Question: What is the best way to prevent proud flesh from forming in wounds below the knee? I've been told by some people not to use water on wounds below the knee, but others tell me it is the best thing. Also, my gelding has been licking a wound on my filly. Do you think that might promote proud flesh?
Answer: Proud flesh is the excessive growth of granulation tissue within a wound that inhibits closure of the skin. In severe cases, proud flesh can protrude well beyond the original wound and become a target of parasites and infection.
Proud flesh is a common complication of wounds at or below the knee and hock, but most heal without incident if they are handled properly at the beginning. This means thoroughly cleaning the wound, taking care to remove irritants such as metal particles, rope fibers and dead tissue (especially bone, tendon or ligament). Beyond that, you can reduce the chances that proud flesh will develop by keeping the wound clean and protecting it from
- rubbing, licking, biting and contact with pasture vegetation, sand or gravel;
- disturbance caused by motion that opens and closes the gap in the skin;
- flies and other creatures that will attempt to feed on or infect the site.Clean water will not cause or worsen proud flesh. In fact, hosing may be the best way to remove surface debris and reduce local wound swelling. Bandaging helps reduce adverse influences but does not speed the healing process or prevent the formation of proud flesh. The best way to prevent proud flesh is to ensure that all of the above criteria are met and if you do notice it forming, call your veterinarian right away to assess the situation before it gets a half-inch or more above the wound edges.If another horse is attracted to a wound as you describe, it usually indicates the presence of aromatic exudate produced in response to a foreign body, dead tissue or parasites. The licking itself is not a big problem, but the reason behind it most certainly is. In most cases, licking indicates the presence of the "summer sore" organism, Cutaneous Habronemiasis. Flies deposit these worm larvae in wounds on the head and lower extremities. They prevent healing, causing the wound to become round in shape and bulge slightly above the surrounding skin. I would suggest having your veterinarian take a look at your filly's wound and then keeping her in a stall or corral until it has healed.
- Matthew Mackay-Smith, DVM, is the EQUUS Medical EditorThis article first appeared in EQUUS, issue 289.