Question: A recent accident at the barn made me want to be better prepared to deal with common health-related issues that could involve my horse. For example: Say he comes in from the pasture with a wound that’s bleeding. How do I handle the situation?

Answer: The sight of blood can be alarming, so your first priority is to stay calm as you approach your horse and begin to size up the situation. If he’s able and willing, lead him to a clean, quiet and well-lit area. Have a helper grab a first-aid kit and then hold your horse so he’s less likely to panic or kick as you continue to gauge his reaction to the injury, assess its extent and take steps to treat it or stabilize it until your veterinarian can respond to an emergency call. Here’s how to proceed.

Step 1: Stop the Bleeding

Concentrate your initial efforts on controlling bleeding, especially if it’s heavy: Apply even and direct pressure to the wound with a sterile gauze pad. You can also use a clean wash cloth or towel, a diaper or sanitary pad. Avoid placing sheet or roll cotton directly on the wound surface. The fibers will stick to tissue and contaminate the site. If blood soaks through whatever you’re using to stanch the flow, place another layer on top to avoid disturbing any clotting that’s occurred. The situation is serious and requires your veterinarian’s immediate attention if the wound

• continues to bleed profusely even as pressure is applied
• involves a joint, which also may be oozing clear, yellowish fluid
• is more than skin deep, especially if an eye or the jaw is involved, or the wound is deep and over the chest or abdomen
• is exposing tendons or bone
• has edges that gape apart or there’s a loose flap of skin
• is very dirty or contains sizable pieces of wood, bits of metal or other foreign material. Caution: Do not attempt to remove any item that has penetrated a horse’s eye. Leave it for your veterinarian. Likewise, don’t pull a nail that has punctured a foot and remains in place. An X-ray will be necessary to determine the internal structures involved and the appropriate course of care. 

Alert your veterinarian, too, if your horse is

• unresponsive or showing signs of shock: irregular breathing, shallow pulse, unfocused eyes, cold ears and feet
• agitated and resisting efforts to calm him
• very lame.

Step 2: Clean the Wound with Care

For a wound that’s relatively minor, you’ll likely be able to administer first aid on your own once bleeding has subsided. Start by flushing out visible dirt and any embedded foreign material that could introduce bacteria and lead to infection. Use a gentle flow of cool water from a hose or irrigate with a stream of sterile saline solution delivered from a bulb syringe or large-dose syringe with no needle. (Note: You can make your own saline solution by dissolving 2 tablespoons of plain table salt in 1 gallon of distilled water.) If flushing alone isn’t sufficient, carefully cleanse the wound area with antiseptic soap containing chlorhexidine, povidone iodine or betadine. (Caution: Do not use chlorhexidine on a wound near an eye.) Avoid vigorous scrubbing, which can further damage tissue, increase bleeding and drive dirt and debris deeper into the wound. End with a thorough, gentle rinsing and allow the area to air-dry.

If your efforts reveal that the wound is more than superficial, call your veterinarian for assistance before proceeding. Her top priority will be to assess the wound for underlying involvement of critical structures. Even a small wound can be life-threatening if a joint or body cavity is involved. Large or deep wounds may require sutures (stitches) to shorten healing time and reduce scarring. Contaminated wounds or those with ragged edges may need debriding and the administration of a systemic antibiotic to prevent infection. Your horse may also need to receive a tetanus booster if it has been more than six months since he was vaccinated.

Step 3: Medicate the Wound as Directed

Because some products can actually inhibit healing or complicate the situation if a wound needs sutures, check with your veterinarian before applying any topical medication to your horse’s injury. A triple antibiotic ointment—which combines neomycin, polymyxin B and bacitracin—is often a good choice because it is not irritating or damaging to healthy tissue. (Note: Topical antibiotics are no substitute for systemic antibiotics in serious wounds.) Silver sulfadiazine cream—a water-soluble white ointment available by prescription—may be recommended for its antibacterial and antifungal properties. Both medications can also help a wound maintain an appropriate moisture balance, which is an aid to healing. A third option, medical grade manuka honey, has been shown to have antimicrobial and anti-inflammatory properties, and research suggests it is effective against a range of bacteria. Often it is used under a bandage so the horse won’t lick it off. A fourth option, an adhesive aluminum bandage spray, may be an option for a minor wound. It provides protection while also allowing the wound to “breathe” during the early stages of healing.

Step 4: Bandage the Wound if Necessary

Rely on your veterinarian’s advice with regard to bandaging your horse’s wound. There are two main considerations: its location and depth. Generally, it’s preferable to leave wounds above the elbow and stifle uncovered. They tend to scab and heal on their own because of the relative immobility of the horse’s torso and the good blood supply to the area. Plus, a bandage here can be hard to maintain. Shallow wounds, too, can be left uncovered once they are thoroughly cleaned.

In contrast, wounds below the knees or hocks usually need a bandage to shield them from dirt, abrasion and insects as well as to minimize motion, which can hamper scar formation. A full-thickness wound—one that penetrates all skin layers—also will benefit from a bandage to keep its edges from pulling apart during healing, protect any sutures and safeguard against infection. 

Your veterinarian can demonstrate the proper bandaging technique for your horse’s wound. In short, you’ll

1. position a nonstick dressing over the wound along with any medication.
2. use a conforming gauze wrap to hold the dressing in place.
3. add layers of sheet or roll cotton to protect the wound, absorb fluids and prevent swelling.
4. secure the entire dressing with an elastic veterinary bandage.

Step 5: Monitor Healing

Over the next few days, you’ll inspect and treat your horse’s wound daily, according to the advice you’ve received from your veterinarian. That may mean reapplying an ointment she’s prescribed as well as replacing a bandage. In most cases, you’ll begin to see healthy pink tissue appear at the wound edges within three to five days. Alert your veterinarian if your horse develops any of these common wound-healing complications:

• foul-smelling discharge or pus oozing from the injury
• the formation of proud flesh (excess granulation tissue rising above the level of surrounding skin), especially on wounds that have been bandaged
• increased swelling at the site
• worsening or continued lameness
• decreased appetite
• fever. 

Practical Horseman thanks Alison Gardner, DVM, MS, DACVS-LA, DACVECC-LA CVA, for her technical assistance in the preparation of this article. Dr. Gardner is an associate professor in clinical equine surgery in the Department of Veterinary Clinical Sciences at The Ohio State University in Columbus.

This article originally appeared in the Fall 2023 issue of Practical Horseman.