by Meggie Garvey, DVM

Exuberant granulation tissue, also known as proud flesh, is a frustrating yet common complication of equine lower limb wounds. Exuberant granulation tissue is essentially an overgrowth of granulation tissue, which is a normal phase in wound healing. The proliferation of excess granulation tissue prevents the wound from healing properly.

There are various causes and predisposing factors. Proud flesh forms in wounds that heal by second intention – those that are left open because they can’t be sutured. It also occurs most commonly on the distal limbs (below the knee and hock), especially over joints because movement interferes with skin contraction predisposing the wound to excess granulation tissue. When a section of skin is torn from underlying tissue, it can become difficult to close the wound surgically thereby increasing the chance for proud flesh. Other causes can include chronic inflammation such as infection, foreign bodies, and bony sequestrum or by using caustic topical substances on wounds.

There are many treatment options for granulation tissue. The ideal treatment is surgical excision of the granulation tissue and specialized bandaging. Depending on the size of the wound, granulation tissue may need to be trimmed several times to allow contracture of the skin along the wound edge. Topical antibiotic/steroid ointments can be recommended in conjunction with specialized bandage pads that speed healing. Treatments to avoid include caustic solutions of copper sulfate, nitric acid, malic acid, and lye as these often end up contributing to the problem.

Managing exuberant granulation tissue can be very frustrating. The best way to prevent it is to follow your veterinarian’s instructions carefully to keep wounds clean and appropriately protected under medicated bandages. Call us at Alpine Animal Hospital 963.2371 if you have any questions.