wound care according to the CSU vet school

["Susan Garlinghouse" <suendavid@worldnet.att.net>]

I've never used Schreiner's, so don't know what's in it or how effective it
is or anything else.  But I'll just repeat what we were taught earlier this
semester in Wound Management, that you should never put anything in contact
with open tissue (ie, a wound) that you would'nt willing put into your own
eye.  They were pretty adamant about it.

What we were told is that anything that stings is also going to cause damage
to the exposed cells and that's going to impede wound healing, not help it.
And, as Teresa pointed out, horses are pretty amazing creatures at healing
themselves as long as the wound isn't infected and blood circulation is
good.  We saw alot of cases where horrendous wounds were just cleaned up and
left alone and six weeks later, you couldn't even anything had happened.
The body is an amazing thing if you just get out of it's way and let it do
what it already knows how to do alot better than humans can.

So, for anyone interested, here's what the surgeons taught us on how to
clean up and deal with an open wound:

First, clean it out, because dirt and crud in there is going to introduce
bacteria and infection.  The sooner the better, because bacteria can
infiltrate into the deep tissue in as little as three hours (where they then
are protected from anything you're doing on the surface).

Using a little pressure to blast off clingy cooties is very helpful---the
best thing to use that's readily available is a spray bottle adjusted
somewhere between a fine jet (that's too much) and a fine mist (that's not
enough).  About the pressure you'd get from a waterpik is just about right.
You can also use a hose, but don't go overboard and waterlog the
tissue---just blast it out and get on with it.  Or, you can use some gauze
squares and get in there with some betadine scrub and give it a good scrub.
Don't take a metaphorical belt sander to it, but especially if the wound has
been there for a bit, and/or is dirty, then you want to remove the outer
cellular layer down to clean tissue (to get those infiltrating bacteria).
Depending on the blood supply and location/type of wound, then not much
scrubbing will result in just the slightest bit of fresh bleeding, which is
about right.  If you have any doubt about structures like tendon sheaths or
joint capsules being involved, then don't take a chance of further damage,
this is definitely a situation for the vet (though you can still clean it up
very lightly and put a bandage over it).

If you're going to use a "scrub", then rinse it off afterwards.  If you're
going the spray bottle route, then better than plain water would be just a
touch of Betadine (or 7% povidone iodine) added to the water.  Don't measure
it, just add a few drops until it's the color of weak tea.  MORE IS NOT
BETTER, you'll actually decrease the antimicrobial effect instead of
increasing it.  Or, you can use Nolvasan solution, but it's hard on exposed
tissue unless the dilution (40:1) is exactly right, so best choice in the
field would be the betadine/iodine.

After you've cleaned it up, put a light coating of triple antibiotic cream
*only* over the wound, and then a non-stick/telfa pad bandage over that,
roll cotton over that and a leg wrap over that.  Wounds will heal better and
are less likely to form 'exuberent granulation tissue' (proud flesh) if
they're covered at least for about the first ten days or so.  I know that's
logistically hard to manage sometimes (like if the wound is on the
hindquarters from a bite or something), but if possible, it's best to get it
covered.

If you don't know how to properly wrap a leg yourself, get someone WHO KNOWS
HOW (like your vet) to show you how sometime before you need the knowledge
up close and personal.  If the wound is on a leg and the horse is sore on
it, it's not a bad idea to put a support bandage on the opposite leg as
well---there's some argument at CSU about how much support that really
provides, but if done properly, it certainly won't hurt.

I don't have my surgery notes in front of me, so I can't remember how often
you're supposed to change the bandage after the initial wrap---if memory
serves, the general impression is that you can change the bandages, but
leave the wound itself alone and don't go dinking around with it other than
checking for swelling above or below the banadage, or a bad smell or other
bad juju like that.  You should re-wrap the outer leg wrap at least once a
day so you don't get pressure sores.  You do NOT want to keep using a hose
on it day after day to 'keep it clean'---plain water is actually harmful to
cells (because it's lack of electrolytes pulls salts out of cells and
thereby destroys them), so you're much better off cleaning it up thoroughly
ONCE and then keeping your damn fingers off of it for at least the first ten
days.

Obviously, this isn't comprehensive, and certainly doesn't cover dealing
with infected wounds, or wounds that need suturing or drains or those that
involve deep tissue like tendons and such, but hope it'll cover the basics
for at-home boo-boos. :-)

Susan G