Ah.
That depends on how much of a vascular supply it manages to develop.
I used dermagel on a pretty nasty (not in that league though) injury last spring and was really impressed with it. Towards the end I did add wonder dust but it went from a fist size area of missing skin to no scar at all.
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As odd as it sounds, thanks for sharing the photos. It is truly amazing how some of these injuries are able to heal. I hope you will have slow and steady progress with healing. Sounds like the mare is a special one. Can you put Vaseline or zinc below the wound to prevent serum scalding the rest of the lower leg? Or is the wrapping absorbing it enough?
Without hijacking, I wonder if Ghazzu and/or JB could answer a couple of questions. When a wound like this has a âflapâ, and it is stitched back into place, what determines if it will heal vs. not heal? Are there factors or treatments that make it more likely to take? Is it blood flow? How disrupted things are beneath where the skin should lay? Some âflapsâ seem to fail and just fall off.
Second part, not necessarily about this particular injury. What the heck is in Underwoodâs that is the active ingredient? Iâve seen some pretty significant injuries and âexuberant growthâ of proud flesh that resolved with Underwoodâs. Iâve never used it or seen it used, just photos.
Pretty much blood flow. Mine also had a skin flap. It was stitched,but all that pretty well fell apart somewhere around the 7-10 day mark, so the vet came back out, cut the flap off, and we started with a fresh âwoundâ again.
I have no idea if layering something between the raw tissue and the skin flap - such as placenta material - would greatly reduce the dying issue.
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Vascular supply. If the flap is coming from above the wound, and extending down into it, it usually has more of an intact vascular supply and is therefore more likely to remain viable. If the flap is extending upwards from below the wound, it usually has lost most of its vascular supply, and, while it may develop some new connections, it is likely to die.
Second part, not necessarily about this particular injury. What the heck is in Underwoodâs that is the active ingredient? Iâve seen some pretty significant injuries and âexuberant growthâ of proud flesh that resolved with Underwoodâs. Iâve never used it or seen it used, just photos.
Everything but the kitchen sink. Likely one of the main âanti-proud fleshâ components is the copper sulfate.
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The good news is severed extensor tendon heal remarkably well. My guy severed his with a degloving (no joint involvement) at age 4 and now heâs 9 and jumping the 3ft3 and 3ft6 hunters and winning! (Heâs the dude in my pics which was taken 2 years after the injury). As everyone else said, with the proper after care to stop him from knuckling over getting back to full work took us about 6 months (this included having a good chunk taken out to remove a bone sequestron). My vet didnât have me use any creams until the wound had filled in and then he came out every 2 weeks to remove any proud flesh until we eventually went to green wound cream and then derma gel.
To wrap i basically used used a Tefla pad to keep the wound moist and clean, then some thicker guaze pads, then went over that with a regular gauze bandage, then we used elasticon wrap which went down and then back up and over the hock in a figure 8 to stop everything sliding down. Then the standing wraps went onâŠphew and this was fully changed every 2nd day. It acted like a nice solid cast structure and Sullivan was able to go out into a very small rehab paddock as he didnât knuckle over. We applied this type of wrap for almost 4 months and then weaned off the wrapping. Itâs a long process but suddenly youâll notice itâs all filling inâŠit just seems to take forever.
heres a picture of the wrap without the standing wrap on to give you an ideaâŠ
And a picture of the injury after the sequest removal and then after it all healed!
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I had a mare that nearly degloved both of her knees (front legs). The good news was there was no joint or deeper damageâbut there was no useable âflapâ of skin to try and stitch up either. She had to be in the stall for 6 weeksâand the bandaging was really key. Just like Eclipse----I did both legs in the telfa pad (a huge one) then gauze,then elasticon wrap all under a standing wrap. The elasticon held the entire thing âupâ (so it didnât slide down over the knee). I changed it dailyâbut the vet said every other day wouldâve been fine. We did have some proud flesh we had to debride. One of the knees was less extremeâand healed completely. The other knee always had a scar on itâthere was about a inch or so diameter circle that never grew hair back. And there was a bit of a raised area too. But she was sound and went on for many years after thatâcompeting in many more events.
Thanks for the explanations, Ghazzu. I read your link about the pinch grafts. Given that a flap may fail withnout adequate blood supply, how do these pinch grafts develop their own blood supply? I understand that they spread out with epithelial cells to cover the wound, and then do blood vessels develop as well? Is it the âpocketâ for each pinch graft that supplies the needed blood for each to stay viable as each island grows and covers the wound?
Eqsiu, please post updates as your horse heals. It may help someone else down the road. Jingles for healing!
The wrap really does need to go down over the top of the hoof and IME, add another layer of stiffness, whether vetwrap or elasticon. The fetlock joint needs to be fairly immovable for a while.
And yes, as mentioned above, the wrap will have to be weaned off down the road - the lymphatic system will âforgetâ how to circulate fluid out of the leg, so it will take some time to allow it to re-learn how to do that without the leg blowing up.
For mine, I had to start with just 30 minutes at a time for several days, and worked slowly up from there.
OP, I think itâs looking pretty danged good. Iâd keep whatever âskinâ on it that you can ⊠until it wants to âmeltâ away. It helps keep everything protected.
Also, I donât know what your vet has told you, but mine told me to do as little washing of the wound as possible. The stimulating from a running hose (the good olâ cold water treatment) has actually been shown to INCREASE proud flesh b/c it stimulates granulation tissue growth. Youâre keeping it wrapping anyway, so you really shouldnât have any need to wash or hose it anyway.
I was going to link some pictures of my guy for some encouragement for you, but my Photobucket is not cooperating Maybe I can do that later.
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I am avoiding the wound when I wash. Basically Iâm gently wiping goo away from the skin around the wound! The wound itself is pretty clean looking. Probably because itâs oozing so much fluidâŠkeeps things flushed away I guess.
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Alright, Photobucket is working today!
To spare people from gory photos, Iâll just link them instead of actually posting them.
So this was my geldings second injury to the hind leg when I found him in the pasture. You can see the scar from his previous injury above the fresh one.
Go to the vet to get him cleaned up. Yes, that big white thing you see in the center is his exposed BONE.
There wasnât much skin to save, but we tried anyway to stitch it up.
The very next day on the first bandage change, the bone was already covered up. Incredible!
Eight days later, you can see the skin starting to âmeltâ away. I knew it wasnât going to hold.
Day nine the skin was really gone. I think I went back to the vet shortly after that to have it cleaned up again.
Day 14 heâs looking pretty filled in and pretty good.
And then 34 days out.
And here we are at 42 days.
Day 58 was after his first day back in the pasture out of the stall (the black on the wound is some Underwoods salve I had tried ⊠but didnât like). Of course, heâs swollen as to be expected since he was wrapped so long.
182 days later, it looks like this.
And then I donât think I ever took a final picture. However, as far as lameness goes, he healed up 100% fine.
I do have a picture of injury #3 on the opposite leg (thank goodness it was âsmallâ) but you can see the scars from the first two injuries on the other leg. Clearly someone canât stay away from fences!
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Thirty years ago a clientâs horse degloved front leg â knee to ankle â spooked from a deer while turned out; scraped leg jumping over post and rail fence. I immediately washed with saline, put flesh back in place and covered with bandage. Vet arrived lightening fast, did his good work.
I canât remember all the after care protocols but leg healed to 100% sound, had scars though.
Well, sheâs developed some cellulitis. Oh joy. The vet is coming out Tuesday to debride the wound. I will have more info on a plan going forward then. Right now he doesnât think limiting fetlock flexion is necessary, but Iâve been wrapping lower just in case. I have 20" quilts and 16â bandages on their way. Iâm hoping the bandages are long enough. Otherwise Iâll be whipping out 22â flannels from my pony club days, which are a bit unwieldly. But otherwise no real problems yet. Sheâs still eating and drinking normally. Because she is isolated I have been sitting with her and talking. But Saturday night I must have gotten something interesting/tasty on my pants because she spent 30 minutes licking my leg. She has loose mineral salt, so I wouldnât think it was a salt issue. She is super well groomed right now!
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Boo on the cellulitis 
Is it really that, or just swelling from the injury and limited movement?
I would ask why (and then do it anyway :lol:) Without limiting flexion, not only is there the risk of regularly tearing the weak new tendon scar tissue connections, you risk hyperflexing the fetlock joint and tearing the joint capsule. BTDT.
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@JB not sure, it could be either without him seeing it in person. Iâll know more tomorrow. Yup, more bandage wonât hurt a thing and may help! Actually wrapping the abd/combine dressing down to her coronary band helps keep the standing bandage nice and even as well as making the whole thing more cast like. And I have 12 8"x20yd. rolls to work with.
Jingles for mild cellulitis, if it is cellulitis.
Good idea. Keeping the whole thing more stable facilitates epithelial growth.
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I donât have experience with a degloving injury myself, but my good friendâs mare tried to jump the pasture fence and caught the hotwire, degloving a leg. No tendon injury, though. It sounds like you have good advice! Her horse needed daily and then every other day/every few days bandage changing. She also actually hired her vet tech to come out and do it sometimes because she couldnât reliably do it on schedule. Most of what she did sounds like what you are doing with your horse. It was a multi-month long haul. Her horse developed significant proud flesh and that was removed 3 times I think. However, 1 year later, her horse was sound and you wouldnât notice the wound unless you knew to look for it. Skin wounds heal really well.
A good freind and barn mateâs 27 year old horse was found crashed through a pasture fence, her chest completely devoid of skin (it was hanging in pieces). The vet said âif you take care of it, itâll heal well. Itâs only a skin woundâ. LOTS and LOTS of care and about a year later, you wouldnât know this happened looking at the horse. It was an amazing process to watch.
Vascular supply is key, as well as viability of the cells on the flap and underlying tissue. Time from injury to being found(or did you witness it and handle it right away), mud and other environmental goodies infiltrating the wound and the horseâs innate immune system all matter in the prognosis.
Both of my friends kept photo logs of progression, which really helped them see how far their horse had come when they were feeling down about the length of time. And if things donât go well, you can see that you gave your mare every chance. GOOD LUCK to you both, and I love that you posted the initial wound and subsequent pictures. Thank you!
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PS., my friend also wrapped to minimize joint movement down below the fetlock as per her vet. I know because I helped wrap that leg.
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