This is a horse that had an accident in the pasture. The medial heel bulb on the right front leg was nearly cut off. The laceration went deep enough to go through the collateral cartilage on that side of the foot. These type of injuries are notoriously difficult to heal for several reasons. First, with a laceration that large and a very large skin flap held on only by a very small attachment, the blood supply to the flap is often obliterated. Without a good blood supply, the skin flap does not receive what it needs to re-attach to the foot and heal together. Secondly, this area has a lot of motion every time the horse takes a step. The flap is difficult to heal together when that motion prevents the cut skin edges from remaining close to each other long enough to re-attach. The plan for this injury was multi-part. First, deal with infection by using systemic antibiotics as well as regional limb perfusion of the foot. This concentrates the antibiotic at the site of injury 100-fold. Second, deal with motion by anchoring the flap back to the foot with suture. This laceration included not only the skin above the hoof, but the hoof wall itself about 2-3 inches below the coronary band. Third, help revive the blood supply to this large flap using shockwave therapy. And finally fourth, eliminate all motion of the heel bulbs by casting the foot for 2 weeks. Following these steps, we worked with great farriers to apply the right kind of supportive shoe for this foot and help stabilize the damaged hoof wall with epoxy. See the case from start to finish in the images below.