Equine Wound Care

1. A feral pony was discovered on a local marsh refuge with a deep laceration and large puncture in the center of the wound. The wound is a line extending around the entire rear of the right pastern between the heel bulb and base of the fetlock and goes around to the inside of the pastern. I suspect it was caused by barbed wire. The pony has been brought to a large corral area of grass and dirt/sand. Flies and gnats are in abundance this time of year and landing on the wound. The veterinarian was able to examine the wound on day two and decided to leave it alone and administer antibiotic injections for two days. The pony's long, thick fetlock hair is now filled with sticky serum and blood which has become caked with dirt and evident on day three. Swelling in soft tissue and tendon areas above fetlock are now seen with the mare resting her foot. It has been reported by some that she is not lame, but another report said it looked like her hoof was "flopping" when she walked. However, no verifications to either of these reports. There has been no evidence of cleaning or bandaging the wound. She is loose in this large corral with also a stallion, mare and foal. Is this the correct wound care protocol for a case like I have described being that she is feral? (View Answer)

   From the conditions you described, I would elect to treat the wound using open wound management. Such would involve cleaning the wound 1-2 times daily using povidone iodine (Betadine) scrub and water. After cleaning and rinsing the wound, I would apply a topical antiseptic such as silver sulfadiazine cream, betadine ointment, or triple antibiotic (Bacitracin-Neomycin-Polymixin) ointment. Systemic antibiotics may be used if you suspect infection exists. Please provide photos for additional information. Nolton Pattio, VMD, Rancho Cucamonga, CA

2. I own an 8-year-old Kentucky Mountain Horse mare that exhibited some lameness in her left front leg approximately one month ago. Looking back, it occurred during the time we were beginning to turn our horses out on grass during the summer. We always do this gradually and have never had an issue with any of our horses previously. The lameness resolved after a few days with seemingly no further issue. I have been riding my mare since then and she has not exhibited any signs of pain. Recently, during a trim (our horses are barefoot,) my farrier noted some widening and damage to the white line in that same left front hoof. My vet said to treat the white line disease with Clean Trax but said adjusting grazing, feeding, etc. wouldn't help now. Should I assume the lameness was due to laminitis? Where do I go from here? Is it still very serious despite resolution of the lameness? My mare is only 8 and have raised her from a foal and have done all her training myself. I keep questioning myself.. what mistake did I make that led to this? And the more I learn about laminitis, the more fearful I become. A little direction would be most appreciated. (View Answer)

   It is difficult to assess the cause of the lameness previously displayed by your mare.  Laminitis is usually a chronic condition, and the fact that the lameness has improved and you are riding her without any apparent difficulty suggests the condition may have resolved.

    

   The changes that you see in the white line do not necessarily suggest laminitis.  We may never know the exact cause of your mare's lameness, but it is good news to read that she is not displaying signs of lameness and is useful again. Nolton Pattio, VMD, Rancho Cucamonga, CA

3. I have a yearling Quarter horse colt that has eight perfectly round sores ranging from the size of a bean to a nickel between his hind legs where they rub together. The sores are slightly raised around the edges and ooze a yellowish clear liquid. They don't seem to bother him but I am worried as to the cause and how to treat them? (View Answer)

   The sores between the hind legs may be caused by trauma or other irritation to the skin. The lesions may or may not be infected. The drainage may be serum or purulent exudate (pus). Please send pictures of the lesions for additional information. Nolton Pattio, VMD, Rancho Cucamonga, CA

4. Is it preferred to use a probiotic spray on minor wounds instead of disinfectants, iodine, etc.? (View Answer)

   I think minor wounds are best managed using dilute antiseptics such as povidone iodine (Betadine) scrub and water. I would not use a probiotic spray for wound care. Topical antimicrobials such as silver sulfadiazine 1% cream, Betadine ointment, or nitrofurazine ointment are also useful. Nolton Pattio, VMD, Rancho Cucamonga, CA

5. I have a horse recently diagnosed with auto immune disease, after multiple rounds of testing. In the winter, he will get open oozing sores on his back pasterns. The biopsy shows vasculitis, cultures (at various times in the disease process) have shown strep. zoo, and most recently MRSA. The biopsy site was taken in December 2017, and remain crusty. Antibiotics (TMS, ceftiofur, baytril) have no effect on the wounds, neither do creams and/or sprays (derma gel, silvasorb, chlorhexidine 2%/4%, scratches steriod crea) as the wounds remain crusty. Chlorhexidine 4% spray leaves a chemical type burn with on the area with skin dying, peeling and remaining tissue very inflamed. Currently, he is on azathioprine, which began in Jan-Feb 2018 and has helped close the biopsy sites, but has not helped with the crust that continues to grow on the site. What options exist for these chronic non-healing type of wounds? Especially when standard/conventional treatments make no changes. (View Answer)

   It appears that you have gone quite the distance for diagnosing and treating your horse.  Biopsy results indicate vasculitis and bacterial cultures have shown Strep and Staph spp.  DDx autoimune (immune-mediated) disease, the treatment of which has been met with challenges and is largely unsuccessful.

    

   At this point, I would try cleaning the pastern wounds with povidone iodine (Betadyne) scrub and water.  I would lather the wounds and scrub twice daily, each time allowing the lather to remain on the skin for 10 minutes prior to rinsing off with clean water.  Following rinsing the pastern wounds, I would dry them with a clean, dry towel and allow to air dry for 15 minutes.  Apply small amound  of silver sulfadiazine 1% cream (Silvadene) after drying the wounds ... do not bandage.

    

   Do this process twice daily for 2 weeks ... please report results ... good luck ... ! Nolton Pattio, VMD, Rancho Cucamonga, CA

6. My horse has been slightly off with lameness in which my veterinarian advised sweating the legs with furazone. By the second day of wrapping, his legs were scalded and ended up with horrible fungus on front of his canon bones. My question is: when treating this condition and after washing, should the heavy scabs be debrided before applying medication or leave them alone? I am getting contradictory answers from the veterinarian and the product manufacturer. (View Answer)

   Based on what you wrote, your horse is allergic or hypersensitive to nitrofurazone ointment, which was used as a sweat to treat lameness. Topical nitrofurazone application irritated (blistered) the horse chemically, and may have resulted in fungal infection on the dorsal cannon region.

    

   I suggest discontinuing the use of nitrofurazone ointment. I would wash the legs twice daily with povidone iodine (Betadyne) or chlorhexidine (Nolvasan) scrub solution and water. Apply to wet cotton and produce thick lather. Lather leg wound lesions and scrub ... allow scrub solution lather to remain on legs for 10 minutes prior to rinsing with clean water. Dry legs with clean, dry towel.  

    

   After drying the legs, apply silver sulfadiazine 1% (Silvadene) cream to dorsal cannon lesions, and leave open (do not bandage).  The scabs should soften and be easily removable with the next scrubbing session.

    

   You may want to try this treatment for 2 weeks and see if there is improvement ... good luck to you and your horse. Nolton Pattio, VMD, Rancho Cucamonga, CA

7. My horse and I currently live in Florida and I can't prevent my horse from getting summer sores. How can I prevent this and what is the best method of treatment? (View Answer)

   Summer sores, also called cutaneous habronemiasis, usually involves a skin wound that gets infected with fly eggs and larvae. It is common in Florida, especially during the summer months. Fly control, in both the environment and on the horse, are essential elements in the prevention of summer sores. Adequate grooming, stable management, routine deworming and parasite control are helpful in the prevention of summers sores in horses.

    

   Diagnosis of summer sores in the horse involves veterinary consultaion. Your veterinarian may decide to biopsy the granulomatous skin lesion to confirm the diagnosis of habronemiasis. Other similarly appearing, granulomatous skin lesions in Florida horses include exhuberant granulation tissue (proud flesh), sarcoids, phycomycosis (fungal wound infection, also called leeches), and skin cancers such as squamous cell carcinomas, cutaneous lymphoma, etc. These and other skin lesions may appear grossly similar, and a biopsy and histopathology (laboratory, microscope, pathologist) may help to differentiate one lesion from another or confirm the diagnosis.

    

   Treatment of summer sores include deworming the horse with ivermectin or similar class dewormers such as moxidectin or Ivermectin Gold to kill the fly larvae in the wound and to improve wound healing. Fly sprays are also used to reduce further fly related complications. Adequate wound care management such as daily cleaning with povidone iodine or chlorhexidine scrub, and applying a wound care dressing with fly preventative (Swat) is also useful in the treatment of summer sores.  In severe, non-healing, complicated or recurring skin wound cases, surgical debridement and resection of the lesion may be necessary.  

    

   Please consult with your veterinarian concerning the particulars of your case for specific wound care management ideas. Good luck to you and your horse. Nolton Pattio, VMD, Rancho Cucamonga, CA

8. I have a 6-year-old Quarter horse gelding that recently had a small cut on the bulb of his heel. It was healing nicely until he scraped the scab off with barb wire and the cut is now infected and that side of his heel is swollen. Is there something I can do prior to the veterinarian’s examination? (View Answer)

   Cuts and wounds on the heel bulb can be difficult to manage; due to their location, ground proximity, and wound tension, wound healing may be delayed.  Heel bulb wounds may reoccur due to additional trauma.  

    

   Treatment may involve surgical repair either by suturing the wound edges or by removing a flap.  Systemic or local antibiotics may (or may not) be used.  The wound should be kept clean daily using an antiseptic wound scrub such as povidone iodine (Betaine) or chlorhexidine (Nolvasan).  You may apply a topical wound dressing such as Betadine or nitrofurazone, triple antibiotic, Swat, or other antimicrobial wound treatment ointment.  Silver aluminum spray (AlluSpray) may also be used topically.  

    

   You will need to decide whether or not to bandage the heel bulb wound, depending on time, traumatic recurrence or contamination issues, infection, wound tension, and other factors.  In some cases, the heel bulb wounds can be successfully managed by leaving the wound open, without a bandage, and applying silver aluminum spray topically 1-2 times daily.  The outcome may result in a scar, but the horse usually returns to complete function, depending on the case.

    

   Consultation with your veterinarian will be useful concerning treatment options and the specifics of your  situation. Nolton Pattio, VMD, Rancho Cucamonga, CA