A few weeks back one of my neighbors horses got caught in some wire and got a nasty cut on the back leg just above his fetlock joint. Ouch! We got it cleaned up right away and wrapped and put the horse on antibiotics. Today I took photos of the wound to show how it has healed so far. It’s going to get cleaned up and wrapped again, per the vet instructions which I will include below in case it might help somebody treat a wound that is trying to develop proud flesh. If you do get a wound like this that breaks through the skin or that looks serious be sure to consult with your own veterinarian. I will post followup photos in a few weeks showing how everything heals up.
Advice from Dr. Susan Garlinghouse, DVM:
1. When you first see a new cut, don’t hose it to clean it. Get a new spray bottle with an adjustable spray nozzle and adjust it to stream setting. Add clean tap water, a pinch of table salt and a squirt of Betadine solution until it is the color of weak tea. Stronger is not better, and just irritates the tissue more. Use the stream to clean out debris, it will also blast off surface bacteria without damaging the underlying healthy tissue. You can use a hose to clean the leg below the cut, but not above (because then dirty water is draining down into the wound). If the leg is swollen, use ice boots, not cold water.
2. If it’s going to be sutured, put a clean telfa pad over the top and a light wrap, like Vetrap or Coflex if it’s in a bandageable area. If it’s not bandageable, leave it alone, or put on a light CLEAN sheet to help keep it from further contamination. If it’s not going to be bandaged, put on a layer of Nolvasan cream or Neosporin (or generic triple antibiotic, you can get it at the dollar store) and wrap if possible. No other ointments or creams. No Wonder Dust, no scarlet oil, no Blu-Kote, no NOTHING. None of the herbal remedies, I’ve seen HORRIBLE tissue reactions from “natural” remedies.
3. If it’s remotely bandageable, try to bandage it so that the joint (if it’s near a joint) is immobilized as much as possible. The more the area stretches and contorts, the more likely it is to form proud flesh, especially around the fetlock. Ideally, you want a fairly thick, firm bandage that applies some firm, even pressure for at least a couple of inches (six inches is better) above and below the wound. The layers I use are a telfa pad, then roll cotton or something similarly cushy (I actually use a bandage material similar to disposable diapers), then 4″ gauze, then 4″ vetrap, then 4″ Elastikon. The Elastikon extends above and below to glue onto the hair to help anchor it. Never use any material that doesn’t have some give to it, or if the leg swells, and the bandage doesn’t, you can make it a lot worse.
4. Once you have it well bandaged, resist the temptation to rebandage it daily, mess with it, hose it and otherwise irritate the tissue. One of the reasons I really like Elastikon is that once it’s on, I have to use a scalpel to remove it, so the owners can’t easily get at the leg to screw with it. Depending on the severity of the wound, I’d leave it bandaged for up to a week.
5. If the wound is starting to form proud flesh, do NOT use any of the proud flesh products on the market—the joke among equine vets is that they’re distributed by equine vets that are looking to increase the frequency and severity of proud flesh cases to boost their practice income. You can apply a steroid cream mixed with the Nolvasan or Neosporin cream under a wrap. The best cream is the prescription stuff Nystatin/triamcinolone, but 1% hydrocortisone from the dollar store is better than nothing. Steroids slow down tissue healing (which is what you want with proud flesh, because the problem is too much tissue formation) and it shrinks the existing proud flesh. In some instances, you have to take a sterile scalpel and carve it back down to skin level. The proud flesh tissue is VERY vascular (thus will bleed like crazy, though never to a life-threatening amount) but has no innervations, thus has no feeling. I generally only had to sedate the horse to keep them from kicking at the tickley feel of the blood running down their leg, or when I started getting close to the new skin edges (which do have feeling and don’t like being cut). You also generally need some pressure to help keep down the formation of new proud flesh, so bandage it as above if at all possible.