The Healing Process

Nearly all horse owners have at one time or another, had to deal with flesh wounds. Regardless of the best stabling facilities possible and the safest, most ideal circumstances, horses will be horses. And it’s very likely they will experience injuries at some point in their lives. Depending on the severity of the wound, the healing process may require a long period of time along with special intervention and medications. Sometimes as an owner, it’s hard to know how the natural process of healing in the horse’s body should take place. For that reason, I thought it might be interesting to share with you a specific leg wound that most unfortunately occurred to one of our horses and the veterinary insight we received when we questioned whether or not we were caring for this animal correctly.

Dr. Mike Scott of Moore & Company Veterinary Clinic answered our concerns as follows:

I do not think you have much to worry about; this wound should heal well in the long run. It is relatively small and although it is in a relatively mobile location, it is basically a linear defect so once it begins contracting it should pull itself together from side to side to some degree. The final scar will only be about half as wide as the current wound.

The wound is relatively superficial, and does not go as deep as the tendons, the joint, or the carpal canal. This is a good thing, as it means that infection of these important structures is unlikely. Furthermore, the wound is mature enough that superficial infection should no longer be a concern. It is an open wound and it will have surface bacterial contamination and therefore some pus and exudate on the surface, but this does not mean that deeper tissue infection is present. In fact, the surface pus may contain some factors that are helpful in wound healing. As long as the horse is sound and the skin around the wound is not sore, there is probably no infection.

So now you are at the point that the initial trauma is over, the pain is gone, the tissues that were going to die have died and been trimmed away or sloughed off, and you have what looks like a relatively clean and healthy wound. Now you need to have 2 things happen: wound contraction and epithelialization. The wound will contract over time as long as there is not excessive motion or swelling (such as the development of proud flesh). These can be prevented to some degree by limiting activity and careful bandaging. In come cases we will apply a cast to overcome these 2 problems for a few weeks, but in this case the wound would be right under the upper edge of the cast. A cast would not work well here unless it was a full leg cast, which I do not think is worth the risk at this point. If this wound became very \”proud,\” a full leg tube cast could be applied but I would not go there at this point. I would just use a bandage and relative rest.

Epithelialization (growth of skin cells across the wound surface) is optimized when the wound is kept clean, warm and moist and when the wound is level. There aren’t any ointments or creams that have a great effect on accelerating this process. Again keeping the wound clean, protected and level is important. You also do not want to trim or damage the skin margins from this point forward as that is where the first new layer of cells grows from. There are some theoretical treatment which may enhance this phase of wound healing, such as the application of platelet rich plasma (PRP) or other biologically derived products that contain growth factors, or the use of repeated low energy shock wave therapy treatments.

I think that regular recheck exams are important to assess progress and watch for any issues, even if nothing much needs to be done. I think that following these suggestions should ultimately lead to a satisfactory outcome.