Thursday, September 26, 2013

Wound healing

Chico's wound is healing very slowly, but it is healing.  It still has quite a deep cleft in it despite debriding a little excessive granulation tissue and I'm starting to wonder if there is something deeper impeding the healing that will eventually require a visit to a more experienced equine vet than myself.  I've been sharing photos and advice with vets from school, but it just might come to taking him down there one of these days. 

Here is a photo series of his wound over the last few weeks.

This is the from the day I found it.  I'm going to estimate that the wound was 5 days old and completely uncared for to this point.  So, this photo is +5 days (9/7/13)

This photo is from 9/12/13, so is +10 days.  For this stage it was getting scrubbed every other day and bandage changes every other day.  He is also on TMS oral antibiotics.

This is + 17 days (9/19/13).  This is the wound I was greeted with when I came home from a short 5 day vacation during which I had my dad and our neighbor caring for Chico and changing bandages.  I suspect maybe he needed tighter bandaging to prevent the movement...or maybe this was inevitable because of where it is.  After I took this picture, I debrided the granulation tissue down to the level of the epithelial tissue and tried to remove the edge of the cleft formed in the middle.

Now we are at +19 days and post debridement (9/21/13).  It's looking better.  I then debrided more from the edge of the cleft.

This is at +22 days (9/24/13), and is also taken before I cleaned the wound after unwrapping it (hence the little bit of gunk accumulated).  The cleft is smaller, but still present.  It seems deeper at the ventral aspect now.  When I found it, it seemed deepest at the dorsal aspect where I could touch bone.  Looking at how it has changed over time shows me that is it getting smaller, but it just seems to be happening so slowly.

Through all this, Chico has remained comfortable, but he is pretty darn sick of being confined in the barn.  He loves his time out to get his bandage changed and some green grass.  He's been a great patient and lets me do whatever I want to him, including debriding tissue without resenting it at all.


Andrea -Mustang Saga said...

That crack down the middle is weird. I know that the horse we're treating who had bone exposed is taking a long time to heal (I think 2+ months now) but his was much bigger. Maybe it just takes time?

How is his overall health? Anything weird that might impede healing? A long time ago I bought a severely selenium deficient horse with a cut and it didn't heal until he was healthy again.

Kara said...

He's overall very healthy. Actually, I think that they are growing in thicker manes now that they've had new mineral for most of this year.

I think the biggest thing that might be impeding healing now is the bandaging. I'm still bandaging it pretty firmly because I think it has made a big difference in the cleft - movement in the skin halves makes the granulation tissue build up higher on the sides and the cleft gets deeper. When I bandage tighter it seems to fill in the middle better. So I'm going to keep bandaging tight until it really fills in well, then loosen the bandage. Once that cleft fills in altother, then I'll stop bandaging. The cleft is filled in over the bone, but it is now deeper in the bottom half and there has always been a different colored piece of tissue in there (not dead, just some other tissue that the granulation tissue is having difficulty getting around. That might need to be removed. I wish I could tell what it is...a nerve? tendon? blood vessel? Hard to say at this point.