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bits & pieces ASK THE VET your horse health questions answered

Be Not Proud The Prevention and Treatment of Proud Flesh BY ERICA SECOR, DVM, AND A. RACHEL ROEMER, DVM, OF NEW ENGLAND EQUINE MEDICAL & SURGICAL CENTER

Q:

A friend has told me that my horse is developing proud flesh on a wound. What is proud flesh? How should I treat it? Can I prevent it in the future?

Prevention

There are several wound management strategies that may help to prevent the formation of proud flesh. Your veterinarian should always be consulted for deep or extensive wounds, those over joints or tendons, and if proud flesh has already started to develop. Continued inflammation or infection in a wound is an important factor in the development of proud flesh. To understand what proud flesh Wounds should be closely examined is, it is helpful to first know how for pieces of foreign material like the normal healing process works after an wood or metal, bony fragments, or injury to the skin. Normal wound healing necrotic (dead) tissue, which could involves a delicate balance of processes, result in a persistently infected wound. with the ultimate goal being healthy skin. Bandaging of wounds should be on One key step in wound healing is called a case-by-case basis. Bandaging will help to reduce contamination and granulation, where cell replication fills the wound bed with tissue, which is later infection. However, some studies have covered by skin. Unfortunately, certain shown that bandaging may encourage steps in the healing process may go the development of proud flesh. The unchecked, which can lead to abnormal effect of bandages on the prevention wound healing and proud flesh. of proud flesh may depend more on the dressing directly applied on the Proud flesh occurs when the granuProud flesh occurs most commonly on the lower wound. Silicone gel dressings are lation step of wound repair is not limbs where the skin is under high tension and properly limited, and the granulation tissue becoming more commonly used, and prone to contamination. becomes excessive. The result is a nonyour veterinarian can instruct you healing wound that appears as a red, fleshy on the use of them. Several over-themass. It may be a single smooth area of counter ointments and salves are also sound to check for any foreign bodies excessive tissue in the original wound, or available that are advertised as proud or bony fragments. If there is no infecmay be multiple mass-like areas. Horses flesh preventatives. Consult with your tion, some veterinarians may treat the are more prone to proud flesh than other veterinarian before using a product you area topically with steroids to reduce the species, and it occurs most commonly are not familiar with. inflammatory response. In many cases, on the lower limbs (below the knee or the most effective way to deal with the hock). The skin is under high tension excess granulation tissue is to surgically Treatment in these areas, and movement results in remove it. Since the granulation tissue Proud flesh is often treated most effectively and efficiently by your veterinarian. fissures forming in the granulation tissue, does not have any nerve supply, this is which causes chronic inflammation. These a basically pain-free procedure and can Generally the first step in managing these areas are also particularly prone to being cases is determining whether there is any be done without any anesthesia to the contaminated, which can lead to infection infectious or inflammatory component. area. In some cases, when the wound is This may involve radiographs or an ultraso large that the skin cannot grow over and more inflammation. the area, skin grafts may be used. The ultimate goal of surgical intervention is to health hints SURGICAL ALTERNATIVES remove the excessive, non-viable granulaMODERATE TO SEVERE PROUD FLESH MAY REQUIRE SURGERY TO REMOVE THE EXCESSIVE tion tissue and reduce the inflammatory response. This allows the wound to fill in tissue. The surgery often is performed with the horse standing, since the granulation tissue with normal granulation tissue and cover has no nerve supply. Following surgery of severe granulating large wounds, a splint or a cast with normal, healthy skin. Proper wound may be necessary to prevent the granulating tissue from regrowing and to enable the skin edges to completely cover the wound. A skin graft can cover large wounds in some cases, management and early treatment when which speeds healing and reduces scar formation. Laser surgery may also be used. proud flesh does occur are key in efficient and successful wound repair.

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11/13/13 1:58:34 PM

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Equine Journal (December 2013)  

Your All-Breed, All-Discipline Resource

Equine Journal (December 2013)  

Your All-Breed, All-Discipline Resource