PROUD FLESH IN HORSES

Exuberant granulation tissue, or proud flesh as it is more commonly known, is part of the normal wound healing response in the horse.

Granulation tissue is the pebbly or granular appearing tissue which develops in healing wounds anywhere on the horse's body.

Granulation tissue is composed of small blood vessels and fibroblasts, but has no nerve supply.

This healing tissue is beneficial within open wounds for several reasons:

1) Granulation tissue helps the open wound resist infection;

2) As it fills the healing wound, it provides a surface for the epithelial (skin) cells on the periphery of the wound to "crawl" over and help cover the wound;

3) Granulation tissue helps aid the wound in contracting or becoming smaller.

Granulation tissue is a very important and necessary part of wound healing in the horse. However, there can be problems when the horse develops too much granulation tissue.

Research has found that horses have the ability to produce granulation tissue in wounds quite rapidly when compared to other animals.

When granulation tissue grows out and protrudes from the wound, then the granulation tissue is known as proud flesh.
Proud flesh is not conducive to wound healing as it prevents the wound from epithelializing (the process of the skin cells covering the wound).

Proud flesh sometimes can take on a "life of its own" if the healing wound is not managed properly. The granulation tissue can become so large it appears to be a tumor, usually obliterating the original wound.

Granulation tissue in this excessively exuberant form usually occurs within wounds on the distal (lower) leg of the horse, such as wounds over the cannon bone or pastern area. Granulation tissue in this form can be very difficult to manage.

We believe excessive exuberant granulation tissue forms as a result of several different factors--excessive movement of the healing tissue, minimal soft tissue coverage around the wound, contamination (infection) of the wound, and a reduced blood supply.

Prevention of exuberant granulation tissue involves good wound management. Any significant wound should be evaluated and treated by a veterinarian as soon as possible.

Proper and timely management is crucial to a satisfactory outcome for any wound, but especially those of lower limbs.

Bandaging is very important in the prevention of exuberant granulation tissue and helps prevent bacteria from contaminating the wound.

It also helps maintain a healthy environment for optimum healing, and helps reduce motion of the tissue, again optimizing wound healing.

You should cover the wound with a non-stick pad and some type of conforming gauze bandage.

Depending on the wound location, that can be followed by a thick cotton bandage and an elastic bandage to prevent contamination of the wound from bedding and dirt.

The pressure from the bandage helps prevent the granulation tissue from becoming exuberant.

The treatment of wounds that have developed exuberant granulation tissue usually depends on the extent of the overgrowth.

Mild overgrowth of tissue--just protruding above the surface of the wound--might require only steroid ointment applied directly to the granulation tissue to inhibit the growth of the exuberant tissue, then bandaging of the wound to prevent further growth of the granulation tissue and to encourage wound epithelialization.

For additional reading see Equine Wound Management by Ted S. Stashak.