Preventing and treating proud flesh is important to everyone who cares for horses. This often exasperating problem can result in unsightly wounds that don’t heal fo
r weeks, months or even years.
There are three phases of healing after a wound: 1) Inflammatory, 2) Proliferative, and 3) Remodeling.
In the inflammatory phase, white blood cells from the blood enter the tissue and work with other white cells normally there, called macrophages. These cells remo
ve dead tissue and kill invading bacteria. They also secrete messengers called cytokines and growth factors that initiate the proliferative phase.
The proliferative phase is when the granulation tissue starts to build. In a horse, this may begin in as short a period as three days. New blood vessel growth also begins, and the skin/epithelial cells begin to migrate across the wound.
In the remodeling phase, granulation tissue becomes more organized and actually begins to contract, which brings the skin edges closer. It becomes more smooth appearing and the blood supply is less. Skin cells continue to fill the gap between the skin edges.
Proud flesh occurs when the wound is ?stuck? in the proliferative phase and doesn’t move on to normal remodeling. Granulation tissue is produced in increasing amounts while the movement of skin cells slows or stops.
Proper Wound Care.
Supporting good early healing is the first step in preventing proud flesh. Wounds should be thoroughly cleaned and all contaminating material removed. Wounds that are less than six hours old should be sutured, if possible (suturing is sometimes difficult on the legs due to minimal skin).
Experts agree that wounds should be bandaged. A nonstick dressing, like Telfa pads, should be placed against the wound. Cover this with a soft padding, such as a standing bandage. Secure that with a self-adherent bandage, like Vetrap, to limit movement and irritation of the wound. Change bandages daily.
If the wound must be left open, it should be thoroughly hosed off daily and inspected for any dead tissue. Dead tissues typically appear as yellow areas and are prime material for bacterial infection.
Although some experts will recommend no topical medication on the wound, we think an antibiotic ointment is a wise choice and should be applied daily, on the wound, under the Tefla pad. Honey and sugar have been validated by research studies that found they stimulate the tissue macrophage cells and have antibacterial effects, but a generic human antibiotic ointment is simple and effective.
Another good choice is Pfizer?s Granulex-V spray, which will dissolve dead tissues and also contains ingredients that protect the wound and encourage epithelial cell (skin) movement across the wound.
While some dermatologists recommend removing the bandage as soon as possible to avoid stimulating the overproduction of granulation tissue, we feel bandaging is the lesser of two evils, especially under real-life conditions where you’re dealing with dirty bedding, dirt and other debris that can contaminate or irritate the wound.
Each day, you should see improvement. First, the edges of the skin will begin to adhere to the wound, then granulation tissue will begin to fill the wound. If the tissue appears to be growing above the normal skin level, you may have the start of proud flesh.
If proud flesh develops despite your best efforts, you should begin immediate, aggressive treatment. Your veterinarian can surgically reduce the granulation tissue back down to skin level. Once this has been done, each day you will need to use a dry gauze sponge to scrub the surface of the granulation tissue until it bleeds. This stimulates contraction and release of growth factors to encourage healthy skin growth.
If this is not sufficient to turn things around, you’ll move to the time-honored treatment of copper sulfate. After treating as above to get a slight bleed, you need to apply the copper sulfate. This is the active ingredient in most products sold for treating proud flesh, including Farnam?s Wonder Dust, Priority Care?s Proud Flesh Powder and Creative Science?s Proudsoff ointment.
Copper sulfate chemically removes the upper layer of granulation tissue. It is applied daily after removing any remaining product and the dead layer of tissue from the day before. There is a high level of success with this treatment. If healing plateaus, consider surgical removal and possibly red-light therapy (see sidebar).
Proper, basic wound care requires daily attention, extreme cleanliness and a keen eye to abnormal developments. We believe the use of an antibiotic spray or ointment and bandaging until the wound heals is a wise choice.
While not available commercially yet, researchers have identified a specific cytokine, named TGF-beta(3), which specifically slows the growth of granulation tissue. It is hoped that this finding can be developed into a treatment to specifically prevent proud flesh in the proliferative stages of healing.