Our equine friends often have a nasty habit of getting themselves into trouble - some more than others! Wounds are a common reason why a vet is called in an emergency. You may not have witnessed how an injury has happened, for example if your horse or pony comes in from the field with a wound, so it is important to know what to check for when deciding whether you will need to call your vet:

• Is your horse very lame? Severe lameness with a wound can indicate vital structures such as a joint, bone or tendon are damaged or infected, and needs urgent veterinary attention.
• Is there significant swelling around the wound? Swelling can occur for different reasons, sometimes just due to the impact that has caused the wound. However, it may also indicate infection, a foreign body, or again, damage to vital structures, so veterinary assessment is always recommended.
  
• Is there severe bleeding from the wound? Although a little blood goes a long way, significant blood loss is always a veterinary emergency, and you should contact your vet as soon as possible. In the meantime, a clean non-stick dressing and a vetwrap-type bandage should be used to apply pressure to the wound to stop or reduce the bleeding.
  
• Is the wound large? Large lacerations or de-gloving injuries clearly need immediate veterinary attention – if they are clean, try to keep them that way until the vet arrives, as this will help healing.
  
• Do you think the wound may be suitable for stitching? Time is of the essence in these situations, as closing a wound with sutures or staples needs to happen within six hours for optimal healing. Closing the wound may significantly reduce healing time and may also improve cosmetic outcome. Some wounds are not suitable to be closed, however your vet will be able to advise you on this and make an alternative plan for managing the wound if necessary.
  
• Is the wound near to, or involving, the eye? Eyes are very delicate and often susceptible to injury, especially in certain breeds which have prominent eyes (such as Welsh and Shetland ponies). Even a small cut to the eyelid margin can cause long term problems with eyelid function, and if the surface of the eye is damaged this will need specific, careful treatment. Getting the eye checked if there is an injury is always important.
  
• Has the wound potentially been caused by a kick from another horse? Although the wound itself may be minor in these situations, damage to underlying structures from the impact of the kick (such as fracture of a superficial bone) may be more significant than the wound itself, so veterinary examination is always recommended.
  
• Is there a potential for infection? Heavily contaminated wounds, any deep or penetration wound, and wounds in certain locations such as on the lower limbs or involving the mouth, are all at high risk of infection. Very careful cleaning of the wound will be vital in these situations, and your vet may need to administer and/or prescribe a course of antibiotics. Appropriate dressings may also reduce the risk of infection depending on the nature of the wound.
  
• Is the wound from something penetrating into the deeper tissues? These can easily introduce infection and leave foreign bodies such as splinters of wood. Although the wound may look insignificant on the surface, looks can be deceiving and small punctures that have gone deeper than skin thickness can cause severe problems.
  
• Does the wound involve a bone or tendon? If you suspect this, or can see either of these structures, the wound needs immediate veterinary assessment.
  
• Is the wound near or over a joint? If a wound communicates with a joint i.e. there has been penetration into the joint, or if the joint capsule has been torn when the wound was sustained, this is likely to lead to a joint infection. You may be able to see joint fluid (thick, stringy and usually yellow fluid) coming from the wound, however penetration of the joint can still occur even with very small puncture wounds. The same applies to tendon sheaths. It is vital to establish whether a joint or tendon sheath is involved as soon as possible. Without treatment, infection can lead to a severe arthritis that can be life-threatening due to the severity of lameness it can cause. Surgery is usually required in these cases.
  
• Has your horse stood on a nail creating a penetration wound of the foot? The location of the nail, type and length of nail, and direction of the penetration are crucial. Leave the nail in place wherever possible and try to prevent further penetration by not moving the horse. If the horse must be moved, it is essential to apply padding the foot so that no weight is put onto the head of the nail when the horse walks. If you feel you must pull the nail out – for example, if the nail will work its way further in if left – take a photo of the foot first. Mark where the nail went in, mark the nail at the depth it went into the foot and note the direction of penetration. Then apply a clean poultice and keep the nail/screw for the vet to see. Time is critical in these cases, and x-rays are the only way to visualise the depth and direction of the penetration. Further advanced imaging (e.g. MRI) may be required to fully assess the foot structures involved if x-rays are inconclusive. Surgery may be required, and any delay in initial examination and subsequent appropriate treatment or surgery may significantly reduce the chances of a horse returning to soundness and their previous job.
  
• Is the wound in a location likely to have healing issues? For example, is the wound in an area of high motion such as over a joint? Or is the wound on the lower limb and therefore have a poor blood supply? Does the location of the wound increase the infection risk (discussed above)? All of these factors will be considered by your vet when making a treatment and management plan for your horse.
  
• Is your horse is vaccinated against tetanus? If the answer to this question is no, you should ask your vet to attend as an emergency for any wound, no matter how small, as tetanus infections from wounds can be fatal. Even if you do not have a wound and your horse is not yet vaccinated, make an appointment with your vet to get you horse covered for tetanus as soon as possible.
• Does the wound smell? Is there discharge coming from the wound? Can you see maggots? All of these things suggest the wound is not recent (and potentially infected) and will need urgent veterinary attention.

Being Prepared

It is helpful to know some basic anatomy to be able establish whether critical structures such as tendons are involved- there are courses available to help you learn this. You may need to clip the hair from around the wound and remove as much surface dirt as possible to fully assess a wound, so keep a small set of clippers/trimmers handy – and if you horse does not like being clipped, work on desensitising them to the clippers before you are in a situation when you need to use them. And finally, ensure that your first aid kit is well stocked for the basic first aid treatment of wounds. Suggested items for initial first aid care of wounds whilst awaiting your vet visit include:

• hydrogel
• sterile swabs
• sterile saline or wound spray
• non-stick dressings
• cohesive bandage such as ‘vetwrap’

Conclusion

The take home message is that most wounds will heal if managed appropriately and given enough time. However, if in any doubt, it is always better to seek veterinary advice sooner rather than later to prevent any delay in healing.

Article written for www.aqueos.co.uk by Jessica Putnam BVMedSci(Hons) BVM BVS(Hons) MRCVS