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The Good and Bad of Proud Flesh

It may be disgusting to look at a red, rubbery substance that bleeds easily, but it is good that horses can produce it. Horses actually produce more granulation tissue or “proud flesh” at a quicker rate than any other animal. In addition to helping heal wounds, proud flesh is linked with a significant loss of tissue.

Horses lived and evolved in an environment that was hostile. A means of filling in wounds was necessary to survival. A horse that was injured couldn’t keep up with the heard and often became a meal for another animal so it was important for large wounds to heal quickly. A type of tissue developed by the early horse begins growing as early as three days after an injury or wound occurs.

The lower body and legs are most often affected by horses. Since these areas don’t have much muscle or underlying tissue, capillaries and small blood

 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.

Read the next horse health tips article on Heaves - Prevention and Treatment.
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