Understanding Proud Flesh

Michael St. Blanc, DVM, MS, DACVS (LA) 

Wounds are common occurrences in equine patients. Complications that can develop during wound healing are numerous and include the development of exuberant granulation tissue, commonly known as “proud flesh.” Early recognition and appropriate treatment are crucial for complete wound healing and optimal cosmetic and functional outcomes. Here we’ll explain the wound healing process, appropriate treatment regimens, and what to expect when managing proud flesh with your veterinarian.  

Wound Healing 

Normal wound healing is a dynamic process consisting of three main stages, of which there is considerable overlap. The inflammatory stage occurs immediately and lasts for several days. During this stage, steps occur for the formation of a wound matrix for optimal healing, and numerous cellular components are involved. In the proliferative phase, which occurs by about the third day, growth of blood supply to the wound increases in a process called angiogenesis. Granulation tissue forms and begins to contract and epithelialize. The remodeling/maturation phase begins about two weeks after wounding. In this stage, the wound continues to remodel and form collagen i.e. scar tissue. The remodeling phase continues for approximately 1-2 years.  

Proud flesh develops due to an inefficient and prolonged inflammatory phase during wound healing. Exuberant granulation tissue is pink in color due to the abundance of small blood vessels called capillaries. Veterinary intervention is often sought when proud flesh develops during the wound healing process. 

Preventing Proud Flesh 

In essence, anything that negatively affects wound healing can promote proud flesh formation. This includes numerous factors such as infection, excessive motion at the wound site, and inappropriate bandaging. Anatomic differences also exist. Wounds on the distal (i.e. lower) limb are also more prone to proud flesh formation. These factors mean that early veterinary intervention and appropriate wound care are paramount in preventing complications associated with wound healing. 

Treating the Issue 

Upon diagnosis of proud flesh formation, several treatments may be necessary. A common first-line treatment is the application of topical corticosteroids, such as Panalog or Animax. These products contain steroids which inhibit the exuberant growth of granulation tissue. These can be effective when applied appropriately to the wound bed. However, care must be taken with their application because over-application can lead to delayed healing in other areas of the wound. If your veterinarian elects to treat the wound with a topical steroid, he/she will recommend frequent bandage changes and monitoring to ensure an optimal outcome. 

Surgical debridement may also be necessary. This involves sharp transection of the exuberant granulation tissue (i.e. trimming) with a scalpel blade so that the wound is level with the surrounding skin. This can usually be accomplished using standing sedation. Granulation tissue lacks nerve endings, so this process is also painless to the horse and is often well-tolerated. Following debridement, bandaging is also key. With either of these approaches, working with your veterinarian to ensure proper bandaging and to closely monitor wound healing is vital for a successful outcome. 

Depending on the severity and chronicity of the wound, treatment may be prolonged and may involve multiple episodes. Other underlying factors such as infection or excessive motion at the wound site should also be treated concurrently. In large, refractory wounds, advanced techniques such as skin grafting may be indicated for ultimate wound closure. Working closely with your veterinarian will allow him/her to manage the wound with the appropriate technique. 

Take-Home Message 

For the best healing, identify and treat distal limb wounds in horses quickly. Involving your veterinarian in wound evaluation and management is paramount to achieving optimal functional and cosmetic outcomes. 

Courtesy of AAEP Media Partner, The Horse.