D. E. Larsen, DVM
It was almost evening in late July when Geoff pull his pickup and horse trailer to a stop along the road adjacent to our house on Ames Creek.
I had just got my vet box installed on my pickup, making a few farm calls. It was far easier to practice on large animals without a clinic than working on dogs and cats. Still, I did not encourage people to bring livestock or horses to the house.
I met Geoff in the middle of the driveway.
“Hi, I’m Dr. Larsen,” I said as I offered this big guy my hand. “Is there something I can help you with this evening?”
“I’m Geoff,” he said. “I was headed into the wilderness area on Three Fingered Jack to scout the area for archery season. I was about a half-hour into the ride when Clyde, my horse, jumped over a log and jill-poked himself in his armpit with one hell of a limb sticking up on the other side. It made one hell of a hole in him. I turned him around right then and started back. I wanted to get back to the truck before he started to get stoved up from the wound. I was wondering if you could get a look at it?”
“I hate looking at a horse so close to the road, but it sounds like Clyde needs some help,” I said. “Let’s unload him and move him on to that little patch of lawn by your trailer.”
Clyde was a big horse, sort of a dirty palomino, almost brown. I wondered about his name. He was big enough to have some Clydesdale in his heritage.
It is difficult to back him out of the trailer. I think this wound was really bothering him now.
Clyde walked the few steps to stand on the patch of lawn with slow, measured steps. He wasn’t dragging his right front leg, but he was using it reluctantly.
I grabbed his leg and used it as a support as I swung my head under Clyde’s chest to examine the wound. I made an audible gasp!
“Wow, Geoff,” I said. “You’re fortunate that you got him back to the truck. Have you got a good look at this wound?”
“I knew it was bad, but I never crawled under him to look,” Geoff said.
“Well, not only is it a big wound,” I said. “But it is in a location that has so much movement, a closure will never hold.”
“So, what are you going to do?” Geoff asked.
“I am going to clean this wound up and then close it,” I said. “If we can get it to hold together for a week or two, it will speed up the total healing time. But I want you to prepare yourself for the morning when you go out and check him, and this wound is wide open.”
“What happens at that point?” Geoff asked.
“Then we will treat it as an open wound,” I said. “These wounds on the body, above the belly line, heal very well if they are kept clean and not allowed to get infected.”
With that, I scrubbed the wound with Betadine scrub. Clyde was very stoic or painful enough that he didn’t want to move. Then I injected Lidocaine around the wound for local anesthesia. I almost had to crawl under Clyde to shave the injury to my satisfaction. Then I gave the wound a final scrubbing.
“I am going to reach up into that wound and explore it,” I said to Geoff as I pulled on a pair of surgical gloves. “He has been pretty good, but you want to get a good grip on his lead rope.”
I eased my left hand into the wound. Clyde did not move. My hand was buried into the tear almost to my wrist when I reached the end of the puncture. Clyde had been fortunate, any deeper, and there are major arteries and nerves.
I explored the wound carefully with my fingertips. I immediately bumped into a chunk of wood stuck in the posterior depth of the wound. I couldn’t quite get a grip on it with my fingertips.
I stopped and retrieved a large forceps from the truck. After changing gloves, I had to almost crawl completely under Clyde, but I could get ahold of the piece with the forceps, and it came out with a good tug.
This was nearly a three-inch piece of wood. Jagged at the end, luckily, it was directed posteriorly, away from the vital structures in the armpit. I held it up for Geoff to see.
“This would have caused a little problem if it was left in there,” I said. “Clyde was lucky that the limb was pointed back. It missed some of the major stuff if this had gone straight up.”
I flushed the wound and placed a couple of drains before closing the wound as securely as possible. I had little confidence that things would hold together but thought we might just get lucky. After a hefty dose of Combiotic and a tetanus shot, we loaded him up for the trip home.
With all the Lidocaine, Clyde walked back to the trailer a little easier than before. He loaded easily. I think he knew he was headed home.
“Geoff, I am just getting started here and have plenty of time to manage cases. I will drop your place in three days to remove those drains. Then we can figure out a schedule of visits. If we get lucky, and this wound holds together, I will leave those sutures in for three weeks.”
“What do I need to do with him when we get home?” Geoff asked.
“If you can bed him down in a clean stall, that would be best,” I said. “The smaller the stall, the better. The more he moves, the more likely this wound will open up. Give him a dose of Combiotic twice a day and give me a call if that wound comes apart.”
Three days later, Clyde almost acted like he was glad to see me. He was in a small stall, but he stepped on his right front leg like it was not a bother. Again, I was amazed that he stood still as I swung on his leg to get the drains out. The wound looked great. I was allowing myself to think that I was home free. I left a note for Geoff, saying that I would check Clyde Monday, Thursday, and Saturday for the next two weeks.
In the middle of the second week, the wound opened slightly in the middle of the closure. There was minimal drainage, and it looked like there was good healing taking place.
I scrubbed the wound and injected some Lidocaine. Then I placed a mattress suture at each end of the opening in the incision. This proved to be an effective strategy, as the remainder of the closure healed well. The small open area took an extra couple of weeks to heal, but Clyde was as good as new after five weeks.
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