Wound Care for Llamas and Alpacas

by Clare Hoffman , D.V.M.
Reprinted from the August 1997 RMLA Journal
with updates from R.C. Callan, DVM, CSUVTH, March 2015

Introduction: Know Your Limits

Raising llamas demands a general knowledge of wound care.  When faced with an injured llama, a medical expert may not always be available to treat and/or offer advice on care - as often you are out on the trail or live in a rural area where a veterinarian is not readily available.  Knowing and performing proper wound first aid could mean the difference between life and death or determine between a temporary and a permanent disability.

You can prepare for such an emergency by reading about wound care, preparing a first aid kit (see insert) and obtaining training from your veterinarian.  If you are not adequately knowledgeable, or do not feel comfortable performing wound first aid, you should NOT attempt haphazard first aid treatments You must assess your knowledge and capability limits.  You must know what to do and what not to do, as you could easily cause further injury to the llama if your first aid is not done correctly and carefully

Causes of Wounds

Care should be taken to make sure that the stable, pen, or pasture area is free from potential wound-causing hazards, such as sharp edges on a barn, protruding nails, or trash and debris. However, even with immaculate living areas, llamas may still get hurt. Llamas are intelligent and careful enough that they do not get wounded very often. When they do, most wounds are not serious. However, when llamas are confined, grouped, trailered, or out on the trail, injuries may occur.

Causes of wounds vary, but a fence, tree branch, or a nail sticking out of a board could result in a wound. Sometimes, llamas can injure each other, especially when intact males are housed together. Fighting males can inflict serious wounds upon each other if they have sharp fighting teeth. These battles can result in shredded ears and infected/abscessed leg and testicular wounds. Baby llamas are also more prone to wounds, as they do not know where environmental obstacles, such as fences and trees, are located and their "brakes" are not yet fine-tuned for quick stops. When playing or being chased, a youngster may tumble over an obstacle or run into a fence resulting in an accidental injury.

Pack llamas venturing out on a trail meet all sorts of obstacles that usually do not cause any problems, but potentially could cause an accident. For example, when crossing a stream, sharp rocks could cut the llama's foot or leg.  Tree branches encountered on the trail are often implicated for wounds.  A wild animal may also bite and injure (or unfortunately kill) a llama on the trail or at home in a rural setting. Lastly, even well-meaning people could accidentally cause a wound.  For example, when trying to perform procedures such as trimming toenails, a slip of a sharp object could cut the llama. (Although quicked toenails tend to bleed, they are rarely serious.)  A tight-fitting halter, or a halter left on a llama that gets caught on an object such as a branch or fence post, or a poor fitting pack could result in an injury.

Abrasions & Bruises

Wounds are generally classified according to their depth as closed or open wounds. Closed wounds, which are less serious, are wounds that do not penetrate through the entire skin layer. An abrasion or scrape is an example of a closed wound. Abrasions are rarely serious and do not bleed very much. Although abrasions are not emergencies, they may be painful to the llama, causing the llama be sensitive to touch in the area of the abrasion.

In addition, even the most minor abrasion could result in an infection. Normal intact skin is quite a formidable barrier to microorganism entry into the body but any disruption of this barrier offers an entry porthole for the numerous microorganisms on and around the animal. Due to this infection potential, the llama should be checked to make sure it is current on clostridia vaccinations. Also, your veterinarian should be consulted regarding the need for antibiotics.

Since treatment for abrasions involves preventing infection and offering the llama soothing relief, abrasions are fairly simple to care for and heal quickly. Gentle rinsing of the abrasion with warm saline removes dirt and debris. (Saline is a sterile mild salt water solution.) This should be followed by application of an ointment to decrease the likelihood of infection, to keep the skin supple and prevent cracking. Povidone-Iodine or Nitrofurazone ointment works very well on abrasions. (Triple Antibiotic Ointment is preferred today, R.C. Callan, DVM, CSUVTH). The abrasion will then form a solid scab which is nature's own perfect bandage. This protects the newly repaired skin as it heals. When the skin is healed, the scab will fall off.

Bruises do not cut through the skin and thus constitute another type of closed wound.  These are often caused by a fall, kick, or a poor fitting pack. Although the skin is intact, underlying tissues such as muscle and blood vessels may be crushed or tom. Usually the only signs these bruised llamas exhibit are pain in the area of the bruise, some heat and swelling due to the inflamed tissues. Wound care includes application of cold packs if the bruise is recent (within the first day) to minimize swelling. Subsequent bruise care (after 24 hours) may include application of warm packs to increase circulation which promotes removal of the accumulated fluid out of the area. Consult with your veterinarian if your llama is acting painful for recommendations on pain relief.

Occasionally a bruised area may result in a leaking blood vessel causing a pocket of blood accumulation called a hematoma.  A seroma which is a pocket of serum, (i.e., the liquid portion of the blood without the red blood cells), can also occur.  Seromas look and feel like water balloons underneath the skin. First aid would include initial cold packs and subsequent warm packs as described above. This treatment usually remedies small fluid accumulations. However, if the seroma or hematoma continues to enlarge or is large to start with, a veterinarian usually needs to surgically drain it.  If left untreated, a large pocket of blood or serum can result in a blemish and offer a great environment for microorganisms to flourish.

Lacerations

Lacerations or cuts are classified as open wounds and are more serious.  These injuries penetrate the entire skin layer to expose the tissue below.  They are often painful, can tear large blood vessels and may damage underlying tissues.  Lacerations also provide a large opening for microorganism entry, thus increasing the chance of infection complications.

The initial first aid for lacerations is to stop excessive bleeding. Most of the time when you notice a laceration on your llama, it has already ceased bleeding. Luckily, most wounds do not bleed very much and those that do, ooze blood slowly. However, occasionally it is possible for a large blood vessel to be cut or torn and result in significant bleeding. With severe bleeding (steady drip or more), first aid should be used to stop the bleeding. Application of direct pressure to the bleeding area is the best way to stop bleeding. This can be done by firmly holding a wound dressing such as gauze, cotton, or a cloth with your hand directly over the bleeding area.

Cold pressure, such as a cold wash cloth, would work even better, as the cold helps to shrink the blood vessels. As blood clots form within the cloth, do not remove the cloth or the bleeding will resume. Instead, if blood soaks through the entire dressing, add additional layers of dressing and continue direct hand pressure. On the legs, a bandage can be used to hold on the layers of dressing. Do not remove the bandage until a veterinarian arrives, or else it will restart bleeding. Although the bandage should apply some pressure to stop the bleeding, it is not a tourniquet and should not be so tight so as to cut off all blood supply to the leg! A tourniquet is rarely needed, is quite dangerous, and should only be used for severe and life threatening bleeding that cannot be controlled by any other means. If the decision is made to use a tourniquet, you risk losing the limb in order to save the animal's life.

In llamas as well as humans, shock can occur with many different medical problems but it frequently is a serious sequel to rapid loss of large amounts of blood. When in this critical state, shock is a means of trying to live by shutting down non­ essential bodily functions, thus attempting to maintain and preserve important organs such as the heart and brain. During shock, blood flow decreases to skin, mucous membranes and muscle.  Therefore the llama's skin (especially over legs, face and ears) and mucous membranes (such as gums, tongue, inner lining of eyelid, and vagina) are pale to blue in color and feel cool to the touch due to the decreased warm blood flow. Another sign of shock indicating circulation failure is a prolonged capillary refill time of more than 2 seconds. This can be checked by blanching the tiny blood vessels or capillaries under the gums with finger or thumb pressure. When removing the pressure, the area will be blanched, but pink color should normally return in less than 2 seconds. If it takes longer, it is a sign of poor blood circulation to the area and shock. Additional signs of shock are weakness, a rapid and weak pulse which may be felt on the side of the face or inner thigh, and irregular breathing patterns.

Shock is an emergency situation and must be treated by a veterinarian, but until a veterinarian is available, life saving first aid will help.

1. Stop bleeding as described above.
2. Assist respiration if it isn't adequate. If the llama is down, it is easier for the llama to breathe if lying on its chest rather than its side. You can help prop the llama by putting a hay bale along its side for support.
3. Don't unnecessarily move, restrain or stress the llama. Excessive stress can be fatal. The llama should be kept comfortable and warm.
4. Don't give the llama any tranquilizers or sedatives to "make it feel better", as many medications are very harmful if given to an animal in shock.
5. Fluid replacement will be the mainstay of the veterinarian's treatment of shock for your llama, as so much blood may have been lost. The fluid given by your veterinarian may be blood or other sterile electrolyte solutions which are injected directly into the veins. If the shock is not severe, the fluids may be given via other routes. Fluids are not absorbed very well from the stomach if given orally during shock.

However, if your veterinarian isn't available and your llama is in dire straits, this may be the only life saving alternative of fluid replacement that you are qualified to administer. In this situation, slowly give small amounts of warm water or warm water with electrolytes (Power Burst®, Gatorade®, Lifeguard®) frequently (e.g. 1/2 cup every 15 minutes to the adult llama).  Only give oral fluids if the llama is conscious, does not have trouble swallowing the fluids and is not regurgitating.

Open Wounds That Require Suturing

Depending on the location, amount of tissue damage and degree of contamination, fresh wounds that penetrate through the entire skin layer can be sutured.  Wound care until the veterinarian can arrive to suture the wound should be aimed at minimizing further contamination.  The majority of traumatic wounds are contaminated and overzealous first aid often causes further contamination resulting in a wound that cannot be sutured, heals slowly or becomes infected.  Many antiseptic powders and wound ointments can actually increase wound contamination and cause further tissue irritation.

The best first aid for the wound until it can be seen by your veterinarian is simply protection by applying a large clean dressing (gauze, cotton, cloth, diaper) to cover the area.  It can be held, taped or bandaged in place.  This cover will prevent further contamination with feed material, bedding, dirt and hair until a veterinarian determines that the wound does require suturing; it can be cleaned easily and won’t be covered in sticky ointments and abrasive powders.  Your veterinarian will advise you of specific wound care following examination and/or suturing of the wound.

Open Wounds Not Amenable To Suturing

If a wound is an older wound, has a significant amount of contamination, or has a lot of dead tissue, it cannot be sutured initially. Depending on the wound, it should heal as an open wound or may be amenable to closure with sutures at some later date. Even if these wounds appear to be small and minor, it is important that you have a veterinarian examine them. Some wounds, such as puncture wounds, look innocuous from the surface and yet have a great deal of damage under the skin and are extremely prone to infection. In addition, wounds caused by foreign bodies, such as wood, glass, porcupine quills, may still have part or all of the foreign body present in the wound. Wounds that are close to or penetrate certain areas of the body such as the eye, joints, or genitals are often more serious than they appear. Wounds may also have devitalized (dead) tissue that need to be debrided or removed by your veterinarian to allow appropriate healing. The necessity of antibiotic usage and vaccination boosters can be discussed with your veterinarian at the time of the examination.

Until an older wound can be seen by your veterinarian for treatment and advice, some basic wound care would be in order. Before beginning your first aid of the wound, make sure that the llama is properly restrained, as you don't want a struggle to result in another wound to your llama or one to you. Once it's restrained, the wound should be cleaned in such a manner that you do not cause further contamination. The surrounding hairs that are long enough to dangle into the wound should be clipped. Protect and cover the wound as you are cutting the hairs, as you don't want them to fall into the wound. A saline-moistened gauze or a water soluble substance such as K-Y Jelly® covering the wound works well for protection. After clipping, the surrounding area can be cleaned and examined.

Next, you should clean the actual wound, as bacteria, soil, and other debris directly irritate the wound, increase the likelihood of infection, and thus delay wound healing.  You must clean these wounds very gently or else you could cause further damage and irritation to the tissues. Do not apply any substance directly to a wound that you wouldn't be willing to put into your own eyeball! Do not use any caustic substances. (Beware, as many of these caustic substances are commonly sold as "miracle" wound care products.) Sterile saline is mild and excellent for cleaning wounds. If saline is not available, tap water will suffice. The saline can be applied to a clean gauze pad and then the wound is cleaned from the center to the periphery, so as not to carry contaminants back into the wound. Once a pad is used on the peripheral regions, do not reuse that pad. Use a fresh one with each washing.

In dirty wounds where this method would prove to be very slow, lavage or wound irrigation is an excellent way to clean debris thoroughly and quickly from the wound. Lavage should be done with saline or water if saline is not available. A large syringe or a spray bottle will work to irrigate the wound, but thorough lavage is achieved by using a Water Pik® at its lower setting and spray the wound until it's clean. When the wound appears "water-logged" or slightly grayish in color, you have lavaged the wound sufficiently.

Antiseptic products are commonly used to clean wounds. They should be mild enough so as not to damage tissue and yet strong enough to aid in decreasing bacteria numbers. Chlorhexidi ne Diacetate Solution (Nolvasan®) at about .05% or less dilution or Povidone-Iodine Solution (Betadine®) at .1-.2% seems to work well at killing bacteria with minimal tissue damage. Antiseptics can be mixed with saline or water and used along with lavage or gauze cleaning pads.

Soaps are generally too harsh for wounds. However, occasionally surgical scrubs such as Povidone-Iodine Scrub (Betadine® Scrub) are used even though they are mildly toxic to wounds because of their antiseptic abilities and the soapy/foaming action which eases contaminant removal from very dirty wounds. If soaps or scrubs are used, make sure to follow the scrub with a very thorough rinse.

Although hydrogen peroxide is commonly used because of its foaming action, it is not a very effective antiseptic and can be toxic and damaging to the tissue and therefore is not recommended. Likewise, other harsh chemicals such as alcohol should not be used on wounds. Consult with your veterinarian if you choose to use other antiseptics not mentioned in this article regarding their safety and effectiveness.

After the wound has been cleaned, it may be amenable to further protection with a bandage. Obviously only some areas of the llama can be bandaged. Leg wounds are often bandaged which provides some immobilization of the wound, as movement delays healing by physically disrupting newly formed tissues. In addition, bandages help to decrease further contamination and swelling. Bandages also hasten wound healing by slightly increasing the temperature of the wound and surrounding tissues.

Initially an adherent dressing such as gauze is useful to absorb drainage and dead tissue from the wound. If after an examination by your veterinarian, it is decided to continue bandaging the wound, you would likely switch to a non-adherent dressing such as Telfa® pads. The bandage is then changed whenever it feels damp or becomes malodorous. After removing the old bandage, wash the wound as described above and apply a new bandage. Initially this care may be needed daily and subsequently, as healing progresses, it may be every 4-5 days.

If an area is not amenable to a bandage, and you continue to provide wound care after consultation with your veterinarian, the wound must be cleaned regularly. Any drainage from the wound should be cleaned from surrounding tissue, as the drainage is irritating to normal skin. This drainage clean-up is easier if you apply jelly such as Vaseline® around the wound so that the discharge does not stick to the skin.  The llama should be kept in a reasonably clean area, as bedding, dirt and insects can complicate healing. If the insects are particularly bad, you can apply repellent around the wound, but if you put repellent directly on a wound, it will delay wound healing.

Finally, to help achieve quick and thorough wound healing, the llama must be in good overall health. The llama will use extra nutrients to heal damaged tissue and must have an adequate diet.  Malnourished and parasite-laden llamas will have poor wound healing capabilities. Older, weak or ill llamas, as well as llamas receiving some long-term medications such as corticosteroids will have less than ideal healing. Keep the llama well fed, healthy, in a clean environment, and the healing will be maximal. Report any bad odors, discolorations, flaps of loose tissue, swelling, or discharges from wounds to your veterinarian. With your vigilant care and advice from your veterinarian, even the worst looking wound can heal with good results.

First Aid Kit for Wounds

• 100 gauze sponges, 2"x2" or  3"x3"  or 4"x4"
• 6 gauze rolls, 3-4" rolls
• 2 cotton
• 2 rolls Elastikon® or ExpAndover® and white tape
• 2 rolls Vetrap®
• 15 sterile Telfa® pads, 3"x4" or 4"x4"
• 1 pair bandage scissors
• 2 liters sterile Saline Solution
• Water-Pik® with accessories or spray bottle or 60cc syringe
• 1 quart Povidone-Iodine Solution (Betadine® Solution)
• 1 quart Povidone-Iodine Scrub (Betadine® Scrub)
• 1 large tube triple antibiotic ointment (per RC Callan, DVM)
• 1 jar Vaseline®

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