Trauma, hands-on, aggressive treatment of body, leg wounds promotes better medicine, income

Trauma, hands-on, aggressive treatment of body, leg wounds promotes better medicine, income

May 01, 2005

The horse often is moving quickly when trauma occurs; though the wounds produced sometimes are superficial and limited in location, they can be extensive and very deep.
Wounds to the body of the horse can be very large and may initially seem quite severe. Because of the natural tendencies of this prey animal to run from possible danger first and to be concerned about the consequences later, many body injuries result from collisions with trees, fences, wire or other environmental hazards. The horse often is moving quickly when this trauma occurs, and the wounds produced are sometimes superficial and extensive, and they also can be more limited in location but very deep. These deep wounds have the potential to penetrate the abdomen or the chest, and either scenario is a medical emergency.

The skin flaps produced by this type of trauma can be impressive, but good cleaning, attention to closure by layer, good apposition and drain placement, if necessary, usually results in good cosmetic results.
Penetrating wounds to the chest have the potential of puncturing lung tissue or damaging the heart. A complete physical examination always should be done in these cases. An evaluation of mucous membrane color, heart rate, respiratory rate and a quick determination of the packed cell volume (PCV) should give the clinician a rapid assessment of possible lung puncture and/or internal bleeding. Crepitus, or air under the skin, also should be looked for because this might indicate some loss of integrity to the respiratory system. Ultrasound of the chest, done between the rib spaces, may also provide some useful information and free air or fluid may be appreciated.

Penetration into the abdomen will result in peritonitis at best and possible intestine or organ rupture as a worst-case scenario. Exploration of the penetrating wound is necessary in all cases, and abdominal wound evaluation also can benefit from ultrasound examination, rectal examination and possible abdominocentesis. The presence of bacteria, ingesta and/or blood following an abdominal tap post body trauma is a good indicator that the wound suffered has compromised the abdomen.

Variable blood supply to the lower leg, lack of muscle, fat and extra skin tissue make these wounds very difficult to deal with, but primary closure within the four-hour "golden period" allows for the best results.
Horses with either chest or abdominal trauma should be started on intravenous broad-spectrum antibiotics, and fluids might be necessary to stabilize the horse if bleeding is noted. Referral and transfer to a surgical clinic may be necessary in these cases and a chest/abdominal bandage should be applied once the wound area has been cleaned and stabilized.

Lacerations and punctures to the lower leg in areas over joints or tendons are a combination of superficial injuries to the skin and potentially serious damage to deeper structures.
Occasionally, horses will be impaled while jumping over obstacles. These boards or poles may have to be left in the horse until the animal can arrive at a surgical facility where aggressive emergency care can be given as the foreign object is removed. If the board or pole is removed in the field, special care and attention should be given to ensure that all pieces are recovered as the splinters can be small and difficult to locate.

Lower-leg injuries that may or may not involve joints, ligaments and other structures must be monitored closely. Attention improves healing significantly and ultimately generates more practice income.
The majority of body wounds that do not involve deep penetration are usually more sensational than serious. The skin flaps produced by this type of trauma can be impressive, but good cleaning, attention to closure by layer, good apposition and drain placement if necessary usually results in good cosmetic results. Multiple areas of subcutaneous sutures help hold large flaps in place as they heal. Penrose drains or other drain types should be placed in the ventral areas of large flap wounds or in wounds that may be infected. This allows for flushing of these injuries with saline and antibiotics, and pulls the resultant fluid and bacteria away from the subcutaneous space. Even if the skin margins of some parts of the wound are traumatized and may not be viable, it is still advisable to use that tissue initially to promote a granulation response in the deeper part of the wound. Resist the temptation to cut away flaps or strips of muscle or skin because any questionable tissue always can be removed at a later date and may survive better than first thought.

If motion causes undue stress on the suture or staple line, then these horses will have to be kept in a restricted area and hand-walked. Some exercise is crucial to improving blood flow and to reducing the chances for adhesions.