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Appaloosa gelding
Injury below hock with avascular necrotic bone.
Arrived May 19,2003

Originally, the care regimen proceeded as normal, with application of Lacerum gel every two to three days. However,
when the granulation surface did not appear over the bone by ~20 days, the bone was inspected for evidence of
necrosis. None was found at that time, so treatment continued with application of Lacerum only over the bone surface
in an attempt to get a granulation surface there. The rest of the wound continued to heal normally. The epithelial
border grew well, and the tendon retained integrity.

Treatment started 5-19-2003


Before     &     After
Day 1
Day 19
Day 26
Day 28
Day 31
Day 38
Day 81
Day 69
Day 71
Day 64
Day 60
Final
A piece of avascular necrotic bone did appear on Day 26 and the dead fragment was removed. Within three days, the
former bone surface had some granulation tissue. Nine days later, another fragment of avascular necrotic bone had
worked out of the deeper granulation bed to the surface of the wound, where it was removed. The granulation bed
failed to thrive, however, and remained separated in several areas. This was due to an infection which developed
resistance to the wound wash used, and the horse was started on systemic antibiotics.
By Day 64 wound wash was applied in a higher concentration and combined with antibiotic therapy.
At Day 90, a piece of amniotic sac was added to the treatment regiment.
The wound site was left untreated after 100 days, and while healing was achieved it was not cosmetic.
Case 69
Hock / Cannon Area Injury
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