Proud Flesh in Horses- and What You Can Do About It.
- Proud flesh is the bane of most horse owner’s existence. It’s ugly, hard to heal, and can give you lots of vet bills. Fantastic.
****** And fair warning – there are some questionably gross photos below.******
But what really is proud flesh?
- During the horse’s wound healing process, his body gets into “overachiever mode” and the new tissues growing in get out of hand. To be perfectly technical, the tissues and blood vessels that bring the edges of a wound together are called granulation tissue. This overachievement of your horse to make this granulation tissue is called exuberant granulation tissue, also known as proud flesh.
This is granulation tissue.
The wound healing process.
- Backing up just a bit from the proud flesh, let’s take a look at the whole wound healing process. It can be broken down into a few stages.
The first stage is inflammation.
- The wound is angry, no matter the size of the wound. There’s a lot of blood, fibrin, platelets, and white blood cells moving in to take care of things. The white blood cells are there to help the wound clean, and they also tell the fibrin to start the clotting process.
- This is a good thing – the bleeding will stop! The inflammation phase also hurts – there’s a lot of activity in the wound! Not only is the tissue damaged from the wound itself, all of the blood and swelling creates heat and pain.
The next stage is debridement.
- This is when your horse’s body starts to clean things out and remove any dead tissue. Sometimes, wounds need some help during this stage, and your vet can surgically debride a wound to help the healing process.
- This stage of healing can also have its own problems – as white blood cells called neutrophils collect in the area to clean the wound, they can overpopulate the area creating pus. This slows healing and can be a problem in and of itself.
- Also during debridement, the skin cells will start to move over the wound during epithelialization, eventually covering the wound. As horses are strange creatures, they do this at different rates. Body wounds can heal at the rate of .2 mm a day, while leg wounds take longer, about .09 mm a day. This does contribute to proud flesh!
Next is the repair stage of wound healing.
- Fibroblasts are filling the wound, and they create a framework for the granulation tissue to form. The goal here is to create just enough granulation tissue so that the edges of the skin can move over the tissue and connect.
- BUT – too much granulation tissue can lead to proud flesh.
And finally – the maturation phase of wound healing.
This is when the skin starts to get back to normal. This can take months – or longer. Sometimes there is scarring, sometimes your horse’s hair coat grows back with white hairs. You can learn more about there here.
This is the same horse as above, just further along in the healing process.
How does proud flesh happen?
- Proud flesh happens when the granulation tissue created during the healing process goes out of control. It normally stops growing once the wound’s gap is connected.
- The granulation tissue will grow outward, beyond the level of the skin. It’s a bit like cauliflower, and very vascular – so full of blood vessels. The more it grows, the harder it is for the skin to connect over the wound, and healing is delayed, and delayed, and delayed.
Proud flesh happens in the legs for a few reasons, some of which are just in the beginning stages of understanding.
- One possible reason that horses develop this exuberant granulation tissue is because of the horse’s inflammatory response – the first stage of healing. In the horse’s legs, this response can take a bit to really step up and do its job, and this delay creates a problem. “Slower” inflammation also tends to linger longer than it should, and this actually helps granulation tissue go haywire.
- There’s another school of thought out there. Ever notice that your horse can twitch his skin to shake a fly? This muscle responsible for this, the panniculus carnosus, twitches the skin and is absent in a horse’s legs. This muscle is thought to be a part of the wound healing process as well.
- Since we are comparing legs to body, think about how tight the skin on the legs is. Body skin is floppier, and has more give, which allows wounds to come together easier. Legs have tight skin, and lots of joints that flex and stretch wounds as they are healing, which can pop open wounds.
- One more component of proud flesh to consider. Granulation tissue is filled with blood vessels, but they might not be able to carry oxygen well. With limited oxygen, the inflammatory cells are not able to do their jobs well to keep the wound clean and safe. When you combine this with how much dirt, dust, and “stuff” that horse legs are close to, there’s an increased need for those debris clearing cells, and at the inflammatory response just keeps going. And the granulation tissue just keeps growing.
Horse socks can be helpful when trying to keep dirt and bacteria and “stuff” out as your horse’s leg heals. These are the Silver Whinny’s from Sox for Horses.
What to do about proud flesh
- This starts with just knowing that a wound on a leg can quickly start to morph into proud flesh.
- If you do find a wound, no matter how big or small, loop your vet in. Even small, seemingly harmless wounds can proud flesh themselves, especially if they are near a joint.
- Wounds should be cleaned with saline or water. Some wounds benefit from clipping the surrounding areas, especially if your horse has a winter coat. If you are clipping the wound, put some KY jelly in it so any hairs don’t contaminate the wound. Petroleum-based products, and alcohol, and hydrogen peroxide, all interfere with the healing process.
This horse is perfectly happy and sound with his proud flesh. It’s under constant vet care, and it’s just part of this horse’s process.
Here’s where wounds and proud flesh get confusing.
Should you wrap the wound?
- Perhaps. Some wounds need a bit of support and stability so that the tissues can come together. Some wounds are irritated by wraps and this might complicate the wound.
- Wraps can also interfere with the formation of scabs, which for some wounds helps with the natural contraction of the wound. Sometimes, the scab needs to come off.
- There’s also some evidence that proud flesh is more likely to form when wounds are kept bandages for extended periods.
Should your horse have stitches?
- Again, a case-by-case basis. The size, depth, and location of the wound all play a role here. Some wounds do much better without stitches, others need them.
What if proud flesh develops anyway?
- Even the most diligent and thoughtful care for your horse’s wound can end up with a proud flesh situation.
- Your best bet is the vet. Surgical resection of the proud flesh is necessary so that the edges of the wound have a chance to get together. Lucky for your horse, this isn’t painful. Proud flesh doesn’t have nerves, but it does have a lot of vessels. The resection can be stomach-turning, in that respect!
- This is, however, possibly painful for your wallet. Resections are often a series of procedures. UGH. If things are just not coming together, your vet may also be able to do a skin graft. Usually, skin is taken from your horse’s mane area to cover the leg wound.
Some horses just end up with proud flesh, no matter what we do, and how much the vet is involved. The earlier you can take care of a wound, and carefully manage it, you may have the odds in your horse’s favor.