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Granulation Tissue vrs Proud Flesh
The initial wound was caused by a severe wire cut.  Due to missing sections 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".

Note: after an initial veterinary assessment, the owner completed all care of this wound.
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.
The owner periodically cleaned and applied a leg wrap. 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

At this point, the injury site is periodically left unwrapped.  The granulation tissue has become dry and scaly.  The healing process will slow when the granulation dries.  To enhance healing, a wet dressing is applied.
August 6, 2008

The horse is only mildly stiff on the leg.  The leg is wrapped 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

The aged lesion is no longer being treated, 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 corona keeps the surface bacteria in check.
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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