Speak to Me of Degloving Injuries

[eqsiu]

So last Tuesday my horse degloved her right hind leg. The vet gave her a 50/50 chance of recovering without complications that would require euthanasia. I thought it was worth a shot. So far she is eating and drinking normally, and bearing weight on the leg. This bodes well. However this sort of wound is beyond any experience in my 24 years of horse ownership.

If you have experienced this, how did the healing go? What sort of treatment was used? Did you have any major complications? I really hope I made the right choice that night. As long as she stays reasonably comfortable I will carry on. But the skin is starting to slough and thus the wound is looking worse, which has me freaking out a bit.

Disclaimer: I have been emailing the vet with photos of progress and am following his recommendations. I just don’t have anyone to talk to who has gone through this with their horse.

[beowulf]

What kind of degloving injury? Joint involvement, or no? Assuming major structures in the hind end are involved?

Barring the involvement of joint injury, most degloving I’ve seen has healed quite well and the horses go back to prior level of work when major structures weren’t compromised. I’ve seen and taken care of some absolutely awful degloving accidents; one of the more recent ones I took care of was a total deglove from mid-cannon down to coronet; the flexor tendon was severed in the process. The mare lived in wraps for 6 months and the wound took a long time to heal but she went back to work as a Pony Club horse for D/C members in the PC my trainer ran.

The wound will always look way worse before it looks better, especially the first few weeks. Keeping an eye on proud-flesh is crucial, and since you have that relationship with your vet, snap pics each time you unwrap to compare. Hot/angry areas might need vet attention ASAP, but in general, you’re going to see swelling, seeping, and nasties.

As far as treatment, IME it really depends on the nature of the injury / structures involved; for the flexor tendon horse, for instance, the first few weeks were lots of wrapping, irrigating the wound, applying Vetricyn, and covering - with the aim of trying to keep the injury dry/clean as possible. Lots of SMZs (oral) in the mean-time.

Got any pictures? Sorry you are dealing with this. I know degloving especially is tough when you’re looking at parts of the horse you’d much prefer to be completely covered by skin…

[beowulf]

I should add, that lower limb (especially hind) injuries can be prone to extra inflammation, proud-flesh/excessive granulation and cellulitis. Staying on top of the slightest hint of cellulitis or irritation is important; and keeping the horse on heavy hitting antibiotics (and I also always add pro/prebiotics when the horse is being fed antibiotics) is not a bad idea.

[Scribbler]

I have watched a few nasty wounds heal, not degloving, and fortunately not under my personal care.

I would agree wounds can look really ugly in the first few weeks especially as the inflammation settles down and that stuff sloughs off and may need gentle debridement. I wouldn’t panic over ugly now, and just follow vets advice. Easier said than done, of course, and it can take a strong stomach to debride.

[beowulf]

Yow! that is impressive! Any idea how she did it? Got caught in something?

What is he having you put on it? I would as a general rule avoid Furazone - it tends to encourage proudflesh IME.

Good news that there is no joint involvement and suspensory and flexor are intact. It looks much better than I thought.

I wouldn’t despair yet. These things tend to heal very well if you stay on top of them. IME I’d pick an extensor tendon tear all day over the other structures in the leg; they tend to heal quite quickly . I am surprised he is giving you such a guarded prognosis but perhaps it is much grimmer on rads? I have seen multiple full severances of the ET and all went back to previous level of work.

I believe @JB had a horse that had a severed extensor tendon injury that came back to full work. Paging them so they chime in

[eqsiu]

She is on an injectable antibiotic now (I am horrible and can’t recall what it is) which will go until Thursday. After that she will likely be put on SMZ orally. She’s getting a gram of bute twice a day to help with discomfort and inflammation. I actually have started researching probiotic supplements. She’s on Right Choice 12% pelleted feed, which supposedly has probiotics included, but I think an additional supplement might be good. At the moment the vet does not have me dressing the wound itself with anything, just sterile bandages. I haven’t heard back yet today, so I may be starting to use silver sulfadiazine as the skin dies back and exposes more of the raw flesh.

[eqsiu]

Did I mention she is blind? I had to move her 3 weeks ago so she was in a new place, and the other 3 horses apparently took off at a gallop after eating. She panicked and tried to follow, but hit a wooden fence post, then quasi-successfully jumped the fence. She made it over, but the electric tape got her leg just right I guess.

Some issues are to be expected with a blind horse, but she had been navigating the pasture super well so I though we were in the clear. She’s been in electric fencing all her life, and lost her vision slowly (uveitis) so had time to adapt. I think just being left so suddenly in a fairly new place was too much. And unfortunately there is not a single boarding place in this area with a solid fence.

[eqsiu]

@beowulf

I am surprised he is giving you such a guarded prognosis but perhaps it is much grimmer on rads?

I think he just wanted to impress upon me how much time and effort would be involved. And was thinking of complications like opposing limb laminitis, infection, etc. Plus without diligent care she would go downhill fairly fast.

[beau159]

Nasty looking wound, and it’s going to take a long time, but I’ll bet she heals up nicely. To my understanding, the tendons usually heal up fine too.

My horse Red is notorious for injuring himself. He’s cut open a back leg on 3 different occasions. The second time was the worst (biggest) and down to the bone. He didn’t have quite as much flesh missing as yours, but his was much deeper. He did have some tendon damage but I couldn’t tell you what percentage – my vet was not concerned about that. We did try to salvage the skin but it didn’t take and I had to go back and have it debrided anyway… He was in a stall for 2 months. After it quit oozing so much, I was able to do bandage changes every other day. Eventually, I stopped bandaging and tossed him out in the pasture to finish healing over the winter. I could have stalled/banadaged a bit longer, but he was healed along far enough that I decided to let nature take it’s course for the rest of the healing.

When needed, I applied either hydrocortisone cream (or ProudsOff when I needed to be serious) on any proud flesh (Which is just basically “too much” granulation tissue.) Lower leg injuries will almost always produce proud flesh, so you’ll just need to stay on top of that.

Otherwise, I used silver sulfadizade … after about 2 weeks first of furozone. Once I quite bandaging, I just put on a good aloe vera wound ointment to keep it soft and protected.

[JB]

Wow, poor girl. Poor YOU!

First, breathe

30% tear in an ET is pretty excellent . Beowulf is right - mine fully severed the long (main) ET, and lacerated the lateral ET. Full Recovery.

The ET has a 75-80% return to full athletic soundness. Your biggest healing hurdle in the beginning will be limiting flexion of the fetlock. Full leg wrap, from below the hock right down to the top of the hoof. Snug. The ends of the tendon reattachment with scar tissue will be fragile for a while, so the leg needs to be “stiff” for a couple months to allow that reattachment to get stronger. So if you have shorter wraps, get the tallest ones you can find. I used gauze on the actual wound, then a layer of sheet cotton for extra absorbancy, then a nobow, then a roll of 3" brown elasticon, then a roll of vetwrap. Yes, that sort of stiff.

I know it’s hard to search for posts by me because the new forum here doesn’t like 2-letter names LOL But if you can, I’ve got several posts laying out a lot of what I did. I think you can probably find them under any thread with “extensor tendon” in the subject.

Yes, it will start looking worse before it looks better, so just be prepared. The actual wound healing will be harder, most likely, than the tendon healing, but it will happen.

I don’t think I used a lot of anything on the wound itself, just some antibiotic ointment, maybe Nolvasan in the beginning, maybe alternating with something else, I’m not sure anymore. If proud flesh really starts taking hold, look to Animax or Panalog, both steroidal abx ointments.

Just keep it clean, obviously, and VERY well-wrapped for joint stability. At some point I went to changing the wrap every other day.

This acute phase does need pretty good stall rest, or equivalent, but what it really needs is limited movement, so whatever situations makes her happy. My vet always says - start with going by the book, but don’t be afraid to treat the animal/situation you have in front of you.

As soon as feasible, some small “turnout” for small, but free choice movement becomes very good for creating a healing situation that is stronger, as movement helps align scar tissue so it’s not just pixie sticks. Mine was starting that after about 2 weeks, starting with small pen turnout while I cleaned stalls, and working up from there.

I’m happy to answer more questions if you have them These things DO heal well.

[JB]

Oh I agree with the NO furacin-anything on this. It is proven to slow healing, and when you’re looking at something as major as this, that’s a lot of extra healing time. So no, not a drop.

[eqsiu]

I have 4-18" quilts and 5-16" quilts (Wilker’s combo quilts). So it’s almost like an old school shipping wrap that only comes to the coronary band! I have been doing several layers of abdominal/combine pad (and thankfully have rolls of the stuff on order) wrapped with gauze and then the standing wrap. There isn’t a ton of movement. Right now no topical treatment, but will start silver sulfadiazine per the vet’s recommendation once the skin flap no longer covers the wound. She’s on stall rest now, but in time may be moved to a stall with a 12x24 run attached.

Man, the wound is so oozy right now. It’s not pus, but just clear fluid. The quilts are almost soaked though everyday. Smells delightful. I have been washing her pastern below the wound so she doesn’t get skin breakdown from serum scald.

I am really glad to hear that others have had good results! I know there’s a long road ahead but it doesn’t seem so grim now.

Also, my phone REALLY wants “wound” to be “would.”

[jetsmom]

I had a barnmate’s horse completely sever the front ET and he ecovered 100 percent going back to doing 3 ft hunters.

[Janet]

A horse that, at the time, belonged to a friend, managed to deglove his front leg jumping a rusty barrel.

I do not remember the details of treatment, but he healed relatively uneventfully. He had a scar, but was sound on it. He was later bought by my sister, who evented him up through Preliminary (ata ge 23), and did some serious show jumping with him. IIRC he died in his late 20s, and never had a problem with it.

[Mango20]

I had a horse with an about 4"x 6" skin tear and partially torn extensor tendon. It was sewed up like yours, and the skin flap sloughed off anyway. I don’t remember all of the details of treatment (this was in the late 1980s), but it involved a lot of bandage changes and waiting for the skin to grow to cover the wound. My horse recovered but not 100%. She was sound at the walk, trot, and canter in the direction where her injured hind leg worked as a diagonal pair with the front. When cantering in the direction where the injured leg worked alone, she took a much shorter step with it, and got the other hind leg down as soon as possible to “help”. She was not hopping in her hind end, but it was noticeable. She seemed to be pain-free and enjoyed life mostly as a trail horse after that.

[HJdaydream]

Saw this on fb- pretty sure it is public because I do not know the person who shared it. Her horse degloved a leg. She used medi honey and dermagel (shown at the end of the album). The album has TONS of photos detailing the recovery. Might help give you hope!!

https://www.facebook.com/klassenn/media_set?set=a.10155464508872111&type=3

[Ghazzu]

You might want to ask about the possibility of doing some pinch grafts (skin) a little bit down the road, after you have a granulation tissue bed. It will accelerate closure.

[Ghazzu]

Even longer. depends on how much time it takes for a good bed to apply the pinch grafts to.
This might be helpful to give you an idea https://aaep.org/sites/default/files/issues/proceedings-11proceedings-379.PDF

[joiedevie99]

Placenta can really help if you get some non-healing spots.

[eqsiu]

@Ghazzu

Even longer. depends on how much time it takes for a good bed to apply the pinch grafts to.
This might be helpful to give you an idea https://aaep.org/sites/default/files/issues/proceedings-11proceedings-379.PDF

Oh, I meant until the flap detaches fully! Not sure how long the vertical portion will hold out.