Client Resources: Articles

Lower Leg Wounds

Some 20 years ago I was paged early on a Sunday morning by a client who used to live right in my town.  Her colt was cut on a front leg.   “Do you want to come out now, or can this wait until tomorrow morning?”  I told her I’d drive right over.

I pulled into Meg’s yard a half hour later.  She brought the young gelding out of his stall and onto the barn floor.  His left front was done up from foot to knee.   I held him as Meg took off the leg wraps.  She explained that when the colt was playing with another youngster, he full ran full tilt into a drainage ditch and right into the end of an exposed steel culvert.    She apologized for getting me out on a Sunday morning, but said she would just feel better if I could suture him up today.

I wasn’t prepared for what I saw when the wrap was removed. The sharp edge of the culvert had slashed through the skin, leaving an eight inch gash down the front of the leg, starting just under the knee.   The skin edges had pulled back from each other, leaving a large gaping wound.  The extensor tendon and the bone underneath were both visible.

The big gap and the fact that there was no fresh blood told me that the accident hadn’t happened that morning.   “Oh, no, it happened yesterday evening, but I didn’t want to call you out on a Saturday night, so I cleaned him up and managed to stop the bleeding with a sterile gauze and a leg wrap. I knew that he wouldn’t die or anything, so I waited until today to call you.”

Well, Meg was right. There was no chance that the colt was going to die.  However, for every minute I would have spent that Saturday night suturing the wound, I ended up spending ten in trying to keep the scar to a minimum. Had she called me as soon as it happened, I would have sutured the leg, and within a few weeks he’d have been back playing with his buddy. Because Meg delayed calling for help, the colt had to put up with months of therapy and daily leg wrappings.

This is an extreme example of something that happens to every equine veterinarian from time to time.   Well-meaning clients, trying not to be a bother, put off calling about a problem until they figure that the timing would be more convenient for their veterinarian.  Some horse owners wait to avoid an after-hours emergency fee. Both are reasons that most veterinarians always expect a full Monday.    But, after all, emergencies are just that, and need immediate attention.   Early colics, eye problems, and respiratory diseases are often more effectively treated if they are caught early on.   However, in lower leg wounds the earlier the better is always the rule.

As soon as a horse is cut the skin edges start to pull back or retract from each other.  This is a natural process that has kept horses together for thousands of years, long before anyone ever thought of running a needle through skin.   When the edges of the skin retract from each other, it causes a gap, wider at the skin than in the depths of the wound.   This allows drainage, and healing from the inside out.  Ideally, once the defect fills in, skin will grow across it, and the two edges will be joined by a strong scar.

The skin that covers the shoulder, neck, and most of the upper body of the horse is quite loose.  You can easily grab a handful.  In those areas there isn’t such a rush to get wounds sutured.   Even though the wound edges have retracted, there is plenty of loose skin to “borrow” to pull the edges together.   Below the knee and hock, it’s a different story.   There is no extra skin in the lower leg, and when a wound retracts (within a few hours), it becomes impossible to pull the two edges back together.   Within days connective tissue starts to fill in the gap.   On the lower legs when that connective tissue reaches the level of the skin it often keeps growing.   That mass of very vascular tissue is called proud flesh, and can become another problem.   The reason is that while skin will grow across defects, it can’t grow up over the mound of proud flesh.  Unless it is removed either chemically or surgically, it will remain there and keep the wound from closing, sometimes for months.

In summary, there are good reasons to call right away when a horse gets any kind of a wound, on the lower leg or anywhere on the body.   If you are unsure, call anyway, no matter what time or what day it is.  Early treatment can make a huge difference in outcome.

Offer to send a digital photo of the wound by email.   These are really helpful in determining whether a horse needs that immediate attention.

 

David A. Jefferson, DVM

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