To Close or Not to Close

Last summer, my horse managed to gash herself on a tree branch in the pasture. It was pretty gnarly… I’ll insert some pictures at the end of this post, so here’s your warning if you’re squeamish to not scroll down.

Of course, I was freaking out when I noticed the huge canyon on my horse’s butt that was not supposed to be there. My initial reaction was to call a vet immediately and get as much stitching as possible to close it up. However, lucky for me, my dad is a retired large animal vet, so I had a little bit of guidance before paying an arm and leg for a vet visit. His advice was to leave it open. This was a foreign concept to me… There’s a foot long gash that’s open to the elements and he wanted me to leave it open?? I was skeptical to say the least. He agreed that it was a bit unconventional – most vets would want to close it up and put a drain in it, but he swore his way would be better. Over the course of the next few months, I followed my dad’s advice and left it open. Obviously, I took extra care to clean it twice a day, redress it with antibacterial cream, and keep the flies out. I also took extra care to monitor her for infection and shock and provide her with anti-inflammatory pain medication. And sure enough, the wound started to heal and close naturally with zero infection. Now, she has a barely noticeable scar. 

Just recently, my boyfriend smashed his thumb at work, which caused his skin to essentially explode and left a huge gash running down and across his thumb. After a trip to the ER, he’s got a line of stitches. It’s got me wondering what’s the best way to encourage healing of large open wounds and why? Are there benefits and drawbacks to each method and what are they?

Aside from the science of it, I also think there’s an ethical question involved. Does leaving the wound open cause more difficulties for people? If someone can’t work with an open wound, then making a decision to leave it open would be a decision without beneficence in mind. In my boyfriend’s case, an open wound would keep him out of work for much longer. However, if someone doesn’t want stitches, I think it’s equally important to honor their autonomy and educate them on ways to keep the wound clean and allow it to heal naturally. In my horse’s case, stitches and a drain tube would have kept her in a stall instead of out in pasture, which she would have hated. These different methods for wound healing both work, so it’s important to cater treatment plans based on the individual patient. What may work for one, might not work for another.