‘Chuck’ is a 15 month old New Forest x Trakehner gelding, who was about to make his debut in the show ring, when he had a rather dramatic run in with a gate post one Sunday evening in early August 2011. Many thanks to his owner Nancy Palmer for letting us use his case study.

The wound was clearly very extensive, extending through the skin and into the muscle on Chuck’s left chest and flank (pictures 1 & 2). He had fractured a rib, leaving a large splinter of bone within the wound, but had fortunately not penetrated his chest or abdominal cavities, and was reasonably bright and interested as to why he was getting so much attention!

After sedation, the most important thing when we first deal with a wound is to remove any necrotic (dead) or damaged tissue and to get the wound as clean as possible. In Chuck’s case, this involved clipping the hair around the wound, removing the rib fragment and ‘debriding’ or cutting back the damaged muscle, subcutaneous tissue and skin until we had healthy tissue. In a wound this size, or in areas such as the lower limbs, where there is limited ‘spare’ skin, we have to be careful not to remove too much tissue, otherwise when trying to close the wound there will be too much tension, disrupting the blood supply to the skin edges and preventing good healing. However, damaged, dirty tissue or skin that has already lost its blood supply will also not heal well and can be a source of infection.

The wound was thoroughly lavaged, by flushing large volumes of sterile saline under pressure through the wound. We then had the lengthy task of suturing the wound back together! A large number of dissolvable ‘buried sutures’ were put in the muscle and subcutaneous layers, and the skin was closed with a combination of staples and nylon sutures which would need removing at a later date (pictures 3 & 4 below).

Picture 5 below shows a ‘drain’ (piece of tubing inserted under the skin and emerging below the wound) to prevent fluid building up in the pockets between the skin and muscle. It was removed three days later once all the tissue swelling started to reduce and the tissue was knitting back together.

We dressed the wound to provide some support even though it was not the easiest place to bandage! (picture 6 below). Chuck also received broad spectrum antibiotics and anti-inflammatories. It is very important for any horse with a wound to ensure tetanus vaccinations are up to date, or provide cover with tetanus anti-toxin. Chuck’s field shelter was hastily transformed to an inviting stable and he was put on box rest, to keep him as still as possible. Wounds heal best when the skin edges are not subjected to excessive movement, a particular problem on limbs or over joints, hence we will often bandage and advise box rest as part of wound management.

For the first few days the wound was looking great but unsurprisingly for a wound this size the centre part of the wound started to break down, most likely due to both the infection and the effect of the trauma on the blood supply to the skin edges. We did have a second attempt at resuturing this middle part, but then decided that as the wound was infected, the best approach would be to leave it open to allow flushing, and allow it to heal on its own by ‘secondary intention’ or the formation of granulation tissue.

A swab from the wound was sent to the laboratory where they bacteria were cultured to determine which antibiotics the infection was sensitive to. A Staphylococcal infection was resistant to many of the more common antibiotics so Chuck received a course of injectable antibiotics, administered intramuscularly by his owner. She did a great job of flushing the wound multiple times a day and keeping it bandaged, not easy in a lively, and by this point rather bored, youngster! We also applied Manuka honey to the wound due to its antibacterial properties and because it doesn’t damage epithelial cells which multiply to form new skin.

After ten days of the new antibiotics, the infection was under control and the antibiotics were stopped, as we now had healthy granulation tissue filling in the open areas (pictures 7 & 8). The wounds were still flushed and bandaged with honey dressings. The staples and sutures were removed from the parts of the wound that had held together, leaving minimal scarring.

After four rather long weeks, we could see that an end might be in sight! (Picture 9) The wounds had started to contract down, with new skin forming round the edges, and Chuck was back out in the field, albeit it with a bandage and cleverly modified rug as protection.

Slowly the remaining wounds will shrink in size, as new skin forms round the edges, until eventually they heal over completely. We are now 2 months down the line and are eagerly awaiting an ‘after’ picture, but we hope the scar will be minimal and Chuck can be back in the show ring next season!

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