Wound Care for Horses: First Aid & Treatment

Horse wounds can be alarming to deal with, especially when horses experience severe cuts or lacerations. Wounds are the second most common emergency issue in equine care.

Horses often sustain wounds from their surroundings, whether from sharp objects such as nails or fence posts in their pasture, rough edges in stables, or even from other horses. Wounds may also be caused by slips or falls during riding or training, as well as ill-fitting or broken tack.

Prompt wound care is essential for the health and well-being of your horse. While minor wounds can often be managed by the horse owner, veterinary guidance is crucial for more serious injuries.

Treatment can pose a challenge depending on the type of wound, location, as well as the severity. ^[1] However, with diligent care, most wounds heal with minimal complications, allowing your horse to return to their normal activities.

Wound Care for Horses

Wounds in horses can be classified based on their cause, depth, and location. Recognizing the type of wound is the first step in determining the appropriate care.

Four main types of wounds that occur in horses include: ^[2]

• Puncture Wounds: These seemingly minor wounds can mask extensive damage beneath the skin’s surface, are prone to infection and have the highest risk of acquiring a tetanus infection.. The skin may heal before the underlying tissue, complicating treatment. Puncture wounds should be left open and regularly flushed out (lavaged).
• Incised Wounds: These slicing wounds tend to have smooth edges and can often be sutured, stapled, or glued together to aid healing.
• Lacerations: Characterized by jagged edges, lacerations may involve underlying soft tissue damage and are prone to infection. This type of wound often requires debridement (removal of damaged tissue and/or foreign objects) and is usually managed as an open wound.
• Abrasions: These superficial skins wounds are generally minor, but require thorough cleaning. They can be treated with topical applications.

Wound Locations

Common wound locations in horses often correspond to areas that are most exposed or prone to injury due to the horse’s environment and behavior.

Examples of wounds that horses can sustain on different parts of their body include:

• Legs and Feet: Prone to injuries like cuts, abrasions, and punctures due to sharp objects on the ground.
• Head and Neck: Susceptible to wounds from bumping into stable fixtures or during interactions with other horses.
• Flank and Sides: Can incur injuries from encounters with sharp edges in their environment.
• Back and Hindquarters: At risk of scrapes and bites, especially in wooded areas or from social interactions with other horses.
• Eyes and Ears: Vulnerable to damage from debris, vegetation, or conflicts with other animals.

The location of the wound impacts treatment and healing, as well as the risk of potential complications. Areas with high movement, exposure to dirt, or limited blood flow often require more complex care and have a prolonged recovery time.

Lower Limbs Wounds

Lower limb wounds on horses are common, often caused by foreign objects such as fencing, gates, farm implements, and building materials. These wounds can be more difficult to manage because of poor circulation, joint movement, and the lack of soft tissue between skin and bone. ^[3]

Wounds on the lower limbs are more prone to developing proud flesh than other locations, largely because of reduced blood flow. ^[12]

Wounds on the lower limbs are also at higher risk of environmental contamination, which can lead to infection and complications. ^[2] These wounds can also involve damage to underlying structures, resulting in chronic inflammation. ^[3]

Lower limb wounds often increase in size after the initial injury. Wounds can double in size within the first two weeks, often due to skin tension, lack of muscle coverage, and movement of the limb. ^[4]

Injuries to the lower limbs might affect critical components such as the flexor tendons or the suspensory ligament. These types of wounds may need to be surgically repaired to restore athletic function or possibly save the horse’s life. ^[5]

Wounds that affects synovial structures (joints) may not have a favorable outcome. ^[5] Prompt veterinary evaluation is crucial for any wound near a joint.

Upper Body Wounds

Wounds on a horse’s upper body, including the trunk, may involve underlying muscle damage but generally heal swiftly and with minimal scarring.

Fortunately, even extensive injuries with significant tissue damage to the neck or trunk areas tend to heal well. ^[3]

First Aid for Wounds

When it comes to horse care, being prepared to handle emergencies is as crucial as routine maintenance. Wounds require immediate attention and first aid to stop bleeding and prevent further damage.

If your horse experiences a non-life threatening wound, you may be able to manage it on your own, without requiring veterinary intervention. However, severe wounds should be examined by a veterinarian as soon as possible.

Here is a comprehensive guide to administering first aid for equine wounds:

Step 1: Assess the Situation

Before approaching the horse, ensure the environment is safe for both you and the animal. Calmly assess the severity of the wound. If the wound is large or deep or appears to affect structures such as tendons or joints, call your veterinarian right away.

Step 2: Calm Your Horse

Approach your horse calmly and speak in a soothing tone. A stressed horse can make treatment more difficult and can potentially cause further injury to itself or the handler.

Step 3: Stop the Bleeding

If the wound is bleeding, apply direct pressure using a clean cloth or sterile gauze. For severe bleeding, keep pressure on the wound until veterinary help arrives. A polo or self-adhesive wrap can be applied over the cloth or gauze to apply pressure.

Step 4: Clean the Wound

Once the bleeding is under control, gently clean the wound with clean, cold water to remove any dirt or debris. If you can safely clip the hair around the wound, this will help you further assess the damage and keep the area clean. ^[5] Cover the wound when clipping to avoid contaminating it with hair.

For superficial wounds, washing with a mild antiseptic is also recommended, but avoid using strong disinfectants as they can damage tissues and delay healing. For deeper wounds, irrigation with sterile saline either with or without an antiseptic is recommended. ^[5] Drug stores carry antiseptic washes specifically designed for wounds. Veterinarians encourage horse owners and care takers to keep some on hand.

Step 5: Protect the Wound

If the wound is straightforward and your horse shows no signs of lameness, you can proceed with apply dressing and/or bandaging. ^[2]

Cover the wound with a sterile dressing to protect it from further contamination. If you don’t have a sterile dressing in your emergency first aid kit, a clean, non-stick or other lint-free cloth can be used temporarily.

Step 6: Immobilize if Necessary

If the wound is on a limb and there is a suspicion of a fracture, the limb may need to be immobilized with a splint. Do not attempt this if you are not trained, as improper splinting can cause more harm.

Step 7: Monitor for Shock

While waiting for your veterinarian, monitor your horse for signs of shock, which can include weakness, a rapid pulse, and shallow breathing. Keep the horse calm and still until help can arrive.

Step 8: Follow Veterinary Advice

Once the veterinarian arrives, provide them with any relevant details about what caused the wound and your horse’s health history. Follow their instructions for wound care and any medications prescribed.

If more than six months have elapsed since your horse’s last tetanus toxoid vaccination, a booster is recommended to prevent tetanus infection. ^[6]

Non-steroidal anti-inflammatory drugs (NSAIDs) like flunixin meglumine (Banamine), phenylbutazone (Bute), or firocoxib (Equioxx) are typically administered to manage pain and inflammation within the initial 72-hour period following an injury. After this period, they are usually discontinued as they may slow healing.

Antibiotics are usually not needed unless deeper structures are involved or infection poses a significant threat. ^[13] It’s important to note wounds older than 6 hours at time of treatment are likely to be infected.

Wound Cleaning

Knowing how to safely and properly clean a horse wound is essential for emergency care. The primary objective in cleaning a wound is to minimize the presence of necrotic (dead) tissue and bacteria. However, you will likely not be able to eliminate all bacteria from the wound.

Any form of cleaning, whether scrubbing a wound or using antiseptic agents will involve some amount of tissue debridement or removal. However, excessive cleaning can cause more harm than good by damaging viable tissues. ^[7]

Previously, it was recommended to scrub wounds, but researchers have since learned that this may actually delay wound healing by damaging healthy tissue. ^[7] Instead, only the intact skin around the wound should be scrubbed.

Studies indicate that minimizing mechanical scrubbing can lead to lower bacterial counts on the skin than the previously recommended five-minute scrub. ^[7]

Antiseptics such as povidone iodine, hydrogen peroxide, and acetic acid (distilled vinegar) can be used for wound cleaning and lavage. But keep in mind these solutions are cytotoxic and they can damage cells, including healthy ones.

Their use should be confined to the intact skin surrounding the wound, not the wound itself. ^[7]

Wound Lavage

Wound lavage, or flushing, is a gentle method to clean wounds and reduce contamination. It can be performed with a syringe, irrigation system, or a hose. ^[7]

For homemade saline, mix 8 teaspoons of salt in one gallon of boiled water. Avoid adding antibiotics to the lavage fluid to prevent bacterial resistance. ^[7]

When to Call Your Veterinarian

For severe wounds in horses, you need to involve your veterinarian. Veterinary intervention is warranted in the following circumstances: ^[2]

• The wound is large, deep, or bleeding profusely
• The wound affects your horse’s eye
• The wound is near a joint or tendon sheath
• The wound involves penetration of the hoof sole
• Your horse is lame or showing signs of pain
• Your horse isn’t healing as expected or their condition worsens
• Proud flesh (granulation tissue) appears in or around the healing wound

Catastrophic wounds require prompt veterinary assessment and are easier to manage in an equine hospital setting.

For instance, severe hemorrhage from a major blood vessel might necessitate surgical ligation or clamping to halt the bleeding. Conversely, bleeding from smaller vessels typically responds well to compression with a bandage. ^[5]

Veterinary Treatment for Wounds

In treating serious wounds, veterinarians may undertake a series of steps to promote healing:

1. Tissue Debridement: Using a scalpel, the veterinarian carefully removes any damaged or contaminated tissue. This type of wound debridement is less traumatic than rubbing or scraping the wound to remove debris. ^[5]
2. Wound Closure: Next, the veterinarian assesses whether the wound can be closed. For many wounds, this is not possible. If the wound is sutured, it will be left partially open or fitted with a drain to allow for drainage. ^[5]
3. Drainage: For wounds that are closed, a Penrose drain may be inserted. This soft, latex tube facilitates drainage from the wound, typically remaining in place for 3-5 days or until drainage decreases. ^[5]
4. Delayed Wound Closure: Also known as secondary closure, this doesn’t work well for horses due to wound retraction. The skin around a wound tends to retract from the edges of the injury, increasing the surface area of the wound, and making it more difficult to close. ^[5]
5. Skin Grafting: For lower leg wounds, skin grafting may be employed. This involves transplanting healthy tissue from a well-healing area, such as the cervical or pectoral area, to the wound site. This can prevent excessive granulation tissue (proud flesh) and expedite healing. ^[3]

Bandaging Wounds

Your veterinarian may also bandage the wound and ask that you keep it bandaged at home. Bandaging helps to ensure proper healing, especially with leg wounds.

Bandages offer several benefits in the management of equine wounds, such as:

• Helping to stop bleeding
• Preventing further trauma to the area
• Preventing bacterial contamination of the wound
• Restricting movement to stabilize the wound site
• Reducing swelling

Bandaging of wounds is often discontinued too soon or not done properly. This can impair wound healing and lead to the development of proud flesh. ^[5]

Best Bandages to Use

A proper bandage for horse wounds should consist of three distinct layers: ^[8]

1. Primary layer: This layer is placed directly onto the wound. It should be made of a non-stick material to prevent damage to new tissue when changing the bandage.
2. Secondary layer: This is the padding that provides gentle, uniform pressure to wound, helping to avoid constriction or excessive tightness. Materials like cotton, wool, or gamgee are suitable for this layer.
3. Tertiary layer: This is the outermost layer that secures the first two layers in place and adds additional compression. Vetrap® is commonly used for this layer.

How to Apply Bandages

Bandages must be applied correctly and used consistently to promote wound healing. Improper application can lead to complications:

• Bandages that are too tight can restrict blood flow and possibly cause damage to tendons and other tissues.
• Bandages that are too loose won’t provide effective compression.

If you’re uncertain about bandaging techniques, seek guidance from your veterinarian.

Before starting, gather the appropriate materials for the three-layer bandage and position your horse on a flat surface. Make sure the wound is clean and dry.

Step-By-Step Guide

Here’s a step-by-step guide for bandaging leg wounds: ^[9]

1. Begin with a sterile gauze pad, with or without a topical wound dressing, placed directly on the wound.
2. Apply the secondary layer by wrapping it around the leg, centering the padding over the wound.
3. Finish by wrapping with your tertiary layer, starting at either the top or bottom of the secondary layer and overlapping as you go. The secondary layer should be slightly visible at both the top and bottom of the tertiary layer.
4. For consistency, wrap the leg from front to back and outside to inside — counterclockwise for the left legs and clockwise for the right legs.

Aim for a bandage that is smooth and tight, without any wrinkles or gaps.

Bandaging Other Areas

Wounds over the knee or hock require a stacking bandage to prevent the bandage from sliding down the leg. It’s best to consult your veterinarian for guidance on how to properly apply a stacking bandage. ^[8][9]

Hoof bandages are more difficult to apply due to the shape and movement of the foot. Here’s a simplified guide:

1. Place a thin layer of rolled cotton on the bottom of the hoof, extending it around the hoof and up to the fetlock.
2. Secure the cotton with Vetrap®, starting from the bottom of the hoof and wrapping upwards, ensuring that a portion of the cotton is visible at the top, just above the edge of the Vetrap®. ^[9]

Remember, hoof bandaging requires precision and should ideally be demonstrated by a veterinarian or an experienced horse handler to ensure it’s done correctly.

Replacing Bandages

Bandages should initially be changed daily to check the wound for infection. ^[9] If the wound is healing well, you can reduce bandage changes to every 3-5 days or as needed if the bandage becomes loose or wet. ^[5]

Stall rest is recommended to restrict the horse’s movement and support the healing process in the early stages. As the wound heals, controlled movement can be beneficial for blood circulation to the affected area. ^[5]

Once the wound is filled with granulation tissue, continuous bandaging may no longer be necessary, except in highly contaminated environments or if the horse tends to chew at the wound. ^[5]

It’s common for horses to develop swelling, or edema, in the area once bandages are discontinued. This swelling typically reduces with exercise or by gradually reducing bandage use. ^[5]

Stages of Wound Healing

Understanding the stages of wound healing helps horse owners monitor the healing process and identify problems early. If a wound is not healing as expected, timely intervention can prevent complications.

Wound healing in horses involves four overlapping phases:

1. Hemostasis phase: The body quickly acts to stop bleeding and forms a blood clot over the wound. ^[4]
2. Inflammatory phase: Immune cells go on alert and begin to remove pathogens and debris from the wound, leading to swelling, heat, redness, and pain. ^[4][5]
3. Proliferation phase: Within 24-48 hours after injury, pro-inflammatory immune cells help form granulation tissue at the site of the wound. ^[4] New blood vessels form and skin growth commences 4-6 days after the injury. ^[5]
4. Maturation/remodeling phase: This phase begins two weeks after the injury and is characterized by wound contraction and scar tissue formation. ^[4][5] Remodeling may continue for up to two years, with tissue becoming more organized and restoration of normal collagen. However, scar tissue remains 15 – 20% weaker than the original tissue. ^[5]

Continued Care

Monitor the wound for any signs of infection or excessive granulation tissue (proud flesh), and consult your veterinarian if these occur.

In leg injuries which expose the bone, a dead bone fragment, or sequestrum, can develop and may need to be removed by your veterinarian. ^[5]

Different topical ointments can be used on open wounds as they continue to heal. Water-soluble ointments are preferred over oil-based ones.

Triple antibiotic ointments are commonly used, but silver sulfadiazine should be avoided in fresh wounds due to its cytotoxic properties. Likewise, nitrofurazone and chlorhexidine might hinder healing and are generally not recommended. ^[13]

Honey has been shown to improve wound healing in some cases. Specifically, manuka honey has been shown to accelerate healing in the first three weeks after a wound forms. ^[1]

If recommended by your veterinarian, a corticosteroid cream can be applied once weekly to prevent proud flesh. ^[13]

Stall rest is advised for serious leg wounds that require bandaging. Limiting your horse’s movement, especially in the initial stages, improve wound healing and prevents re-injury. ^[5]

Problems that Arise During Wound Healing

Complications can arise during the healing of equine wounds, potentially leading to extended recovery times, costly treatments, or in severe cases, euthanasia. ^[10]

Proud Flesh

One of the most frequent issues in healing lower limb wounds is development of exuberant granulation tissue, known as proud flesh. While granulation is a natural part of healing, too much can protrude above the wound, hindering skin closure and recovery. ^[8]

Proper bandaging can often prevent proud flesh by applying steady pressure to the area. If proud flesh does occur, it may require surgical removal or the use of topical medication for management. ^[4][8]

Additional Complications

Additional complications include infection, fly strike (myiasis or parasitic infestation), and ongoing bleeding. Chronic wounds that fail to heal are more typical in the lower limbs of larger horses and less so in ponies. ^[3]

The formation of bacterial aggregates, known as biofilms, can also impede healing. This is more common in leg wounds, possibly due to a weaker local inflammatory response and reduced blood supply causing reduced oxygenation in this part of the body. ^[4]

Other issues that can lead to impaired wound healing include: ^[3][5]

• The development of sarcoids at the wound site
• The presence of foreign objects in the wound
• Dead (necrotic) tissue remaining in the wound
• The horse’s poor overall nutritional or health status
• Inappropriate use of topical corticosteroids or harsh chemicals
• Too much movement of the affected area

Long-Term Complications

Wound sites can develop scarring that are often penalized as cosmetic defects in the show ring. Wounds to areas of high movement, like the shoulders, can develop scar tissue that limits range of motion. Rehabilitation is required in these cases. Wounds to muscular areas that involved loss of tissue can develop permanent indentations after they heal.

Preventing Wounds

Many injuries can be prevented with careful management and attention to the horse’s environment. Here are some ways to minimize the risk of wounds in horses:

• Keep your horse’s environment free from hazards such as sharp, protruding objects or broken boards or fencing.
• Monitor herd dynamics and separate aggressive horses if necessary.
• Regularly check equipment and tack to make sure it is functioning properly.
• Ensure that your horse’s living quarters are well-maintained and free of debris that could cause injury.
• Provide proper training and desensitization to reduce the risk of injury due to spooking or bolting.
• Use protective gear such as leg boots, bell boots, or fly masks when appropriate to prevent injuries during turnout or exercise.
• Implement a consistent grooming routine to check for early signs of injury or conditions that could lead to wounds.
• Ensure your horse is up-to-date with tetanus vaccinations, as wounds can be a potential entry point for the bacteria that causes tetanus.

Summary

Successful wound healing in horses hinges on timely and appropriate care, including cleaning and protecting the wound from further damage. ^[3] Wounds must be closely monitored for complications or signs of infection.

For severe wounds, involve your veterinarian as soon as possible. Delayed treatment can negatively impact healing and lead to a worse prognosis.

Being prepared to administer first aid for wounds can make a significant difference in the outcome of an injury. Always have a well-stocked first aid kit in your barn and know the basics of wound care.