Digging Deep

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Penetrating wounds are a serious concern wherever they occur. The goals in all cases are the same: to stop the bleeding, protect the injury, and prevent infection. But deep puncture wounds of the foot have their own special needs as well. So, here’s a quick run-down of an all-purpose treatment program, with specific attention to the foot.

Open Wounds Defined

1.?Partial thickness wounds

• are caused by a sharp or jagged object;

• do not penetrate through all layers of the skin;

• the cut edges stay close together;

• typically, the bleeding is minimal and controlled easily.

2. Full thickness wounds

• typically occur when a sharp object cuts through all layers of the skin and may also penetrate the deeper underlying tissue;

• the skin edges will gape open;

• there may be profuse bleeding.

3. Puncture wounds

• are commonly caused by a sharp object such as a stake or nail;

• generally do not create much blood flow, unless a major blood vessel has been penetrated.

With puncture wounds it’s best to contact a veterinarian if the situation involves eyes, muscles, bone, or is located over a tendon sheath or joint, or if the horse is lame on the injured limb, has a fever, or if the wound is likely to have penetrated the chest or abdomen.

Stop the Bleeding

Whether the wound is spurting bright red blood (arterial) or trickling dark red blood (venous), or both, there are two methods for stopping the bleeding—the pressure dressing and the tourniquet (the pressure dressing is preferred due to its safety).

Bandaging is most effective on leg and foot wounds; wounds on the face and upper body are more often too difficult to manage. Be sure to place several sterile gauze pads over the wound and pad the leg well (pillow wraps or double sheet cottons, are best) to prevent the bandage from becoming too tight.

Find out if the horse is up to date on his tetanus toxoid vaccine (within the year). If not he’ll need one, as well as a booster vaccination.

The Pressure Bandage

If the wound is on the body, apply steady pressure with a clean bandage or towel for at least five to fifteen minutes. Loosen or remove the bandage if there is swelling below the point at which it is applied. If the wound is on the leg, take several pieces of clean linen or sterile gauze and position them over the wound before bandaging. Make sure not to wrap the leg overly tightly, as you can cut off the circulation.

If blood is spurting from the wound before pressure is applied, or if after several minutes the blood is soaking through the pressure bandage, call a veterinarian.

Tourniquet

A tourniquet is used to stanch a spurting arterial wound on the leg or tail. It should be placed between the heart and the wound (above the wound). Loop a piece of gauze or cloth around the limb or tail, and then tighten it by hand or with a long cylindrical object (a stick will work) positioned inside the loop by twisting it. Keep twisting until the squirting stops, and call your veterinarian. Release the tourniquet every 30 minutes for five minutes to allow blood to enter the site.

Wound Care

Once the bleeding has subsided, the wound should to be cleaned. Clean water or normal saline is the preferred choice to clean wounds. Hose it with a moderate flow of water to flush out the dirt and debris from the wound (use a clean wet cloth for wounds on the face). Do not remove the bandage to clean the wound if the bleeding is severe enough for you to have called the veterinarian—just wait.

When the wound has been thoroughly cleaned, assess the damage. If the skin edges are separated, or muscle damage or tendon injury is present, contact your veterinarian for deep tissue evaluation and suturing.

Do not apply antiseptics, detergents, creams or powders—they interfere with healing. However, a mild antibiotic ointment may be applied to prevent the area from drying out. Note that povidone iodine (Betadine 10 percent solution), chlorhexidine diacetate two percent solution (Nolvasan) and three percent hydrogen peroxide are too caustic and can damage sensitive tissues.

Your veterinarian should determine if systemic antibiotics are needed. While they are not needed in all cases, depending on the cause, depth, and involved structures, there may be instances where antibiotics would be necessary.

Deep Puncture Wounds of The Foot

Commonly occurring in the bottom of the foot and typically caused by a sharp object (nail, broken glass, metal pieces or stakes), puncture wounds should not be taken lightly even though they generally don’t produce a lot of blood. They are a frequent cause of immediate lameness, and can be extremely serious. If you’re lucky, the object will be visible, making for easy identification and a subsequent treatment plan. However, if it is not apparent, such as when it has entered the frog, the journey to an accurate diagnosis can be a long and arduous one, even with the help of a hoof tester or radiographs.

Note: if you see a nail sticking out of the foot near the frog, it is best to leave it, not move the horse, and call the veterinarian who will be able to tell which direction the nail penetrated, the length of penetration, and if he/she needs to do a contrast injection with radiographs to see if the joint, bursa, or tendon is penetrated. The reason for this is that if the nail is taken out beforehand, often the hole will close in an hour, and you won’t be able to locate it. If you do pull the nail, however, be sure to save it, and mark on it the depth of penetration.

That said, a puncture wound to the sole is even more of a concern, as there is no direct drainage point to the outside. Therefore, an abscess beneath the sole will generally travel to the coronary band to find an outlet. Black spots on the white line, also caused by a puncture wound, similarly indicate an abscessed pocket underneath, which is referred to as a “gravel.” And, like a puncture wound in the sole, a gravel is likely to take the path of least resistance by making its way to the coronary band to drain.

What’s worse, though, is if the infection does not find a drainage point and spreads internally. In that case, it can become the architect for a number of potentially devastating conditions, including bacterial laminitis, tetanus, and septic arthritis of the coffin joint, infection of the Navicular bursa, or deep flexor tendon, all of which may lead to osteomyelitis (navicular bone infection) and blood poisoning.

Treatment

To avoid the more severe complications, a veterinarian and farrier should be called to establish a ventral drainage tract at the wound’s entrance, and again, the veterinarian will determine if systemic antibiotics are indicated. Not all sole abscesses have to be treated with antibiotics, but all should have ventral drainage.

Once the abscess is exposed, you’ll need to keep the tissues hydrated to encourage drainage for 3 to 7 days. Drainage prevents the wound from closing prematurely and keeps infection in check. Essentially, you want the foot to stay soft and supple so that it will heal from the inside out.

Apply a poultice or do warm water soaks with Epsom salts at least twice a day. A draining wound should be redressed every day for the first 3 to 7 days; you don’t want the seepage to leak through. Using a disposable diaper is a good way to prevent this and to provide extra cushioning.

Note: if there’s no obvious improvement within three days, it could indicate a more serious problem, in which case your veterinarian will need to examine the foot and possibly take radiographs or perform specialty radiographic procedures.

You can begin the drying phase of treatment by irrigating the area with povidone iodine solution followed by a packing of povidone iodine-soaked gauze before bandaging.

The horse should be confined to a clean, dry stall until healing is well established. In complicated or severe cases, a protective shoe may be needed to protect the injured area.