More on Second Intention healing...
TREATMENT CHOICES
FOR SECOND INTENTION HEALING
The most recent topic was on second intention healing, which is healing without the benefit of the wound edges being brought together, or those rare cases when the sutures do not successfully hold the wound together. This may also be a wound where so much tissue loss makes first intention healing difficult. Whatever the reason, some treatment choices will dramatically speed the process of healing. We will discuss those today.
Bandaging is one of the most effective methods of wound healing. If the wound can be
safely and successfully bandaged, it will heal smoother, cleaner, and faster. This usually works for wounds of the lower legs.
The wound is protected from possible contamination from the outside, and is kept moist.The pressure of the bandage will prevent the development of “proud flesh” ( a condition unique to horses, which we will discuss below).The bandage also serves to hold antibiotics against the wound.A properly applied bandage will draw infection from a wound.And finally, a bandage will limit movement of the limb, allowing the wound to heal much faster.The first time or two the bandage is removed, the smell and appearance can be pretty rough. The warmer the outside temperature, the worse the smell. The drainage we usually see below a wound is held in by the bandage. After a bandage change or two, and any infection is drawn away and/or treated with injectable antibiotics, there will be noticeable changes in the size and condition of the wound. The surface will become a healthy pink. The size will be smaller each time the bandage is changed.
If the wound is higher up the leg, bandaging may be more difficult to achieve. If it is not possible to bandage a wound, topical treatment will be needed. For all wounds other than punctures, spraying the wound with a water hose will remove contamination and wash away infection. This should be used for several minutes two or more times a day until the above mentioned pink surface starts to form.
If the wound is a deep one, we will treat it with a drug that stimulates granulation. As we say somewhat tongue in cheek, it will cause the wound to heal right in front of your eyes. The wounds do heal quickly, and this treatment must be stopped when the surface of the healing tissue reaches the level of the surrounding skin.
Once healing begins, our choice of treatment is a mixture of antibiotics with steroids. This mixture works great by keeping the wound moist while the antibiotics prevent infection, and the steroids reduce swelling and prevent itching while the wound heals.
Proud flesh is a result of the rapid healing process Mother Nature has given the horse to help it survive in the wild. Healing progresses very rapidly. If it is a large wound, or if it is located in an area of movement, the mass of healing tissue does not stop at the level of the surrounding skin. The resulting mound of scar tissue can be very unsightly. It may not heal and the surface will continually be wet and raw. Its size may be so large that it actually interferes with movement. The most common place to observe this tissue on many horses is behind the pastern of the front legs. Many will have experienced the pain of pawing barbed wire, and the movement in this area delays healing until proud flesh has accumulated.Next week we will discuss treatments for prevention of proud flesh. We will also discuss treatments that aid in wound healing.
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