How to Prevent and Treat Exuberant Granulation Tissue
An article cribbed from the 2011 AAEP convention, by Richard P. Hackett, DVM, MS, Diplomate ACVS.

Granulation tissue is the body’s process of filling in deeper wounds. In some horse wounds, granulation tissue continues until it is raised above wound edges, becomes inflamed, and this excessive production prevents skin cells from covering and healing the wound. Exuberant granulation tissue (proud flesh) is especially likely on distal limb wounds, high movement areas like hocks and heel bulbs, in large-breed horses, and in wounds with chronic infection or foreign material. Long term bandages become irritating and perpetuate proud flesh.

Prevention of Proud Flesh
  • Whenever possible, limb wounds should be closed, even if sutures need to be delayed.
  • Confine horses to reduce mobility
  • Control infection, remove all foreign debris and damaged tissue (debride and lavage)
  • Bandage daily with pressure bandages, cleaning daily.
  • Once granulation tissue has filled in the wound level with the skin, apply a silicone gel dressing (Cica-care) . Dressings may be washed and reused. Any granulation tissue protruding above skin level must be removed with a scalpel immediately and pressure wrapped for 24 hours. This should be repeated as often as needed to allow skin cells to migrate onto the granuation bed and wound contraction to occur. A quiet wound may be left uncovered. Skin grafting can be accomplished if needed.
  • Chronically inflamed wounds may need an occasional topical corticosteroid (once weekly?)
  • Casts may be applied over high motion wounds on the heel bulbs for 10-14 days before silicone gel dressings are applied.

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