OTC Wound treatments and what's really going on

Wound treatments explained

So you’re at the local tack store and a yet another wound product claiming to regrow hair or prevent proud fresh is screaming at you from the shelf display. Will this one really work or will it just end up collecting dust like so many other products you have bought in the past?

Before we discuss ingredients or products let’s first briefly discuss how the horse’s body heals.
Once any injury occurs, the area must go through 3 “stages” of wound healing before the area will be completely repaired. The first being acute inflammation, during which, the blood vessels respond to form a clot and call white blood cells to the area to remove debris, dead cells and bacteria. These white blood cells are responsible for the exudate (pus) that can be present in a contaminated wound. At the end of this stage, small epithelial cells travel under the scab and start to fill area for the “scaffolding.” Healing cannot proceed without the completion of this stage. Infection, extreme cold, improper skin pH and the wound becoming too dry can all impede or halt this stage.
The second stage is repair, in which, the cells begin to make the scaffolding for the healing to occur on. Macrophages continue to clean the wound and stimulate development of fibrous connective tissue and a rich coating of fibronectin and hyaluronan. Capillaries form within this grid giving it a bright red to pink color. This is now called a granulation bed and should not be confused with proud flesh. Proud flesh or exuberant granulation tissue occurs on or below the hocks or knees when too much motion or irritation of the wound causes the granulation bed to expand past the wound and grow outward. This prevents the skin from contracting and the excessive tissue must be removed in order for the skin to close fully. However, if the wound was treat properly, no proud flesh should be present.
With this rich bed in place the edges of the intact skin can crawl inwards starting the final stage roughly 2 weeks after the initial injury. The skin moves across the granulation bed at a rate of 1mm a day from all sides of the wound. If the previous stages have proceeded with no interruptions, this final phase will close the wound with minimal scarring. Hair follicles are in the skin that is crawling inwards, no product can grow hair on skin that does not already contain hair follicles….period. If a scar is present and no hair follicles were able to cover the area, the only way to restore hair to the area is a skin graft.
Now on to products and treatments options:Different stages all need different treatments during the inflammation stage, the biggest obstacle is preventing or treating infection. Systemic antibiotics are the best way to treat infection in a wound, as topical products cannot penetrate the wound effectively. A correctly applied wrap should be placed on any lower limb to reduce movement and prevent contamination as well as keeping the wound warm and moist. The wrap also increases tissue oxygenation by lowering the pH at the wound’s surface. All of these benefits of the wrap increase the rate of epithelialization, and thus the healing rate. This wrap should be changed every 1 to 4 days (more often in the beginning) and left in place until the wound is level and begins to contract, at which time, the wound can usually can be left open.
Cleaning a Dirty WoundIf the wound became dirty or is infected, cleansing with a dilute betadine or chlorhexidine followed by cold hosing will reduce the amount of debris and bacteria present on the wound. As one of vet school professors said, “Dilution is the solution to pollution.”
Topical Creams and SpraysThese products are not necessary in a clean wrapped wound, however, if you must put something on the wound make sure it will not hinder the healing process.
Triple antibiotic, chlorhexidine cream, or zinc oxideo Can be safely be used for the first 3 to 5 days, after that it stops new cells from bridging gapo Some studies have shown a 25% to 33% increase in healing rate
Silver sulfadiazineo Safe for all stages in horses (other species it has decreased healing in some stages)o Some studies have shown a 25% increase in healing rateo Has broad-spectrum antibacterial, antifungal and antiviral activity
Hydrogelso Safe to use during any stage of wound healing but are particularly useful during the 2nd stage
Any product labeled to reduce proud flesh, contains copper, or needs baking powdero Never on a fresh or early stage wound as they will kill the new cells and actually slow the healing processo Why put something that says poison on the label on a wound?o If the wound was treated correctly early on, no proud flesh should be present
Nitrofurazoneo Not to be used on these early stage wound, as studies has shown a 30% decrease in healing rateo During later stages it increases the rate of granulation of the woundo Known carcinogen, wear gloves
Oilso Scarlet Oilo Stimulates granulation tissue on belly and sideso Could cause proud flesh if used too much on the lower legs
Powderso Lime (i.e. Wonder Dust)o No, just no…o Its caustic and drying, we just went over how wounds heal…
Natural Products
Honeyo Antimicrobial action from osmolality, acidity and hydrogen peroxide created on the wound surfaceo May be extremely dependent on type of honey
o Increased granulation due to irritation
Sugar (mixed with Dilute Iodine)o Good antibacterial propertieso Best in early stages
Tea Tree Oilo Has some effect on healingo Can be very irritating to some horses skin
Colloidial or Chelated Silvero Good antibacterial propertieso A lot of research is currently being done on this product
Hydrogen Peroxideo Never over a jointo The jury is still out of the effectiveness and safety of this product in horses § It is no longer used in human ERs due to suspected cell damage and delayed wound healing
Taro Another big NO!o Delaying healing by 45.9%o Studies have proven it actually increases the severity of infection
Bacon Greaseo If grease grew hair back, bald men would cover their heads in it.o No product can grow hair in an area with damaged or absent hair follicles
For anyone out there that says: “I used so and so and my horse healed great, so you are wrong”, my answer to that is most likely the horse would have healed no matter what you put on it because skin wants to heal. Check your healing time and I bet it was the same as normal healing or slower.
Take Away Tips· Properly wrap lower legs if possible to enhance healing and prevent contamination until wound is level and begins to close· Topical creams are not necessary but if used make sure they don’t impede healing instead of helping· Never put an acid or any product labeled to reduce proud flesh on a fresh or early stage wound as it kills new cells· Hydrogels and Silver Sulfadiazine are safe for all stages of wound healing in horses· No product can regrow hair on an area with no hair follicles (i.e. scar) · If a wound is over a joint, call your veterinarian to make sure the joint itself is not involved· If the product would burn or injure your eye, think twice about putting it on a wound· If a wound isn’t healing right, call your veterinarian!
(If anyone wondering the wound in the above picture healed perfectly after veterinary intervention)