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 Veteran
Posts: 256
   
| I am looking at treatment options for this cut behind the knee. He is under vet care but I am wanting different opinions. We are going on 3 weeks. It was stitched up but as you can tell the stitches pulled out last Thursday. Would you keep it open or wrap? What would you put on it. Luckily I don't have much experience with cuts. Attaching a picture.
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 BHW Resident Surgeon
Posts: 25351
          Location: Bastrop, Texas | You really won't accomlish much by wrapping. The edema is temporary and cosmetic, more than anything. In fact, wrapping it could reduce the blood supply.....think about it. If the horse is sound, etc...., I think you will be fine. Personally, the best and least expensive way to deal with this is to keep the surface "debrided" of pus, dead tissue, etc.... That way the wound will shrink up/ contract and skin will grow over the top of the beefy red/pink base. Good old elbow grease works well. I'd scrub it with a soft bristle brush, soap, and water. Surgical soap (ie: hibiclens or betadine) works well, but just about any soap will work. Antibiotics probably won't help....not even topical antibiotics. Hose the hell out of it....hydrotherapy. If you want to spray on some topical antiseptic, fine, but it really doesn't matter that much.
I'd say do this a minimum of twice a day, but more is better. You will start to see that pink granulation tissue get beefier and red. That's good. If you keep this up you will see the rate of healing progress more rapidly.
A lot of people swear by a lot of products for wounds, but honestly there's no substitute for elbow grease and a lot of water. The underwoods, vetericyn, etc.... Is fine, but definitely not mandatory, IMO. Good luck! You'll do fine. | |
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  A Lady with Fight
Posts: 2701
    Location: NC | Underwoods horse medicine. Spray. Sprinkle some baking powder on it. Repeat two or three times a day. It should be healed up in no time. No need to wash or wrap or scrub. Just spray and sprinkle. That's it.
I've healed some pretty gnarly injuries with Underwoods. It's great for high mobility places since you don't need a wrap or anything.
ETA: If you use Underwoods, do NOT rinse or scrub or wash it at all once your start using it. It's meant to just be left alone while it's healing. You'll notice a scab will form and fall off every few days and you'll see nice new skin underneath. As long as you keep up with it, you shouldn't have any issues with proud flesh.
Edited by hlynn 2015-06-23 7:27 PM
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  Northern Chocolate Queen
Posts: 16576
        Location: ND | Bear - 2015-06-23 6:22 PM You really won't accomlish much by wrapping. The edema is temporary and cosmetic, more than anything. In fact, wrapping it could reduce the blood supply.....think about it. If the horse is sound, etc...., I think you will be fine. Personally, the best and least expensive way to deal with this is to keep the surface "debrided" of pus, dead tissue, etc.... That way the wound will shrink up/ contract and skin will grow over the top of the beefy red/pink base. Good old elbow grease works well. I'd scrub it with a soft bristle brush, soap, and water. Surgical soap (ie: hibiclens or betadine) works well, but just about any soap will work. Antibiotics probably won't help....not even topical antibiotics. Hose the hell out of it....hydrotherapy. If you want to spray on some topical antiseptic, fine, but it really doesn't matter that much. I'd say do this a minimum of twice a day, but more is better. You will start to see that pink granulation tissue get beefier and red. That's good. If you keep this up you will see the rate of healing progress more rapidly. A lot of people swear by a lot of products for wounds, but honestly there's no substitute for elbow grease and a lot of water. The underwoods, vetericyn, etc.... Is fine, but definitely not mandatory, IMO. Good luck! You'll do fine.
AGREED! This is the most recent bad wound I've had to deal with. I did have to wrap it due to flies & keeping it clean. It took forever to completely heal but there is not a bump on her leg.
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 A Gopher's Worst Nightmare
Posts: 5094
    Location: Southern Oregon | Underwoods....it saved my mare twice! She about ripped the entire bulb of her heal off twice. ugh..... Nothing worked until I found underwoods. The owner is super amazing as well and loves to talk horses and treatment help if needed. | |
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 Take a Picture
Posts: 12838
       
| Underwoods | |
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Member
Posts: 41
 Location: Texas | Underwoods | |
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Veteran
Posts: 127
  Location: Kansas | wonderdust | |
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 Veteran
Posts: 187
   
| I'm treating a wound on a leg, right above the fetlock joint. Happened May 3. I am wrapping every other day as she will just rub it with her nose all day and the flies are TERRIBLE! I tried Underwoods but she just rubs it off. I leave her tied til its dry but she still rubs it off. I also douse her in fly spray. | |
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Elite Veteran
Posts: 1131
  
| We swear by vetricyn, it's amazing. It did wonders with this injury. We sold the horse before it fully healed, so no after pics, but he ended up going back to the show pen for a few seasons.
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 Namesless in BHW
Posts: 10368
       Location: At the race track with Ah Dee Ohs | Underwoods and baking powder | |
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 Elite Veteran
Posts: 669
    Location: Central Texas | Bear - 2015-06-23 7:22 PM
You really won't accomlish much by wrapping. The edema is temporary and cosmetic, more than anything. In fact, wrapping it could reduce the blood supply.....think about it. If the horse is sound, etc...., I think you will be fine. Personally, the best and least expensive way to deal with this is to keep the surface "debrided" of pus, dead tissue, etc.... That way the wound will shrink up/ contract and skin will grow over the top of the beefy red/pink base. Good old elbow grease works well. I'd scrub it with a soft bristle brush, soap, and water. Surgical soap (ie: hibiclens or betadine) works well, but just about any soap will work. Antibiotics probably won't help....not even topical antibiotics. Hose the hell out of it....hydrotherapy. If you want to spray on some topical antiseptic, fine, but it really doesn't matter that much.
I'd say do this a minimum of twice a day, but more is better. You will start to see that pink granulation tissue get beefier and red. That's good. If you keep this up you will see the rate of healing progress more rapidly.
A lot of people swear by a lot of products for wounds, but honestly there's no substitute for elbow grease and a lot of water. The underwoods, vetericyn, etc.... Is fine, but definitely not mandatory, IMO. Good luck! You'll do fine.
Absolutely, this! My mare cut herself much worse than this on the front side of her hock (in the bend). Gave her a round of antibiotics, followed this procedure and you can barely see the scar. | |
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 Expert
Posts: 1857
      
| Bear - 2015-06-23 7:22 PM
You really won't accomlish much by wrapping. The edema is temporary and cosmetic, more than anything. In fact, wrapping it could reduce the blood supply.....think about it. If the horse is sound, etc...., I think you will be fine. Personally, the best and least expensive way to deal with this is to keep the surface "debrided" of pus, dead tissue, etc.... That way the wound will shrink up/ contract and skin will grow over the top of the beefy red/pink base. Good old elbow grease works well. I'd scrub it with a soft bristle brush, soap, and water. Surgical soap (ie: hibiclens or betadine) works well, but just about any soap will work. Antibiotics probably won't help....not even topical antibiotics. Hose the hell out of it....hydrotherapy. If you want to spray on some topical antiseptic, fine, but it really doesn't matter that much.
I'd say do this a minimum of twice a day, but more is better. You will start to see that pink granulation tissue get beefier and red. That's good. If you keep this up you will see the rate of healing progress more rapidly.
A lot of people swear by a lot of products for wounds, but honestly there's no substitute for elbow grease and a lot of water. The underwoods, vetericyn, etc.... Is fine, but definitely not mandatory, IMO. Good luck! You'll do fine.
Agree 100%!! Not a fan of underwoods, especially anywhere at the knee and below. Water, water, and more water!! | |
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Elite Veteran
Posts: 682
     Location: Northwest | Silver Lining Herb's Power Dust and Equisalve. With some Vetricyn thrown in for good measure. Honestly though, the stuff by SLH works miracles, highly recommend. | |
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 Extreme Veteran
Posts: 317
   Location: Idaho | Vinegar, Epson Salt, and warm water! It does wonders! Clean the wound up using a sponge with the vinegar and epson salts and then put some columbia powder on it after you have used the mixture on it! My mom always used about half a small bucket. Just make sure you don't get the water too hot. | |
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 Experienced Mouse Trapper
Posts: 3106
   Location: North Dakota | Bear - 2015-06-23 7:22 PM You really won't accomlish much by wrapping. The edema is temporary and cosmetic, more than anything. In fact, wrapping it could reduce the blood supply.....think about it. If the horse is sound, etc...., I think you will be fine. Personally, the best and least expensive way to deal with this is to keep the surface "debrided" of pus, dead tissue, etc.... That way the wound will shrink up/ contract and skin will grow over the top of the beefy red/pink base. Good old elbow grease works well. I'd scrub it with a soft bristle brush, soap, and water. Surgical soap (ie: hibiclens or betadine) works well, but just about any soap will work. Antibiotics probably won't help....not even topical antibiotics. Hose the hell out of it....hydrotherapy. If you want to spray on some topical antiseptic, fine, but it really doesn't matter that much. I'd say do this a minimum of twice a day, but more is better. You will start to see that pink granulation tissue get beefier and red. That's good. If you keep this up you will see the rate of healing progress more rapidly. A lot of people swear by a lot of products for wounds, but honestly there's no substitute for elbow grease and a lot of water. The underwoods, vetericyn, etc.... Is fine, but definitely not mandatory, IMO. Good luck! You'll do fine.
I agree with this but have to add that I like to keep the wound soft as well so I will cover with furacin or triple antibiotic ointment, pretty heavy too. It keeps the tissue soft and doesn't allow it to "break apart" between scrubbings, plus, if you can't get it scrubbed for a day or two it still continues to heal and makes it easier to work with when you get back to it.
I'm not a big fan of underwoods but I do have some for wintertime when hydrotherapy is not a good alternative. | |
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  A Lady with Fight
Posts: 2701
    Location: NC | If you really want to see a real good case of healing with Underwoods, just send a PM to wyoming barrel racer. She had a colt impale itself on something and rip it's chest open to the windpipe in the dead of winter. She used Underwoods and you can see a faint scar but that's it. It really is amazing stuff. I swear by it and won't use anything else.
Here are just two instances where Underwoods has healed some wounds on mine. The first is a few weeks apart I believe The vet was never called. I just started with Underwoods right away. Left it open. Never scrubbed. Just sprayed, sprinkled, repeat. It healed without any scarring at all.
The second is just one of the hocks of my good gelding. He got tangled up in the wire the colt tore down while he was playing. Tore up both hocks. It took about 3 weeks to heal completely and you can't even tell anything happened. I won't ever be caught without my Underwoods.
Edited by hlynn 2015-06-24 9:30 AM
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 Good Grief!
Posts: 6343
      Location: Cap'n Joan Rotgut.....alberta | Underwoods and baking powder.....and it has to be reapplyed a few times a day....it has worked miracles for me on many occasions..that actually isnt that bad of a wound but its such a bad spot gonna take a bit of time to heal....m
Edited by mruggles 2015-06-24 9:26 AM
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 Duck Duck Goose
Posts: 1280
      Location: Ohio | PF Wonder Salve. You can apply it and leave it alone. Will keep the proud flesh off and flies away. No need to try to wrap.
My horse had a similar wound last year. It worked great. | |
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 Party Girl
Posts: 12293
        Location: Buffalo, Wyoming | I have good luck with a sugardine paste and ACV and black pepper. I would cold hose the heck out of it and put ACV and pepper on it to keep the flies away. | |
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 Elite Veteran
Posts: 670
    Location: Running my kids somewhere. | Bear - 2015-06-23 7:22 PM You really won't accomlish much by wrapping. The edema is temporary and cosmetic, more than anything. In fact, wrapping it could reduce the blood supply.....think about it. If the horse is sound, etc...., I think you will be fine. Personally, the best and least expensive way to deal with this is to keep the surface "debrided" of pus, dead tissue, etc.... That way the wound will shrink up/ contract and skin will grow over the top of the beefy red/pink base. Good old elbow grease works well. I'd scrub it with a soft bristle brush, soap, and water. Surgical soap (ie: hibiclens or betadine) works well, but just about any soap will work. Antibiotics probably won't help....not even topical antibiotics. Hose the hell out of it....hydrotherapy. If you want to spray on some topical antiseptic, fine, but it really doesn't matter that much. I'd say do this a minimum of twice a day, but more is better. You will start to see that pink granulation tissue get beefier and red. That's good. If you keep this up you will see the rate of healing progress more rapidly. A lot of people swear by a lot of products for wounds, but honestly there's no substitute for elbow grease and a lot of water. The underwoods, vetericyn, etc.... Is fine, but definitely not mandatory, IMO. Good luck! You'll do fine.
I think Bear said it the best. That is the route I would take. Best of luck. | |
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 Born not Made
Posts: 2931
       Location: North Dakota | Quote " Bear - 2015-06-23 7:22 PM You really won't accomlish much by wrapping. The edema is temporary and cosmetic, more than anything. In fact, wrapping it could reduce the blood supply.....think about it. If the horse is sound, etc...., I think you will be fine. Personally, the best and least expensive way to deal with this is to keep the surface "debrided" of pus, dead tissue, etc.... That way the wound will shrink up/ contract and skin will grow over the top of the beefy red/pink base. Good old elbow grease works well. I'd scrub it with a soft bristle brush, soap, and water. Surgical soap (ie: hibiclens or betadine) works well, but just about any soap will work. Antibiotics probably won't help....not even topical antibiotics. Hose the hell out of it....hydrotherapy. If you want to spray on some topical antiseptic, fine, but it really doesn't matter that much. I'd say do this a minimum of twice a day, but more is better. You will start to see that pink granulation tissue get beefier and red. That's good. If you keep this up you will see the rate of healing progress more rapidly. A lot of people swear by a lot of products for wounds, but honestly there's no substitute for elbow grease and a lot of water. The underwoods, vetericyn, etc.... Is fine, but definitely not mandatory, IMO. Good luck! You'll do fine. " Quote
I'll be the odd-ball and disagree with the parts I have highlighted.
Many people have an issue with proud flesh when dealing with wounds like these. And the exact thing that will cause the proud flesh to proliferate even more is manual scrubbing of any kind. Once granulation tissue starts to form (which yours already has) you do NOT want to scrub the would or directly cold hose it (running water over the wound will also stimulate proud flesh growth).
You do want to keep the wound clean but really do the bare minimum you need to do. Clean it if you need to, but do not over-do it. You can wrap it if you want to, to help keep it clean but you don't have to. Plus it is always tricky to get a knee bandage to stay up.
For my horse's injury a couple years ago, it actually started to heal so much faster when I WAS able to get a bandage to finally stay up. This picture was from day 17 and I was still having trouble perfecting my wrapping skill and getting the darn thing to stay on. Granted, it was the middle of winter and we had a very cold one that particular year, but by vet advised me to do NO washing or stimulation (scrubbing) of the wound, or as little as possible.

After I was finally able to get a bandage to stay on for 3 days at a time (and then I would change it), I really started to see progress.
Once I stopped wrapping it, I started using PF Wonder Salve. I have no experience with Underwoods, but I have heard good things about it as others are suggesting.
While I was bandaging my horse, I used silver sulfadiazine. When I started to get a little too much growth (proud flesh!) I kind of rotated between ProudsOff and plain ol' hydrocortisone cream (less noxious than ProudsOff).
This was 188 days after the initial injury. It did continue to heal a little more but he does have a scar remaining.

But the point of my long, long post is NOT to scrub the wound, once granulation tissue has formed. You'll make the proud flesh grow that much faster.
For a fresh wound, do all the cold hosing and scrubbing you want. But not once the granulation tissue has formed.
Edited by r_beau 2015-06-24 11:19 AM
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 BHW Resident Surgeon
Posts: 25351
          Location: Bastrop, Texas | I suppose I've had the typical amount of experience with wounds like this as anyone else, but what helps me is my understanding of the basic science of wound healing, after 35 years of experience with difficult wounds in humans, plus a pretty good background in immunology. There are all sorts of regimens and routines out there for dealing with wounds in horses, and the one thing they tend to have in common is the seemingly miraculous way they tend to heal, regardless of what you do. In some cases, it's because the treatment was masterful, while in others they healed in spite of what was done. There's always a tendency, I think, for people to make the management of these wounds more complicated than they need to be. "Proud flesh" is granulation tissue, which is vascularized fibrotic tissue that is poorly organized, but vital to the healing process, because it becomes more organized, histologically, over time. Scrubbing a wound does not mysteriously "stimulate" ugly proud flesh, actually. That's a myth. What it does do is accelerate healing by reducing the anmount of dead flesh and debris and bacteria. In fact, what actually happens in instances of proud flesh is that accelerated healing causes the granulation tissue to grow over the skin edges, and that in itself can impede the in growth of skin, which normally heals at a rate of approximately 1 mm a day. When the edges hit that "wall" of proud flesh, the rate of healing slows, while the "cauliflower" of granulation tissue piles up. The way you get around this is to either scrub the granulation tissue to keep it level, or excise it at the skin level. Granulation tissue can actually sometimes scooped away with a spoon, or you can do it sharply. The goal is to preserve that vascularized bed, while allowing the skin to grow over it. Granulation tissue is not innervated....they can't feel you scraping it away. Handling, scrubbing, and hosing the wound desensitizes the horse. At least that's been my experience. After a while, they pretty much treat you like a farrier. When you do debridement, the granulation tissue bleeds, sometimes a fair amount. Pressure for a few minutes, plus more hosing, will cause that to stop. That bleeding is a good sign. The reason people have problems with persistent proud flesh is because they just let it continue to build up.......trim it to skin level and you won't have this problem. There's no mystery here. Pressure with wrapping, etc, actually hinders oxygen supply to the wound. You can do it in situations where the wound gets very heavily contaminated, but just keep that in mind.
Many "treatments" applied to these wounds actually kill normal healthy tissue because the acids and chemicals are toxic. You can try it, but just keep it in mind. They are not as effective as debridement.....elbow grease. Some people use steroids.....I don't think that's a good idea either, because steroids impair healing and actually cause skin atrophy. You want the new skin to be healthy....not atrophied.
As to the issue of water.....the more the better. The notion of cold water or warm water somehow magically "stimulating" proud flesh in a bad way is a myth. Just keep the granulating bed at skin level so you don't get the cauliflower effect.
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 Veteran
Posts: 256
   
| Thank you everyone for the replies. I do not have any Underwoods on hand... I always say I'm going to get some but I didn't do that in time. What I was worried about most is the "proud flesh" so thank you Bear for your knowledge. You are saying to just scrape or trim the granulated tissue away if it starts to protrude the edges of the wound? I have been washing it twice a day with iodine but I didn't know how aggressive to be with the hosing. By the sounds of it I can't do too much as far as the water and scrubbing? I haven't been applying anything topical. My vet did prescribe antibiotics at the beginning so I have stayed away from all the creams, etc. Thanks again for everyones opinions. | |
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 Shelter Dog Lover
Posts: 10277
      
| My gelding had a deep cut on a joint and it would not hold stitches either, each step opened it back up. After 2 months with one vet and not getting any healing I went to another who immediately had a brace made that was welded to his shoe, ran up the sides of his leg and immobilized the joint. He could walk with it but not use that joint- he healed in 2 weeks. Something to think about if he keeps opening it up. Good Luck | |
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Elite Veteran
Posts: 629
  
| Medi-honey. | |
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| Bear - 2015-06-24 2:30 PM I suppose I've had the typical amount of experience with wounds like this as anyone else, but what helps me is my understanding of the basic science of wound healing, after 35 years of experience with difficult wounds in humans, plus a pretty good background in immunology. There are all sorts of regimens and routines out there for dealing with wounds in horses, and the one thing they tend to have in common is the seemingly miraculous way they tend to heal, regardless of what you do. In some cases, it's because the treatment was masterful, while in others they healed in spite of what was done. There's always a tendency, I think, for people to make the management of these wounds more complicated than they need to be. "Proud flesh" is granulation tissue, which is vascularized fibrotic tissue that is poorly organized, but vital to the healing process, because it becomes more organized, histologically, over time. Scrubbing a wound does not mysteriously "stimulate" ugly proud flesh, actually. That's a myth. What it does do is accelerate healing by reducing the anmount of dead flesh and debris and bacteria. In fact, what actually happens in instances of proud flesh is that accelerated healing causes the granulation tissue to grow over the skin edges, and that in itself can impede the in growth of skin, which normally heals at a rate of approximately 1 mm a day. When the edges hit that "wall" of proud flesh, the rate of healing slows, while the "cauliflower" of granulation tissue piles up. The way you get around this is to either scrub the granulation tissue to keep it level, or excise it at the skin level. Granulation tissue can actually sometimes scooped away with a spoon, or you can do it sharply. The goal is to preserve that vascularized bed, while allowing the skin to grow over it. Granulation tissue is not innervated....they can't feel you scraping it away. Handling, scrubbing, and hosing the wound desensitizes the horse. At least that's been my experience. After a while, they pretty much treat you like a farrier. When you do debridement, the granulation tissue bleeds, sometimes a fair amount. Pressure for a few minutes, plus more hosing, will cause that to stop. That bleeding is a good sign. The reason people have problems with persistent proud flesh is because they just let it continue to build up.......trim it to skin level and you won't have this problem. There's no mystery here. Pressure with wrapping, etc, actually hinders oxygen supply to the wound. You can do it in situations where the wound gets very heavily contaminated, but just keep that in mind. Many "treatments" applied to these wounds actually kill normal healthy tissue because the acids and chemicals are toxic. You can try it, but just keep it in mind. They are not as effective as debridement.....elbow grease. Some people use steroids.....I don't think that's a good idea either, because steroids impair healing and actually cause skin atrophy. You want the new skin to be healthy....not atrophied. As to the issue of water.....the more the better. The notion of cold water or warm water somehow magically "stimulating" proud flesh in a bad way is a myth. Just keep the granulating bed at skin level so you don't get the cauliflower effect.
Years ago, I had a mare with a horrible neck injury. It took so much patience NOT to do much to it as the vet was instructing me to do. What he did have me do was hose it and then spray it with Granulex, which I did...seemed to take forever but she healed without so much as a tiny scar...that from a huge and very ugly laceration. The Granulex did exactly what Bear is talking about...removes the necrotic tissue and keeps the environment good for healthy tissue to heal in the area without leaving a big ugly proud flesh type of healing. You literally would never of known this mare had had an injury. | |
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 BHW Resident Surgeon
Posts: 25351
          Location: Bastrop, Texas | Yes, ironically, sometimes you can care for a wound so well that the granulation tissue grows so fast that it mushrooms up over the advancing skin edge.....like cauliflower. Then the skin has nowhere to go...it hits that wall, so to speak. You don't have to debride every day...just often enough so that the granulating bed is nice and level with the skin. When you have that, the skin will advance rapidly. You might only need to debride sharply once a month. If it bleeds a lot just hose it real well and wrap it for a few minutes. A little oozing doesn't hurt.
As for those granules, yes we do sometimes use them in human wounds....especially ones that are like a divot or hole. They just draw out the serum and pus like a wick....they aren't toxic to tissue.
Another suggestion to the OP. I'd remove those purple sutures that are dangling in there. That foreign body just makes matters worse. Those look like absorbable sutures, but they take a long time to absorb. Just pull them out.
Edited by Bear 2015-06-24 9:00 PM
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Member
Posts: 28

| Underwoods and baking powder. | |
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Veteran
Posts: 216
  Location: In between 4 ridges | Vetricyn! | |
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 Famous for Not Complaining
Posts: 8848
        Location: Broxton, Ga | Pickling lime..........I have the best results with that........amazing how it heals and stops proud flesh | |
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 Expert
Posts: 1857
      
| Water, surgical wash and a wash cloth!! This year I started using GenOne spray but the down side is that it has a steroid in it, which slows the growth of the granulated tissue(helped with excess "proud flesh"), and the wound took longer to heal, but it healed beautifully. Water, soap, and a wash cloth did amazing on it. Just scrub hard enough that the yellow layers of tissue will peel and the underneath is pink. I would stop scrubbing once I saw the pink. I would also peel off all the scabs on the edges(soak first so they don't pull off good tissue with it). Anything below the elbow, this is how I treat it. | |
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 Expert
Posts: 1611
   Location: bring on the heat, NV | Dealing with the same kind of wound. Whats worked for me is vetricyn gel sprayed liberally and wonder dust applied on top. I tryed iodine mixed with water to clean but holy smokes the proud flesh went wild so just plain water to keep any drips from scalding the skin. I alternate wrapping one day and airing out for a few days ( i added more days airing out as it healed). Its pretty much healed up just a 1/4 to go. Vetricyn gel and wonder dust or swat if you have to many flys. Ill wrap to debride without the scrubbing. Like a bandaid peel off apply goo let air. Pretty simple very effective. | |
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 Expert
Posts: 1857
      
| I feel like wounds have to get really ugly before they get any better... Seems by the end of the first week it looks horrible and I start to second guess myself but by the end of the second week it starts to come back around. Not sure if it's the tissue dying off that first week but goodness, they can look horrible that first and second week! | |
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