Minimizing Scars
Wound treatment and follow-up care have a significant effect on the degree of scarring that accompanies healing. Whether your horse suffers a minor scrape or extensive injury, he'll heal better if you heed the following guidelines:
When in doubt, consult your veterinarian. Not sure if a cut needs stitches or can heal properly on its own? Play it safe and contact your veterinarian early on. In most cases, suturing is best done within six hours of injury. Even if stitches are not necessary, your veterinarian may want to treat the wound to prevent infection.
Keep the wound clean and moist. Flushing the wound with plain water or saline solution is a safe way to clear dirt and debris from an open wound. Moisture also encourages granulation, epithelization and wound contraction.
Wounds that are left uncovered may benefit from daily cold hosing to prevent contamination, but avoid vigorous spraying of the site. High-pressure hosing may drive contaminants deeper into a fresh wound, and later it can harm the new tissues. "Water helps stimulate granulation tissue, and when you want it to appear, that's good," says Adair, "but epithelium is fairly fragile. If you pound it with water from a hose, you'll actually hinder it."
When possible, keep the wound covered. It's common sense that a bandaged wound remains cleaner, moister and better stabilized than an exposed wound, thus encouraging speedier healing.
Some studies show that wrapped injuries heal 30 percent faster than unbandaged wounds. But bandaging isn't ideal at every healing stage. Other studies suggest an association between bandaging and the development of proud flesh. "There's no clear answer to the question of bandaging," says Adair. "It depends on the timing."
In addition, bandaging effectively and safely demands a degree of practiced skill. A too-tight wrap can cause pressure sores, while a sloppily applied bandage can work loose. If you choose to bandage, use a nonstick pad against the wound as a barrier to the gauze, cotton or other absorbent materials that dry the tissues and can become embedded in the wound.
Restrict movement. Healing of lower-leg wounds may require limiting the recovering horse's activities or applying a bandage or cast to give epithelization a boost. Wounds elsewhere on the body may also need protection from rubbing, biting or other irritation that will disturb the fragile tissues.
Use topical treatments judiciously. There's been great debate over the benefits of topical agents in wound care. Some veterinarians support the use of certain topicals that may accelerate epithelization, while others reject "gunking up" a wound with ointments that disrupt natural healing and attract contaminants.
"The healing process can be viewed as an orchestra," says Knottenbelt. "Every instrument has a job to do. If you take one out, the orchestra is still recognizable, but it won't be as good as it can be. Anything you put on the wound can be harmful to the tissues."
Petroleum-based products, such as Vaseline, are generally cautioned against because they tend to promote proud flesh. Caustics, such as copper sulfate, are murder on granulation tissue and have no place in wound healing; even as supposed treatments for proud flesh, they do more harm than good.
Accept blemishes; revise significant scars. Even when you've done everything possible to facilitate healing, your horse may still end up with an ugly, hairless scar. In rare cases, scarring does affect function, as with facial scars that interfere with breathing or eyelid action. Surgery can be performed to remove or rearrange the scar tissue and rejoin the new wound edges so there is a likelihood of a more elastic and less disruptive union.
Revision can also improve the appearance of an ugly scar that has affected a valuable horse's show career or salability. But the results are not guaranteed. "The consequences may be even worse than the original scar," Knottenbelt cautions.
Skin from another part of the body is sometimes grafted to the scar-revision site to improve the final appearance, but, again, the results are variable. Skin grafts don't "take" to a fresh wound site as successfully as to granulating tissue in a healing wound. "In general, the thicker the graft, the less likely it is to survive, but the better the cosmetic effect will be if it takes," says Knottenbelt. "A grafted area will always be more fragile."
This article originally appeared in the April 2003 issue of EQUUS magazine.
