Page 7 - Equine Matters - Autumn

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WOUND C A S T I NG
AUTUMN/WINTER 2011 ISSUE
EQUINE MATTERS
6
Certain types of wound can be managed
very effectively with the application of a
limb cast. Whilst the initial costs may be
greater, the period of wound healing can
be considerably shorter, with an earlier return
to work, less need for repeated bandage
changes and a better cosmetic result.
The main benefit of limb casting is the rigid
stabilisation of the wound within the cast. This
reduces the amount of proud flesh production
and allows the normal healing process to
progress, without being continuously disrupted
by movement at the wound edges. This
benefit is particularly important with wounds
over joints such as the fetlock.
For a cast to be applied, the wound site must
be healthy and relatively free from infection.
Removal of any dead or infected tissue and
excessive proud flesh must first be completed
(Figure 2). Partial or complete suturing of the
wound is often carried out at this time (Figure
3). Depending on the location of the wound
and temperament of the patient, preparation
of the wound and application of the cast
can be undertaken either using standing
sedation with local anaesthesia, or under
general anaesthesia.
Lower limb casts can include only the hoof,
or extend up to the fetlock, or knee/hock
(Figure 4), depending on the location of the
wound. Several layers of padding are
applied to the leg, including foam strips
around the main pressure points before the
cast is applied. Modern cast materials set
very quickly, are light weight, but very strong
and durable. Equine patients tolerate casts
very well and soon adapt to having a slightly
longer and inflexible leg.
Casts can remain in place for up to about
three weeks, before being removed under
sedation using a cast cutter. At this point
the wound can be re-assessed and a light
bandage applied for a short period to
protect the area. If the wound has healed
well then the patient may be able to return
to normal work considerably sooner than
expected (Figure 5).
Binscarth Farms
Case Study -
Wound Casting
Veterinary Surgeon
Chris Lehrbach
XLVets Practice
Chapelfield Veterinary
Partnership
Chris Lehrbach BVMS MVM Cert ES (Orth) MRCVS
, Chapelfield Veterinary Partnership
T
raumatic injuries commonly involve the lower limbs, wound healing in this area is notoriously slow, often
resulting in excessive proud flesh and scar tissue formation and poor quality healing (Figure 1). Bandaging
may be necessary for prolonged periods of time, resulting in considerable expense and time off work.
Figure 1
Heel bulb laceration with bulging
proud flesh and damage to the coronet.
Figure 2
Healthy wound flap after removal of
proud flesh, ready for suturing.
Figure 3
Wound flap after suturing, re-aligning
coronary band to avoid hoof wall defects.
Figure 4
Casts prevent movement of the joints,
tendons and ligaments of the lower leg.
Figure 5
Three weeks after repair and casting,
the coronet wound has healed very well, with
minimal scarring.