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 Maybe Someday
Posts: 4551
  
| Horse has proud flesh on a pastern wound(Treated and sewed up by vet 3 weeks ago)Vet recommended to order Equiaide but it can take a week or more to get some here.So curious what others use or recommend. | |
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Official Butt Slapper
Posts: 11055
 
Location: guthrie | http://www.su-perstore.com/m7/sswcausticwound--su-per-caustic-wound.html | |
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Veteran
Posts: 268
| PF wonder salve works well too. | |
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Sock Snob
Posts: 3021
| a lot of proud flesh meds have some type of lyme in them. i just use a bag of pickle lime
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 BHW Resident Surgeon
Posts: 25352
Location: Bastrop, Texas | The best way to deal with proud flesh is to start with an understanding of what it actually is, why it develops, and go from there. Once you understand these things, you can deal with it easily.
"Proud flesh" is actually "granulation tissue" which is a normal, healthy part of the process of wound healing. Granulation tissue is vascularized, fibrotic tissue. When you have an open wound in which the skin edges haven't been approximated, there is an eventual ingrowth of granulation tissue. Bacteria colonize on the surface of the open wound, and that causes the normal, healthy inflammatory response to the foreign bacteria as a defense. White blood cells and other cells are called in to kill the bacteria and build a "wall" of tiny blood vessels and collagen. That's what you want....that beefy red tissue, which bleeds and oozes easily. We've all seen this. While this is going on, the epithelium or skin begins to grow in from the edges, over the top of that granulating bed. Normally, this ingrowth proceeds at a rate of 1mm a day, maybe more. The pus and bacteria on the surface should be "debrided" frequently to maximize this ingrowth from the skin edges, plus this enables the wound to shrink and contract gradually. Sometimes when there hasn't been enough debridement, that granulation tissue begins to heap up like a log jam.
Skin edges don't grow up and over this heaped up beefy tissue and it slows or stops. It travels best when the bed is as level with the skin
as possible. Hydrotherapy, scrubbing with a brush, or frequent dressing changes removes the pus, bacteria, and debris, and it keeps the granulation tissue from heaping up, which maximizes the rate of skin ingrowth or "epithelialization". When the skin stops it's ingrowth and the granulation continues, you get "proud flesh". You can get rid of it with a variety of caustic chemicals that are commercially available, or some other homemade remedy. They all seem to work to varying degrees. Just remember that those chemicals that kill the proud flesh do the same thing to the normal, healthy epithelium on the edges. Frequent hosing with a jet of water and scrubbing with a brush accomplishes the same thing. When you hose it and/or scrubbed it to the point of bleeding, that's a good thing. If I have a wound that is out of control and starts to get heaped up a lot, that's when you get proud flesh. I will sometimes actually cut it back with a scalpel, sharp knife, or scissors down level with the skin and that will free up the skin edges to grow in. It will bleed, sometimes a fair bit, but that stops with hosing and pressure. If you stay on top of it, the skin will close in faster. If you reach the point where the wound forms a big scab or "eschar", you can back off a little and just keep an eye on it. Every once in a while, if you start seeing pus coming from the edges, just peel the scab off and hose it down 1-2 times a day for a couple days. I use surgical soap like Hibiclens or Betadine, but any soap will do.You can go ahead and spray things like vetricyn on it if you want.
My point is that the mechanical debridement (getting rid of debris), with scrubbing, hydrotherapy, and sometimes trimming is the best way to handle these wounds. Normally, oral or IM antibiotics aren't necessary. In fact, they may do more harm than good.
Using this approach, I've never had an instance of proud flesh, and I've dealt with dozens of open wounds over the years.
"An ounce of prevention is worth a pound of cure."
- Benjamin Franklin
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BHW Resident Surgeon
Posts: 25352
Location: Bastrop, Texas | Tennbarrelracer - 2017-03-28 7:57 PM
Horse has proud flesh on a pastern wound(Treated and sewed up by vet 3 weeks ago)Vet recommended to order Equiaide but it can take a week or more to get some here.So curious what others use or recommend.
I could have predicted this would happen. For one thing, you are closing a wound that is basically getting doused with manure 24/7.
Many times vets are too focused on getting a nice looking closure, and all too often they wind up draining pus and melting. If there's any tension on the skin edges, which there will be with a wound in that location, the skin edges die and get liquified by bacteria. Unless you are dealing with an area where the cosmetic appearance is important, such as eyelids, face, or ears, if you have a wound and you decide to suture it, you should place as few sutures as possible....enough to barely approximate the skin edges. Any small gaps in the skin between sutures is actually a good thing, because it allows the blood, serum, and pus to escape. Most of the time, even ugly wounds, properly managed, will barely even be noticed.
Vets usually put in too many sutures, too close together, and often too tight. Some make the mistake of trying to close a wound that is too old and too heavily contaminated. Those should be left open and treated the way I already described. | |
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 Balance Beam and more...
Posts: 11511
Location: 31 lengths farms | There is a product called Prouds Off, its a cream and it works awesome!!! The nice thing with it being a cream is you can put it right where you want it and need it. Also I have not had one case of proud flesh since I had started using Schreiners Herbal Treatment during the healing phase.
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Veteran
Posts: 227
Location: Heart of Texas | Good ol wonder dust | |
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Maybe Someday
Posts: 4551
| Thanks Scott.Main reason for sewing it was shooting blood.I wasn't surprised for seeing the proud flesh come up.So pressure with hose 2-3 times a day?So many products on the market and I find myself second guessing what I've done for 40 years.
Edited by Tennbarrelracer 2017-03-29 7:43 PM
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 Expert
Posts: 1268
Location: North of Tulsa, Oklahoma | Underwoods and baking powder. | |
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  Sock eating dog owner
Posts: 4557
Location: Where the pavement ends and the West begins Utah | Blue wonder dust a very old remedy.after this does the trick cover wound with raw egg whites for fast healing. | |
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Equaide or ? To treat proud flesh