Case 6: Wound Healing by Second Intention
This is the story of Callie, a four-year-old warmblood cross mare and her unfortunate accident.
Callie is usually a sensible young mare, so it was quite a surprise when she was found out in her pasture one morning with a huge gaping wound.
The wound was 5 inches deep in places, and the accident had torn some muscles from their attachments on the pelvis. Callie was understandably sore.
Callie’s tetanus vaccination status was determined and the wound was carefully cleaned. The options for managing the wound were discussed, to suture or not to suture? The wound was in a very high motion area, and the skin edges would be under a lot of tension, increasing the risk of breakdown of the repair. The North Florida Equine veterinarian made the decision to let the wound heal by second intention.
Second intention healing means that granulation tissue must first fill the large wound, then this specialized scar tissue contracts, bring the wound edges closer together and allowing skin cells to bridge the gap. The healing process is much slower than when stiches are used to close a wound (a.k.a. “first intention healing”) and it requires a dedicated owner to clean and monitor the wound daily.
Callie was given pain medication and started on a course of antibiotics. A drain was placed temporarily to prevent fluid pockets from forming. It was important to keep the wound moist and protect it from dirt and insects…but the hip is a very difficult area of a horse to bandage! The North Florida Equine veterinarian placed a tie-over bandage that allowed Callie’s owner to perform daily bandage changes easily (see pictures below, three days after the accident).
Callie was much more comfortable on the injured leg and tolerating the wound care like a champ.
Callie’s owner put in countless hours of cold-hosing, wound care and bandage application over the next several weeks.
This is the wound at 13 days after the injury.
In the following close-up you can see a healthy bed of pink granulation tissue forming.
Just 10 weeks out from the injury, Callie has made amazing progress.
Callie shows no sign of lameness from her ordeal. There is a slight deformity were muscles were torn from the pelvis, but this hasn’t slowed Callie down at all. Callie’s pasture was searched for whatever could have caused the injury. The blame was pinned on a partially cut tree branch that had several sharp inches remaining. How Callie ended up impaling herself on it will never be known.
Second intention healing can be the only way to manage large wounds where skin edges cannot be brought together with sutures. Wounds on the body of a horse can heal very well by second intention and, unlike lower leg wounds, there is much less of a concern for proud flesh.
Second intention healing requires good wound care by a dedicated owner and a little patience.