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Since 1962 there has been a major revolution in the understanding of wound healing as a physiological process. However, the research has inevitably focused on the laboratory animal, and the clinical bias has been towards the human species. The particular problems faced by horses in their tendency to wounding and their known difficulties with healing, have not been addressed seriously until the last 5 years.

Management of the acute wound in horses is clearly a critical factor; immediate intensive management of a wound can make a vast difference to the way in which it heals. The once highly regarded ‘golden period’ in which bacteria were present but not in a replicative adherent fashion, was used to emphasize the importance of early intervention in the management process of wounds. Now the same philosophy is applied to more diverse aspects of wound care. It is now clear that the fastest healing occurs when the inflammatory process is rapid, intense, and transient. The manner by which ponies heal so well in contrast to larger horses suggested that it was worth examining the healing processes in a comparative way. In the future there may well be ways of enhancing the ‘sluggish’ acute inflammatory response characteristic of larger horses, and allowing it to terminate rapidly, so that the wounds will more accurately follow the healing process of ponies. This will be a major advance but in reality it is likely to be far more complicated than just applying a dressing that contains high concentrations of TGF-beta! The complex interrelationships that exist between the various growth factors means that all efforts have to be directed towards reducing any harmful effects as far as possible. In this way we at least try to encourage the normal healing process. Of course, given the remarkably efficient healing in ponies, it is easy to view the problems in larger horses as the result of man’s interference in breeding larger horses! Therefore there may be a future in genetic studies of the wound healing process, and the inflammatory response in particular.

The particular problems the horse suffers, particularly in respect of the notoriously bad healing capacity of the healing process of the distal limb regions of the larger horses (over 145 cm), has continued to frustrate the clinician. In a few cases healing proceeds uneventfully (just as it does on the body trunk of horses and the limb and trunk of ponies less than 145 cm), but in others the wounds not only fail to heal but actually expand. Exuberant granulation tissue is a really serious issue in horses that has at last come under direct scrutiny. In the first instance the clinician needs to eliminate any of the overt causes of failure of wound healing, and having completed this should use the best possible dressings to ensure a rapid repair. The faster the repair, the less the opportunity for exuberant granulation tissue or the development of an indolent wound or abnormal scarring.

Wound dressings are an area where there has been much progress. Historically, wound dressings were regarded as a passive aspect of wound management. They were almost all made from various forms of cotton (lint, cotton, wool, gauze swabs) and were designed to cover and conceal the wound. A major role was in hiding exudates and sealing in the unpleasant smells and purulent exudates that were typically present. Many older dressings had positively harmful effects on wound healing (e.g. wet–dry dressings), and fortunately these have lost any relevance in modern wound management. The concept of moist wound management proposed in 1962¹⁰ changed the whole philosophy, so that dressings were then regarded as being an active part of the management of wounds. From a position where wound management products formed a very small part of the medical and veterinary pharmacopoeias in the middle of the 20th century, there are now thousands of products, each being advertised with amazing reports of instant solutions to wound problems. The reality is however, that this large armamentarium of products simply provides the clinician with opportunities to select appropriate dressings for each stage of each individual wound. There is even now no single dressing that is applicable to all stages of all wounds, and indeed no wound that can be managed simply by a single universal dressing.

In human wound care scar management is a major factor. There are several reasons for this including the obvious cosmetic advantages. Scarring in humans can be a major limiting factor in restoring normal function because wound contraction can be extremely powerful and persistent. Fortunately in horses, scarring is seldom problematical apart from the cosmetic aspects in show horses. In some sites however, such as the cornea, scarring can limit function and so scar management is a significant aspect of wound care.

The future of wound management is being driven by clinical need and by the creditable desire to restore the horse to normal as soon as possible. There are welfare and commercial forces that will gradually advance our understanding of wound management. New wound care products (dressings and hydrogels in particular) are being developed in response to the improving awareness that it is possible to improve healing dramatically by correct selection of the best products for particular circumstances. Only through clinical research and commercial cooperation will we find enough resource to solve the many aspects of wound care that remain.