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Day of Arrival
3-yr-old filly arrived with wound after 8 months of care. The wound wouldn't heal due to lack of exercise. Not eh horiz. and vert. cracks in the wound bed.
Mother Nature can be a great teacher. My education started on our family farm in
Virginia. The golden rule was if you buck Mother Nature, you lose. If you adopt and adjust, you win.
How does a rural vet in Arkansas discover such a practical truth? I have been lucky enough in practicing veterinary medicine to apply this principle, specifically in the use of Platelet Derived Growth Factor (PDFG) in healing wounds.
Wounds heal best with good blood supply to the site. To see the converse of this principle, take for example, a diabetic wound: lacking a good blood supply by definition, this type of wound, usually an ulcer in an extremity, has difficulty healing due to the fact that as new tissue tries to grow, bacteria take over. Now consider a cut inside of the mouth or rectum, where the basic principles of healing are also compromised. Bacteria are present in this instance also. Tissue is moist and in constant motion, and no bandages can be utilized. Topical medication is not easily applicable, yet, the wound will heal in three days to four weeks, depending on its size. Why? Because mucous membrane tissue has a prolific blood supply.
I believe this to be the basis principle of wound care. In over 40 years of treating catastrophic wounds, I have never seen an infection occur under any solid bed of granulation tissue (new connective tissue) unless a piece of necrotic bone or a foreign object was present. Again, to use the example of diabetes: When a sterile wound won’t heal, it’s necessary to amputate. Horses with this condition often face euthanasia. So is granulation tissue public enemy number one in wound care or is it the body’s effort to bring (a mucous membrane type tissue) blood supply to the wound site?
Platelets: The Way Toward Healing
Most experts would agree that the most beneficial agent at a wound site is platelets, most obviously for blood clotting, but also in the release growth factors at the wound site. These factors take charge of directing the entire cell activity at the wound (not just clotting blood). We know there are at least 50 growth factors in human platelets, but we haven’t determined the number in horse blood platelets yet. So there is more to be learned.
Blood platelets can be concentrated in the form of a gel. I have applied this concentrated gel to fresh wounds, even at bone level. A key factor in healing wounds is time: The sooner the platelet and healing agents are applied to the wound the quicker the new tissue begins to grow. Trapping the fluids, serum, and cells that came out of the tissue at a new wound site is very important to starting tissue to regenerate. Washing the wound with water and soap and depleting the wound site of the cells (platelets, growth factors) is actually killing the cells and therefore not a good idea. Under the guise of removing bacteria and contamination, Mother Nature’s best tools for wound healing are removed. A great alternative is using a non-cytotoxic wound wash that kills bacteria and fungus at the wound site without killing tissue. It is available to horse owners under the brand name Eclipse Wound Wash and to veterinarians as Lacerum Wound Wash. Now with an antibacterial, antifungal, non-cytotoxic wound wash, combined with a natural product in blood that organizes the cells at the wound site and speeds up healing rates, the healing can begin, along with the following regimen.
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Note reduction in wound size as well as development of epithelial boarder.
Stage I Healing (Day 0 through 14)
If a generalized infection exists, a course of IV and IM antibiotics will be necessary. After three or four days use wound wash, platelet derived growth factors, and on occasion, if a joint or bone is exposed, antibiotic therapy for generalized infection at the wound site. A typical wound should be decontaminated with wound wash. Serum, platelets, etc., are bandaged and left wrapped for 2–3 days with an occlusive bandage, trapping the fluids that form at the wound site. If wound care was initiated quickly enough and no harsh drugs (i.e.: those designed to kill proud flesh by destroying circulation) were used, then the granulation tissue should begin covering the bone by day 10. By days 20–30, the granulation tissue may have reached skin level.
Stage II Healing (Day 14-21)
The goal of stage 2 is to utilize a “wet to dry” bandaging technique that removes moisture from the granulation cells, preventing tissue overgrowth by allowing the cells to stabilize. Pull off the dried scabs every other day. In doing so, you are disturbing the vessels, thereby insulting the blood vessels into sealing off. No medications that stimulate growth are added at this stage except to the epithelial border around the wound where the skin connects with the granulation tissue. I do not use any heavy metal drugs that rupture blood vessels and suppress granulation overgrowth. I admit that wounds won’t heal if the granulation tissue is above skin level, but I prefer not to prolong healing by stopping blood supply to the wound site.
Stage III Healing (Day 21–30)
Stage 3 healing treatment begins after 20–30 days to allow the granulation tissue to mature and smooth out. Remember to remove the scab from the wound every other day. Stage 3 focuses on protecting the granulation bed and stimulating the epithelial border with Lacerum Cream. Apply wound wash and bandage. (Make sure to consult your veterinarian on supportive bandaging techniques). In the case of big wounds on the parts of the legs where tissue gets stretched, exercise and flexing is very important to prevent cracks in the wound. It may be necessary to put a cradle or a bib on the patient to keep him from chewing the wound surface. On occasion, Banamine or Bute maybe necessary to prevent self-mutilation.
Know your anatomy and listen to your veterinarian
Different wound locations pose different challenges for healing. Hock injuries are difficult to heal because of bandage placement and because tissue gets stretched to the point of splitting. Lacerated tendons are special because this type of wound may require support braces, in addition to the tissue being more susceptible to infection. Hoof problems are unique as well. Think about healing a fingernail that gets pulled off and needs to grow back. It does not take a year to grow a hoof back, only about 4–6 months, but it does involve constant care.
Finally and critically: Wound care is a team effort between the owner and the veterinarian, with the goal always being the patient, then the outcome. I have found that in my 47 years of veterinary practice, Mother Nature and time are the best educators. And while time may not heal all wounds, when combined with the right techniques it does have an exceptional success rate.
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The filly was put back into training as she continued to heal.
Dr. David Jolly is a veterinarian with more than 45 years of experience. He is an Equine practitioner and has worked at racetracks in West Virginia, Maine, and Arkansas. Since 2001, Dr. Jolly has focused on Equine Catastrophic Wound Therapy, pioneering the use of platelet derived growth factors in healing wounds at Step Ahead Farm and Training Center in Hot Springs, Arkansas. He has consulted on cases of catastrophic wounds worldwide, and more information can be found on his website, http://www.stepaheadfarm.com/