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Hints on proud flesh in the horse

Proud flesh. This mare had caught her leg in a wire fence and panicked, running with the fence still attached.

Proud flesh. This mare had caught her leg in a wire fence and panicked, running with the fence still attached. © Clementine Benjamin/Millanean Sport Horses

by Dr Brad Jackman

Proud flesh is an excessive growth of granulation tissue that has the appearance of cauliflower. It usually develops over an open wound, and most often occurs in areas of excessive tension and motion.

Proud flesh usually is seen in injuries of the distal limbs (below the knee or hock) due to the lack of underlying soft tissue structures, which allows for an excessive amount of tension in those areas.

These distal areas mainly are comprised of bone, ligaments, and tendons, and lacks underlying muscle. This anatomy causes the skin surface to be tense, which increases the risk of proud flesh because of the difficulty for skin to grow back over a wound.

The best treatment of proud flesh is prevention, and the best prevention is performing a primary closure (suturing) of the wound immediately, or as soon as possible, after the wound occurs.

Proud flesh can become a problem when primary closure is not an option, and the skin has to heal through second intention healing.

Second intention healing is when the skin has to heal first by granulation tissue forming over the wound, then the skin grows over the granulation tissue.

It is at this point you get proud flesh.

Another preventative method is to limit the motion in the area of the wound as much as possible. This is generally done by bandaging, or placing the lower limb in a cast. By reducing the motion in the area, you speed the healing process allowing skin to grow over the granulation tissue, which greatly reduces the occurrence of proud flesh.

Proud flesh healing on the pastern of Simon Says, owned by Patti Woodall.

Proud flesh healing on the pastern of Simon Says, owned by Patti Woodall. © Denise Garlinghouse

If proud flesh does occur, there are a couple of options for the horse owner.

First, surgical removal of the exuberant granulation tissue generally provides the best results. In this process, the granulated tissue is excised to be level with the skin’s edges. In some horses, sedation is not necessary as granulation tissue is devoid of a verve supply. While there are no nerve endings in the tissue, there is a tremendous blood supply. Once the tissue is debrided, a pressure bandage is applied to help stop the bleeding. This debridement process might need to be performed more than once, depending on the size of the wound and how much proud flesh is present.

The second option in treating proud flesh is to use a caustic substance to eat away the granulation tissue. There are several caustic products on the market. The problem with caustic substances is that their purpose is to destroy cells, and in addition to destroying exuberant granulation tissue, they also destroy healthy cells and might cause further damage to the wound. Using a caustic substance slows the healing process when compared to the surgical treatment of proud flesh. The surgical method is generally preferred because it removes much of the unwanted granulated tissue and leaves healthy tissue underneath, whereas the caustic method destroys all cells whether or not they need to be destroyed.

Once the excess granulation tissue is removed, a steroid cream or ointment is applied to the area. Steroids have been shown to inhibit the formation of granulation tissue without inhibiting epithelialization. Epithelialization is the process of skin cells growing from around the edge of a wound and slowly covering the damaged area.

The healing process all depends on the size of the wound, and how large the proud flesh area has become. Since skin cells have to grow from the edge, the larger the wound, the more time it takes to heal. If the horse is put in a cast to restrict his movement, it generally takes two to three weeks. However, in most lower limb wounds, it is usually a minimum of three to four weeks if a bandage is applied, but it could be as long as several months.

Another factor that affects the healing process is the physical condition of the horse. If the horse is in peak condition and is having all of his nutritional requirements met, then the immune system is working at peak performance and the healing process will be shortened. But, if you have an older horse, or one that has been nutritionally compromised, then the healing process will take longer.

In some cases where large wounds are involved, skin grafting is performed to try to aid the healing process. With large wounds, proud flesh often leaves a hairless scar that will crack and bleed. Skin grafting improves the healing of these large wounds by decreasing scar tissue. This also leaves an area that is more cosmetically appealing.

Although not a common complication, there is a small risk that a sarcoid could develop. A sarcoid occurs when the scar tissue changes its characteristics to become a benign skin tumor. While not common, it has been reported and is occasionally seen in association with proud flesh.

by Brad Jackman, DVM, MS, Diplomate ACVS, surgeon at Pioneer Equine Hospital located in Oakdale, California.
Courtesy of the AAEP


 

 

Day one, when the horse was found, January 3, 2011.

Day one, when the horse was found, January 3, 2011.

The images below by Jill Dickie show the injury and healing process of proud flesh over a year.

“The horse was found on January 2, 2011, lying down, given up really.  He was being grazed elsewhere and his owner unknowingly took me to purchase him and this is how we found him!

“We brought home and treated rather than pts.

“His healing journey took some time, and we had a couple of incidents with it which opened it up again, but by about April/May 2012 it dried to a scar. It still has a slight scab over it now but this is all scar tissue rather than anything “live”.

“I tried various creams (hydrocortisone, “the yellow liquid” (now unavailable), Emu Cream, etc etc, but nothing really ATE the proud flesh like the “Panalog” I used, as you will see in the August pic. Amazing stuff that is usually prescribed for cats & dogs with yeast infections in their ears!  I guess the steroid in it worked like little pacmen and munched it all up.”

 

This series of proud flesh healing pictures is by Michelle Morris Horan.

 

Originally published on Horsetalk in 2001

 

 

About the Author

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Comments (6)

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  1. Finola says:

    We have had great sucess with some leg wounds just using ordinary honey, applied to the wound by wrapping it with honey on a pad ( such as a disposable nappy, which has the advantage of adhesive tabs so you can keep it on while you reach for the bandage or vetwrap ).The honey is naturally antibacterial and promotes healing. Don’t be afraid if the wound looks yellow and messy – just keep using the honey and it heals from the inside out.

  2. Kathy B says:

    We also have used honey with success. Also plain white table sugar works wonders. Just sprinkle on a moistened pad (we use diapers too!) and apply over the wound and wrap, can be left for several days at a time. It’s cheap and easy to use, keeps the wound clean and healing and there’s no smell.

  3. Mare' Amy says:

    After much research (and confusion) I phoned my vet…she suggested packing the wound with meat tenderizer (available in the grocery store spice section). I wish I had taken photos. The proud flesh has gone from an inch of ballooned tissue to almost completely flat in 5 days. I pack, pad and bandage the leg every other day. Amazing. FYI, I use sanitary pads to absorb the weeping from the wound and to provide a non-stick padding. Works beautifully. This method has worked better than I could have imagined.

  4. Sonia Dewdney says:

    Recently had a mare with a 12cm x 8 cm open wound on lower leg that could not be sutured and was badly infected. Medical honey (manuka honey) and solosite (gel to keep it moiust) was applied daily and wrapped. The wound closed beautifully and did not scar. Fully furred and invisible within 6 weeks. Wounds have been found to heal fastest with the presence of carbohydrates, and the solosite helps prevent granulation, as the wound is moist. Medical honey has strong antibacterial and fungal properties, and in this case the infected material was drawn out and sloughed of beautifully. Wound was clean and smell free after just a couple of days. Have used medihoney before with great success, and would thoroughly recommend.

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