Proud flesh part two - prevention is better than cure
Following on from last weeks blog https://www.hannahcoxphysio.co.uk/post/proud-flesh-explained
management and prevention is the key!
Minimizing and preventing proud flesh is a difficult task and it is best to be proactive during the early phases of wound healing.
Contamination can be reduced by immediately hosing a wound with clean lukewarm tap water, gently rubbing any dirt or debris away with clean fingers and gently scrubbing the surrounding area with an antiseptic detergent but not the wound itself.
Clipping or trimming the surrounding hair is also advised if this is touching the wound, so not to risk further irritation or contamination.
Consulting your vet to see if there is a need for stitches, or if there’s any concerns for underlying joints, tendons or ligaments is always advised especially If the wound looks more serious than just a cut or abrasion
limit movement, if possible reduce movement in the affected area by confining the horse to box rest or a small paddock
Bandanding! Whether or not horses’ wounds should be bandaged is still somewhat controversial. During the initial stage of healing, bandaging can help to restrict movement, reduce the risk of contamination, particularly when the wound is close to the ground. Bandages also help to keep wounds moist, promoting epithelialisation thus speeding healing And also help restrict movement But if discharge accumulates under the bandage, this may prove irritating to the newly forming tissue and it may create a barrier that prevents much-needed oxygen from reaching the wound cells.
Remember if your not confident bandaging Then seek help, a bad bandage can cause more damage than good, it may be better to have no bandage!
Speak to your equine physio about Blue light therapy, blue light has an antibacterial effect and is a great noninvasive way of helping keep a wound healthy and Bacteria free.
If the wound is oozing quite a bit, it’s OK to smear a petroleum based product on the area beneath it to protect the skin from being scalded by the discharge.
what do I do if I think proud flesh is forming?
Call you vet!
The best treatment at this stage is to resect—cut away—the excess tissue with a scalpel. There are no nerves in young granulation tissue, so this process is not painful. Don’t be surprised if this procedure produces a lot of blood. Because granulation tissue is so infused with blood vessels, this is normal.
your vet may insist on box rest/restricted exercise
you vet may also choose to use topical creams on the proud flesh instead of resection.
its worth addressing the rest of the body too! consult your equine physiotherapist about massage and muscle stimulation to encourage circulation, help maintain muscle and joint health during periods of rest. physio sessions often help increase moral and can be of benefit In many ways.
Most cases of proud flesh need to be resected more than once a good debridement and resection are the best way to treat this condition, so be proactive and follow your vets advice.
Talk to your vet about anti-inflammatory drugs if inflammation is still present to reverse the chronic, unnecessary inflammatory response that will promote the growth of proud flesh.
Large wounds may also require a skin graft. This will aid the healing process, decrease the deposition of scar tissue and help with a better cosmetic appearance in the long term.
your equine physiotherapist can help to aid healthy tissue growth with the use of phototherapy. Red light administered at regular intervals to the edges of the proud flesh will encourage epithelial growth and increase blood flow to the area which then increases the nutrients (this can be used in conjunction with blue light therapy)
Further down the healing process your physiotherapist may also advise the use of Ultrasound to the scarring to help increase elasticity within the tissues, and increase circulation to the area.
In conclusion, proud flesh can be a time consuming, expensive and sometimes unavoidable problem to a wound. A trivial wound may take months to heal and, remarkably, some wounds heal when a complication is expected. Treatments directly to wounds and indirectly through physiotherapy may need to be tailored to each individual need, but with patience and careful attention to detail recovery is achievable over time.