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Natural wound healing involves granulation, a physiological process that connects exposed soft tissue to new layers of skin. Proud flesh occurs when excess granulation tissue amasses due to an abnormal healing process.

Wounds on the lower legs are most likely to develop proud flesh because they are closer to agents of infection such as manure and dirt, they have a limited vascular supply, they are difficult to suture, and they are in nearly constant motion. All of these risk factors make it difficult for lower leg injuries to heal properly.

Repetitive motion can create small fissures in damaged tissue, leading to inflammation. This motion also makes it difficult for skin to grow over the wound. When skin fails to cover the site of injury, the granulated tissue continues to grow and eventually protrudes from the wound. This protrusion makes it impossible for skin to grow over the site, thus perpetuating the problem.

Proud flesh must be treated quickly and with a veterinarian’s supervision. Topical cortisone ointment can reduce the formation of granulated tissue. Excess tissue is usually removed from the site, wrapped in a pressure bandage, and treated with antibiotics to prevent infection. Removing proud flesh can be bloody because the tissue is so vascular, but it is not painful because proud flesh is not innervated.

Proud flesh sometimes recurs even if it has been removed previously. The removal process is repeated until the wound heals naturally. Proud flesh can be a frustrating problem to treat because it is persistent, as it is difficult to culture healthy tissue faster than granulation tissue. Skin grafts are used in some extreme cases to encourage successful healing.

When a horse sustains an injury, especially in the lower leg area, it is important to keep the area clean and under surveillance for excess granulation. Granulation is not an inherently evil process—in fact, it is necessary in healing wounds—but it is troublesome in excess.

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