Proud Flesh

If your horse has ever suffered a wound, you may have heard your vet bandy about the term "proud flesh". Below is all you need to know about the problem.

What is proud flesh?

Granulation tissue, or proud flesh as it is more commonly known, is part of the wound healing process in horses. It is made up of small blood vessels and fibroblasts, but has no nerve supply. The tissue forms usually in wounds left open to heal rather than ones stitched up.

It is beneficial for three reasons:

1.    It helps the open wound resist infection

2.    As it fills the healing wound it provides a surface for the skin cells on the edge of the wound to "crawl" over and help cover it.

3.    It helps to aid the wound in becoming smaller.

The tissue is a vital part of wound healing in your horse - but you can have too much of a good thing if too much of the tissue is developed.

Horses have the ability to produce granulation tissue more rapidly than other animals. When the tissue grows out and protrudes from the wound, it then becomes known as proud flesh.

Proud flesh is not beneficial to helping wounds heal as it prevents skin cells covering the wound.

It can sometimes take on a life of its own and can overwhelm the original wound.

It is believed the excess tissue forms as a result of excessive movement of the healing tissue, a small amount of soft tissue covering the area around the wound, infection of the injury, and a reduced blood supply.

This normally happens with injuries on the horse's lower leg (as it is often moving and has less skin to cover the wound) and can be very difficult to manage.

It is therefore important that when a horse is wounded on its lower leg, steps are immediately taken to prevent proud flesh developing.

Prevention

Good wound management is the key to preventing proud flesh. Any major wound should be seen and treated by a vet as soon as possible.

Bandaging is crucial in the prevention of proud flesh as well as preventing bacteria from contaminating the wound. The injury should be covered with a non-stick pad and gauze bandage. Depending on where the wound is, that can be followed by a thick cotton bandage and elastic bandage on top - to prevent contamination of the wound from bedding and dirt.

The pressure of the bandage also helps to prevent proud flesh.

Treatment will depend on the extent of the overgrowth.

Mild overgrowth - just protruding above the wound's surface - might need just steroid ointment applied directly to the tissue, then bandaging to prevent proud flesh developing as well as encouraging skin to grow over the wound.

Moderate or severe overgrowth will require surgery to remove the excess tissue. This must happen to allow the skin at the edge of the injury to grow over the wound.

If the overgrowth is moderate, a scalpel can be used for the procedure while the horse is standing - as the tissue has no nerve supply.

However, severe proud flesh must be removed under anaesthetic or in several stages as there can be a significant amount of blood loss. A splint of cast might then be used to stop the proud flesh from re-growing. In some cases a skin graft is used to cover large wounds, accelerate healing, and reduce scarring.

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