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Preventing and Treating Proud Flesh in HorsesBy Kentucky Equine Research Staff · January 8, 2013

Your gelding comes in with a cut on his pastern. It doesn’t look too bad, so you clean it and put some antibiotic cream on it. You decide not to call the veterinarian because the cut has stopped bleeding and isn’t very deep. Two weeks later, the cut is no longer open, but it hasn’t exactly healed, either. Instead, there’s a layer of reddish, lumpy tissue covering the wound. You call the veterinarian, who informs you that what you’re seeing is proud flesh, or an overgrowth of granulation tissue.

Proud flesh is most often seen as the result of an injury of the horse’s lower leg. Below the horse’s knees and hocks, there is little soft tissue and the skin is pulled tight over the bones and tendons. Near joints such as the pastern, the skin moves every time the horse takes a step, so healing is slowed because the cut is constantly pulled open.

Injuries in other areas of the horse’s body develop proud flesh less often because the skin covering the muscles is not under as much tension and the horse’s movements do not pull as hard on the edges of a wound. Cuts in these areas can usually be sutured, which almost always prevents the growth of proud flesh. Suturing should be done as soon as possible after the wound occurs in order to allow faster healing with minimal scarring. It is much more difficult to suture wounds on the lower legs because the skin is wrapped so tightly.

Wounds normally heal by the formation of granulation tissue first, after which skin grows over this layer, beginning at the edges of the wound and growing toward the center. When an injury is in an area where suturing isn’t possible, excessive growth of granulation tissue can develop where skin formation is disrupted by tension or frequent movement.

To give leg wounds the best chance of healing, a veterinarian may use bandaging or a cast to limit motion as much as possible. This gives the skin a better chance to grow over the normal granulation tissue, preventing or reducing the amount of proud flesh. If it does occur on a wound, proud flesh should be cut back until the wound surface is level with the skin surface. In cases where the proud flesh has been allowed to become massive, this may have to be done in several smaller stages, so proud flesh should be treated fairly early in the course of its development. Trimming usually causes a lot of bleeding but may not be terribly painful to the horse because granulation tissue doesn’t have nerves. Healthy tissue around and under the proud flesh does have nerves, however, so the horse may need to be sedated for this surgery.

After the excessive granulation tissue is removed, the area is bandaged to control bleeding and the wound, now trimmed down to healthy tissue, is allowed to heal. The veterinarian may prescribe a steroid ointment to inhibit the regrowth of proud flesh while not impacting the formation of new skin that eventually grows in to cover the wound. If the wound is very large, the veterinarian may suggest performing a skin graft to reduce healing time and produce a better result. Natural healing can leave a scarred surface that is subject to cracking and bleeding, potentially producing a new wound that is slow to heal and at risk for infection. A skin graft reduces the area of scar tissue with a surface that looks better and is less subject to  cracking.

After proud flesh has been removed, several weeks or months may be required to allow the wound to heal completely. Smaller wounds will achieve a skin covering before big ones will, underlining the importance of dealing with proud flesh before it develops into a large mass.