Case Report: Saving Sunny

When a pasture accident leaves a gelding with a massive facial wound, a family works together to help him heal.
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When a pasture accident leaves a gelding with a massive facial wound, a family works together to help him heal.

More than most horses, Sunny likes to toss his head while cavorting in his pasture. This habit makes the 13-year-old Arabian gelding easy to spot as he chases his herdmates or gallops off on his own.


“He’s just a big goofball,” says Sue Apel, who purchased Sunny as a yearling. After a brief career in the show ring under his registered name, JD Rashik Sundown, Sunny eventually settled into life as a trail horse. He became known as a trustworthy, steady mount; his silly head-tossing habit was evident only when he was at liberty in the pasture. But on Memorial Day 2013, that quirk led to a serious injury that threatened his future.

Apel had family over to her Evansville, Wyoming, property for a holiday barbecue, and her small herd---Sunny and two mares---was turned out for the day on new spring grass. “They hang out in a pen made of panels that slide together and are secured with pins,” says Apel. “That morning, I had opened up two panels and pulled them toward the inside of the pen so the horses could go out into the larger adjacent field. They’d have to come back to the pen to get water, which was about 75 feet away from the panel opening, but it wasn’t an issue for most of the day.”

In the early afternoon, however, Apel looked out her kitchen window and noticed that her mares were grazing the field and Sunny was nowhere to be seen. “That was unusual because he’s always with them,” she says. Moving to another window, she spotted Sunny, standing alone in the smaller pen area.

Worried, Apel walked down the driveway to the pen. Even before she made it through the gate, she could see something was terribly wrong. “His head was hanging just a little and I could see skin hanging from the left side of his face,” she says. “I ran to the gate and scrambled over instead of opening it, but he never moved. When I got up to him I could see the damage he had done. It looked as if the left side of his face had been torn off.”

Sunny had a gruesome tear---not even a tidy cut---in his face starting just below his eye, extending down about six inches. From that wound, the skin had pulled back toward his ear. Through the blood, Apel could see bone and even the roots of a few of Sunny’s teeth.

“I screamed and ran for the house,” says Apel, whose husband and kids met her halfway down the drive. She told them to call the veterinarian, then turned back to tend to her gelding. “I couldn’t put a halter on him, obviously, so I just tossed a lead rope around his neck and led him to a stall. He stayed nice and calm, even while all the humans were running around in a panic. I’m sure he must have been in pain, but he wasn’t acting like it.”

While one of her sons stood with Sunny awaiting the veterinarian, Apel began looking for clues to the cause of the injury. “When I saw a bit of blood and skin on one of the open panel pins, it wasn’t hard to imagine what happened,” she says. “He probably came up for a drink with the mares and the girls wandered back out to the field without him noticing. Then, when he realized he was alone, he probably did one of those head tosses of his and lodged the pin right under his eye. When he reacted and ran off, the pin pulled down the length of his face.”

The veterinarian arrived and assessed Sunny’s situation. “He told me that this type of wound was beyond what he was equipped to care for. He told me that I needed to get Sunny to a referral clinic as soon as possible, and he recommended Dr. Vlahos.”

Rocky Mountain Equine Hospital, the practice belonging to Ted Vlahos, DVM, has two offices in Wyoming---in the towns of Sheridan and Cody---and one in Billings, Montana. The closest one to Apel, Sheridan, was 160 miles away from Evansville. It was a long trailer ride for a horse with a serious wound. “My husband and mom went with me. I think I cried the entire way,” says Apel. “Sunny was so quiet the entire ride that I was scared of what I’d find when we got there and I opened the trailer, but there he was---quiet and calm. There wasn’t even a whole lot of blood in the trailer.”

A veterinary team was ready to meet them when they arrived late in the evening. Apart from the large wound on the side of his face, Sunny was in good shape. His vital signs were stable, and the bleeding had tapered off. The team started him on intravenous fluids to ensure he stayed hydrated, along with an antibiotic injection and a painkiller. Vlahos himself was returning from an out-of-town trip and wouldn’t be at the clinic until morning.

With nothing left to do but wait, Apel headed home for a restless night of worrying about her horse. “The wait was awful,” she says. “I was sure Vlahos was going to tell me there was nothing he could do, and I’d have to put Sunny down. I had prepared myself for the worst and had my mom and my husband there to help me cope when I finally heard it.”

Instead, Apel was stunned when Vlahos called the next morning to say he thought Sunny might be OK.

“It was a pretty nasty wound,” says Vlahos. “No doubt about it. He basically removed the covering to his maxillary sinus cavity on the left side of his face. The skin was gone and much of the bone covering the sinus was either gone or badly damaged. The affected area was about the size of a deck of playing cards.”

Still, Vlahos believed the wound could heal well. “Head wounds are shocking when you first see them, but the outcome can actually be quite good,” says Vlahos. “The head is a tremendously vascular area so wounds tend to granulate quickly and well, and proud flesh isn’t typically an issue. We hear ‘head wound’ in humans and think the worst, but the horse’s brain is tucked up safely behind his ears, so it’s more a matter of healing tissues than neurological trauma.”

Even the lost and damaged bone wasn’t a big concern. “The bone plate is very thin in that area,” says Vlahos. “In a healthy wound, it fills in well with osteoblasts that lay down more bone. The bone here doesn’t have to strengthen like a cannon bone fracture does because the skull isn’t weight bearing.”

Radiographs offered more good news: The orbital bones around Sunny’s eye were intact, as were his teeth. “In wounds in this location we worry about the integrity of the orbital rim and the nearby nasolacrimal duct [tear duct],” says Vlahos. “You can have long-term issues in terms of vision and persistent draining from the eye. You can also have damaged tooth roots, leading to tooth loss.” Another possibility was damage to the facial nerves that control sensory and motor functions in the head. “You can never know for sure, but our early assessment was that this horse looked good on all those counts,” Vlahos says.

Apel listened carefully, trying to process all this information: “When I heard he might be saved, I asked about his quality of life and whether or not he’d be rideable. Dr. Vlahos told me he couldn’t say for sure if I’d ever be able to ride him, but that there was a good chance he’d have a happy, pain-free life. I told him that I’d be ecstatic with that; if Sunny could just stand in my field and not be in pain, I was ready to do whatever it took.”

For safe, clean healing

To help the wound heal, Vlahos first needed to debride the area---to clear away all dead material and bone fragments, as well as tissue and bone that was so badly damaged it was likely to die. “In any wound, if infection sets in, you can have a real problem,” says Vlahos. “In a wound this large, that risk is even higher. Removing any non-viable tissues is an important first step in preventing infection.”

The surgical team sedated Sunny before beginning the work. “You cut away anything that doesn’t look absolutely healthy,” says Vlahos. “In this case, it was a significant amount of tissue. By the time we were done, looking at the wound area was basically looking into a hole in [Sunny’s] face.”

With the wound debrided, Vlahos reexamined the damage to the orbital bone just below the eye. He decided to strengthen the area with a small amount of bone cement. “In some
horses, we are rebuilding bone with the cement, but in this case it was more a precaution,” he says. “We just wanted to shore up the area a little bit.”

Vlahos opted not to try to suture the wound. Not only was there very little tissue to pull across the opening, but leaving the wound open would allow it to drain and be flushed regularly. “We’d pour a large amount of saline solution directly into the wound, and it would pour through the sinus cavity and out his mouth and nose,” says Vlahos. “We did this several times a day in the beginning. I couldn’t tell you how often, but the flushing, in addition to the antibiotics, was the way to fight infection.”

Once the team finished the first flush, they coated the exposed tissues with an antiseptic ointment, then wrapped Sunny’s entire head with protective bandages, placing a Plexiglas “cup” over his left eye for protection.

That’s how he looked when Apel and her mother returned the next morning. “As soon as I stepped in the stall he came right to me, with this huge bandage on his whole head and his left eye covered,” she says.

Vlahos told Apel that Sunny was eating and drinking well, with stable vital signs and a good attitude. He also showed her the radiographs and explained how, ideally, the healing would progress. He reiterated that it was still too early to determine how well the wound would heal or whether Sunny would be left with any long-term problems, but for now, things looked good.

Sunny remained at Rocky Mountain Equine for 18 days, as the staff continued to change his bandage and flush the wound twice a day at first, then once a day. Occasionally, Vlahos would identify and remove a bit of dying tissue, but overall he noted that the wound was filling in quickly with healthy granulation tissue, with no sign of infection.


Apel visited regularly and watched the bandage-changing process. Finally, Vlahos asked if she thought she could do it on her own. “I was nervous but more than ready to have Sunny home,” she says. So, stocked with medications and supplies, as well as a long list of care instructions, Apel loaded Sunny into the trailer for the trip home.

“We made the trip with no problems,” says Apel, but I think the mares thought I brought an alien home since he still had his entire head bandaged and the funny mask with the plastic bubble on it.” Sunny was settled into a large private stall in the barn, and he seemed happy to be at home.

The challenges began the following day, when it was time to clean and rebandage the wound. “My mom had agreed to come across town each day and help me do it,” says Apel. “But even with the two of us it was still tough. I can wrap a leg no problem, but wrapping heads is really difficult. I think my hands shook through the whole thing; I didn’t want to hurt him but I didn’t want infection in it either and I didn’t want the bandages to come off in the night.”

Together, Apel and her mom managed to do the job, a process that became easier each day. “It wasn’t nearly as pretty as the vet tech’s bandaging, but it did stay put,” she says. “Sunny was awesome through the entire thing. He just stood there and took it like a man.”

Each week for nearly two months, Apel and her mom took Sunny back to Vlahos for a follow-up. The wound continued to heal well, and after the first return visit, Vlahos told them they could reduce the bandage changes to every other day.

In late July, Vlahos told Apel to discontinue the bandaging and the antibiotics. The wound had filled in almost completely, and the swelling was minimal. The gelding’s lip drooped a bit on the left side, as did his ear, but those issues were improving rapidly, which suggested no lasting damage to the nerves.

Finally, in mid-August, Vlahos turned to Apel and said, “Take him home and ride him.”

Apel was stunned. “I said, ‘Just put a bridle on and go ride?’ and he said he wanted to see Sunny again in a month, but it was time for him to go be a horse again.”

The timing could not have been more poignant. For years, Apel and her mother had gone on a girls’ trip to ride in Black Hills National Forest in South Dakota. Apel had assumed the trip was off for this year, but with Vlahos’ blessing, it was back on. Just three months after she thought her horse would have to be put down, she was riding him through majestic mountain ranges.

“I told my mom that we’d have to take it easy, but he charged up the first hill and wasn’t even breathing heavy when we got to the top,” Apel says. “He was his old, wonderful self. I cried the first night when we got back from our ride just because I was so happy.”

Now, more than two years later, Sunny’s face shows a visible scar from his injury, but he
appears to have sustained no lasting damage. His nerves function well, and he has no signs of excessive sinus drainage or damage to his teeth. Apel had one brief scare when Sunny’s left eye clouded over shortly after she started riding him again. A quick trip to Vlahos’ clinic assured her it was a small scratch on his eye, and a week of treatment cleared it up with no effect on his vision.

For her own peace of mind, Apel decided not to turn Sunny out with the mares; he now lives in his own separate paddock. “They can be pushy, and I worry he’s going to get chased into something,” she says. “I’m nervous, I guess.”

Sunny, however, shows no lingering anxiety from his ordeal. “He still does that goofy head-shake,” says Apel. “I saw him do it just the other day and I asked him, ‘Don’t you remember what happened, Silly?’ I don’t think he does.”

This article first appeared in EQUUS issue #457, October 2015.