One thing that a horse owner can get quite concerned about when their horse has an open wound that stays open for a while, is proud flesh. The reason it’s so concerning is that it looks weird and abnormal and in one 5 year old’s words, “it looks like a brain”. Which was funny at the time, but if you look closely enough, yes, it kinda does. Here’s a great example:
Anyways, proud flesh is something both to be concerned about and not concerned about. It’s kind of like good wine, you can have just enough of it and things can go pretty good, but too much will be no good both now and later on. Proud flesh is a bit like that. Let’s talk about when and why it happens first, and then we’ll talk about what to do about it.
If you have done a search on the internet wondering what proud flesh is then I don’t doubt you’ve seen the phrase “exuberant granulation tissue”. This is the medical term for it. There is normal granulation tissue, and then there is the exuberant kind. The kind that gets rather excited to be around and makes more of itself to join the party. As it goes, when there is just the right amount for the party, all good, too much then you wreck the place. Granulation tissue is a lot like that because it’s there for a reason but too much actually makes it work against the horse.
So, exuberant granulation tissue comes about because your horse has an open wound. Not just an open wound though, as horses get lots of those, but one that has been open for a while. Maybe a week or so. Horses seem to be prone to all kinds of accidents, especially their lower legs. These things are magnets for wires and nails and screws, and if a horse is going to get kicked, it’s usually on their lower leg where it happens. If you’re really unlucky then they get whacked on the hock, but outside of that, it’s the lower leg. These wounds take forever to heal and are prime spots for proud flesh. Other great spots are large wounds that are left to their own devices to heal in the chest, hind quarters and neck etc.
So the first step is to get a wound. Here’s a great example that is well on it’s way to getting proud flesh:
From the side:
The next step is to not take care of it in a timely manner. Timely being, about 3 to 5 days or so. The reason is that this exuberant tissue is forming because the horse’s body is ordering this tissue to be created to keep out the outside. Which was the skin’s job, but since it got wrecked, now it’s up to the exuberant tissue to get in on things. This stuff is crazy good at keeping the outside out of the inside of the horse’s body. It’s mostly blood actually and a bit of tissue to hold it all together, but essentially if anything scrapes it or causes it trouble then it immediately flushes it out with a crazy amount of blood. In turn, keeps the outside out of the inside and keeps things clean to reduce chances of infection.
Up until now, everything is good. Exactly what should be happening, keeps the horse alive and well and without needing antibiotics and all kinds of things that help kill infections. Here’s where this exuberant granulation tissue gets it’s bad rap, it creates too much. If left alone and in poor shape, a horse’s body will allow this proud flesh to grow beyond what is efficiently needed. When this happens it starts to resemble a tumor as it can grow the size of a basket ball in some cases. Other more minor cases you might get a golf ball or a soft ball, but with big enough wounds you can get a basket ball. That’s crazy. Search out proud flesh on the internet and there are lots of examples to show you how ridiculous the horse’s body can take this, “protecting against infection” thing. The first picture is what happens if left alone too long, here’s the view from the side in comparison:
Now you know when it happens and why it happens. Again, this is primarily the result of inadequate care and attention to the wound on a horse. Without proper intervention by a care provider, like your vet, the little bit that is needed can quickly grow out to too much and now you have a problem. Interestingly though, some horses will actually chew off their own proud flesh, attending to their own wound with usually successful results. Most don’t though as you don’t hear about that result too often. Maybe it’s because we deal with it beforehand, it’s hard to say. The idea is though that the extra stuff likely needs to be removed so that the wound can actually heal.
A quick break here while we talk about wound healing. Wounds can only heal if the skin on one side of the wound can meet up with the other. Skin isn’t so good about getting over stuff and generally tends to do the best if the surface is relatively flat. Not to say it won’t get over something that is the size of maybe half a marble, but it would prefer not to. Takes longer, and in reality, is weaker. I’ve seen it happen though to some very successful results. Either way though, the flatter you can get the wound, the faster the skin can grow back over. So if we use our imagination and everything above we can quickly surmise that if there is too much granulation tissue that makes a very large bump on a wound, the skin will not be able to grow over and now you have a problem that can never go away as the granulation tissue will only stop growing once the skin gets across. Chicken and egg thing almost.
Back to the proud flesh, it’s an absolute requirement to either remove or squish down what is there to allow the horse’s body to grow back the skin together. Keeping in mind that it takes about a day to grow just a millimeter. If the wound is about an inch or so, that’s 30 millimeters, which means 30 days! Patience is a virtue when it comes to wound healing in horses, especially if you have the added complication of proud flesh getting in the way. Here’s a decent wound dressing:
and another with different material:
So now we get to the, “how do I deal with this stuff then?” part. It’s sort of tricky. Generally you would call out your vet and have them deal with it. This article certainly isn’t a replacement for good veterinarian advice, but perhaps you may come out of this more knowledgeable to make an informed decision when given options.
Dealing with proud flesh is as simple as either getting rid of it, through either surgery or caustic powder, or just forcing it back into a smaller size through pressure. If you don’t have too much on there, which is relative to the person judging it, you can use pressure and likely have good results. Perhaps if it sticks out less than half to three quarters of an inch. More than that is likely to require removing it and then quickly applying that pressure. The thing about proud flesh is that it comes back fast! Very fast. In fact, it forms fast too. One day you might see a bit of yellowish flesh growing over and then the next day it’s a sizable bump. Day 3 brings you craziness. Cutting or removing it can get the same results, and as we talked above, until the wound heals over the horse’s body will just continue creating it.
So, two options primarily. Surgery through cutting with a scalpel or sharp knife with lots of cleanliness going on is the obvious choice. This is one your vet will likely advise. They have likely done it a thousand times before and it’s a normal event. When you watch it happen you should be prepared for lots of blood as proud flesh is crazy full of veins supplying blood to it (reasons given above), but no worries as horses are full of blood and can lose a significant amount in comparison to humans and be fine. Another option is to try to force it off through pressure of water. Being that some hoses can get quite powerful, it’s quite easy to knock of proud flesh and get back to the bare wound again. This option is “clean” but not guaranteed clean as you’re relying on your local water supply to be in good shape. Also, it’s not as quick and the water spraying into the wound from where you have knocked off the proud flesh will likely be painful for the horse. You may have varied results here. Here is what the above proud flesh looks like after being squished for a bit:
The last option is to use a caustic powder that is sold in most tack stores labeled something like “proud flesh remover”. Make no mistake though, this stuff is tissue destroyer. Getting any of this on good tissue, and yourself for that matter, can have very detrimental results. If you think that maybe you’re going to save yourself some cash on a vet and do the job yourself with this stuff then I urge extreme caution in how you use it and how you treat the wound after. There actually is a video of a guy that swears that this is the only option he would ever use for proud flesh and the video he shows is quite successful when he treats a horse. He’s not a vet, he’s more of an “old cowboy” sort that has found this procedure to be the best option. It is proof that this option can be an option, but I can’t urge enough caution when taking this route. It is absolutely imperative that you use as little as possible to get the job done and don’t get a single speck of it on good tissue as it’ll eat it alive. You’ll just be making things worse. Here is a picture of the proud flesh removed:
Which allows the infection to drain out too:
A week later after careful bandaging and regular cleaning:
Another week or so:
No matter which route you choose the goal is to get down to the original wound. From there the care is all the same, apply a dressing with pressure enough to stop the tissue from forming again. From there it’s all patience and commitment to keep the dressings clean and fresh.
Again, it comes down to the size of the wound. Allow for 1 millimeter per day and calculate how much gauze and wrapping you need. Surprisingly this can get quite expensive, so make sure you can make that commitment beforehand. Once you are down to that original wound then it’s up to you to make sure that you keep the wound clean and moist to allow the skin some time to form up and keep the outside out of the inside.
After about a month the wound made it down to this, and then another week or so to finish closing up: