When Tess first came home after her coffin bone surgery, I had to change her bandage. It was unnerving, for sure… but the wound looked nothing like it does now.
You see, when Tess went back into the hospital to remove (and recover from) her negative reaction to the hospital plate, Dr. Errico did a partial resection of her hoof wall at the top.
He was afraid that she had a pocket of ‘nasty’ stuck up in there and he wanted it gone for good.
The resection hole is connected to the hole in her sole – all the way through.
This is Tess’ sole. The large hole is at the toe where the surgeon went in to clean the scar tissue and infection from the coffin bone. It looks through now, to the top of the hoof where he also did a partial resection of the hoof wall to clean up a pocket he felt could harbor infection.
WARNING: SOMEWHAT GRAPHIC PHOTO BELOW OF TESS’ SURGERY SITE.
WRAPPING THE FOOT
The goal right now is to have her heal without any infection inserting itself anywhere near the exposed (actually, it is covered with granulated tissue now) coffin bone.
Dr. Errico has stressed to me that we cannot be too careful. The wound has to be checked, washed and rewrapped everyday.
This would be easy peasy – except the bandage is a doozy. Dr. Errico knew this so he gave me two lessons, handed me a box full of supplies and patted me on the back.
Go forth and Wrap!
I walked out of Loomis Basin with a huge box of:
–Bulk Saline Solution
–Bleach
–Koppertox (Yes, that horrible, caustic stuff…)
–Bulk Gauze
–Bulk Cotton Wrap
–Brown gauze
–Irrigation syringes
–Elastikon
And I added: duct tape, lighted tweezers (a Christmas present from my mother), vet wrap, my military power headlamp, towels and a huge platter to carry everything.
Here are my tools.
STEP BY STEP
I tried to take photos of every step, but some had to be combined and done in a hurry, so you’ll see the amalgam with my explanation.
1) SET THE FOOT IN THE CORRECT POSITION WITH CLEAN TOWELS BENEATH
First, I tied Tess very closely so she couldn’t step much in any direction. I wanted to be able to control her hoof placement. I then set several folded towels under the hoof. If one towel becomes wet or soiled, I can remove it and there will be another underneath to protect her hoof from the ground.
I have the towels on top of her portable floor pads that I bought from Bed Bath and Beyond. I love those things! I move them all over and use them constantly. Tess eats while standing on them and the Theraplate (incredible invention) is lined with these pads so she has a comfortable dismount.
(SOMEWHAT GRAPHIC PHOTO OF HER SURGERY SITE)
This looks pretty scary, I know… This is the hole the maggots started and the surgeon finished. There was a pocket of necrotic tissue here that had to be removed. But, even though it looks awful, it is clean and healing. Tess has enough hoof wall to allow her to walk fairly comfortably – and she does. The coffin bone is covered with granulated tissue – which is good. There is no discharge or foul odor.
2) IRRIGATE THE WOUND WITH DILUTED BLEACH AND SALINE SOLUTION (YES, BLEACH.)
After combining 9 parts saline to 1 part bleach, I irrigate the top first – making sure to inspect the hole for any foreign objects or foul odors.
The solution flows through to the bottom.
I then pick up her foot and irrigate all around the hole at her sole – which then flows out through the top.
She doesn’t seem to mind this…
This is irrigating the top of the hoof with diluted bleach and saline.
3) STUFF KOPPERTOX COATED GAUZE AND ABSORBING GAUZE INTO THE TOP WOUND – ELASTIKON OVER
Now I put in the infection deterrent, Koppertox. Ugh. I hate Koppertox… but, it is what I’ve been instructed to use to wipe out anything that even hints at compromising her hoof.
So, I wet gauze with Koppertox (not a soak, just moist) and stuff it into the top hole, making sure the green is against any tissue. Then, I pack the top of the hole with fresh gauze and cover it with Elastikon.
This photo is a bit blurry. But it is the Kopperox gauze and absorbing gauze stuffed into the top hole.
Wound covered on top.
4) DO THE SAME KOPPERTOX GAUZE AND ABSORBING GAUZE ON THE SOLE HOLE – THEN WRAP WITH VETWRAP.
I had to do this fast so I didn’t take pics of the underside of her hoof when I placed the gauze at her toe and stuffed it in there. But, the idea is to get the green against tissue and the inner walls to stop any infection. Then use the clean absorbing gauze to pack in there.
Wrap. Be sure to not get the vetwrap on shaved skin. I was told it is irritating.
With the foot covered, it almost looks normal.
5) USE THE BOLT COTTON ROLL LEG WRAPPING MATERIAL TO CREATE A BALL BANDAGE.
Dr. Errico gave me cotton that was like a bolt of material. Wide and long. He cut several swaths and rerolled them for me. Anyway, I take an individual roll and pick up her foot in my other hand. The idea is to wrap the foot from just above the fetlock and then take the excess and fold it back over the hoof sole. This creates a very poofy wrap around the leg and especially over the sole of the hoof. I then put on the brown gauze wrap so the cotton holds against the leg/hoof (I did figure 8s with the brown gauze around her hoof and then created a waist of tighter wrapping around her leg).
This keeps the poofy cotton ball bandage in place. I added a piece of pink vet wrap to hold the end of the brown gauze in place at the waist.
Note: It amazed me, but moisture has been all over the brown gauze, but never inside the cotton ball bandage. I’m not sure if perspiration creates the moisture?… but for some reason, when I cut off the previous day’s bandage, the brown gauze is always damp but the inside of the cotton wrap is dry.
I had to wrap the cotton ball bandage in the brown gauze and then take the photo. So, the cotton part is covered up by the gauze. I put the old cotton warp nearby so you could get an idea of the material. I also added a piece of pink vet wrap to hold the end of the brown gauze.
6) HAVE YOUR DUCT TAPE BOOTIE PREPARED AND APPLY IT NOW
If you would like to know how to make a Duct Tape Bootie, I wrote about it previously here.
At this point it is time to protect the bandage from moisture. So, put on the duct tape bootie. Make sure to cut the slashes into the corners of your bootie so you can fit it.
After the bootie is on, go around the base and bottom of the bootie with the duct tape roll. I also wrapped the top so no water can get in there. It ended up looking like FrankenBootie, but it is a good wrap in case she steps in urine or water.
This is my duct tape bootie with extra duct tape around the bottom and top.
7) ELASTIKON AND… OLE!
I’m not exactly sure why Dr. Errico wants me to put Elastikon around the top of the boot, but he does. I think this is to control any water that may seep in from the top.
*Note: Elastikon is super difficult to unroll and work. So, I have learned to unroll it first (using your hand or you can stick it around a stall bar and unroll it from there), then reroll it. In this way, it is easier to apply.
Here is my final wrap, complete with Elastikon. My wrap is not as beautiful as Dr. Errico’s but it works…
8) CLEAN THE OTHER FOOT AND SOFT RIDE BOOT WITH KOPPERTOX
Dr. Errico wants both feet to be germ free. So, he has asked that I remove her Soft Ride once a day (easy) to clean it out and apply Koppertox to the sole of her good (right) foot.
Here she is, putting full weight onto her bandaged foot. It hardly looks as awful when it is covered, eh?
Here she is stepping onto the Theraplate with her bad foot! Full pressure. She was getting on the Theraplate so many times today, she had messed it all up with shavings already! She loves her Theraplate!
Here she is, watching her boyfriend (Hubby) fix the feed room sink from her Theraplate. She loves that thing! She rides it whenever I turn it on – thank goodness! Her sole is over an inch thick each time we Xray her between trims.
BELLA WILL BE ON LOCAL TV on Wednesday! I’m hoping for a link to the story and new photos soon! A mold was taken of her leg… Bella is our February Bucket Fund Foal! Click image to read her story!
Click for Tess’ Surgery, Limb Perfusion and Post Care Fund!
