Day 1
Day 15
Day 24
Counter
This case was handled as a consultation, through this website, e-mail, and phone conversations.
This horse was located in Houma, Louisiana, (515 miles from Step Ahead Farm) and was treated by the owner,
with the assistance of a local vet.
After Dr. Jolly viewed the pictures sent by the owner,  he sent her two dvds on hock and cannon wound cases
similar to the injury on her horse, and one dvd on bandaging.
Dr Jolly was able to give her guidelines in advance on what would happen with the wound during the healing
process, which gave the owner the ability to be prepared and to know what to look for and how to react to each
situation. (example: the occurrence of avascular necrotic bone, which the owner eventually took the horse to LSU
to have the bone removed surgically)
Treatment 3-4-2010 through 8-15-2010
Day 81
DAY 24 -
OWNER - Yes, I am using serum, please send that DVD on bandaging. Thanks for all
your help. I will definitely keep you posted!

DOC -    I was wondering if you would mind sending some more pictures of your
horses hock so that I can reevaluate the progress.

OWNER -    Saturday I hauled an hour down the road to local vet...He removed some
excess granulation.  I dont have any more exposed bone but I'm not crazy about the
tissue that is in its place. He said top two black spots are dead or dying granulation
? And the lower black spot was a blood clot ? Overall I think we're doing good, I
wasn't expecting the bone coverage to happen so quickly.
Day 81 -
OWNER - These pictures were taken yesterday 81 days post injury.
LSU did punch skin grafts (4/18/10) most of which have taken, but as you can
see there are some areas that just didn't accept them.  
He is walking well only knuckling over once or twice a week. I have begun
hand walking him and I have a recheck appointment in three weeks.  I have
been treating the granulation with panalog, I think that stuff is amazing, we
haven't had to remove any exuberant granulation since the sequetrum
removal on 4/10/10.
I'm hoping to start riding him in a month or two, but I don't think that will
happen because he still knuckles from time to time.  Well if you need some
help with the web thing let me know!
Day 10
A NOTE FROM DR. JOLLY - Traditionally, skin grafting is a widely accepted
and practiced procedure. For those people wishing to achieve the best
cosmetic effect possible, the expense is probably justified. In my experience,
these wounds healed properly do not require this effort, and contrary to
popular belief, the hair does not come back in white unless there is follicle
damage due to improper bandaging.
These wounds will continue to contract down over a period of one to two
years, provided the use of caustic materials to prevent overgrowth of
granulation tissue (or proud flesh) is not employed since it also destroys
epithelial growth.
From Dr. Jolly

This is an indication of how utilizing computer graphics and technology enabled us to assist a courageous horse
owner in how to treat her horse's injury and to recognise when she was beyond her ability to do what needed to
be done, and move to the next step.
i.e. Taking it to the vet school to have the avascular necrotic bone removed.

I am more impressed with the fact that is has inspired her to establish lifetime goals in the area of animal care, as
well as deciding with her farrier how to shoe this horse so it can perform effectively.

Jessica also needs to know my current message to people aspiring to go to veterinary school - "If you have to go on
a student loan, don't go. Paying off the student loan will control the rest of your life, and the financial
compensation does not justify the educational cost.
Think of going to the alter with your future husband, owing $150,000 student loan, and he is in the same position.
This being said, I have the utmost respect for what Jessica has accomplished and the impact it has made on her,
and I would tell anybody that I'm 74 years old, I still practice veterinary medicine everyday and have no intention
of retiring."

My advice to Jessica is go to your local vet and become a part of his catastrophic wound team. You can become an
asset and even help to set up a catastrophic wound treatment center.
READ THIS INSPIRING CONCLUSION TO A SUCCESSFUL CONSULTATION CASE
From the Owner:

Hey how's it going!

A few discoveries I wanted to let you in on....when my horse's leg gets swollen the granulation begins to overgrow.  
So I have been leaving a regular standing bandage on the leg, it works great and haven't had to use panalog at all.
Began light riding, he is stabbing his toe in the dirt during downward transitions.  I designed a shoe template for
my farrier to encourage the foot to be placed correctly. Rocker toe, a few degrees less on the angle and to leave a
little behind the heel for extra support. It originates from a reiner shoe they put on horses that knuckle over
during a slide. I let you know how that works.  

Epithelialization has slacked so I ordered Lacerum Finish. I have made a transparent graph to track progress.
What is the difference between Lacerum Finish and the Eclipse stuff?

With your guidance as well as the university, I think that my horse is doing exceptionally well given his injury. I
would like do more.  I have begun to take classes at a local school with hopes to apply to LSU's DVM program
sometime next year. I would be honored if you send a letter of recommendation for me. Because of your guidance I
know I can help these animals avoid being euthanized.  I would like to specialize in traumatic wounds and large
animal surgery.  I've always loved surgery and now know that I assisted in the recovery of my horse. I want to help
others the way you and LSU helped me give my horse back his quality of life.
DAY 5 -
OWNER - This picture was taken yesterday (day 5). The current bandaging used is as follows:
1 saline saturated gauze with silver sulfadiazene, covered with two wraps of vet wrap or dry
gauze. Then covered it with a diaper and "No Bows" a thick wrap like rolled cotton, and then a
splint support made of fiberglass on the back of the leg, with a snug ace wrap. I think if I had
no splint the sutures would have totally separated. Oh by the way, the suture picture from
yesterday did not include the dorsal view. So these sutures have been this far apart from day
one. How long would you employ the splint? Without it the wound just pulls apart. Do you see
any bone here, perhaps where that hole is ?
Thanks much for all your help thus far, look forward to seeing the videos.

DOC - Informed owner that the wound was about to open up all the way, the vast majority of
injuries of this type will not hold sutures. Recommendation to remove the splint as the horse
would learn to use his leg better, and give the area better exercise.
Day 5
DAY 1 - Owner had injury sutured by local vet. Dr. Jolly
advised owner that the sutures would break open by day 3
and instructed on bandaging.

DAY 3 -
OWNER - You were right ! The stitches didn't hold. They are
separating.
DAY 10 -
OWNER - Well like you said, a huge gaping wound is
what I have now....how could I get my hands on some
lacerum?

DOC - Informed owner of how to get lacerum and
other medications and materials.
DAY 15 -
OWNER - A few questions if you have a minute.....
By the way, he's walking well w/o splint and no pain meds!!!
Pictures are of day 14.
1.) Why is granulation tissue growing better/faster on the inside of leg?
The outside seems to not have much growth at all.
2.) What is red clot on bone surface mean? (dorsal pic)
3.) Does the bone appear the correct color?
4.) Overall what do you think?
Great videos!  
DOC - I have great confidence in mother nature's ability to deal with the loss of tendon and
muscle structure, exposed bone, altering circulation patterns, etc.
Proper bandaging is critical and will become your big cost item. Do not focus on the bandaging
used on case 34 because that is an example of what you don't want to do. If you want to invest
$20 more on dvds, I'll send you our dvd on bandaging which will save you a lot of money and
help prevent the overgrowth of granulation tissue.
Did you use the serum idea? If you didn't, then I will be willing to send you some product
already prepared. But, it has to be shipped frozen which is expensive.
I would continue to try and keep the wound surfaces moist and at present, I anticipate that the
covering of the bone will be slow. Your pictures are excellent and at present, give no indication
that you have infection.
The red clot can be wiped off the bone with q-tips, it is dried blood (always spray q-tips with
wound wash prior to wiping the wound). If the granulation tissue does not grow on the bone,
you may have to anticipate avascular necrotic bone growing later (about 30 days). If the cortex
bone pops off, the red tissue underneath is granulation tissue and will not get infected. Keep me
posted.
DOC -     If this red area is indeed a clot, this can be removed with a q-tip soaked in wound
wash.  If you'll rewatch the video on bandaging, you'll notice that our bandaging protocol
works to serve several functions, but a main function is to prevent granulation tissue
overgrowth.  A Robert Jones Bandage isn't a bandage that I recommend as it tends to push
a wound more toward granulation tissue overgrowth.  If you will rewatch the bandaging
video and listen to the commentary then you will be able to better understand our
bandaging technique and the philosophy behind it.
I appreciate you keeping me up to date and look forward to seeing some follow-up
photographs.
DAY 29 -
OWNER - Just thought I'd let you in on my drama, the vet who removed some granulation called today to check on
him. He asked me how I was wrapping, I'd told him I returned to using my pantyhose and diaper with Elastoplast.
(He didn't like the wrap I showed up in Saturday) Under his direction I used Robert Jones bandage for 5 days post op
and had absolutely no new granulation where I need it, I told him this, he said that I need to keep it from
overgrowing, but I said it's not growing at all. He then said he'd like to see him next week.... End of conversation.
Personally I'd would much rather overgrowth than no growth. And not to mention he is way more comfortable with
the diaper and pantyhose.
Black clot is hiding some bone with no granulation. Today is 29 days so hopefully it will pop out.
I will send some pics next time I get some good ones.

DAY 30 -
OWNER - You were correct!  30 days avascular necrotic bone, going to LSU in the morning to have it removed. Pulled
out a little myself but couldn't get it all!

DOC -     We are eagerly awaiting what the veterinarians at LSU said regarding how this wound has healed and the
response to your treatment under our supervision.  Underneath the necrotic bone piece should be granulation
tissue, which will be great.  
This granulation tissue is resistant to infection and the wound should continue to close in and heal.  Again, I will be
curious to hear what the LSU clinicians say and their response to your care so far.

DAY 34 -
OWNER -   Three separate pieces of bone, one I removed myself, another they removed today that was embedded
proximally and distally in the granulation bed, and a third piece that is completely covered with granulation. They
are going to remove that tomorrow, and he performed a leg perfusion to reduce swelling.  10" to 12" above and below
was really swollen.  He said that the wound would have been much further along if I didn't have sequetrum. The
granulation around bone did not look healthy. Yes, there was granulation under both the pieces that's been
removed. Radio-graphically no evidence of osteomyelitis. The bone was different from Mrs Kitty (case 34) because
the granulation was growing over and trapping the piece from coming out on it's own and causing some trauma to
the new tissue  growing around it.  He did not criticize my wrapping techniques like the local vet so I'm assuming he
had no issue with my pantyhose. The only setback to the velcro loop idea is that leg was so swollen the
smallest circumference happened to be just above the hock causing an almost raw spot. I'm the only one who
noticed it. I wish I would have initially brought him to you and I apologize for engaging your time while I am in the
end paying someone else ton a ton of money. I appreciate all your help and again I'm sorry I didn't haul him to you,
I guess I thought I would spend less keeping him at home. My vet at LSU said your exact words " veterinarians do so
a poor job on these wounds"

He would like also to skin graft in a few weeks.  He also goes with your thoughts on exercise as soon as possible to
increase the circulation.

DOC - If you had not removed that piece of bone that was overgrown with granulation tissue, then the wound would
never have healed. (That constitutes a foreign body) We would like to use your case on our website as an example as
to how people can get help with catastrophic wound care until adequate local help is available. It would be listed as
"as case of the month". If the professors at LSU agree with me, that the veterinary profession is not up to speed on
catastrophic wound care, (and we consider what we have done with you a perfect example) then we are opening up a
new channel of input that the internet makes available to people all over the world. My longest distance call so far
was on the phone at 11pm from a lady in Australia, who's closest vet was 7 hours away. Please send us update
pictures, and if you are having issues with granulation overgrowth, we consider ourselves experts in that situation,
and using a knife is not the first option.

OWNER - That sounds like great idea, yes you can use my pictures.
Case 215
Cannon Area /
Fetlock / Hock Injury
Before
Day 1
&
After
Day 160
Day 160

Jessica sent us update photos on her horse's
injury, her favorite photo is the third one.

Note that there is no granulation overgrowth,
the epithelial border is well established, and
there is no swelling in the leg. A job well done !
Click on the photos to enlarge the view.