Wound Wars: The Battle Of Proud Flesh

Proud flesh:  the nemesis of wound care.  When you have any open wound that can't be stitched (which seems to define nearly all horse wounds), you have to wait for them to fill in on their own with granulation tissue.  However, this tissue has a serious overachievement problem & inevitably multiplies into a cauliflower-esque explosion of cell growth that protrudes well above the skin surface.  It then blocks the migration of healthy skin cells that would otherwise move in to close the wound.

It is particularly problematic in areas of poor blood supply & high motion, like the lower legs.  Where 100% of my horses' wounds were.  Of course.

If the wound in located somewhere you can apply a pressure bandage, like a standing wrap, you can prevent proud flesh.  When those cells can't push outward, they seem to just give up & pout, giving the good cells room to do their magic.  This was awesome for 25% of our wounds, specifically, Solo's skinned cannon bone.

You can see by mid-Sept the bone is once more covered by a sub-layer & as of this weekend, new skin has covered more than 50% of the original area.  I'm keeping a non-stick pad coated with Dr. Bob's Magic Red Sauce + standing wrap on this until it's filled in more, as one less place I have to fight the evils of proud flesh.

Solo's hock has been the primary battleground.  High motion, impossible to pressure wrap, with a horizontal cut destined to pull apart - it was inevitable, really.  The Magic Red Sauce (I don't know all the ingredients in this concoction) is supposed to help both retard proud flesh & encourage epithelial cell growth, but its magic definitely has limits.

I was scrubbing madly with my dilute betadine, but it wasn't enough, so mid-Sept, I called Dr. Bob.  He knows I do surgery on endangered species (& they live), so he gave me permission to get aggressive.  Really aggressive.  I dunked the knife & scissors on my multi-tool in the beta-water & charged back into battle.
 
The one good thing about proud flesh is that it doesn't contain any nerves, just a zillion blood vessels.  So it will make an unholy mess when you hack (very carefully) away at it but your horse won't feel a thing.  This wasn't a super fun addition to the twice-a-day cleanings & it made them even longer, but Solo dozed patiently while I chopped off endless tiny tissue nodules, just trying to keep it roughly even with the skin surface.

Front

Looking good today (white is Corona)

Lateral side

Today's view, still a little proud flesh, but the skin will soon swallow it

After scrubbing, I would alternate between polysporin & Magic Red Sauce.  I am happy to say that after several weeks of battle, not only is the proud flesh on pouty retreat, but the front hole has finally closed, meaning no more diaper wrapping & ending the 2-roll-a-day vetwrap suffering!  There is still some fill in that hock, so it gets hosed daily, but has drastically reduced with today's cooler weather.

Echo's return to work was delayed by the fact that it took me an hour to do Solo's bandage when I got home from work, after which it was basically dark.  He is now back under saddle, though, for the past 10 days.  He is almost completely healed.  The friction burns on his chest have vanished under his new winter parka-in-progress, you can't even tell they were there.

Top is Sept 3, bottom is Sept 27

Proud flesh did rear its ugly head on his knee, so it also got the knife & is now gasping its very last, tiny breaths.  A few more Red Sauce treatments & it too will vanish.  The cut on the outside of his cannon is a small scab hidden in fur.

My knife hasn't been needed in several days.  Both boys are sound & happy.  So much so that my next story for you involves a lesson (OMG, a lesson!!?!) in which Baby Monster is making some very exciting progress.

Coming soon...

Read More

Tricks of the Equine First Aid Trade

Since I am currently using nearly all of the equine nursing tricks I've developed over the years, I wanted to share a few products I've adapted from the human world.  In many cases, this is much cheaper than buying "horse" labeled products, as we all know that's an automatic 300% markup. 

Horses & humans may both be mammals, but are NOT interchangeable, so product transference should always be done with caution.  I check with my vet before I try anything new.  And Dr. Bob himself has suggested several of them!

In my wound care kit right now:

• Generic wound wash from CVS -- a mix of antiseptic & lidocaine, this stuff has become the first thing I grab for cuts & scrapes.  Dr. Bob first mentioned something like this when Solo got staples in his head last year, as the lidocaine reduces itching so they don't rub on everything.  I squirt on a clean cloth to apply & a bottle lasts me a long time (uh, usually).
• Non-stick wound pads (biggest size available) -- fabulous for things on legs that get wrapped.  In the last post, you can see one sticking out of the wrap around Solo's cannon scrape.  I've found that if you leave a little sticking out above the vetwrap, it helps prevent the pad from sliding out the bottom.  They absorb without peeling off healing tissue when you change bandages.
• Nitrile gloves (altho medium is of course too small for my giant man-hands) -- not sterile, but cleaner than my fingers & saves me from having to wipe 5 different kinds of goop off my hands.  I also like that the blue is easier for me to see when I drop it or it blows out of a trash bucket.
• Polysporin -- a long time ago, a dr. told me that 10% of people develop allergic responses to Neosporin, so polysporin was a safer choice.  I don't know if this is applicable to horses or not, but I've used the poly ever since on full-thickness cuts & it works well.
• Colored duct tape -- I always tape wraps/standing bandages that are worn unattended.  I try to get tape that is a different color than my standing wraps so I can easily see from a distance if it's still there, but I had blue left over from something else, so oops.  
• Gorilla tape -- I usually only use this for hoof wrapping, for which it is a godsend, but I was about to run out of duct tape, so have also used it on standings.  It has not left a residue or caused any damage to my standing wraps.

The discolored gladware with 3 little syringes is my wound lavage kit.  NCSU vet school taught me this method when I had to clean out Solo's healing head-holes.  Add a little Betadine to water, so it's a diluted mixture, about the colour of weak tea or lighter.  Use the syringes to flush out the wound.  Syringes allow you to control direction & pressure of stream pretty well.  Because Betadine is cytotoxic, you never want to use it full strength on an open wound & even dilute, use only when needed to prevent infection/flush out debris.  It will stain whatever container you put it in, so pick something you don't plan to eat out of later.

Finally, the big fat syringe is just a dosing syringe with the tip cut off, making it easier to give dissolved stuff like SMZs without losing 1/3 of your dose stuck in the plastic tip.

What about you?  Do you have favorite products you've adapted to equine use?

Read More