First, Do No Harm •  Have at least one other person assist you as you work on an injured horse. •  Do not tranquilize a wounded horse, as your vet will need to assess for dehydration and shock. •  Use gauze sponges, or fingertips, to cleanse wounds, rather than roll cotton, which can shed infection causing fibers. •  Leave a deeply embedded foreign object in the wound and let your vet remove it to avoid hemorrhaging. This applies to hoof punctures, too. •  Use no more than 7-15 pounds per square inch of pressure for cleansing wounds (about what you get from a spray bottle) to prevent further damage to tissue. •  Avoid putting fly sprays or repellants directly over or on an open wound or suture line. Apply at least a quarter-inch from the wound edge.

Some horses seem more prone to injuries than the average 3-year-old child. Even if your horse seems relatively hazard-proof, the chances are still high that somewhere along the line he’s going to hurt himself, and you’ll find yourself caring for an injury.  What can and should be done to treat the horse injury will depend quite a bit on the type of wound it is.

Horse wounds generally can be classified as one of the following:
•  Abrasion.  A superficial loss of the upper skin layers, such as a minor brush burn.
•  Laceration. Injury to the skin that involves an actual separation in the skin, can be either partial thickness (not through all the layers of the skin), or full thickness (entirely through skin and exposing the fat or connective tissue/muscle underneath the skin). Full thickness wounds tend to bleed more and gap open further.
•  Puncture. Wound with a relatively small entry point, but which has penetrated deeply into the underlying tissues.
•  Avulsion. This type of wound involves damage to the full thickness of the skin, as well as the actual loss of a portion of skin and/or deeper tissue. Avulsions are likely to occur if the horse gets hung up on something and struggles to pull himself free, or if a sharp object actually slices through tissue and cuts off a piece of it, as can happen if the horse steps on his heel with a shod hind foot, or on his coronary band with the shoe from the opposite foot.  Skin avulsions are fairly common with lower leg injuries if the horse’s leg becomes trapped and he pulls it free.

Another term commonly used when describing wounds is “foreign body.” A foreign body is anything that does not belong in the wound, like pieces of dirt, wood, leaves, penetrating objects, and such.

Working with the Injured Horse
Horses vary as much as people in how they react to stress and pain. If trapped, for example, in a ravine, or tangled in a fence, some horses will stand motionless until help arrives. Others panic and struggle. Some will allow you to inspect and treat the wound with minimal fuss, some will be very anxious, and still others will resist violently.

Unless you have had to deal with the situation with the same horse in the past, you will not be able to predict how your horse will react. It’s important to remember that your horse’s normal personality cannot always be used as a guide. The shock-like state that often goes along with wounds can also be deceiving. When you first find the horse, he may seem very “out of it.” He may be very unresponsive. But that can change very quickly if you approach the wound.

Here are some safety guidelines:
•  Make sure the horse is aware you are there by approaching from the front and talking in a calm tone, before touching him.
•  Get control of the head with halter and lead rope before focusing on the wound.
•  Have a handler at the head, standing on the same side as you and the wound, before going to work.

Doing a bandage change safely will require cooperation from your horse. Ground training in advance of any mishap will make treatment easier on everyone when the need arises. Photo by Betsy Lynch.

Pre-Vet Training Prep There are few things that will test your horse’s training and trust more than having you attend to an injury. Your horse may be frightened as well as in pain, and he might not be exactly willing to go along with your ministrations. It will be up to you to calm his fears, assess the damage, and take whatever emergency first-aid measures may be required. And, of course, you’ll also likely be assuming the responsibility for cleaning and dressing the wound while it heals. Unlike your vet, you likely won’t have the means to sedate your horse—nor is that the best idea even if you could, since recent research shows that sedation can slow healing. But you will need to be able to work with your horse safely.  Training before you encounter a crisis is essential, so you’ll have the cues you need to keep your horse calm if an emergency arises. In order to help yourself, the horse and the vet , your horse needs to be taught exceptional ground manners. He should: •  Be easy to catch and halter •  Know how to lead, stand tied, and give to pressure •  Pick up his feet •  Be comfortable as you move around him •  Accept your touch from head to toe •  Be respectful, courteous and non-threatening •  Recognize and trust you as his partner and leader By establishing these behaviors during uneventful times, you'll be better prepared to handle your horse in a stressful situation. Responses to your cues will become automatic. You'll also want to teach your horse the calm-down cue from the ground.

First Aid
Superficial wounds and abrasions can usually be handled on the farm or ranch without the need for your veterinarian, assuming you can work with the horse safely and get the job done correctly. Superficial wounds, involving only the upper layers of the skin, do not require suturing. They will heal nicely on their own if gently-but-thoroughly cleaned to remove surface dirt and other contaminants, and are then kept clean during healing.

Sterile saline solution is preferred for washing wounds, but few people have access to the large amounts needed to thoroughly clean wounds. Water can be used instead. Distilled water (keep a few gallons at the barn) is a good compromise between sterile solutions and tap water. Distilled water will contain few organisms and no potentially irritating minerals. Supplies you will need are water, gauze sponges, gloves for your hands (available as nonsterile “exam” gloves in drug stores), wound-cleansing solution (preferably one that is povidone-iodine or chlorhexidine based).

For a superficial wound, control bleeding by applying gentle pressure for a few minutes. These wounds generally ooze rather than bleed profusely. If the wound is old and already clotted when you find it, you can expect some bleeding as you clean. This is normal. Continue cleaning, and then apply gentle pressure to stop it when you’re done.

If the wound is very dirty, has a heavy build-up of crusted blood, or seems very tender to touch, consider hosing with very cold water, or apply an ice pack for about 10 minutes before you start. If available, switch to warm water or warm saline for cleaning, as this will more easily loosen dirt and dried blood. Wet the wound thoroughly and gently work up a lather using the cleaning solution (usually called a “scrub” on the label) on a gauze sponge, or simply apply the scrub to your gloved fingers.

The advantage of gauze sponges is there’s more friction to work dirt free,  but the finger-only scrubbing may work better for horses that are very touchy. If the wound has a heavy build-up, allow the suds to stay in contact with the area for a few minutes before rinsing. Repeat the scrubbing and rinsing steps until the wound is clean. Apply pressure with dry gauze sponges after cleaning to stop oozing, if needed.

Considerable debate exists over whether wounds should be dressed with powders, ointments, creams or occlusive sprays. All have pros and cons. In general, a light antibiotic wound dressing, such as sold in human drug stores, is usually best. However, if flies and repeated contamination of the wound are major problems, you might be better off with an occlusive spray, which protects the surface. Your veterinarian may have a preference.

Check the wound daily. If it shows buildup of dirt or secretions, gently cleanse it. Otherwise, do not disturb it. Within about three days, you will be able to see the skin edges growing in from all directions to bridge any open area. The new skin will look white or gray and will not have any hair. Call your vet if:
•  Pain seems disproportionate to the severity of the wound.
•  Pain and swelling are not obviously improving within three days.
•  You can see obvious.

Recipe for Saline While you aren't likely to have enough saline solution on hand for immediate first-aid care of wounds, you might want to consider switching to it later on. Saline is fluid with the same sodium content as blood. As a wound flushing solution, it is gentler to damaged and healing tissues than plain water or other scrubs. You can make a good saline substitute by adding 8 teaspoons of plain table salt to a gallon of distilled water. For your horse's further comfort, and improved ability to loosen blood and dirt, stand the bottle in in a bucket of very hot water to warm it.

How Wounds Heal
All injuries heal in stages, starting with the painful inflammatory phase, and ending with the remodeling phase when scar tissue begins behaving more like normal tissue.

Inflammatory Phase
When an area is wounded, immune system cells (neutrophils and macrophages) are immediately activated and spring into action. Their job is to ward off invading bacteria, clean up cells that have been damaged beyond repair, and create a wall between the injured area and the rest of the body. These responses involve the release of various enzymes to “dissolve” dead tissue, and bursts of peroxide-like substances to kill organisms.

As you might imagine, this is the most uncomfortable phase for the horse, but it is absolutely essential to set up the proper conditions for healing. As the inflammation begins to subside, chemical messengers that trigger the growth of new blood vessels and the proliferation of connective tissue cells and skin cells take over.

The best way to minimize the severity of the inflammatory phase, and keep it as short as possible, is to clean the wound thoroughly, remove all dead tissue, and keep it clean. Infection prolongs the inflammatory phase and prevents healing. Uninfected wounds, with no dead tissue, resolve the inflammatory phase within three days. Heavy use of anti-inflammatory drugs during this period is counterproductive. It’s better to ease any excessive discomfort by applying ice for recommended periods. Otherwise, leave the body alone to do its work. The wound is at its weakest during the inflammatory phase and can easily break open or become more extensive with excess movement or any trauma.

Healing Phase
Also called the “proliferative” stage, this is when the production of new blood vessels, skin cells and deeper connective tissues occurs. Blood vessels will supply the needed nutrients. Connective and scar tissue will be laid down in the depths of the wound and gradually rise to skin surface. Skin edges all around the wound will start growing toward the center until they meet. As this phase progresses, the strength of the wound increases.

Remodeling Phase
Once the area of the original wound has become covered with scar and skin tissue regrowth, it will be able to resist breaking open. However, scar repair may not have as much elasticity and freedom of movement as normal tissues. Over the following weeks, months or even years, as the horse moves about he will be continually putting minor stresses on the scar tissue that cause it to go through cycles of microscopic breakdown and repeated repair. In the end, the injured tissue will behave more like normal as a result of this.

Tetanus and Wounds The horse lives in an environment that is swimming with the organisms that cause tetanus. Where there is a horse, there is manure. Where there is manure, there are tetanus organisms. Truth is that the usual yearly tetanus vaccinations are probably more than adequate protection, but because tetanus is almost 100% fatal and the vaccine has not been associated with any concerns about side effects or long-term health issues, there’s nothing wrong with playing it safe . Punctures, wounds which involve full thickness breaks in the skin and deep- tissue damage are the most dangerous. A tetanus booster given at the time your vet inspects the wound is cheap protection and will increase antibody levels quicker than the organism has a chance to multiply and release toxins. If the horse has not been vaccinated previously, or has not had a vaccine in many years, both antitoxin (serum containing antibodies) and vaccine will likely be recommended. There is a slight risk of serious liver reactions to antitoxin (called serum sickness), so antitoxin should not be used routinely. The risks and benefits for your individual situation can be discussed with your vet. Note: This includes materials that may have  punctured a foot. Your vet will need to see how far in it went to judge what structures may be involved.

Lacerations & Deep Wounds
Any wound that involves all the layers of the skin is a candidate for suturing. However, for the wound to heal without problems after suturing, the repair has to be done within six hours of injury. This is called the “golden period.” If the wound is older than six hours, your veterinarian will still likely suture it to protect the deeper tissues, but there is a good chance that some, or all, of the skin may be lost. In the vast majority of cases, you will also have wound infection within the first few days.

Whether or not there will be skin loss also depends on the location of the wound and whether there is good blood supply to the spot. Wounds below the knees and hocks are particularly problematic. Horses (but not ponies) have poor blood supply to their lower legs, resulting in poor immune responses and wound repair.

Any wound that cuts through the full thickness of skin and gapes open, and any injury where deep tissues are exposed, needs to be seen by a vet. If the horse is bleeding heavily, apply firm pressure with gauze sponges, or use the cleanest, most lint-free material you have available to slow the bleeding and allow the blood to clot. Keep the pressure on for at least five minutes before checking to see if bleeding has stopped. If the material you were using to apply pressure is now firmly stuck to the wound, leave it in place.

While the materials used to clean more serious wounds are the same, do not touch the wound until you have spoken to your vet. Most vets will prefer to clean the wound themselves, so that they can better assess the nature of the injury. The vet will want to evaluate its depth, and what structures might have been damaged. Just follow your vet’s instructions.

While waiting for the vet to arrive, keep your horse quiet and still. Unless the wound involves the head, neck or abdomen, you can offer water and hay unless the wound is serious enough to possibly require general anesthesia for repair. Again, ask your vet first before feeding or watering.

If a wound involves a foreign object, leave any deeply embedded pieces of wood or other foreign materials in the wound, and wait for your vet’s arrival. Removing the object may cause hemorrhaging. This includes nails or other items that may have punctured a foot. Your vet will need to see how far in the object went to judge what structures may be involved and the best way to remove and treat it.

Remember the Whole Horse If you’ve ever had a wound that penetrated below skin level, such as you slicing yourself with a knife or stepping on something that penetrated your foot, you probably remember having a body-wide wave of sensation that made your stomach sink. It may even have made you feel lightheaded. This is your body’s “alarm bells” going off. Your nervous system is responding with a rush of chemicals, such as adrenalin. The same thing happens to your horse when he suffers a significant injury, and results in a shock-like state. Your horse’s gums may be pale and his pulse may weaken.  He may be shivering or shuddering and appear depressed. Reassure the horse, keeping someone whom he trusts at his head. Blanket him if he is shivering, and offer small sips of water if he’s interested. Be sure to call your vet, as shock can be even more life-threatening than the actual injury.

Lower-Leg Wounds
A limited blood supply and less ability to mount an effective inflammatory stage of healing in the horse’s lower legs make leg injuries problematic. “Proud flesh” (excessive granulation tissue) is common. Granulation tissue is the pink tissue that fills in the interior of wounds. When mature, it becomes dense scar. If the wound is under constant tension or movement and skin does not grow in to cover it, the production of granulation tissue continues. (See the sidebar “How Wounds Heal.”)

Your best defense against proud flesh is early and correct wound care. This includes careful cleansing, removal of dead tissue, and repair with suturing within the “golden period.” If, despite your best efforts, you see granulation tissue begin to protrude above the edges of the skin, or a halt to the normal regrowth of skin over the wound, consult with your vet. He will likely want to remove the excess granulation tissue with a scalpel—a simple procedure that the horse won’t even feel because this tissue has no nerve supply.

Beyond that, a time-honored treatment for proud flesh is the application of caustic powders to the granulation tissue to shrink it and give the skin a better chance of bridging the gap. There are also many new treatments being tried all the time. Your vet is your best source of up-to-date information of what does, and does not, work. Another option is low level laser therapy. This is extremely effective in controlling granulation and encouraging skin edges to repair.

Bruises and Contusions
Bruises and contusions don’t involve any obvious injury to the overlying skin, but you should be aware of them anyway. Because horses have dark skin under all areas that are not covered by true white hair, it is very easy to overlook extensive bruising. Bruising, aka “black and blue,” can occur anytime there is a forceful blow to the skin. It is caused by rupture of the small vessels in the area.

Contusions are basically the same thing as bruising, but this term may be used when the bleeding extends to areas deeper than the skin. Extensive bruising or contusion leads to the formation of a hematoma, a pocket of blood.

Bruising, contusions and hematomas are often a large part of the reason why the area around a wound is swollen and tender even for a considerable distance away from the wound edge. Simple bruises will take a week or two to resolve, but hematomas may take several weeks for the body to break down and reabsorb all the blood cells and excess fluid.

First-aid measures of cold water or icing will reduce the amount of bleeding into the tissues when started shortly after the wound occurs. However, the cold therapy is not likely to be of much benefit in reducing the size of the swelling after the first few hours, but it does provide some pain relief.

Of fianl note: anytime your horse is injured in an event that isn't witnessed, remember there could be injuries other than the obvious wounds. Keep a close eye out for swelling, indicating bruising or confusion, for the frist 24 to 48 hours by running your hands all over the horse's body, including the belly. Areas of swelling or tenderness could indicate damage to the tissues underneath. If this does not slowly get better, or if the horse is not eating or drinking well, is depressed, shows colic pain, or exhibits any symptoms that might be out of proportion to the visible wounds, contact your veterinarian.