Give me your tricks for Minimizing Scarring? EDIT: photos added Post 13

[IPEsq]

Also a big fan of SSD cream. And I think Betadine daily will be pretty harsh on the skin. If infection looks to be under control, maybe switch to a more gentle cleanser like chlorhexadine and then just a clean rinse to the best you can with what you have available. Agree to try to keep it moist. And the hydrophilic dressings can help keep it both covered and moist. They will also absorb minor drainage. You might have to secure with Elastikon or something like that. I have found that those things can help also extend the days between scrubs by keeping the area cleaner.

Following a similar approach, I have only a very faint and tiny scar after having a pretty nasty road rash wound on my elbow.

[JB]

@lifeishorsesarelove

I will continue with daily betadine scrubs

If you’re using straight betadine, I would personally dilute it to look like weak tea. You still get the antibacterial benefits, but without so much caustic action on even healthy cells

@lifeishorsesarelove

applying/packing with furacin were the directions given

I don’t know why vets still suggest this product It’s been proven to slow healing by as much as 25% . There are SO many better products out now, several of which have been mentioned

[lifeishorsesarelove]

Well, I’ve run out of betadine, so we’ve switched to Prepodyne surgical scrub (similar product). And yes, definitely using it diluted with warm water - I doubt my mare would tolerate any of these applied straight. I would prefer to not have to use something this drying/caustic, but we’re still scrubbing out a LOT of dead tissue on a daily basis and plain water was not cutting it.

I think I will go through the initial jar of furacin as instructed (won’t take long with the amount we’re using) and then ask about swapping to SSD cream or straight manuka honey.

Here are today’s photos, obviously there is some necrotic tissue in the middle of the deeper wound, but it’s still connected a little too well for her to let me take it off. If it won’t let go tomorrow I will be sedating her Friday with dorm gel for a more thorough scrubbing (and her 2nd shot of Excede).

It’s crazy how much it changes on a day-to-day basis. It does smell much better post debridement.

[IPEsq]

Although it still looks very goopy, since you mention smell, I’ll add another story.

At one point, I was tasked with helping a horse with severe bed sores. The upside down bell boots or fetlock shields were not cutting it. Well, the first day I worked on the horse and gave them a good scrub I almost puked. It smelled like road kill. Following the advice I gave above, I tried to keep them covered with a hydrophilic foam dressing and Elastikon as long as possible in between scrubs. At first they oozed so much that the dressing would have to be changed every couple of days. Plus a shampoo with chlorhex shampoo. The smell quickly went away and they did start to heal. The trick became keeping new damage at bay, but at one point I did have a good amount of hair growth back.

With a good scrub that you have done and antibiotics on board, I would be inclined to switch soon to SSD cream and try to keep it covered and moist. Perhaps the Furacin is recommended for now to help get the rest off that needs to come off, but it is for sure not my first choice for any open wound or even just broken skin for that matter.

[JB]

another thought - can you get your hands on frozen amniotic membrane?

Using Amniotic Membrane for Wound Healing in Horses

Cryopreserved equine amniotic membrane and its use in cutaneous wounds of horses

[Small_Change]

Honestly, the last pictures there make it look awfully good! I’m a human ICU nurse, and have pretty extensive experience with wounds, both traumatic injury and things like pressure sores. I absolutely 100% agree with not closing this wound over with any dressings at this point, unless you can’t keep it clean. (We generally cover open wounds to keep them clean, protect them from secondary injury, or to manage exudate. It’s never to “seal” them closed.) Irrigating with saline to clean it out regularly is a much better idea. The last thing you want is for it to close over on the surface and create a pocket or abscess. This wound needs to drain, and needs to heal from the base on up. If you are having trouble managing the drainage, coat the surrounding skin with a layer of cream or Vaseline to protect the skin. Don’t put caustic things into the wound, and use saline flushes and mechanical scrubbing to clean it. Vashe (https://www.urgomedical.us/products/vashe) or something similar would be excellent as well, if you can get your hands on it. The smell could just be the serum and goo, rather than true infection, especially since you covered your bases well initially. Flamazine (silver sulphadiazine) would be wonderful in that wound for protection, keeping it soft, and promoting healing.

Time and cleanliness are your biggest tools here. Keep at it, and don’t get discouraged if it takes a bit. At least you don’t have to worry about flies in there too this time of year! Once the wound heals from the bottom up, granulates in and has new skin over it, keeping the skin moisturized and supple will be best for minimizing scarring. Don’t worry about that yet though, just keep it clean and let it granulate from the bottom up.

[lifeishorsesarelove]

I was able to sedate her with some dorm gel (what a wonderful product) today and give the wound a good scrub, as well as remove the last remaining pieces of the original skin flaps (this plan was approved by my vet already and was the plan all week). We had to give her the 2nd dose of excede today and because it had to go in her hindquarters, rather than her neck, for everyone’s safety we opted to sedate for that, so I made the most of it. My vet is concerned about Clostridium bacteria and her neck is just SO contaminated from wound drainage and whatever gets washed out each day, so we are avoid any additional injections or anything else into her neck as much as we can.

It looks so much healthier than it did last weekend, and I’m genuinely quite pleased with how it was looking today. It certainly looks and smells much healthier than a week ago. We’ll see if we end up needing additional debridement next week.

Once we get past the long weekend I will ask about trying SSD cream in place of furacin. If they say no and things still look good, I will probably switch to straight manuka honey once the jar of furacin has been used up(or mostly used).

[Rel6]

For the silicone sheets, I was told the opposite by my vet. I was specifically instructed to use it once the wound had filled in just enough that proud flesh became a concern, since the silicone sheets were recommended to prevent proud flesh from developing (worked remarkably well for that).

[walktrot]

I used Equaide on wounds and to remove proud flesh. It did what the manufacturer said it would do. I used it on small open wounds. I wouldn’t have hesitated to use it on larger wounds, but my horse didn’t have any.

I thought it was ridiculously expensive, but it was worth every penny. It comes with a small brush that you paint it on with. It is not caustic like copper sulfate so it doesn’t damage healthy tissue around the wound. It doesn’t need to be scrubbed off every time you clean the wound. I used chlorhexidine scrub on gauze squares that I jiggled around a little bit to work it in. I cleaned up loose scabs etc., then painted it again. My horse was much happier when I quit using betadine.

I also used it to remove ancient proud flesh on the back of the left hind pastern. It was there when I bought him in 2001. It looked like he caught it on wire. Proud flesh doesn’t have nerves, so I picked it off with a fingernail until a little blood appeared. I was astonished at the results after a few applications.

I have a friend who used manuka honey years ago. It was on a 12” gash close to his tail. It definitely helped the healing process – no proud flesh formed.

I bought Equiaide from the manufacturer. I did order it once on Amazon but it is no longer available there. I googled it tonight. I had to put my horse down in 2022 but I used it for about 5 years. Great product.

[skydy]

Hang in there.

Many of us have had to deal with an awful wound to a horse. It’s daunting, but it is incredible how, if you keep it clean and give it time, nature will heal.

Good luck. It’s going so well already.

[Jenerationx]

That looks really good. I think you’re doing a great job so far.

[Rel6]

It is a product marketed for human use, so the directions on the box aren’t referring to any type of equine application. I’m not doubting what you’re saying with regard to its use on people.

But studies of its use in horses for reducing proud flesh on still healing wounds are also easily accessible. (https://aaep.org/sites/default/files/issues/proceedings-11proceedings-367.PDF, https://avmajournals.avma.org/view/journals/ajvr/66/7/ajvr.2005.66.1133.xml?tab_body=pdf)

Of course any individual should talk to their vet to see what is appropriate, but stating broadly that silicone sheets should only be used on wounds that have closed completely with total skin healing doesn’t reflect the current research or current equine veterinary guidance.

[endlessclimb]

Not the same as it was a standing surgical removal of a mass that got infected and blew out the stitches, but here’s my saga in photos. For mine, I flushed the snot out of it daily (3-5 minutes of irrigation), and then left it alone. I literally put nothing on it. The horse was not on antibiotics of any sort.

I’m sure the wound will heal fine, if my experience means anything.

[lifeishorsesarelove]

Thanks everyone for the suggestions here. I did switch to cleaning it with just water/saline flushes earlier this week, now that the wound isn’t producing so much exudate. I also asked my vet about switching from Furacin to SSD cream in my last email, but they didn’t respond to that question, so I’m making the call to switch to manuka honey once my Amazon order arrives, as we have granulation tissue and even the beginnings of new skin(!!) starting at the edges as of today! But the skin around the wound is definitely looking a little fragile.

Right side, Dec 30

Left side, Dec 30

I’ve continued to laser about every other day - her patience with everything is running a little thin and I can’t entirely say I blame her, but she has been well compensated with treats and at least continues to meet me at the gate, so I’ll take that. She’s also more comfortable, because her halter fuzzies and blankets have been noticeably dirtier the last few days because she’s been rolling again.

I can’t believe how much it’s improved in just a week from my last update.

[lifeishorsesarelove]

That is quite the gaping hole you had to work with, how unpleasant.

[Demerara_Stables]

It looks great!! My mare had a crazy accident this spring with about a dozen wounds that needed daily cleaning/wrapping/lasering so I understand the grind and the relief when it starts to look better! There’s light at the end of the tunnel

[Small_Change]

@lifeishorsesarelove

I can’t believe how much it’s improved in just a week from my last update.

Really well done! Time and diligently keeping things clean makes such a huge difference to the healing process. You deserve a lot of credit for how good that looks!

[skydy]

Time and keeping it clean does wonders doesn’t it? Good job.

[lifeishorsesarelove]

Figured I should post as update - it’s getting so close to being closed up, I am so relieved. I can’t believe it looks like this only a month later. She’s been off oral antibiotics for a few days now and doing well.

The current routine is a daily scrub with plain hot water and some gauze, cold laser for 5-10 mins on each side (which she enjoys because I spend the entire time rapid-firing tiny carrot pieces into her mouth so she’ll stand still), and then we are now doing carrot stretches to minimize any “tightness” from the scar tissue. I finish up by applying Equiderma Wound Ointment to the surrounding skin (which now had hair grown back in, and pure manuka honey on the wound itself. She is still wearing a slinky hood daily under her blanket neck to keep mud/dirt/hay/god knows what out of the wound.

She does have a noticeable dip in her crest, but I’m hoping that some of that is the fact that the hair is much less dense there right now, and may improve as her mane (hopefully) comes back in. And/or may improve if/when I can put her back in work.

Because of course, this injury happened while she was already off with an injury! It seems silly to worry about if my possibly retired horse will ever look right in hunter braids again when I don’t even know if she’s going to be sound enough to show again, but here we are.

[IPEsq]

Although dips in the soft tissue / disruption of the fascia can look a little wonky and potentially be permanent, I wouldn’t worry too much about function long term. You might try e-stim or electro acupuncture once the wound heals.