Case Study: My Lesson in Wound Care

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At first the wound didn't seem as if it would be a big deal?just one of those injuries that horses suffer to ?annoy? you. We never imagined that it would require a surgical procedure, take 90 days to heal, and radically change my competition plans for the year.

It began in late March, when my mare Firebolt, aka Alba, came in from her night turn-out with a deep abrasion (think serious road rash) on the outside of her right hind leg, just above the coronet band and just in front of the outside heel. I suspected she?d brushed against a rock.

I cleaned it with Betadine soap and sprayed it with an antiseptic and?since we were to drive 500 miles in a few days to compete in open preliminary and we were in the midst of a rainy, muddy California winter?I decided to confine her to her stall to keep the wound clean and dry.

That strategy worked well initially, as Alba earned her best dressage score ever (30.00) and was one of only three horses in the division to jump completely faultlessly around the cross-country course, to finish fifth. And when we got home, the wound looked to be healing well, so I started turning her out again.

But the wound only became worse. It turned red and angry looking and painful. Alba was obviously not wanting to bring her right leg under her and push off. It also started developing proud flesh and was more painful. See?Wound progression photos, Sutures and Location.

CLEAN, MOIST AND STILL.? that's when I asked Dr. Grant Miller, my Horse Journal colleague, to look at Alba?s wound. Grant said he should immediately surgically debride the wound?which means to cut off the growing proud flesh. The wound needed to be kept clean and moist with a wrap and wound dressing, and we needed to limit Alba?s movement, which meant she was confined to her stall with only 10 minutes of hand grazing per day.

Grant showed us how to put silver sulfadiazine cream on a non-stick pad, then wrap gauze around the hoof and leg to hold it in place. Then we wrapped an entire adhesive bandage around the hoof and lower leg (similar to what you do for an abscess) with an outer criss-cross pattern of duct tape to envelope the entire hoof and lower leg. We changed the bandage every two to four days, depending on how quickly Alba wore through it.

CROSSED FINGERS. Grant performed the debridement on May 4, nearly six weeks after the injury happened. Alba was supposed to contest the classic-format CCI1* at Rebecca Farm in Montana on July 12-15?nine weeks away.

So while Grant dexterously cut away the proud flesh and Alba?s leg bled profusely, I crossed my fingers. I was particularly eager since Alba, a 15.2-hand, appendix Quarter Horse mare, had proven that she is a fine three-day event horse.

As the weeks progressed, the wound healed steadily, but Grant? warned that riding her again before the wound had healed completely would be one of the worst things I could do. So, I canceled her entry in what was to be her final horse trial before the Rebecca Farm three-day event. That left four to five weeks of training and conditioning time between putting her back to work and the July three-day event.

Unusually, my primary concern wasn?t her cross-country fitness. She was extremely fit when she began stall rest. But how much of an effect would five weeks of stall confinement have' I wasn?t sure.

My greater concern was Alba?s show jumping practice. The only thing Alba had done before her previous owner abandoned her with us in 2008 was barrel race, and the directive of ?20 seconds, as fast as you can!? has never entirely left her.

Show jumping reminds her most of barrel racing, and my strategy for dealing with that memory is to school her over a limited number of relatively low jumps two or three times a week. Basically, I try to keep show jumping from being a big deal to her.

RIDING AGAIN!? Finally, on June 5, Grant said we could stop wrapping Alba?s leg and start light work.? I spent the first week just walking her, to help her regain her strength and suppleness. On June 12, I optimistically sent Alba?s entry to the July three-day.

The most obvious effect of her incarceration was that her right hind foot had grown about half an inch longer than her left?because she wasn?t standing on the hoof or using the leg. Our farrier, Mike Piro, trimmed her on June 14. He didn't drastically trim that hind foot, concerned that he?d make her sore.

After Alba had been trimmed, I started to work her on the flat, and I noticed that she was still swinging her right hind leg abnormally.

We suspected that Alba was suffering from a compensation injury, that the right hind was weak from six or seven weeks of abnormal or non-use, and that the left front shoulder was tight or stiff from her attempting to displace her weight on to it. It would be 10 days before our equine chiropractor, Dr. Suzanne Guyton, would be here.

But that was 10 days I didn't have, if we were to get to Rebecca Farm. I canceled the entries.

THE RIGHT DECISION. Skipping the three-day was the right decision. Even with her chiropractic adjustment, it took two weeks before Alba felt 100 percent. I spent those two weeks stretching and massaging her myself and doing numerous stretching, strengthening and suppling exercises under saddle.

When I spoke with Grant again, he said, ?Alba?s wound healed better than I expected, due to the fact that you actually followed and stuck to my recommendations and did not deviate halfway through and make it worse again?which is what the majority of the clients do because they listen to somebody other than their vet.?

Grant also prescribed rubbing vitamin E oil into the wound site for several weeks, to prevent the build-up of scar tissue and assist the body in replacing genuine tissue at the wound site.? ?Scar tissue is just filler tissue?it has very poor load transferability and virtually no elasticity,? Grant told me.

REGROUPING.? After four-plus months away from competition, Alba returned to competition at Woodside in mid-August, the start of her prep for the classic-format CCI1* at the Galway Downs International Three-Day Event, which ended up canceled. She was certainly ready for cross-country and zoomed around the course perfectly, as if she hadn?t been away at all. Her next two trials went equally well, and I'm now preparing Alba to move up to intermediate level next spring.

Article by Performance Editor John Strassburger.