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"Proud Flesh" and its treatment...
"Proud Flesh" and its treatment...


As we discussed last week,  proud flesh is normal tissue that has become overactive.  In an attempt to heal wounds rapidly, the surrounding tissue reproduces so quickly it accumulates more tissue than is needed.  The process moves at such a rapid rate it has trouble stopping.  The resulting mound of tissue will protrude beyond skin level.  This is unsightly and may actually interfere with movement.

As we treat wounds, we must regulate the speed of healing in order that the final scab and wound closure will be at skin level.  The treatments used to fill in a large wound would not give us smooth level wound healing of the skin.

Two treatments are very effective in reducing the amount of proud flesh.  A bandage applies counter pressure to the wound, reducing the tissue growth.  Each time the bandage is removed, the wound will be smaller.  This is a very effective method of healing wounds with the smallest scar.  Our medicated bandages only need to be changed weekly, reducing the chore of
wound treatment.     

Once the bandage’s effectiveness is used up, as indicated by the slowing of the healing process, we start treating the wound topically.  As soon as the bandage is removed, the surface of the wound will start oozing a clear serum.  This is because, after weeks of support by a bandage, the wounded limb is suddenly without it.  This should be expected, so seeing it at the time of bandage removal is not a surprise.  We then start treating the wound with an antibiotic and cortisone mixture.  The antibiotic will protect against contamination and infection.  The cortisone will slow the healing process and prevent the formation of proud flesh.  Within 12 hours there will be a dry crust form and a scab will be close behind.  This scab should be left in place.  After a few days it will fall off, revealing a moist pink surface, but the size of the wound will be reduced.  Continued treatment will result in a continuous reduction in wound size.

Other treatments that accompany any wound are antibiotics and anti-inflammatories.  Only after bacterial infection is eliminated from the tissue surrounding the wound will it start to heal.  If your horse has a wound that is going no where or is worsening, there is a good chance infection is present.  The antibiotic of choice depends on the infection but should be used for at least five days, and probably administered by injection or orally.  Topical antibiotics, even under bandage, will probably not be able to penetrate this type of tissue.

Anti-inflammatories are almost as important to good wound healing as antibiotics.  These medications will reduce the thickness of the wound, allowing more effective healing because there will be less pressure on the sutures or overlying bandage.   This allows better blood flow which dramatically speeds healing.  They also reduce the itch of healing and thus reduce the need for chewing the wound.

The sooner treatment is initiated for a wound, the quicker healing will be accomplished and with minimal scarring.  From the other view, when we see the worst of wounds, we must remain optimistic and proceed with treatment.  All wounds will heal, some prettier than others, but heal they will.  If major structures are not involved, the horse will usually return to soundness.

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