Once granulation tissue is elevated significantly above the skin level it is called “Proud Flesh”. In most cases, it must be surgically removed. It is your vet’s job to determine why it developed and what can be done to promote healthy wound healing going forward.
Surgical removal of proud flesh begins with wound cleaning. Vets usually wears latex exam gloves to perform this procedure. The wound is cleaned and hair clipped away so that the edges of the wound are visible. In some cases, sedation is used to help keep the horse still for the procedure.
In most cases, healthy young granulation tissue does not have much nerve supply, so proud flesh can be cut away with a scalpel blade without causing the horse much pain. In some cases, however, over time the granulation bed does develop a nerve supply. Due to this, I am always careful to test the tissue for sensation before cutting.
A scalpel blade is used to cut away the tissue. Granulation tissue is mostly made of blood vessels, so there usually is significant bleeding. How much bleeding depends on several factors.
The time that the procedure takes depends on the size and characteristics of the wound bed. Usually it just takes a few minutes. When the tissue is cut below skin level, vets often places a pressure bandage to stop bleeding.
Thereafter, your vet typically helps prevent recurrence of overgrowth of tissue through a variety of proud flesh inhibitors.
As with any wound, it is critical that you perform the treatments and management of the equine as your vet instructs. If you are to perform bandage changes on a challenging wound, be sure to communicate with your vet using photos so your vet stays well informed of the wound’s healing progress and can advise you on dressings and treatment.
Note: Some vets prefer to use caustic topical chemicals to “burn away” proud flesh. There are a variety of types of chemical types that destroy proud flesh.
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Consider Potential Side Effects & Complications
Granulation tissue consists of budding blood vessels, so it bleeds heavily when cut. This may look like a lot of blood, but it is insignificant in most cases.
After the procedure, vets ofen place a pressure bandage over the wound to reduce hemorrhage and tell you when you can remove it.
Removal of proud flesh does not resolve the underlying problem that caused it. This cause also must be remedied, or proud flesh will recur.
Consider Reasons Not To Use This Treatment
Surgical removal of proud flesh is not usually used when topical ointments and other treatments are sufficient to prevent it.
Underlying problems (excessive movement, infection or involvement of other structures) should be considered and treated along with removal of proud flesh, or it will recur.
Skills I might need
Is It working? Timeframe for effect
Progress is assessed at each bandage change. After a surgical trimming of proud flesh, the wound bed should be at or below skin level.
The horse should never be lame. There should be minimal or decreasing drainage and/or swelling. The wound should decrease in size over time.
For difficult wounds, send a photo to your vet every few days or at bandage changes so they stay informed.
Questions To Ask My Vet
- Why did proud flesh develop in this case?
- What could have been done to prevent it from forming in the first place?
- How frequently should the bandage be changed?
- What topical ointments or dressings should I apply at home?