Prefacing this post with a disclaimer: Graphic wound images are contained in this post.
After working with particular clients enough, you get a feel for what kind of emergencies they do and do not call about. Depending on experience, knowledge and comfort level, some may call for a tiny cut or they may only call when it appears their horse may bleed-out. And with others, you never know what you’re going to find.
One of our clients left a message on the office phone the night before. Her mare had sustained a wound to her haunches that she thought might heal well on it’s own. She described the wound as superficial, probably a kick from a pasture mate. She said the wound was not bleeding and you couldn’t see any real obvious wound. She didn’t want to pay an emergency fee because finances had been tight, so the office asked if I was willing to work her into the busy day. Fortunately, we were running early and finished up with the day’s appointments a couple hours sooner than we thought.
On arrival, the small palomino mare was in a pen. I had seen her a couple months ago for a face laceration, and before that, an episode of choke. The mare was always suspicious as we approached her with a tote of supplies. Almost an entire roll’s worth of tape had been used to secure a bandage over the right gluteal muscles. As I pulled the sheet of tape off, I saw the soaked maxi-pad that the owner immediately commented on. “I figured, what’s more absorbant than a maxi pad, right?” I removed the maxi-pad and was surprised at the severity of the wound. It was definitely a wound requiring attention, and not superficial in the least.
An L-shaped laceration resulted in a large flap of skin. Beneath the flap of skin, was a deep gaping wound extending several inches into the underlying musculature. The owner must have read my expression because she soon asked “It’s bad, isn’t it?”
“It is big, and it is deep. But luckily, this is fairly fresh.”
We set about clipped the area, scrubbing the wound and exploring the extent of the damage. Meanwhile, the owner wracked her brain about what could’ve caused the wound. Most of the time we never find out what happened. It is unnerving, knowing that what sharp object inflicted the damage, still lurks in the field with the possibility of a second offense.
The front half of the laceration was sutured together easily enough. Dead space was minimized with a deep layer of sutures, and the skin was re-opposed with simple interrupted. Since some dead space existed, and considering the extent of the wound, a Penrose drain was placed. The mare was started on Excede, with the plan to add SMZs due to expense. Bute and SSD were also dispensed. The owner would continue on-farm care involving flushing the wound and readjusted the drain daily. Vaseline was applied to prevent scalding of the back leg from constant drainage that was sure to ensue.
Based on the location, a simple bandage was not possible. We put in 8 stay sutures that would allow us to feed a shoelace through just like you would a tennis shoe. This shoelace method, a tie-over bandage, would secure a clean towel or pad to the wound. Unfortunately, I did not remember to take pictures of the finished work.
In 4 days, the drain will be removed. If the skin flap survives, the owner will continue to flush the wound daily and may also end up packing some of the wound with gauze. However, profound swelling and reduction of dead space, did not allow for room to pack the wound.
It has been a couple days now, and due to financial concerns, the owner could not afford for a recheck. We will be back to remove the external sutures in 10-14 days, and next time I’ll be sure to take more pictures.