Page 105 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

80 CHAPTER 1

VetBooks.ir The prognosis for elimination of cracks associated structures that may be affected include the palmar
digital vessels and nerves, the DIP joint, the DDFT
with poor conformation, which can be corrected by
trimming and shoeing, is good so long as the predis-
cartilage.
posing cause is managed appropriately. Those cracks and sheath, the navicular bursa and the ungual
associated with prior trauma, concurrent disease
or uncorrectable balance or conformation require Clinical presentation
indefinite therapeutic attention. Heel bulb lacerations present either soon after
acute trauma or after excessive granulation tissue
HEEL BULB LACERATIONS has delayed wound closure and caused an unsightly
blemish. Lameness is variable but is more likely in
Definition/overview horses with acute wounds or wounds that are associ-
Heel bulb lacerations usually form an inverted ated with injury and infection of deeper structures.
U-shaped flap, with the apex of the U proximally. The haemorrhage from lacerated palmar digital ves-
The distal extent of the wound margins is usually sels can be profuse.
either just proximal to the coronary band or extend-
ing up to 1–2 cm into the coronary band. Differential diagnosis
None.
Aetiology/pathophysiology
The injury is caused by acute trauma. It is charac- Diagnosis
terised by irregular margins and varying damage to Diagnosis is based on visual inspection. The wound
the underlying tissues. If untreated, these wounds should be examined to determine its full extent, the
are prone to excessive granulation tissue formation involvement of deeper structures and the severity of
and slow epithelialisation because of the movement contamination present (Fig. 1.135). Additionally, the
between the opposite margins of the wound. The margins of the wound are assessed for viability and
prolonged healing delays the return to work, pro- epithelialisation, and the bed of the wound for evi-
duces an unsightly scar when it has epithelialised dence of granulation tissue formation (Fig. 1.136).
and, if large enough, may impede function. Deeper If excessive granulation exists, a biopsy may be

1.135 1.136

Fig. 1.135 Heel bulb laceration. A severe acute Fig. 1.136 Heel bulb laceration. Chronic heel bulb
laceration of the heel bulb that has injured the ungual wound with a healthy granulating surface.
cartilages, coronary band, hoof and heel soft tissues.
(Photo courtesy Graham Munroe)