Veterinarians contending with hard-to-heal wounds on equine patients welcome new ointments and therapies, but many wounds can be successfully treated from the start using bandages. “Some of the potions and lotions I’ve tried actually slow wound healing,” says Dean Hendrickson, DVM, MS, Dipl. ACVS. “I’ve had such great success with bandaging that I can treat 90 percent of equine wounds using the method alone, and I’ve even instructed colleagues of the right time to move to the next bandaging step by examining digital photos of the wound.” Dr. Hendrickson, a professor of surgery at Colorado State University, says using the same type of bandage throughout the wound-healing process is outdated. “The wound composition doesn’t stay the same. Why should the bandage?” Hendrickson comments. Using bandages at the beginning of wound healing is labor intensive, which can turn off some horse owners, Hendrickson says. But diligence pays off with faster healing and less scarring, he says. Rehydrate If Necessary For dry wounds that haven’t been treated, Hendrickson uses a hydrogel bandage containing glycerin, polymers and water. “After the wound has been rehydrated,” he says, “I use a debridement dressing that removes necrotic tissue and bacteria. Curasalt, a sodium chloride dressing, uses a 20 percent hypertonic solution and causes minimal damage to healthy tissue.” Honey and sugar can be used in the debridement stages, experts say, but Hendrickson has had the best results while using Curasalt. After the debridement phase, the third bandaging step promotes the growth of granulation tissue. “I use a calcium alginate dressing that encourages granulation and wound contracture,” Hendrickson says. “This gives a surface for the epithelium to grow. After an appropriate amount of granulation tissue or proud flesh has formed, I use a dressing to encourage the epithelium to grow using a semiocclusive foam dressing. This increases the temperature of the wound by 1 or 2 degrees and encourages the epithelial cells to grow as opposed to fibroblasts that make granulation tissue.” He also uses Kerlix AMD antimicrobial dressing to reduce bacteria penetration. Hendrickson says he does very little granulation removal surgery because he changes bandages frequently during the debridement and granulation phase and alters the bandage type until the wound is healed. Though bandages can be less stressful on the patient, the treatment requires diligence to make the therapy a success. “Bandaging can be the most intense part of wound care and many owners don’t have the time to commit to frequent dressing changes,” says Alison J. Morton, DVM, Dipl. ACVS, a clinical assistant professor at the University of Florida. “As veterinarians, part of using the right wound care means using a method the owners will comply with.” Other Therapies Vaccum-assisted closure (VAC) can be used on hospitalized patients to promote wound healing. The therapy uses negative pressure at the wound site to draw the edges together, remove infectious materials and promote granulation at the cellular level. “Using VAC means the more labor-intensive part of the wound-healing process can be done at the hospital in five to 10 days and the horse’s final bandaging needs can be done by the owner at home,” Dr. Morton says. “After the wound is clean and into the healing process, bandages need to be changed less frequently.” Another wound-healing technique, extracorporeal shock wave therapy (ESWT), can expedite wound healing. Morton uses the therapy at the University of Florida. “I use ESWT in new wounds as well as chronic injuries,” she says. “This helps increase blood supply, which is often a problem on legs. The therapy also prevents tissue death and helps fight bacterial infections. The shock wave therapy is used in twice-a-week intervals for about two weeks. A lot of veterinarians outside of academia aren’t aware of the benefits of ESWT.” Another therapy, hyperbaric oxygen chambers, remains a topic of interest to equine veterinarians but the benefits have divided the profession. An equipment shortage means veterinarians often seek more feasible treatment routes–like maggots. “Monarch Laboratories is one company that sells sterile maggots, which do a really good job of cleaning and debriding wounds,” says Eric Davis, DVM, Dipl. ACVIM, Dipl. ACVS. “If you can get past the stigma of using maggots, they do a good job in the early wound-healing stages. After the maggots have done their job, they can be flushed out and removed.” Morton says some of the best advice for equine clients is to prevent wounds from occurring in the first place. The majority of wounds are caused by fences and other obvious hazards. “Horses are like Dennis the Menace and seem to always be at the wrong place at the wrong time,” Morton says. “They usually don’t remember that they were hurt on something before, so if they go right back to a hazardous environment, you can’t expect them to know better and avoid another injury. An ounce of prevention is worth a pound of cure in this circumstance.” Prompt wound therapy can mean the difference between a lame horse and one that quickly recovers, Morton says. “The economy has many owners going from gold standard care to silver, and others delaying treatment due to fear of the expense,” Morton says. “Wounds can often heal without treatment, but it takes longer and is at the horse’s expense.” The size of a wound—from a small puncture to a large, ungloved injury—doesn’t matter. Either can turn into a life-or-death situation, experts say. “I’ve seen wounds on horses’ bodies that I could stick my head into,” says Dr. Davis, director of field services at the Humane Society Veterinary Medical Association. “Since the upper body of the horse has greater muscle mass, more exuberant blood supply and more skin, huge body wounds can heal while small puncture wounds to the leg can lead to joint infection.” Davis says he’s encountered many owners who opt for minimal treatment because they can’t afford to take their horse to a referral facility. The sometimes sad consequences of that approach must be made clear to the owners, he says. “As soon as you pat yourself on the back for treating a horrible wound, you get one that looks like it will be an easy fix and it’s not, and all of that patting on the back goes down the drain,” says Robert Moody, DVM, who owns the Equine and Large Animal Practice in Coupeville, Wash. “Depending on the region in which a veterinarian practices and their client base, the newest technology isn’t always practical, but the veterinarian should always recommend the best therapy for their patients.” Veterinarians who have treated a patient should be able to walk away knowing they have made the best recommendations. “Client compliance is often an obstacle in veterinarians’ preferred care,” says Harry Werner, VMD, owner of Werner Equine in North Granby, Conn., and past president of the American Association of Equine Practitioners. “It is important for owners to recognize the value of excellent wound care to their horse and themselves. In the long run, less costly but substandard wound care is of little value.” Want more Veterinary Practice News? Go here. <HOME>
