How to prevent and heal proud flesh

Most horses will get wounded at some point in their lives. When scrapes and cuts happen, follow these tips to prevent the development of proud flesh – and heal it quickly when it does occur.

Imagine being out for a ride when your horse suddenly gets spooked, runs into a fence, and cuts himself.  The wound is not bad enough to suture, so you decided to take care of it yourself.  You grab the betadine or chlorhexidine, a bucket, and gauze. You dilute the product, scrub the area well and rinse, apply salve, and bandage the wound. Then you repeat the same process twice daily. Unfortunately, within a couple of weeks, the laceration starts to develop exuberant granulation tissue or proud flesh despite your consistent care.  Now you must call the veterinarian to surgically remove it and start the process all over again. Why does this always seem to happen, and how can you prevent it?

Understanding proud flesh (and what not to do)

A layer of fatty acids and oils known as the sebum covers the skin and creates a watertight barrier that protects and feeds the skin. When the skin is penetrated or compromised, this barrier is broken down.  In order to heal, the skin must re-epithelize (replace the cells) and restore the sebum layer.

Our goal should be to assist in this process. However, if the wrong approach is taken, we can do more harm than good. Betadine and chlorhexidine are sufficient as antibacterial/antifungal scrubs or shampoos. Products containing these ingredients are designed to remove skin debris, and both are harsh and work as astringents. However, they have a very drying effect.

When tissue dries it contracts and creates inflammation with movement. Salves are often used to solve this problem, but salves are emollients or heavy oils that sit on the surface of the skin holding moisture in. If the skin is dry to start, the emollients just hold the dryness in and repel water from getting into the skin.

Before applying the salve, most horse caretakers scrub the wounded area with gauze. Mechanical cleaning is often necessary to remove the any debris. But subsequent cleanings should be more geared toward removing the salve and skin debris (caused by inflammation). If you scrub every time you clean the wound, you’ll irritate the tissue causing inflammation, which will stimulate the body to react and start the process of granulation/building scar tissue. Scrubbing also removes healthy baby cells that have formed delaying the healing process and reinjuring the wound (creating more inflammation) each time.

Next, horse caretakers typically bandage the wound to keep it clean. But this starves the wound of oxygen – another element, like moisture – that the healthy cells need to survive.

When we break down the process, it becomes apparent why proud flesh occurs. These methods have not changed much in the past fifty years. Maybe it’s time to rethink the course of action. There are various products and methods that are helpful. Below is a list of what steps should occur when caring for wounds.

1. The wound must be protected ASAP with a sebum-like product before drying occurs.

For this step, reach for one of the following oils:

  • Ozonized olive oil (antibacterial/antifungal/anti-inflammatory)
  • Ginkgo oil (anti-bacterial/anti-inflammatory/controls excess sebum production)
  • Oligoelements – contains trace minerals

2. Clean the wound using the least amount of mechanical cleaning possible with mild products (non-astringents)

The following list of products work well for this step. They should be left on the wound for at least five minutes before rinsing.

  • A sulfur-based product (such as Zolfo) as an anti-fungal
  • Mineral Plus Crème Shampoo – honey-based, works as an antibacterial

Bacteria and fungus are in competition so it’s best to treat both at the same time.

3. Hydrate the wound using a humectant conditioner, which draws moisture in the skin

Look for a pH balancing conditioner formulated for animals (don’t use human products). Leave on for 8–10 minutes, then rinse.

4. Bandage the wound – or don’t

If the wound needs to be bandaged, use the least amount of bandage material possible so it can breathe and heal.  In many cases you can also leave it unbandaged, as a small amount of oil on the wound will repel debris.

When it comes to healing wounds and preventing proud flesh, the ultimate goal is to minimize inflammation, gently prevent bacteria/fungus, hydrate, and feed the tissue so it can heal naturally. Scrubbing, drying, and restricting oxygen is a great recipe for failure. If we keep doing it the same old way, how can we expect different results?