVM
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Podiatry proficiency - initial hoof wound assessment can require anesthesia, antibiotics, wire probe and radiographs


DVM360 MAGAZINE



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If the joint or tendon sheath is determined to be infected, then it should be lavaged initially with large volumes of saline, and this treatment should be continued every-other day. Amikacin, a potent antibiotic, can be added to the flush solution, and regional antibiotics can be perfused into the area in question, which further raises antibiotic blood levels. This treatment should be continued until joint-fluid analysis or clinical signs indicate no further infection.

All clinicians agree that primary closure of traumatic wounds is the best treatment option. Cleaning, suturing and bandaging a wound generally produces the best long-term repair. Unfortunately, that approach is not always possible. Excessive tissue loss, infection or instability of the repair can prevent primary closure in some foot wounds. These wounds can respond more favorably to debridement and immobilization. Cleaning the wound and removing any damaged tissue is the first step. Because some tissue can retain good blood flow and will respond over time, it is usually better to proceed slowly and to take less rather than more tissue.

If primary closure is not possible, then granulation or second-intention healing will allow the wound to fill in slowly over time. Fibrosis, scarring with loss of mobility and poor cosmetic appearance, are possible complications of second-intention healing. Cold hosing, hand walking and appropriate bandaging can help this type of treatment succeed.

Stabilization of hoof and heel injuries is very important, and the proper application and monitoring of bandages or cast material is crucial for healing success. Parks says a hoof cast placed on the horse under standing sedation creates a more normal hoof angle and axis, and it is associated with better healing. Drs. Pabareiner, Jarvicek, Honnas and Crabill of the Texas A&M University College of Veterinary Medicine reported on 101 cases of heel bulb lacerations in the horse at the 2004 American Association of Equine Practitioners annual meeting. Using the techniques of lavage, debridement, antibiotics and immobilization, they reported that 56 of 65 (77 percent) of the horses in their study were able to return to their intended use after healing. So these principles are considered the standard for care of this type of equine injury.

Traumatic abrasions Rope burns or traumatic abrasions caused by the interaction between skin and rope are possible, but they appear to be a much less common cause of injury in the horse. This might be because many more owners and trainers have accepted the need to train their horses properly rather than the previous mentality that insisted that the horse be "broken" and made to be submissive and obedient.

This "gentling" process often involved tying up a leg or tying the horse up closely to a pole. Such practices often resulted in traumatic abrasions to the back of the lower leg, pastern or foot, and while this type of injury is much less common currently, cases do still occur. These wounds can be evaluated just like lacerations or other types of skin injuries and a first-step assessment should attempt to determine if deeper structures are involved. Cleaning, lavage and the placement of support bandages on these wounds is often enough to stimulate granulation tissue and promote healing. Correct physiotherapy can lessen the scarring that often occurs following the healing of rope injuries.

Overall, horses seem to be very adept at injuring themselves, and the means and methods they use to do so is astonishing. A familiarity with and knowledge about the various types of equine wounds is necessary for all clinicians, and treatment plans for theses wounds should include the major principles of lavage and evaluation followed by debridement and antibiotics. Finally, use of immobilization to achieve wound closure and healing should provide horses with optimum chances for successful return to use following injury.

Dr. Marcella, a 1983 graduate of Cornell University's veterinary college, was a professor of comparative medicine at the University of Virginia. His interests include muscle problems in sport horses, rehabilitation and other performance issues.


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Source: DVM360 MAGAZINE,
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