Rehabbing Funny Bunny B’s Injury: Conquering Proud Flesh

“My goal for Buns since the day of his accident was to provide all the resources I had available to ensure his healing process was smooth and efficient…Around approximately week two post injury, proud flesh decided to rear its ugly head.”

A note to our readers: there are graphic images of an injury contained in this post. Proceed with caution.

If you read my first article about Funny Bunny B’s complex injury, you know he has a long road to recovery ahead of him. If you haven’t had the chance to read about the nightmare, here’s a recap: On October 7, 2019, Funny Bunny B (Buns) sustained an injury to his left hind leg. He has a fracture, torn tendon and soft tissue damage. On his journey to recovery I, along with In Stable Hands, have faced many challenges and educational topics that I would like to share. The first one being proud flesh.

Proud Flesh, also known as granulation tissue, is a highly vascularized tissue with no nerve endings that can be a nuisance during wound healing. Because this type of tissue has no nerve endings, most of the time it is painless, but once it starts to overgrow, it can be a real pain to treat and diminish. This annoyance spreads quickly in horses, most commonly in the lower extremities.

My goal for Buns since the day of his accident was to provide all the resources I had available to ensure his healing process was smooth and efficient. I, along with In Stable Hands, have been dedicated to his care and rehab. We’ve been diligent with his medications and dressing changes, making sure all care has been executed correctly.

Buns’ wound prior to proud flesh. Photo by Misty Hollow Equine Practice

Around approximately week two post injury, proud flesh decided to rear its ugly head. The day before its appearance, the wound looked flat, flush with his leg, and healthy. The following day, I removed the bandage and there it was — bumpy, raised, granulation tissue. In a 24-hour period, the proud flesh pushed some stitches open while covering some of the other stitches that were placed.

Photo by Marcella Gruchalak

Having dealt with proud flesh before, I knew some common remedies and tricks (such as meat tenderizer or hemorrhoid cream) to use in order to diminish proud flesh. Unfortunately, these home remedies and over-the-counter options also kill the healthy tissue in the wound and I did not want to risk hindering the healing process.

I phoned my vet for her expertise and recommendations. She stated that with the tendon damage and exposure the wound should have minimal exposure to topical creams and remedies. For the following few weeks I followed the care plan my vet proposed.

One task the vet saw as an important part of Buns’s healing process is cutting the proud flesh off. The proud flesh spread quickly and grew outward past the edges of the wound. It raised past the wound bed making it a less than ideal area for healing.

Every one to two days I make sure to cut the proud flesh back to the point where it is flush with the wound. The process is painless for Buns. He just stands there in the cross ties while I remove the excess tissue. When trimming back the proud flesh, because it’s a highly vascularized area, the amount of blood that is expelled can be alarming. The blood pours out onto the floor of the barn aisle way at an extremely quick rate.

If this were my first time dealing with proud flesh I probably would have had a heart attack, thinking that I cut into a major artery. The process is tedious and at times I feel like I am not accomplishing anything.

The cutting back of the proud flesh is not the only intervention I rely on to decrease the amount of proud flesh on the wound. With just that one intervention, the proud flesh would continue to grow back. After cutting the proud flesh off, I dress and wrap the wound. The key to a successful wound dressing that will minimize proud flesh is how firmly you wrap it. The dressing should be tight and secure so that the proud flesh does not have any space to grow outward.

This part of the process is a science. First I place nonstick 4 x 4 gauze pads directly over the wound. After placing the gauze, I wrap the leg securely with gauze wrap. After wrapping the leg with gauze wrap, I wrap the leg with a cotton leg wrap. You thought the dressing was done at this point, didn’t you? Nope, we’re about half way through. The cotton leg wrap is then secured with vet wrap. Once secured with vet wrap, a quilted leg wrap is then applied and held in place with MORE vet wrap. This process is done once daily to insure that the wound stays clean and dry and the dressing stays firm and intact.

Photo by Marcella Gruchalak

Recently the vet came out to do a biweekly check up on Buns’s injury. She scraped off all the proud flesh, dug out the remaining stitch or two and decided that it was an appropriate time to add a topical medication to really get the proud flesh under control. The medication that now goes on the wound before it is wrapped is called Animax. This topical contains antibiotic, anti-inflammatory, anti-itch and antifungal medications. It’s been a week since I started applying this topical to Buns’ wound and the wound has healed significantly in just seven days.

Proud flesh is a barrier that takes time and consistency to conquer. It’s made the healing process slower and has created the illusion that Buns’ accident has happened longer than a month ago. The manifestation of proud flesh at the wound site is just a minor setback at this point but has been a major annoyance. However, it has been managed correctly and the amount is decreasing every day.