Lacerations and Penetrating Wounds

1. Lacerations and Penetrating Wounds Dr Amy Plummer Large Animal Emergency and Critical Care University of Tennessee College of Veterinary Medicine

2. Overview • Emergency lacerations • Blood loss • Joint involvement • Penetrating wounds • Care of lacerations

3. 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

4. Emergency Lacerations • 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

5. Emergency Lacerations • Common sites • Distal extremities • Neck lacerations

6. 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

7. Blood Loss

8. 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

9. Blood Loss • Visualize the bleeding vessel • Hold vessel off • Tie vessel if easily done

10. Blood Loss • Once the vet arrives • Ligate vessel • Sterile bandage • If significant bloodloss: • Referral for IV fluids and/or blood transfusion

11. 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

12. Lacerations with Joint Involvement • VERY important to determine if joint is involved • If laceration is NEAR a joint, consider it an emergency

13. Anatomy

14. Anatomy

15. Joint Involvement • Emergency veterinary care • Keep horse quiet and in clean environment • Clean? • Bandage?

16. Joint Involvement • Veterinary Care • Determine structures involved • Radiographs? • Lavage of joint/tendon sheath • Antibiotics (IV, regional, intra-articular) • Phenylbutazone

17. Joint Involvement • Radiographs for foreign bodies

18. Joint Involvement • Determining if joint is affected

19. Joint Involvement • Prognosis • No joint affected • Joint contamination vs infection • Multiple levels of care • Monitor for lameness • Acute non-weight bearing lameness

20. Joint/Tendon Sheath Involvement • Antibiotics • Systemic • Intra-articular • Regional limb perfusion

21. 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.

22. 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

23. Penetrating Wounds • LEAVE object in place

24. Penetrating Wounds • Puncture wounds on limbs or upper body • Tetanus status • Monitor for swelling, gas production

25. Penetrating Wounds • Can be more significant that what meets the eye

26. Penetrating Wounds • Wounds to the sole of the foot

27. Penetrating Wounds • Radiographs

28. Penetrating Wounds • After radiographs, veterinarian will remove object

29. Penetrating Wounds • Wounds to sole • Sole vs Frog

30. Penetrating Wounds • Frog • Navicular bursa • Coffin Joint • Treatment depends on structures involved

31. Penetrating Wounds • Wounds to sole and frog • Dr Gray will present more this afternoon with Non- Weight Bearing Lameness

32. 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

33. Care of Lacerations • Primary closure • Clean, fresh wound • Adequate skin • No synovial structure involvement • Before closing • Lavage • Debride area

34. Care of Lacerations • Debridement • Remove layer of compromised tissue, decrease bacteria

35. Care of Lacerations • Lavage of area • Wash away contamination and decrease bacteria • Solution?

36. Care of Lacerations

37. Care of Lacerations • Primary closure

38. Care of Lacerations

39. Care of Lacerations

40. Care of Lacerations • Primary Closure- Complications • Infection • Dehisence • Delayed primary closure- allows more debridement • Lavage • Wet-to-dry bandaging

41. 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

42. 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

43. Care of Lacerations • Second intention

44. Care of Lacerations • Second intention healing

45. Care of Lacerations • Second intention healing

46. Care of Lacerations

47. 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

48. Care of Lacerations • Bandaging

49. 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

50. Questions?