Volume 1, Issue 3

THE WOUND DILEMMA
 
Puncture Wounds
 
Puncture wounds are deep penetrating holes caused by close encounters with sharp objects, such as nails or wire.  Even a small entry wound can be severe because of the dirt and bacteria being driven deep into the tissue by the offending sharp object. If a puncture wound is not treated properly, the onset of infection can occur rapidly. The tetanus bacterium is a prime example.  Being that it thrives in an anaerobic environment…one lacking oxygen…it would find the depths of a puncture wound particularly inviting.
 
Puncture wounds are not limited to impalement injuries.  A blunt-trauma injury, such as a kick from another horse, can result in a puncture-type wound.  The blow may produce a small surface wound, but the pressure can cause a deep tract to form in the tissues below and can only be detected by probing the wound’s opening.  Such a wound should be treated as a puncture as long as a more serious underlying injury, such as a fracture, hasn’t occurred. (Note:  If your horse steps on a nail, refer to the “Foot Wounds” section)

Flow chart

1) Is the puncture wound near enough to a joint to have entered the joint cavity? (If so, you’ll see “bubbly” yellow joint fluid seeping from it)
 YES → CALL YOUR VET
↓
NO
↓

2) Is excessive swelling, heat, or a puss-like discharge present?
 YES → CALL YOUR VET
↓
NO
↓

3) Does your horse have a fever (over 102 degrees) indicating a possible infection?
YES → CALL YOUR VET
↓
NO
↓

4) Is the puncture wound on an extremity?
YES → CALL YOUR VET
↓
NO
↓

5) Does it appear as though a foreign body, such as a nail, is present in the wound?
YES → CALL YOUR VET
↓
NO
↓

6) Will your horse allow you to treat the wound?
NO → CALL YOUR VET
↓
YES
↓

Apply Home Treatment
↓
 
> Probe the wound with a clean "teat cannula" (long thin tipped tube you can get from your vet) to determine if there is an underlying tract.  If so, attach a 30 to 60 cc syringe to the "teat cannula" and flush the wound with a dilute Betadine/water solution (one part Betadine to 20 parts water and appearing as the color of weak tea).  This will provide antibacterial protection. 

> Continue flushing the wound until the fluid coming out of the wound is as clear as the fluid going in.  No antibiotic ointment is necessary to a puncture wound because the wound’s inner recesses aren’t exposed to air and dirt (and it gains antibacterial protection from the Betadine solution).
 
> Check your horse’s tetanus-immunization status and take appropriate measures.
 
> Flush the wound daily to prevent infection and allow for healing from the inside out.  During this process you may need to remove the scab and it may become increasingly difficult to insert the teat cannula.  You need to persevere and continue flushing until the hole has completely healed up to the skin’s surface.
 
> If the wound is draining, serum build up can cause skin sores.  Smear Vaseline on the skin beneath the wound to prevent such a build up.

> Give your horse 1 gram (1,000 milligrams) of Phenylbutazone (“bute”) twice daily (or 2 grams once a day if that is all your schedule allows) for approximately five days.  This will reduce inflammation and minimize swelling.

If your horse develops signs of an infection (see flow chart)
Call your vet immediately

What To Expect If You Call Your Vet
 
Your Vet…..

> Will probe the wound to determine the depth and severity.  If it appears to be an uncomplicated puncture, (not involving bone, joint or tendon sheath) he will flush it out with an antiseptic solution, such as Betadine and water.

> May collect a joint fluid sample to check for signs of an infection if the injury is near a joint. If joint involvement is suspected, he may also flush the joint.
 
> May x-ray the wound area to determine a treatment course if a foreign body or extensive damage is suspected.
 
> May infuse antibiotic ointment into the wound to help prevent/treat infection.

> May prescribe systemic antibiotics, in the form of pills or injections to help stave off infection; he may also prescribe non-steroidal anti-inflammatory drugs, such as Bute or Banimine, to help reduce inflammation and swelling.

> Will evaluate your horse’s tetanus-immunization status and take appropriate measures.
 
Most uncomplicated puncture wounds respond well to treatment and you can expect your horse to heal in a week to 10 days.

                    
ALWAYS REMEMBER…WHEN IN DOUBT….CALL YOUR VET

© Wendy Teddiman, Trainer (wen-dacres@cox.net)   (http://Wen-D-Acres.com)  (http://shop.wen-d-acres.com)  949-357-8040