Wound Management help

[colorfan]

As soon as I saw her I knew something was wrong! Yup, there on the front of her foot, halfway between her fetlock joint and hoof was a big gash!
I placed a call to the vet and cold hosed the wound. After speaking with the vet I was able to send her some pictures, she felt it was a nice ‘clean’ cut and although more than superficial she didn’t really want to stitch it. She felt the stitches would pull through making the wound bigger and more scaring.
She said I could give a gram of bute and continue to cold hose, poultice with honey and cover to keep clean, contain the mare to minimize walking and losing/dislodging the bandage.
Tomorrow I am taking the mare in to have an actual look see.

Questions: How long should I cold hose? It is +8 here this evening. Thinking hosing is to prevent swelling as well as clean the wound.
When I hosed her tonight I noticed some gray material, some of that came off with hosing, should I hose until it all comes off?
What pressure should I hose, mist, sprinkle, shower, jet?
After hosing I could see variations in the flesh, pink to red which seems normal but also some spots of yellow, is that serum or?

I happened to have some diapers in the house-grandkid preparedness- I placed the diaper around the ankle, taped the top above the fetlock and the bottom to the hoof wall. This seems to work amazingly well, no direct pressure to the wound but secure around it.
Regarding the tape, I remember learning to never circle the limb but I did cross the tape (last night) over the front of the fetlock. Kinda hard to explain, today in better light I wound the tape around in a spiral but in order to get the top of the diaper secure I had to spiral both ways. The tape is not tight, just there. Is this spiraling ok?

How often should I change the poultice/apply the honey? How often should I hose her?
Any other tips, thoughts or what I should look for?
thank you.

I have taken pictures so maybe when she is much better I will post a progression series.

[4LeafCloverFarm]

I would not keep washing it. After the initial debridement, and all is clean, a little Betadine, then your salve/poultice of choice, then wrap. Remove wrap once a day to check wound and reapply your poultice. If yellow/green puss appears, it is infected and that may require SMZs. Then it does need to be cleaned again with warm water, generous Betadine, salve and wrap.

Only wash it if your bandage comes off and there are shavings and poo and stuff stuck to the wound - but don’t hose - use warm water and a sponge to pat at the crusty bit to soften them (or squirt small amount of warm water to flush it), so you can get whatever is stuck loosened up so it will come off.

To reduce swelling, those gel packs you stick in your freezer you get from the drug store work great - just tape one on with duct tape. 20 minutes or so, then remove. Pop back in the freezer. In a pinch, a bag of peas or lima beans or blackeyed peas all work too. Just label them with a sharpie that they are no longer to be eaten - so when you stick them back in the freezer, you won’t grab them and serve them for dinner!

I’ve had a horse (twice) bust open his pastern, on the rear, above his heel bulbs. Both times got stitches. They were fine (never popped open) and aided healing. Can’t even see a scar. The advantage to stitches is no wrapping! Just a little salve on top to keep it moist and keep dirt/poop out.

I wish your horse well.

[colorfan]

On the advice of the vet I did wash the wound. (sorry 4leafcloverfarm).

The wound grew proud flesh,(is that what you thought might happen?) a few days ago I took her in the vet again, had it debrided but I can see already it is regrowing the proud flesh.
The vet has not changed the care protocol, wash daily, treat with honey, bandage. BUT with respect to the vet and her years of schooling, what I see is another cycle of treating, debriding, repeat…

Is this a typical cycle that gradually reduces?

Every day there is a layer of yellow blah that every article I have read says needs to be rinsed off. A thread on this forum suggested saline water instead of tap? Why might that help?

I would appreciate advice on how to proceed please.

I have searched several times for ideas on how to correctly bandage this area.

What I am doing: clean with tap water, apply honey, apply ‘diaper’, use vetrap to secure diaper, applying pressure from below the wound upwards to help close the wound. Use a bit of duct tape on the bottome edge of the diaper to the hoof to secure the bottom.
This has worked well to keep debris out of the wound, a couple times there has been minor swelling around the fetlock joint and just above, as most days there is no swelling I think I must have gotten the wrap too tight on the days there is swelling. I find the 'tightness tricky because the vet says to wrap tightly to close the wound but the swelling says sometimes it is too tight.
Most days I extend the wrap above the fetlock, it feels less ‘tourniquet-ish’ and my gut says this is right, But my gut has very little experience with wounds and none with this location.
( several online articles show wrapping first with gauze, several also use a pillow wrap, proceeding like applying a standing wrap over the initial bandage.)

Any advice on how to wrap?

On a positive note, this mare has shown tremendous patience and is still willing to come and be caught. Has never once been difficult to handle, wash, bandage.
One time she bumped my head, ouch she said, and sometimes she moves her foot away. She has really impressed me with her tolerance.

[4LeafCloverFarm]

Is it possible for you to take & post a couple of pictures - before you wash it and after you wash it? That way everyone can see exactly what we are dealing with here.

ETA: Ye Gads - its been a month. Didn’t realize so much time had passed since your original post. Clearly, the treatment protocol that your vet prescribed is not working.

First - ditch the diaper. If it is modern diaper that has an outer shell of plastic, that may be creating an environment that is harboring bacteria.

Second - ditch the honey. I’ve not heard of using honey as a salve, and it may be a perfectly good solution in certain situations. But its not working here, for your mare.

Do you have betadine, peroxide, vaseline, non-stick gauze pads and vet wrap (or elasticon)? If not, get to a drug store and stock up.

But I’m not sure if a call to a different vet might not be in order, for a second opinion.

[candyappy]

All you need is one of the many products that remove the proud flesh. It is a common problem to have proud flesh on many wounds once it has filled in and is healing.

I like Wonder Dust since you apply to a wound once you have washed the area. Wash, puff it on the wet area and it dries and that is all( I do not wrap).

The next day you wash the wound, removing the left on WD and repeat. You will find after a while the wound is shrinking.

[Simkie]

@4LeafCloverFarm honey is commonly used on wounds. It can be very effective. There’s quite a lot of literature about it’s use, but this will get you started:

https://www.ncbi.nlm.nih.gov/pubmed/26061489/

https://www.ncbi.nlm.nih.gov/books/NBK538361/

@colorfan can you post some pics? Sounds like something sure isn’t going well, but it’s hard to paint a picture with words. Pics will help a lot

[4LeafCloverFarm]

@Simkie

@4LeafCloverFarm honey is commonly used on wounds. It can be very effective. There’s quite a lot of literature about it’s use, but this will get you started:

I’m all for natural, simple solutions. They are often better choices. As I said, I’m sure it is effective in certain situations. But after a few weeks, I think I’d try a different approach if the honey wasn’t working.

[Simkie]

@4LeafCloverFarm

I’m all for natural, simple solutions. They are often better choices. As I said, I’m sure it is effective in certain situations. But after a few weeks, I think I’d try a different approach if the honey wasn’t working.

I don’t disagree that perhaps a different approach is warranted here, but if you’ve never heard of using honey, there is significant peer reviewed literature supporting it’s use. It’s fairly mainstream.

But using peroxide and undiluted betadine outside of the initial cleaning of a particularly dirty wound is certainly NOT recommended, as it’s pretty toxic to the healing wound bed. Flushing with a weak (tea colored) solution of betadine and water can be useful, though.

[4LeafCloverFarm]

@Simkie

But using peroxide and undiluted betadine outside of the initial cleaning of a particularly dirty wound is certainly NOT recommended, as it’s pretty toxic to the healing wound bed. Flushing with a weak (tea colored) solution of betadine and water can be useful, though.

Actually, those are items I keep on hand for the initial wound cleaning/prep/bandaging. I was just suggesting them as a basic first-aide supply, as OP said they just used tap water initially to clean. Just like you might keep the same items in a first aide kit for a human. Hence the “stock up” comment.

As an aside, the Betadine I use is a 5% solution and the Peroxide is 3% - both, I believe are not “full-strength”. But yes, I do mix with water or place on a wet sponge when using - I don’t just pour it on there. And never treat with both at the same time.

Sorry my second post was so unclear. I had a rough morning - bad news from electrician, then dog Bailey, who has Epilepsy, had a bad seizure. My thoughts clearly came out jumbled.

[colorfan]

Yes, clearly something isn’t working, which is why I am looking here,

Someone just told me about wonder dust yesterday, I have some and tried it last night, I think I already saw improvement
but maybe just wishful thinking.

I am taking her back to the vet in the morning to have the wound debrided again. I think I will try the Wonder Dust instead of honey, but will see what the vet says.
I did tell her I was concerned that we seemed to be on a loop that isn’t working. The vet mentioned something about perhaps using a cortisone cream?

I will try to get some pictures up.
thank you for the ideas!

[4LeafCloverFarm]

I don’t know what it might be called in Canada, but in the US “Cortizone-10” is the widely available 1% hydrocortisone cream. It is over the counter (no prescription). Great addition to a first aid kit. It seems to be the only thing (on my horse) that gets rid of his scratches - and I’ve tried everything.

[colorfan]

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Somehow the pictures are out of order, the first picture is the proud flesh regrown and the second picture is the first day after washing.

[colorfan]

4leaf I must have the name wrong as she said whatever it was wasn’t usually used for horses…we’ll see tomorrow.

Cutter, thank you for the detailed protocol. Good job you!

[Simkie]

Does that pink part stick up above the level of the skin margins? I’m really having a hard time reading that as proud flesh in this pic.

This is a wound I’d treat with some wound gel, wrap well with a non stick dressing and a pressure bandage, and not touch for 3-4 days at a time.

Based on this pic, I’d not use any chemical debridement like wonder dust. They dissolve all tissue, and you can create a pretty big hole in something like this.

Were systemic antibiotics ever prescribed?

[4LeafCloverFarm]

@cutter99 - I did not know that proud flesh could form so rapidly. That’s quite the effort you’re putting in daily to manage your horses care. Glad they are on the road to recovery.

I guess the four times I was dealing with a really bad laceration over the years, it was able to be completely sutured up. And each time, was told to keep absolutely dry, and dab any crusty bits with a warm, damp sponge until they wipe off, let dry, then apply a salve. So I clearly misspoke about the daily cold hosing.

I’ve learned several things today. So its a good day.

[TBKite]

I’ve had excellent luck with bandaging with white sugar the same way you are using the honey. It’s the same principle as honey (too much sugar for the amount of water present, thus bacteria cannot survive, same principle as making jam), but easier to tell when it needs to be changed - there should always be some dry sugar left, to be sure the moisture level is low enough.

I use a big chunk of cotton batting, hold it in one cupped hand while I pour a big pile of sugar onto it, then quickly press it against the wound, cover it with a bandaging quilt, and apply a standing wrap over it. This one for me would be wrapped from coronet to as high up the leg as my quilt reached, changed as often as needed to keep some dry sugar present at all times. My last one was done every 2-3 days once the initial swelling and oozing settled down.

There is plenty of research indicating that caustic, irritating, and drying treatments slow wound healing compared to maintaining a clean, uninfected, moist wound surface.

I hosed my last one each time I changed the bandage, but plan to try it without next time I have to deal with a wound.

[cutter99]

@4LeafCloverFarm

@cutter99 - I did not know that proud flesh could form so rapidly. That’s quite the effort you’re putting in daily to manage your horses care. Glad they are on the road to recovery.

I guess the four times I was dealing with a really bad laceration over the years, it was able to be completely sutured up. And each time, was told to keep absolutely dry, and dab any crusty bits with a warm, damp sponge until they wipe off, let dry, then apply a salve. So I clearly misspoke about the daily cold hosing.

I’ve learned several things today. So its a good day.

Thanks 4LeafCloverFarm! It has been quite the adventure! And of course this is my youngest, soundest horse, who is a great individual, so I am really trying hard to get this to heal. He partially cut an extensor tendon as well, so I am hoping he comes sound. He is a lot better than it was when it first happened, so I am hoping for positive outcome.

I, too, had never realized proud flesh could form so quickly, but my horse put his leg over a concrete pony wall and through the wood upper wall in our run in shed. The vet said scraping the concrete will make proud flesh reproduce like crazy. When I saw the leg that first morning, I could not believe how much proud flesh could form in 13-14 hours at the most.

[cutter99]

@colorfan

4leaf I must have the name wrong as she said whatever it was wasn’t usually used for horses…we’ll see tomorrow.

Cutter, thank you for the detailed protocol. Good job you!

Thanks! I appreciate the encouragement! It has been a long 8 weeks. I do really love this horse though and would love to see him sound again.

If I can help you in any way, feel free to pm me! Hang in there!

[mvp]

@4LeafCloverFarm

I’m all for natural, simple solutions. They are often better choices. As I said, I’m sure it is effective in certain situations. But after a few weeks, I think I’d try a different approach if the honey wasn’t working.

Wait a sec. Manuka honey contains hydrogen peroxide. It is inherently sterile. It will sterilize e a wound in 48 hours. Its fantastic stuff.

OP, over the counter 10% (?) cortisone salve will take down the proud flesh. When my mare had a stitched up “star” wound and we needed to take out any granulation tissue so that the skin have the best chance of growing together at the middle. I was told to use the cortisone salve, but not often. You should see the granulation tissue appear to have melted back down after a dose of it. This was my “at home” alternative to having her debride it.

Also, I can’t tell whether you think the wound is infected or clean/healthy but producing granulation tissue. And I can’t tell what the yellow is from the picture. If it doesn’t smell, the yellow stuff is tissue and not puss, I think you are good. To me, that means you can use honey on the piece of gauze that you slap over the wound before you bandage it. The cortisone creme is what I’d try first at least once to see what it does to bring down the granulation tissue. So long as the wound doesn’t smell when you take the bandage off, you are good.

My vet’s rule for maually debriding proud flesh was that she’s cut it off if it were sticking out, 3-D above the surface of the skin. Again, all you are trying to do is not block the skin as those thin layers of cells try to grow together.

[RInurse_Rider]

There is a difference between cheapo supermarket honey and manuka honey. I work in a skilled nursing facility, and we use Medihoney or Therahoney (non-prescription items) for treatment of wounds that need some gentle debridement. Supermarket honey may not even be 100% “real” honey, or so I’ve heard.