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Granulation Tissue vrs Proud Flesh
The following images are of "Chester" a horse owned by Castle Mountain Outfitters with long-term veterinary care administered by Amada Bissell.  All care was administer under my direction supervision.  At the time of the injury, Amanda was a student at the University of Alaska in the Veterinary Aide Program.  

The initial wound was caused by a severe wire cut.  Due to missing tags of skin and contraction of skin around the wound, the injury could not be treated by traditional suturing of the laceration.  The wound was allowed to heal by "Second Intention".
This series of images outlines the progression of healing as granulation tissue fills the gaps, providing a foundation for skin to migrate across.  "Proud Flesh" is the situation where granulation tissue grows out of control and outgrows all boundaries.  The following examples are granulation tissue within normal parameters.  

At no time was this horse treated for "Proud Flesh", but rather the Granulation Tissue was allowed to develop, which promoted the healing process.
July 17, 2008

This photo was taken a few days after the incident.  Unfortunately, Images of the wound were not available immediately after the injury (July 14, 2009).  The wound has been thoroughly clipped and cleaned.

Note the margin of granulation tissue developing around the skin border.
Amanda Bissell did an excellent job of nursing care during the entire healing process.  The leg was periodically cleaned and a leg wrap applied. Frequency of bandage change depended upon the condition of the wraps and discharge from the wound.  A damp saline soaked gauze was used to keep the area moist and pliable.  Occasionally, an antibiotic ointment was used to reduce surface bacteria.
July 20, 2008

The granulation tissue has increased significantly and skin edges have contracted back.  An exposed tendon is now showing in the lower corner of the laceration.
July 24, 2008

Granulation tissue now covers the entire wound.  Granulation tissue has a tremendous blood supply and easily bleeds when disrupted.  Note that the tendon in the lower corner has receded.
July 26, 2008

Amanda has left the injury site unwrapped for a day.  The granulation tissue has become dry and scaly.  The healing process may slow when the area dries like this, so she applied additional wet dressing.
August 6, 2008

The horse is only mildly stiff on the leg.  Amanda is applying wraps about every other day, using either a saline soaked bandage and/or anti-bacterial ointment.  The granulation tissue has extended well above the margin of the skin - no additional measures were taken at this point.
August 12, 2008

The granulation tissue has increased moderately in size. At this point, any mild trauma or irritation to the granulation tissue may cause it to grow abnormally.   A pressure wrap can be applied to help reduce this rapidly growing tissue and also provide protection.
September 12, 2008

Amanda is no longer treating the injury, other than an occasional washing of the site to reduce debris build-up and application of Corona Ointment.  Corona Ointment is a lanolin based product which has a mild anti-bacterial property.  The ointment keeps the area soft and flexible, plus keeps the surface bacteria reduced.
June 1, 2009

Almost a year after the initial injury.  The lesion has healed nicely, the horse is a sound athlete again.  At the bottom of the scar is a horny mass (very similar consistency to an ergot or chestnut).  The stiff horny mass can be periodically treated with Corona Ointment.  Generously apply the ointment to the scar daily, until the area softens.  The mass can then be scraped away or reduced with a file.
Glacier Veterinary Service, LLC
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