5 Wound care steps to prevent proud flesh

When your horse cuts himself, especially on the lower leg, take steps to ensure that healing proceeds smoothly.
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When your horse shows up at the gate with yet another cut or scrape, it’s wise to tend to it right away to head off infection, aid healing and prevent complications.

One complication you’ll want to be especially careful to avoid is proud flesh. Also known as exuberant granulation tissue, proud flesh is the excessive growth of the connective tissue and blood vessels that begin to fill in a healing wound. In severe cases, the mounds of pink tissue can take on a cauliflower-like appearance and protrude beyond the surface of the skin. New skin is unable to grow over the tissue, and healing stalls. Proud flesh develops most frequently in wounds on the lower legs, but under the right circumstances it can appear anywhere on the body.

Several factors increase the risk for proud flesh, including the wound’s severity, level of contamination and location---the potential for disruption of fragile healing tissue in wounds over joints and other mobile areas makes them more vulnerable. Also, some horses are simply more prone to developing proud flesh than others. Consult your veterinarian if your horse has a wound that “gapes” when he moves, affects a joint, tendon or bone, or contains embedded debris or other contamination. In some wounds, sutures may be the best option, and your veterinarian will want to address any other issues that might compromise healing.

In most cases, you can probably manage your horse’s minor injuries yourself. But if you have any doubts do not hesitate to call your veterinarian. It is far better to get healing on the right path from the outset than to try to compensate once complications have developed.

1. Rinse the wound well. Dirt and debris---including hair, rope fibers, fragments of metal or wood, or dead tissue---can create chronic inflammation and infection that inhibits proper healing and encourages growth of proud flesh. Saline solution, which has the same salt concentrations as blood, is the safest way to flush impurities out of a wound without disrupting injured tissues. If you don’t have any saline at hand, water from a hose can do the job. In fact, the cool water has the added benefit of helping to reduce swelling and inflammation. Inspect the area closely to make sure it is completely clean.

2.Apply appropriate treatments. Flushing a clean wound with a dilute antiseptic wash, such as Betadine or Nolvasan, can reduce the risk of infection even further. If you choose to apply a wound ointment, use a water-based gel during the earliest stages of healing---these help protect the tissues without inhibiting healing. At the outset, avoid heavy, greasy ointments such as ichthammol---these are more effective for protecting tissues during the later stages of healing. At any stage of healing, your best bet is to stick to products labeled for use on horses. Meat tenderizers, hemorrhoid creams and other home remedies may control inflammation, but they will also damage normal tissue and may inhibit healing.

3.Bandage, if appropriate. Apart from superficial scrapes, almost any wound on the lower leg will benefit from bandaging to keep it clean while it heals. You’ll want to first cover the exposed tissue with non-stick gauze or other wound dressings that won’t adhere to the fragile healing tissues. Wounds above the level of the elbow or stifle can often be left open to heal; the relative immobility of the horse’s torso means the healing tissues won’t be disturbed as often, and these areas are likely to remain cleaner. You’ll want to change the bandage at least daily while healing progresses; more frequent changes may be necessary if the gauze is getting soaked with exudates.

4.Keep your horse still. Too much motion in a healing wound pulls at the tissues and can prevent the skin from closing over it. Bandaging will help keep the limb still as your horse heals, and for larger wounds your veterinarian may recommend splinting. Keep your horse in his stall or in a small corral or round pen until the wound is stable.

5.Seek help quickly if healing stalls. Even with the best of care, some wounds may develop proud flesh. Call your veterinarian immediately if you start to detect rounded, bumpy tissue in a healing wound. In addition to curbing the growth of proud flesh, it’s important to rule out similar-looking conditions, such as ulcerated sarcoids0 or various fungal, bacterial or parasitic infections.

In Focus: Proud flesh (overgranulation) 

Definition

: overgrowth of granulation tissue that rises over the edges of a wound, making healing impossible

Causes: Proud flesh is more likely to develop in wounds to the lower limbs, wounds that remain contaminated with foreign matter, and those in more mobile areas.

Signs: The granulation tissue—which fills in the deeper portion of a wound that penetrates all the way through the skin—will take on a lumpy, reddish-yellow, rubbery appearance. If infection is present, it may exude fluids and have a noxious odor.

Diagnosis: X-rays or ultrasound may be used to look for damaged bone or embedded foreign matter. Testing may be necessary to distinguish proud flesh from sarcoids and various types of infections that can create similar-looking lesions in open wounds. 

Treatment: Surgical removal of the excess growth is the primary treatment for proud flesh. For more moderate cases, a topical corticosteroid may shrink the tissue enough to allow proper healing. The leg may be placed in a splint or case to keep it still while healing progresses. Skin grafts may be used for larger wounds.

Applying a bandage

Bandaging is an important part of wound care. Not only does it help keep the wound clean, it can hold topical medications in place. But it’s important to do the job carefully. A bandage that is too loose or too tight can slow healing or even make a wound worse. If you’re unsure of your technique, ask your veterinarian to help you improve your skills.

Before you start, you’ll need to choose the best dressing for your horse’s wound. For years, sterile gauze squares were the primary choice for covering the wound surface before applying the wraps to cover it—and these will still get the job done. However, a better option may be one of the newer products designed to keep the healing tissues moist, such as calcium alginate or foam pad dressings. Although it was once believed that the best way to promote healing was to let a wound dry out, recent research has shown that open wounds will close faster and with less risk of infection if the surface remains evenly moist. In addition, specialized dressings are now available that can help debride infected wounds or restore moisture to wound surfaces that dried out before the injury was discovered. If you’re unsure of which type to use, ask your veterinarian for a recommendation. As with any product, read the labels carefully and follow the instructions.

Once you have wound dressing, you’ll also need rolled gauze, padding such as a quilt or cotton sheet, self-adhesive bandage and elastic bandaging tape (Elastikon). 

1. Wrap the rolled gauze just above the wound, pulling it just tightly enough to remain in place but not so hard as to stretch out the weave. Make sure it lies smoothly and that each layer overlies the preceding layer by about 50 percent. The highest risk of injury to healing tissues come from shifting or slippage of this gauze layer.

2. When you reach the level of the wound, place the gauze pad or other dressing over the exposed tissue, holding it carefully to ensure it lies flat with no wrinkles. Then continue with wrapping the gauze roll down the leg to cover the dressing and extend beyond its lower edge.

3. Wrap the cotton padding around the leg, taking care that it lies flat.

4. Apply an additional layer of rolled gauze to help hold the padding in place as you continue wrapping.

5. Start the self-adhesive wrap about a half-inch below the top of the padding and work downward, taking care to overlap it by about half with each turn and to prevent it from bunching up or wrinkling. Also leaving about a half-inch of padding exposed at the bottom, continue wrapping back up the leg for a total of two layers. You want to finish with a smooth, snug covering.

6.To help secure the bandage more firmly, apply two or three rounds of elastic bandaging tape at both the top and bottom, overlapping both the horse’s leg and the bandaging material by two or three inches.

This article first appeared in EQUUS issue #453, June 2015. 

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