Beyond Skin Deep: Recognizing and responding to equine lacerations

Horses have a mysterious ability to injure themselves in the most unlikely of places. 

Lacerations are among the most common injuries they sustain, and while some cuts are minor and need basic care, others can be deeper and located on or near vital structures. Knowing what to look for, and the best course of action, can greatly impact your horse’s healing and long-term soundness.

If the injury has grazed but not fully penetrated the skin, simple first aid may be all that is required. If the wound is actively bleeding, note the severity before applying a pressure bandage and calling your veterinarian for guidance.

“Sometimes it is hard to tell the depth of a laceration,” said Emily Schaefer, clinical assistant professor of equine emergency and critical care at the Marion duPont Scott Equine Medical Center in Leesburg, Virginia.  “A drafty, foxhunter-type horse may have skin on its legs that could be a centimeter thick, making it difficult to determine if the wound extends beyond the skin. If it completely breaches the skin, thought must be given to what underlying structures may have been affected,” 

“Consideration should be given to both the type and depth of the injury,” Schaefer explained. “Injuries to the pectoral and shoulder regions, however deep, have a good chance of healing successfully. Structures from the hock and knee down are more complicated, as the only tissues there are skin and bone with a few vitally important structures like tendons, ligaments, and synovial structures in between. There is much more risk associated with lower leg injuries, as they are difficult to treat and don’t heal as readily as skin and muscle. If the wound has penetrated beyond the skin into a joint or tendon sheath, the underlying infection can be incredibly difficult to treat and can be career-ending or even life-threatening. That’s why we treat lower limb wounds, or any wounds near joints, very seriously and very quickly.”

When it comes to lacerations into synovial structures (joints and tendon sheaths), time is of the essence. If a veterinary assessment on the farm is not an option, or if the attending veterinarian determines the injury’s location and depth require advanced diagnostics to evaluate the underlying structures, the horse should be transported to an equine hospital. While some diagnostics can be done on the farm, more definitive diagnostics as well as the treatment and aftercare are often better served in a hospital setting. 

Ultrasound and radiographs are commonly used to evaluate lacerations and assess synovial involvement. Combined with bloodwork and joint fluid analysis, these tools help indicate the chronicity of infection while also assessing vital organ health. 

At the Equine Medical Center, the in-house laboratory allows clinicians to collect samples for immediate evaluation. Joint and tendon sheath samples are analyzed through cytology for bacteria or other signs of infection, and fluid can be cultured in the microbiology laboratory to ensure that the antibiotics selected are the most effective available.

For treatment, surgical procedures may be necessary, depending on the type of wound, diagnostic testing, and the owner’s financial comfort level. In many cases, surgical lavage (sometimes called a “joint flush”) of the infected structures is recommended and can only be done at the hospital. This procedure flushes bacteria and debris from the wound while allowing for the application of antibiotic medication. In certain situations, lavage can be performed with the horse standing. Needle lavage involves the insertion of one or more large needles to flush sterile fluid into the joint. While this helps remove small debris and promote healing, it can be limited by the smaller entry point, which allows for lower fluid velocity and volume.

More complex lacerations often require treatment under general anesthesia. Deep injuries requiring extensive debridement, repair of distal limbs, or treatment of joints, tendons, or bone fractures may call for arthroscopic lavage. This specialized procedure uses a small camera to visualize the joint cavity and guide precise debridement. Foreign bodies, if not removed, can cause ongoing infection or pain. Thorough cleaning and repair of these deep lacerations provide the best chance for full recovery. 

Lacerations involving wood or wood splinters can complicate treatment and require specialized care. Transporting the horse with the object still in place is often advised, provided it does not compromise the horse’s comfort or risk severe hemorrhaging. Removal of such objects is best performed in an equine hospital.

Penetrating injuries to the base of the foot, which are often called “street-nail” injuries, are particularly problematic and would warrant a separate article. The horse should be kept quiet and calm while radiographs are taken to identify the exact location and track of the nail or penetrating object. This step is essential before removal to ensure successful diagnosis and therefore treatment. In some cases, radiographs can be taken on the farm and the object removed prior to transport. If the nail is not likely to be driven deeper into the foot, bandaging it in place and transporting the horse is acceptable.

One of the most memorable lacerations Schaefer has encountered was a flank injury.

“A gate latch caught the horse’s flank and stripped a substantial amount of skin away from the body,” Schaefer recalled. “Thankfully, everything beneath the skin was intact, but the sideways V-shaped wound extended from hip to elbow. Under standing sedation, we were able to confirm that no body cavities were penetrated, and we performed paralumbar anesthesia along the horse’s spine that allowed us to get the whole side of the horse numbed in one fell swoop. This case is memorable because of the extent of the wound and how many hours it took to repair the wound, despite the convenience of the block that allowed us to work quickly, and how well she did in the end. Drains were placed during the repair to allow inflammatory fluid to exit the wound safely and those were closely monitored for several days with frequent bandage changes and then removed aseptically. The skin did not lose vitality thankfully, and with frequent bandage changes and antibiotic treatment, the horse recovered successfully.”

While wounds that involve more than just skin should be treated at the hospital, even the horses with large skin wounds without synovial involvement benefit from hospitalization. The monitoring, bandaging, drain management, and intravenous antibiotic therapies can make a big difference in the outcome.

Contact:

Andrew Mann
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