vessels in these areas will develop the proud flesh. After these vessels
grow into loops the developing granulation tissue is invaded by other types of
cells such as fibroblasts. Collagen is formed from the fibroblasts and then
effectively fills the wounded and injured areas.
Epithelial or skin cells can migrate along the surface provided by the
granulation tissue. Skin defects are repaired by these cells, but they can only
grow in one direction. These cells can not grow down into a wound or up over a
lump. However, epithelial cells can grow across the surface of a large wound
that has been filled in by granulation tissue which allows the skin to recover
in that specific area.
In addition, granulation tissue protects wounds from bacterial damage since this
tissue is resistant to infection. Skin gains its elasticity from the development
of collagen which is carried in fibroblasts. This helps provide the basic
framework of wound contraction. However, there is a bad side to this tissue
which helps a horse heal itself. The problem is when the process becomes too
much and gets out of hand. When more tissue is produced than needed for wound
healing it can become a problem. When too much of the tissue is produced it can
grow up over the skin level and develop into a large, red mass that is
unsightly. When bumped, rubbed or traumatized in any way the proud flesh will
bleed excessively. The presence of this tissue also prevents the growth of skin
cells across the injury and slows the healing of the wound. The excessive tissue
needs to be removed in these situations. You should also seek aggressive
treatment in order to get the best outcome.
Proud flesh can effectively be removed chemically by using caustic agents and
substances called astringents to cauterize or burn the cells. However, the
common compounds used are strong iodine, lye or sulfur which are not selective
in what they destroy and often end up destroying the surrounding skin cells as
well. This means a larger scar formation and a slower healing time.
A better option that results in a better cosmetic outcome is surgical removal of
the excessive tissue and application of a bandage. Studies show that the
formation of granulation tissue is reduced by a bandage and the amount of carbon
dioxide at the surface of the wound is increased. This means the wound stays
more acidic and as a result bacterial growth is inhibited. This means less scar
formation and quicker healing time.
A better idea is to get ahead of the formation of granulation tissue through the
application of an antibiotic cream combined with a steroid solution. Infection
is prevented by the antibiotic while the steroid greatly reduces the amount of
proud flesh produced.
To get a healing that fills in flat with surrounding tissue it is a good idea to
apply the cream to the outer edges and work towards the center as granulation
tissue fills in the wound. This allows the easy growth of epithelial cells on
top of the granulation tissue and cosmetically sealing the wound.
For best overall healing this is an excellent approach although the horse will
need conscientious and dedicated care. You should recognize the granulation
process early and start treatment right away otherwise the tissue will grow
above the skin rapidly and then treatment with ointment won’t be as effective.
Daily treatment is also important since proud flesh can overgrow rapidly.
There are some other topical treatments you can use. One option that is slowly
becoming more popular is n-butyl-cyanoacrylate. This is a surgical compound that
is similar to the Super Glue substance and can cover the surface of large
wounds. Not only is this option easy to use but it also reduces contamination
and slows the production of granulation tissue.
Some large wounds are covered with strips of equine placental tissue by
veterinarians. These tissues are collected after foaling and then cleaned before
being stored for later use. This tissue is also effective at slowing production
of granulation tissue and providing a barrier against infection.
The way excessive granulation cases are handled may soon be changed by surgical
lasers. Since proud flesh is made up of capillaries this is very important,
since laser surgery can not only remove excessive tissue but also cauterize the
small blood vessels. Surgical lasers are also very selective which allows it to
leave healing skin cells alone while removing excess tissue. The best healing of
all may soon be found in lasers.