Q: What do you recommend as a treatment for proud flesh? My mare has a cut on her cannon bone that looks like it has proud flesh developing. The barn manager where I board swears that applying meat tenderizer to it will help the wound heal, and someone else told me that hemorrhoid cream will take care of it. Both of those sound a little “out there.” Is there a particular product for proud flesh I should buy? Name withheld by request

A: Proud flesh, also known as “overgranulation,” is a frequent complication of limb wounds in horses; it is an excessive growth of tissue that inhibits closure of the skin. The mechanism that triggers contraction essentially fails and the wound becomes “stuck” open, in a continuous state of low-level inflammation. The granulation tissue, which normally forms a level bed for epithelialization (new skin growth), continues to grow, building up into mounds that rise above the surface of the surrounding skin, effectively stalling or halting the healing processes.

There are many reasons why overgranulation may develop. The first is excessive movement at the wound site. The second possibility is foreign bodies or underlying damage to bone or tendon. In equine limb wounds, it is not unusual for what may be perceived as a small injury to be coupled with deeper damage to the bone. Only veterinary intervention can rule out and address these factors, and they can be resolved relatively quickly and economically if recognized and treated early.

Assuming that underlying causes for proud flesh have been ruled out, your veterinarian may use various products or methods to remove the physical barrier of overgranulation. The aim is to facilitate normal healing while halting the growth of excess granulation tissue, and—as you’ve learned—many more remedies are “recommended” by fellow horsemen.

It is no surprise that hemorrhoid creams are often suggested because they usually contain steroids that switch off the inflammatory response and antibacterials that control infection. However, they also inhibit healing in normal tissue, so they should not be used on the healthy epithelial margins of the wound. In addition, they can interfere with the local immune responses, which may allow infection—a strong inhibitor of wound healing—to develop. So it is recommended that these products be used only with a veterinarian’s guidance.

Your veterinarian may also prescribe corticosteroids or recommend the application of aloe vera and even meat tenderizers (some derived from papaya or peach leaves), which work by switching off the inflammatory response. Other anti-inflammatory medications might well instigate contraction and epithelialization, and once this is in action healing is usually impressive. However, if the wound already has a large amount of excess granulation tissue, these products are unlikely to remove it; at best they will only stop more proud flesh from being formed.

So, in answer to your question, “home remedies” are not recommended. Instead, we would strongly advise  you to consult with your veterinarian and try to find the underlying reason for the overgranulation. Surgical removal of any accumulated proud flesh and even skin grafting can be undertaken very easily. Skin grafting sounds like a big procedure but is an easy and routine matter for any competent veterinarian. It can be performed on a standing horse under sedation, and this is a really good approach to a granulating wound.

Almost all equine wounds heal quickly if the right steps are followed at the outset and suitable corrective measures are employed should healing be delayed. Using the best approaches from the start maximizes the healing processes and gets your horse back in action as quickly as possible. Don’t wait until something has gone wrong and, more particularly, don’t treat any wound on a horse any differently from the way you would treat your own wounds!

Georgie Hollis, BSc, MVWHA
Secretary, Veterinary Wound Healing Association
Norfolk, England

Derek Knottenbelt, DVMS, MRCVS
University of Liverpool
Liverpool, England