University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Lacerations and Penetrating Wounds Dr Amy Plummer Large

University of

Tennessee College of Veterinary Medicine

Department of Large Animal Clinical Sciences

Lacerations and Penetrating Wounds

Dr Amy Plummer

Large Animal Emergency and Critical Care

University of Tennessee

College of Veterinary Medicine

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Overview

• Emergency lacerations

• Blood loss

• Joint involvement

• Penetrating wounds

• Care of lacerations

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Emergency Lacerations

• When to call your veterinarian– Blood loss– Laceration/wound over a joint

• What to do while you wait– Pressure bandage– Clean?– Keep horse quiet

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• Blood loss– Can cause death, although rare– Arterial blood loss blood usually

pulsating– Quantitate blood loss

• Drops/sec• Visualize pool of blood

– More concern if bleeding does not stop with pressure

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• Common sites– Distal extremities– Neck lacerations

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Blood Loss

• Apply pressure– Manual with hand (cleanliness)– Pressure bandage

• Minimal padding and vet wrap

– Do not remove first bandage, apply another bandage over the first

– Minimize movement of the horse

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Blood Loss

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Blood loss

• Amount of blood– 20% of blood volume (approximately

9-10 liters or 2 gallons) before life threatening

– Clinical signs• Respiratory distress• High heart rate• Weakness

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Blood Loss

• Visualize the bleeding vessel– Hold vessel off– Tie vessel if easily done

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Blood Loss

• Once the vet arrives– Ligate vessel– Sterile bandage– If significant bloodloss:

• Referral for IV fluids

and/or blood transfusion

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Blood Loss

• Majority controlled by pressure and/or ligation

• Rare to need blood transfusion

• Keep wound as clean as possible

• Bandage best on leg wounds

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Lacerations with Joint Involvement

• VERY important to determine if joint is involved

• If laceration is NEAR a joint, consider it an emergency

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Anatomy

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Anatomy

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Joint Involvement

• Emergency veterinary care

• Keep horse quiet and in clean environment

• Clean?

• Bandage?

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Joint Involvement

• Veterinary Care– Determine structures involved– Radiographs?– Lavage of joint/tendon sheath– Antibiotics (IV, regional, intra-

articular)– Phenylbutazone

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Joint Involvement

• Radiographs for foreign bodies

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Joint Involvement

• Determining if joint is affected

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Joint Involvement

• Prognosis – No joint affected– Joint contamination vs infection

• Multiple levels of care

• Monitor for lameness– Acute non-weight bearing lameness

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Joint/Tendon Sheath Involvement

• Antibiotics– Systemic– Intra-articular– Regional limb

perfusion

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Penetrating Wounds

• Observe horse carefully to find

• Look for matted hair, swelling

• Often result of wire, fences or gates but can be from tree limbs ect.

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Penetrating Wounds

• If object is in place, LEAVE in place, unless unable to do so

• Prevent hemorrhage/bleeding

• Help veterinarian know direction, depth of the penetration

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Penetrating Wounds

• LEAVE object in place

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Penetrating Wounds

• Puncture wounds on limbs or upper body

• Tetanus status

• Monitor for swelling, gas production

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Penetrating Wounds

• Can be more

significant that what

meets the eye

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Penetrating Wounds

• Wounds to the sole of the foot

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Penetrating Wounds

• Radiographs

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Penetrating Wounds

• After radiographs, veterinarian will remove object

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Penetrating Wounds

• Wounds to sole

• Sole vs Frog

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Penetrating Wounds

• Frog– Navicular bursa– Coffin Joint

• Treatment depends on structures involved

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Penetrating Wounds

• Wounds to sole and frog

• Dr Gray will present more this afternoon with Non- Weight Bearing Lameness

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Care of Lacerations

• Primary closure, Delayed primary closure– Sutures– Staples

• Seconday closure– Lavage and debridement first, then closure

after granulation tissue

• Second intention healing– Unable to suture, allow to heal on its own

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Care of Lacerations

• Primary closure– Clean, fresh wound– Adequate skin– No synovial structure involvement

• Before closing– Lavage– Debride area

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Care of Lacerations

• Debridement– Remove layer of compromised

tissue, decrease bacteria

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Care of Lacerations

• Lavage of area– Wash away contamination and

decrease bacteria– Solution?

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Care of Lacerations

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Care of Lacerations

• Primary closure

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Care of Lacerations

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Care of Lacerations

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Care of Lacerations

• Primary Closure- Complications– Infection– Dehisence

• Delayed primary closure- allows more debridement– Lavage– Wet-to-dry bandaging

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Care of Lacerations

• Secondary closure– After bed of granulation tissue

present– Often when there is an infected joint

or tendon sheath– Delay closure until infection under

control

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Care of Laceration

• Second intention healing– No closure of wound– Depend on Contraction and

Epithelialization– Best for upper body wounds, not as

good for limbs– Sometimes there is no alternative

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Care of Lacerations

• Second intention

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Care of Lacerations

• Second intention healing

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Care of Lacerations

• Second intention healing

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Care of Lacerations

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Care of Lacerations

• Treatments– Bandaging of limbs

• Important technique• Keeps clean and dry

– Lavage• Depends on wound

– Topical medications• Depends on wound• Numerous available products- discuss

with your veterinarian

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Care of Lacerations

• Bandaging

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Lacerations and Penetrating Wounds

• Blood loss– Pressure to stop bleeding

• Lacerations near joints– Know the anatomy– Treat as emergencies

• Discuss care of a specific laceration with your veterinarian

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Questions?

Documents

University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Lacerations and Penetrating Wounds Dr Amy Plummer Large