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Discussion on Long Term Proud Flesh Problem
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New Member:
Gohlson
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Posted on Monday, Jun 27, 2005 - 6:42 pm:
I have a long term care project which I need help with. I have just adopted a neglected mule and I am in the middle of caring for a severe injury to her left rear leg which extends from just above the cornet band to high up into the gaskin with most of the damage being done to the front of the hock between the cannon and gaskin. The wound is going on three years old and most of it has completely healed except for the joint which is now covered with an extensive growth of proud flesh. While it does not slow Nacho down, it does create a very sorry sight to be seen.
About 6 weeks ago we started a moist wound treatment to try and remove much of the proud flesh which was hanging from the front of the joint and to also start trying to heal this wound. The stables have had two vets look at the wound over the past two years and each of them have stated that we are making a valiant effort, but that the outcome does not look good. Since we started this treatment, the progress has been fantastic in the removal of over 3 inches of proud flesh which was hanging off the wound with an extensive amount of drainage yet we still aren't having any luck in closing the wound to allow for complete healing.
Since the local vets are reluctant to give us any advice on treatment, hence, surgically excising it is not an option, we have consulted with surgical MDs and created the following treatment schedule which is done every 2 days:
1) After removing the old bandage the entire wound area is washed with Equine Elite Antimicrobial Equine Body Wash
2) Area is rinsed several times with clear, warm water
3) Light washing with betadine solution
4) Application of a water based tea tree ointment to keep the wound site moist
5) Cover the wound site with Vaseline Petrolatum Gauze Dressing
6) Wrap the wound with light gauze to keep the outer vet wrap from rubbing on the wound and transferring the die used in the wrap to the skin
7) Full wrap of the hock with the 4” by 5 ft vet wrap
After extensive research, I have learned that I need to start applying a cortisone preparation to remove the exuberant granulation tissue instead of the tea tree ointment. Once I get rid of the proud flesh, I am at a loss about what I need to do to solve this problem, long term. I will take pictures of the wound site tonight and post them tomorrow. I am not ready to accept the comments of these two vets as we are not ready to throw in the towel but will do whatever is necessary to solve this problem and return Nacho to good health.
Thanks for listening,
Gary
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Member:
Mrose
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Posted on Monday, Jun 27, 2005 - 8:53 pm:
Too bad you have such "woosey" vets. More power to you, and I'm betting you'll succeed. Lucky mule. Dr. O. will have to advise you. I've used silver nitrate sticks on a much smaller version of this type of wound, and had good success; but don't know if it would work on this size wound.
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Member:
Eoeo
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Posted on Monday, Jun 27, 2005 - 10:05 pm:
You might try cleaning it, then smother it in Vicks VaPoRub, the stuff people use for stuffy noses. Put a cover over that and wrap it up. It might take a while, but it just might fix it right up. We used it on a smaller wound, about 3 inches across that had proud flesh and was draining and in 3 weeks we had it the size of a dime when we sent the mare home. She came that way to be bred. EO
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Member:
Mrose
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Posted on Monday, Jun 27, 2005 - 10:41 pm:
EO, did you use Saran Wrap to cover it? How often did you change it? (This sounds like one of those good "old wives remedies" that work, so thought I'd ask.)
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New Member:
Gohlson
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Posted on Monday, Jun 27, 2005 - 11:06 pm:
We took a picture of the wound this evening and if you don't have a weak stomach, here it is:
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Member:
Eoeo
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Posted on Monday, Jun 27, 2005 - 11:58 pm:
Sara, no, I didn't. I just put a big wad of vicks on with a chunk of gauze pad over it and put vet wrap around. I squirted some betadine over it and cold water hosed it off every other day. I tried to not disturb it any more than I had to. I was flat amazed at how it worked. I imagine you could put saran/plastic wrap over it for the first couple of times then go to the gauze. EO
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Member:
Eoeo
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Posted on Monday, Jun 27, 2005 - 11:59 pm:
Gary, I bet 5 bucks the vicks would work on the mule. EO
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Member:
Eoeo
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Posted on Tuesday, Jun 28, 2005 - 12:06 am:
BTW, Gary I could post a picture of one of these that was in the front of the hock that I guarantee you wouldn't be able to stomach. We never did get it completely healed before we sent her back. I didn't think about the vicks until a couple of months later when the other mare arrived. If i NEVER see another one it will be too soon. EO
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Moderator:
DrO
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Posted on Tuesday, Jun 28, 2005 - 6:27 am:
Hello Gary,
The first thing is the image does not have any obvious exuberant granulation tissue (proud flesh) visible and appears more like ulcerated scar tissue, see Equine Diseases » Skin Diseases » Wounds / Burns » The Treatment of Proud Flesh or Exuberant Granulation Tissue. Concerning the use of steroids on granulation tissue, it may reduce formation, but I have no information on it reducing that already present.
Perhaps if we could have a image after the wound has been well cleaned with a hose under pressure I would feel different. Also I would like to see several different views that demonstrate how enlarged the leg is.
I always hate picking on LKR because of her extensive experience but her wounds are healing "in spite of what she is doing" and not "because of what she does". The menthol in the product is tissue toxic. Please don't anyone out there start using Vicks for wound care.
DrO
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New Member:
Gohlson
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Posted on Tuesday, Jun 28, 2005 - 8:28 am:
Thank you everyone for your comments, please keep them coming.
Dr. O. I have attached another picture after the wound has been washed which also shows the full extent of the original injury to Nacho. Please remember that we have been treating this wound for over 6 weeks now and each time we change the bandage, we are able to cut off 1/8 to 1/4 inch of dead flesh from the wound site, which by the way, has never bleed.
Also, in the removed bandage, there is still a bloody discharge and a very noticeable dead flesh smell to the leg. When we started this care, the entire pink area was covered with the dead flesh which we were able to soften up and remove.
We will take some additional pictures this evening and post them a bit later.
Thanks again!
Gary
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New Member:
Gohlson
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Posted on Tuesday, Jun 28, 2005 - 8:30 am:
By the way, the swelling has been reduced from twice the current size to where it is today, about 50% larger than the other leg.
Gary
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Member:
Eoeo
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Posted on Tuesday, Jun 28, 2005 - 9:24 am:
I don't mind you picking on me, Dr. O. I learn from it. It may be that things heal because of the care, however, the vicks cleaned the garbage off and out of it, so in that respect, it helped. What do you think of a product called Shriners? EO
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Member:
Suzeb
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Posted on Tuesday, Jun 28, 2005 - 11:13 am:
LKR,
The product is called Schreiners Herbal Solution.
Google searching will yield some ingredients  .
Susan B.
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Member:
Dres
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Posted on Tuesday, Jun 28, 2005 - 11:46 am:
I have use the Schreiners Solution... it burns, so after the first application, well lets say, the horse remembers and tries to get away... don't have much more to report on its usage ...
On the first day God created horses, on the second day he painted them with SPOTS..
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Member:
Deggert
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Posted on Tuesday, Jun 28, 2005 - 12:41 pm:
Dr O.
I have had so few leg wounds in my time that I haven't any experience in preventing proud flesh. I read all the wound care articles but my yearling cut his leg,now 10 days ago (he likes to climb the wire with his front legs and stand straight up) Well, I think his foot went through an area and when he pulled it out he had a shallow puncture/rip in the skin just below where his splint bone would end. We hosed and cleaned and hosed and he swelled, used a little bute the first few days, hosed more and kept it scrubbed and furacin spray on it. My question is, swelling is gone, he was never lame, we have cleaned the dead edges away and have not wrapped. Due to the location of the wound, when he runs around sometimes he hits the area with the other foot. We continue to keep clean and started putting cotton inside a soft splint boot to protect it. I could try a wrap but he will tear it off for sure. I am afraid to use vetwarp because after he gets done with it it will be a rubber band on his leg. Now it is a clean looking circular raw area, fairly level with the surrounding skin but raw. I keep hearing about the steroids to prevent proud flesh. I have a product called Gentocin topical, with betamethasone. Could you suggest a protocol from here out to get the best results and as little scar as possible. thanks, Debbie
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Member:
Eoeo
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Posted on Tuesday, Jun 28, 2005 - 3:23 pm:
I have used the Shreiners with good success. I just wondered what Dr. O thought of it. EO
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Moderator:
DrO
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Posted on Wednesday, Jun 29, 2005 - 6:49 am:
We have discussed Shreiner's before, run a search on the name and it should come up.
The stuff you are cutting off must be a mixture of coagulated exudates and defoliated cells because nothing else would form that quick. Of course it can't be proud flesh since it always bleeds profusely. This is a much better picture but I still cannot pick out key details that only a thorough look and palpation might reveal. It appears that you have a large area of scar with a area that has not healed well, or finished healing. This is a complicated wound because of the location over the hock, the extent of the damage, and the very long time of inappropriate care before you got him.
Gary the report on the swelling is good news as it means you are making progress but I don't like the fact it smells necrotic. This indicates it needs more frequent cleaning but I am uncertain this wound needs bandaging which would make the cleaning much easier and prevent the conditions for the bacterial growth. What concerns me the most is the areas that bleed and have exudate after 3 years: we need them to go ahead and scar in but it does not sound like there is any health granulation tissue to turn to scar. First try our long term care recommendations including the use of nitrofurazone spray between treatments to see if we can make further improvements. If 6 weeks more does not result in ongoing improvement, this may truly be a place to put a caustic substance to finish scarring it in. I would use Wonder Dust. If you truly have such a non-healing area it may require surgery that removes the surrounding scar down to healthy bleeding tissue that then can granulate in. I have never seen such a wound that would not heal in though some that did not receive good early care developed non-functional scarring. I cannot remember seeing such a wound that was still bleeding 3 years later.
This should be run by someone who can actually examine the wound: maybe the suggestions would get the vets to quit shrugging their shoulders.
DrO
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