What is Proud Flesh?
When an open wound is left to heal, it naturally produces a type of vascular tissue known as granulation tissue as part of the healing process. Proud flesh is a disorder in which this vascular tissue that develops grows out of control. Known medically as exuberant granulation tissue, these growths can interfere with the growth of new skin. This can significantly increase the healing time for open wounds, although the granulation tissue itself can help protect against infection.
Proud flesh is the common term for a medical condition known as exuberant granulation tissue, an overgrowth of vascular tissue over an open wound.
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Symptoms of Proud Flesh in Horses
Proud flesh is known medically as exuberant granulation tissue. Granulation tissue develops on the healing surface of a wound and is a growth of vascular flesh. Granulation tissue has the following characteristics:
- Grainy appearance
- May have pulse
- Red or pink
- Usually painless
When the granulation tissue becomes overgrown, skin is no longer able to grow over it, and it becomes exuberant granulation tissue or proud flesh.
Proud flesh can occur in any type of wound, but some types are more common than others. The most common types of wounds on horses include:
Scrapes and abrasions are very common in horses, occurring even during normal activities. Scrapes are somewhat less likely to develop proud flesh.
Deep cuts, also known as lacerations, can be either straight or jagged and tend to bleed profusely. Lacerations are the most common type of wound to develop cases of proud flesh. Having deeper lacerations sewn shut will help to prevent exuberant granulations to form.
Contusions are bruises, injuries that bleed internally without breaking the skin, usually caused by blunt trauma to the area. Unless the contusion later swells and breaks the skin, proud flesh is unlikely to develop.
Puncture wounds are frequently deep and may go undetected, sometimes which can lead to cases of proud flesh.
Causes of Proud Flesh in Horses
Proud flesh is found most often in wounds that are in areas with very little in the way of underlying muscle and tissue. It is also more pronounced in areas where the skin is in areas where there is a lot of motion as the edges of the wound are being consistently tugged on. Other circumstances that may increase the chances for the granulation tissues to grow out of control can include infections, reduced blood supply, and excessive movement of the underlying tissues.
Diagnosis of Proud Flesh in Horses
Although exuberant granulation tissues have a relatively distinctive growth pattern and appearance, there are a few things the examining veterinarian may want to test. Sarcoids sometimes have a similar appearance to proud flesh. A sarcoid is the most common neoplasm found on equines and if it is found will change the treatment plan. If a sarcoid or other type of growth is suspected, your veterinarian may choose to do a biopsy of the tissue.
Extra care must be taken when collecting samples from the vascular tissue as it tends to bleed very heavily. In severe cases, when the vascular growth is unusually large or when the exuberant granulation reoccurs, additional imaging diagnostics may be recommended. Ultrasound and x-ray technology may help to visualize if there are any foreign bodies trapped in the tissue, or if the bones or nearby joints are damaged. Damage to the joints and bones may make healing more difficult, thereby increasing the chance that proud flesh will develop.
Treatment of Proud Flesh in Horses
In mild cases of proud flesh, topical steroids may prove effective in reducing the growth enough to allow the skin to grow over the tissues on its own. More advanced cases will require additional treatments to reduce the amount of vascular tissue. This is generally accomplished by one of two methods; either surgical removal of the overgrowth of tissue or the application of caustic agents to the tissue. Caustic agents are not as frequently recommended in recent years as they were in the past due to the possibility of damaging healthy tissues, but still remain viable in some situations.
More often, the tissues will be cut away, and the remaining wound treated to prevent regrowth. The granulated tissues may bleed heavily during this procedure, however, no nerves develop within the proud flesh, so it is generally painless. In some cases, the granulation may be entwined with normal healing tissues making the removal more difficult, and possibly painful and requiring sedation.
Recovery of Proud Flesh in Horses
Granulation of wounds occurs more rapidly in equines than it does for other animals, and should be guarded against. There are several steps that can be taken to prevent the formation of proud flesh on open wounds.
- Clean and treat injuries right away
- Continue to clean the wound daily
- Contact a veterinarian for large or deep wounds
- Keep the horse calm and quiet during healing
- Remove foreign objects and dead tissue
- Suture wounds closed
Depending on the circumstances, bandaging wounds can be either helpful or detrimental and should be decided on a case by case basis with your veterinarian’s help.