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  Keeper of the King Snake
Posts: 7622
   
Location: Dubach, LA | Massive. Entire back is affected. He will lose all skin and hair where he is stitched. it is already sloughing off. Any advice?
The entire back of this horse is falling off. Wrap him in saran wrap to keep it moist? Any other tricks? I can't be the only one that has dealt with an open wound of this magnitude?
Edited by CanCan 2016-12-19 8:52 AM
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 Expert
Posts: 1718
Location: Southeast Louisiana | What happened?? Sorry to hear about the massive wound. Sending prayers for a complete recovery.
I have heard of using honey to treat large wounds like that, but I believe it's for burns and such. I'm sure you can google it and see if it will help your specific case. | |
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 My Heart Be Happy
Posts: 9159
Location: Arkansas | As usual I know nothing in the way of help, but I will pray for a quick and uneventful recovery  | |
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Member
Posts: 6
| You can rinse the area with BioWash and then apply BioGel spray. Will heal up super fast and keep everything clean. Will create a barrier from dirt and bacteria, hair will grow back normal with no white hairs or scarring. Good luck!! :)
http://www.teskeys.com/biowash.html
http://www.teskeys.com/biogel.html | |
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Keeper of the King Snake
Posts: 7622
Location: Dubach, LA | Bump | |
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 BHW Resident Surgeon
Posts: 25352
Location: Bastrop, Texas | Can you post a picture or give more details? How did this happen? | |
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 Good Grief!
Posts: 6343
Location: Cap'n Joan Rotgut.....alberta | Honey and more honey make sure its unpasturized...i was a non believer until i used it on my mare that got hit by a longhorn bull...i was amazed at how fast it worked.....m | |
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Keeper of the King Snake
Posts: 7622
Location: Dubach, LA | The honey scares me because of the fire ants we have. He couldn't roll if he was attacked. | |
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Keeper of the King Snake
Posts: 7622
Location: Dubach, LA | Bear - 2016-12-19 9:36 AM Can you post a picture or give more details? How did this happen?
Got hung up in a piece of scaffolding. One of those, "Let's see if I can fit in here" moments. Two puncture wounds on either and multiple deep scrapes. Everywhere that was stitched is dying and falling off. | |
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 Extreme Veteran
Posts: 310
Location: North Dakota | Hard for me to say without actually seeing what you're working with. But from what I'm picturing, I would take a clippers and shave the area around the wounds, place a bandage over them, and use elastikon tape to hold the bandages in place. Saran wrap would most likely bunch and move around and create pressure points. Clipping around the affected area would give you a place for the tape to stick without worrying about pulling hair each time you changed dressings. | |
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 Elite Veteran
Posts: 999
Location: Sunny So Cal | I would start him on the NutraWound to help his body to heal from the outside in. Maybe also put some zonox on it. I know Krystal had great success with NutraWound and Underwoods for her open wound that she dealt with. | |
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BHW Resident Surgeon
Posts: 25352
Location: Bastrop, Texas | OK, I have a better idea now. Do these deep scrapes involve full thickness of skin, to the extent that the subcu tissue (fat) is exposed?
The thing about lacerations in horses is that unless you catch them real early, they are heavily contaminated in a short period of time.
Even with "clean" lacerations, here's what I would do. You have to decide if sedation is needed. Most likely it is, if you have a lot of suturing to do. I'd scrub the wound well with bacteriocidal or surgical soap like betadine or hibiclens. I'd avoid drains, unless there's a large hole or space, because they just allow continued contamination down the tract of the drain. If the soft tissue (fat or muscle) is approximated (touching) when you approximate the skin, then that's all you need. A lot of times I see vets put too many sutures in, too close together and too close to the skin edge. It looks great at first, but usually they pus out and the skin between the stitches dies and the stitches pull out. The goal is to approximate the skin edges, ideally with monofilament sutures like monofilament nylon or monofilament absorbable suture. If, for instance, I have a deep 6" laceration, say in the back, I might place 3 or 4 mattress sutures equally spaced apart. That's about all. You might a small amount of exposed subcu tissue in between, but that's OK because that will allow free drainage of blood, serum, and pus. You want that.
The main goal is healing, not cosmetics......besides, even the most ugly wounds look great once things are healed up anyway. Deep sutures in the fat are not going to accomplish much, other than provide a focus for later abscess formation. Bottom line is to approximate the skin with as few sutures as possible. I like mattress because they hold best, plus they keep tension off the skin edges, and are not so apt to rot and pull apart.
As for the wound care, most likely keeping a dressing in place will be a pain in the ass and a constant struggle. Open, exposed wounds or fat is best treated with good old fashioned "elbow grease".....frequent hosing, soap, and water. Forget about trying to eliminate bacteria, because that's not possible. As long as you have an open wound, it will always be contaminated. The goal is to keep removing all dead tissue, surface blood, and pus, and that's called "debridement". The more often, the better.....at least 2-3 times a day. Soft brushes work great for this. Sometimes, if you get significant amounts of dead tissue (skin and fat), you might have to excise the dead tissue sharply with a sharp scissors or scalpel. You might need sedation for this, although if a horse is desensitized to your daily debridement schedules, they can be remarkably tolerant. If you debride sharply, make sure you remove all the non bleeding, dead tissue. Dead tissue, serum, and blood, is "food" for bacteria. Most of the time systemic antibiotics aren't necessary. Topical preparations like bacitracin, neosporin, or silvadine are OK, but even they are marginally helpful. Once you get that nice, beefy looking pink-red granulation tissue, you are on the right track. I know there is a concern about "proud flesh", but unless the granulation tissue begins to pile up above the level of the adjacent skin, I wouldn't worry about it. That stuff is your friend.
The gaps between the skin edges will close up and become covered with normal skin. A lot of times, problems with "proud flesh" can be solved by shaving the heap of granulation tissue down to a point level with the skin edges. Don't worry about the oozing. Wash it and hose it and it will stop. If it keeps oozing, try putting a temporary dressing on it. That will probably do the trick within an hour. Granulation tissue doesn't have pain fibers, so you won't hurt the horse.
There are literally dozens of topical solutions, creams, gels, and powders and they are fine and might be helpful, but usually you can save your money, provided you are willing to put in the time to do what I described. I use vetricyn myself, but it's not crucial, in my opinion. Don't abandon sound principles for some magic topical agent. They are fine and might help, but nothing is better than adherence to hydrotherapy, soap and water, and debridement, when necessary. | |
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Keeper of the King Snake
Posts: 7622
Location: Dubach, LA | Bear, this is pretty much what's going on. I had hoped there was some innovative magical treatment. | |
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BHW Resident Surgeon
Posts: 25352
Location: Bastrop, Texas | CanCan - 2016-12-19 12:48 PM
Bear, this is pretty much what's going on. I had hoped there was some innovative magical treatment.
I'm pretty up-to-date on wound care innovations. They are out there and some are pretty expensive, like wound "growth factors", etc...
Dilute iodine (betadine) can be helpful, as well as silver in silvadine, but the benefits aren't that huge. A lot of things people slather on wounds actually do more harm to adjacent healthy tissue, and worsen the situation. The vast majority of wounds we deal with in horses can be managed inexpensively with proper suturing, a good hose, mild soap, and patience. The other stuff is optional, and usually of marginal benefit, to be honest.
Remove the dead stuff, wash the living tissue, and let the healing process do the rest. | |
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BHW Resident Surgeon
Posts: 25352
Location: Bastrop, Texas | Here is an excellent slide presentation of wound healing. The illustrations are excellent. Good basic science.
http://www.kumc.edu/Documents/surgery%20education/Didactic%20Suppor...
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