Small injuries to the skin happen continuously, and we take for granted that the body will heal these, and keep infection at bay. However, the process of healing which the body goes through to resolve both minor and major wounds is complex, and the use of correct herbs can be significantly assist in both speed and effect.
Think about a serious cut to the lower limb of a horse. As soon as it happens, there will be pain and blood loss. Once the initial critical stage is passed, inflammation and swelling will begin to occur, infection may begin to set in and unbeknown to you, tissue repair will have already started. Proud flesh is always an issue with injuries to horse limbs, but this will not become a problem until later.
The initial trauma
Blood loss: On the lower limbs, blood loss is not usually a significant issue as the leg itself is not extensively vasculated. However, there are arteries and veins serving the foot which may become severed. If this is the case, then major blood loss could become a problem and this must be attended to as soon as possible. Use your usual first aid techniques in this case.
There are herbs to assist which are outstanding if you have available. The two to look for are shepherd’s purse (Capsella bursa-pastoris) and yarrow (Achillea millefolium). Shepherd’s purse is a bit stalky and hard to use but yarrow is readily available in pasture and is outstanding as a haemostat. All you need to do is pick a generous amount, scrunching up to bruise and break up the leaves, apply directly to the wound and, if possible, bandage it in place. Our most spectacular use of this was on a dog which had been fighting a rat. Although the outcome was in dog’s favour, it suffered a severe bite to the end of its nose. It was bleeding profusely but the application of yarrow very quickly stemmed the bleeding.
Pain: Although pain is likely to be an issue until the wound is substantially healed it will often not occur until a few moments after the injury. Having said that, pain is often associated with inflammation, and can be dealt with in the same manner. In serious cases where inflammation and pain are likely to be present, we use devil’s claw (Harpagophytum procumbens) as a proven, effective and fast-acting treatment. Because you want a quick as action as possible, it is important in these instances to use good quality liquid extract, and also to choose one using ethanol, which ensures a high level of bioavailability.
Providing there are no other factors to prevent it, you can use large doses of devil’s claw in the initial period of recovery, say one to five days, of up to 50ml twice a day. After that, it is fine to reduce it as you see fit.
Fear: Although not usually thought of as something that needs first aid treatment, over-excited behaviour or unwillingness to co-operate can be a serious issue with injured horses. In extreme cases, it can become a safety issue for you. Hopefully, you will have some valerian (Valeriana officinalis) in your first aid kit, and now is the time use it.
The first week
Internal support: Once the wound is stabilised, the process of longer-term healing begins, and this is where your ongoing diligence will be rewarded. As you move into this period, you should maintain the pain relief and anti-inflammatory herbs as appropriate, and probably incorporate them into a bespoke formula.
Along with proud flesh, the risk of infection is probably your biggest worry. Even if the cut is clean, there will be bacteria present on the skin and on whatever caused the injury, which will be enough to allow an infection to develop.
In our experience, approaching this from two fronts is the best. Firstly, incorporate immune support and antimicrobial herbs into your formula. For immune support, echinacea (Echinacea purpurea) is the most appropriate. It is extremely safe, readily available and should not be too expensive.
For specific antibacterial activity, we will incorporate barberry (Berberis vulgaris) into the formula. These should both be started as soon as possible. Do not wait until an infection is apparent.
External support: The other approach to infection control is topically on the wound itself. Here, the solution is to use a mixture of calendula oil and manuka honey.
Because they will not remain blended, you need to mix them as needed.
How you apply them will depend on the wound itself, but if it is a lower limb cut, say on the cannon bone, a dressing of gamgee is the best. If the wound is very bad, you may need to use petroleum jelly-impregnated gauze to stop the dressing sticking to the wound.
We find the best way to apply the honey/oil mixture is to cut the gamgee to about A4 size. If you are using gauze, put it on the gamgee then apply the honey/oil mix. Don’t be mean with it! Put the whole dressing on the leg and bandage in place.
The calendula oil is best made from your own home-grown calendula (Calendula officinalis) but failing this, buy the deepest orange one the you can find.
The honey is included for its antibacterial properties so use the highest UMF rating that you can afford. We have a little stash of UMF 25+ in our first-aid kit. Keep it well away from the kitchen; it is far too valuable to eat.
If the wound occurs during the summer months, it will attract flies and there is always a risk that it might become fly-blown. Even if it is well bandaged, this can happen.
Neem oil (Azadirachta indica) is fabulous for keeping the flies away, and you can also use it over eyes and on yourself. It does smell strange to some people, but is far superior to essential oil-based fly deterrents because the effect is much longer lasting. We used it on a horse with multiple cuts in places that could not be bandaged. It was midsummer so we diluted the neem oil with water and misted it all over the horse. It is quite safe over open wounds, and in this case kept the flies away with only a twice daily misting.
When tissue is traumatised, not only is there blood loss, which should be short-lived, but there is also a continuous loss of interstitial fluid. This is the clear exudate that keeps wounds moist. It does, however, cause some problems if it is excessive, and combined with the honey and calendula oil can cause a ‘burning’ to the surrounding healthy tissue. To prevent a build up of debris on the wound and this burning problem, we give the wound a thorough wash once a week. Don’t use soap, or anything other than clean water.
To rebandage, or not?
Re-bandaging seems to be a slightly contentious issue. We have found through experience that the best results occur if you apply new dressings every day. It is tempting to leave it but in the end you will regret it. Just remember that diligence and attention now may save your horse from extensive scarring and infection. If the worst happens, the wound could take months to heal, but if you make a few days’ real effort at this stage, it will pay off.
If all goes well this intense period of treatment should only last about two weeks.
Dealing with proud flesh
Unfortunately, many wounds are not discovered until some time after the event. This delay allows for the contraction of the skin on the lower limbs or a cut close to a mobile joint, and usually renders suturing (stitching) unsuccessful.
Proud flesh, more theoretically known as ‘exuberant granulation tissue’ is excessive growth of the granulation tissue which forms to fill in the wound during the healing process.
In the first few days after injury, the wound prepares for healing by removing damaged or dead cells, white blood cells fight infection and fibroblasts begin collagen synthesis. The granulation tissue begins to proliferate and filling in the wound.
Granulation tissue has a high density of capillaries, so is red, very fragile and bleeds easily. The skin edges normally contract in and heal over the granulation tissue until they meet, forming a scar.
Normally, the body receives signals when there is sufficient granulation tissue to allow full healing. but sometimes, the necessary information to stop growth is not received, so once it reaches the edge of the skin it continues to rise above the wound edge; hence proud flesh forms. The skin edges can’t contract over this tissue, causing the wound to stay open and granulate uncontrollably.
Established proud flesh is managed in two ways; it is either surgically removed or cauterized, or caustic or drying agents are applied to destroy the tissue to or just below the wound edge. These methods do not necessarily stop the proud flesh growing, and further intervention may be necessary.
However, a regular application of calendula oil can be really effective, applying daily for at least a month after bandaging has ceased.
Most herbs that support tissue repair and wound healing are used topically but gotu kola (Centella asiatica) can not only can be used topically, but can also be taken internally to encourage healing. The significance of this is that the healing potential of gotu kola is not just confined to the skin, but can be used to promote healing in any tissue ie. skin, bones, ligaments etc.
Gotu kola ensures efficient regeneration and repair of tissue, so can be used in any post-operative or trauma recovery. As healing progresses, gotu kola supports the speedy production of new connective tissue and the reduction of scar tissue.
Research in to the properties of gotu kola has been going on for some years, and the body of knowledge is steadily growing, but there are some promising results.
On the home straight
If you get to week two with no problems, you should be on the home straight. The healing process should be well underway, but you will need to keep up the dressing protocol. Depending on the circumstances, you may be able to relax by about Day 17 and just keep applying the oil. Bandage at discretion and keep applying the oil for a few weeks.
Typically, by about Day 60, the injury should have well healed – hopefully with minimal scarring. Success at the end will be a direct result of the diligence you bring the beginning of the process.
If you think the wound is overwhelming don’t despair. Our worst case by far was a filly who tried but failed to jump a wire fence. She damaged all her legs and ended up stuck in the fence with severe lacerations in the stifle area on both sides. She was in such a state of shock when we found her that she could scarcely move. Because she was so bad, we involved our vet. She had just one shot of penicillin, then the herbs I’ve discussed. No-one admitted it until later but we all thought that she would end up being euthanised. How wrong we were. She healed up fantastically, made a full recovery and went on to be a very good polo pony.
- This article was first published in the February 2017 issue of NZ Horse & Pony