Conference noted::equitation

    
    Proud flesh does not have any nerve endings, and thus there
    is no feeling in it.  I don't think you can do much about the
    scarring, but it doesn't sound like there is a proud flesh problem.
    At this point, keeping the wound clean and free of flies should
    let it heal ok.....

I feel for you since I'm also battling proud flesh at the moment.  
I'm curious, what ointment, if any are you using to help prevent 
further granulation?  My vet is having me use Kylmar ... which 
seems to be working fairly well in leveling the wound site. 

My vet is having me keep it clean (scrubbing vigorously
with betadine), keep pressure on it (bandaged) and no
exercise.   I'm on my 7th week now, 2nd infection, and
4th visit by the vet.  And I expect it to take about 2 more 
months if I'm lucky.  If I'm not lucky, I'll be having
some skin grafts done.

Under the best healing conditions, the skin can close
1 millimeter per day.  The trouble is trying to create
those healing conditions.  So long as the wound is higher
than the edges, it isn't healing.

Best of luck,

Melinda

I have a similar wound for one of my horses and I'm using a newly developed 
gel from Janssen Pharmaceutica (Johnson & Johnson group), named VULKETAN.  It 
is a medium size tube (like toothpaste).  The gel is applied after cleaning 
the wound with water and nothing else should cover the wound for best 
results.  I'm very satisfied with the result (applying now for 8 days) and 
the wound heals from inside outwards without generating 'wild flesh'.  Cost 
price in Belgium is 425 Bfr (approx 13 US$) and can only be obtained through 
the vet.

Hope this helps !

Philippe.

Philippe,

I'm very interested to learn what the active
ingredients are in this newly developed drug.
I've been told by an assortment of vets that
I must keep pressure on the site.  My horse's
wound is in a difficult place to keep bandaged
so I'm intrigued by this gel you're using that
works best without a bandage.   How large
a wound are you trying to heal?   My horse's
wound measures about 3 inches across at the
widest part, and about 5 inches long.  
Are you able to exercise your horse?

Thank you for the info,

Melinda

    Melinda,
    
    Having listened to your tale of woe - Crunchie's problem
    is nothing.
    
    The ointment I'm using is Calendula (a homoeopathic ointment).
    There is other convential ointment such as PANALOG we could use
    but the vet didn't have any to give me.  (There maybe difficulty 
    here comparing products as I'm in the UK).
    
    Apart from that and rubbing with gauze, the leg is dressed at all
    times.  Being so close to the knee I have difficulty in applying 
    pressure without interfering with the tendons and things at the 
    back of the leg.
    My solution, has been to use tubigrip (an elasticated tube bandage)
    over a non-stick dressing, which is itself covered with a pad,
    slightly larger than the wound.
    In the eary days I added pressure by applying a bandage over the top of
    this lot, but have now left this off, as I was worried about putting
    too much pressure where it shouldn't be.
    
    The problem I have with rubbing is that Crunch clearly has some
    feeling, in that area, but could it be from the good flesh under the
    wound ?
    
    All the best with your battle - you're not alone in your fight.
    
    
    Judy
    
    

Judy,

My vet also gave me panalog, but told me the kylmar was more effective,
and only to use the panalog when the proud flesh is clearly under control.

The first few weeks, the wound was filling in from the inside out and it was
definitely still very sensitive.  After it filled in, I think he only
acted like he was in pain when I was cleaning it, because he remembered
how it had been sensitive before.   After a week or two, he finally realized
that the cleaning didn't hurt him.

Melinda

    Melinda
    
    Crunchie's wound has got more sensative as it's filled in.
    She's a fairly tough soul, so to have her showing any signs of
    discomfort is unusual.  Every thing looks clean so I'm not afraid 
    of secondary infection.
    
    Could it be that what I'm calling proud-flesh isn't.
    
    Philippe
    
    I too would be very further information you can give us on your 
    product.
    
    Judy
    

Judy,

Well I might not be giving you a proper definition
of proud flesh, but this is how I understand it.
If you're dealing with a depression, then you haven't
reached the point yet of worrying about proud flesh.
As soon as the wound site fills in completely with
flesh, then you need to start worrying about it.

First off, there is a white line (epidermal?) surrounding
the wound site.  This is new skin trying to work its
way from side to side across the wound site.  When
the wound area is higher than this white line, the
skin can't cross it and will never heal.  

Ideally the wound should be one flat plane -- a pink
color like a tongue's surface.  When it gets proud,
it gets bumpier and multi-colored - almost looking like 
pizza.  Sorry for this gross analogy but its the best 
description I can come up with.

Melinda

�                      <<< Note 1804.8 by BROKE::MELINDA >>>
�                           -< how to know its proud >-


Check out this issue of Equus magazine (Oct 1993).  They have an article on 
many common types of injuries and disfigurements, among them being rope 
burns, scars, and proud flesh (including a photo of proud flesh).  The 
article also includes some recommendations on treatment to minimize proud 
flesh and scarring (which sound pretty close to those discussed here 
already.)

    Hi Judy,
    
    Sorry to hear that Crunchie has injured herself yet again. We have one
    like that too. In fact, our injury-prone mare had a similar knee wound
    many years ago. It healed up fine and she's been 100% sound on it for 
    the past 13-14 years. So, take heart. She may be perfectly alright
    within 6 weeks or so!
    
    Melinda's right. It sounds like you are in the stage of preventing
    development of proud flesh rather than coping with it. Proud flesh is
    very coarse and granular. It is an *overfilling*(i.e. above the skin
    level) of new tissue. It's basically normal tissue regeneration gone
    wild!
    
    If you've still got a "hole" in the flesh which is below skin level, my 
    guess is that you've got normal healing progressing. Now, the trick is 
    *slow* the regeneration of flesh so that the skin gets a chance to close 
    *before* the flesh becomes proudflesh...that's what the ointments, 
    scrubs, etc are for...
    
    Good luck,
    John

	John,

	Many thanks for your words of encouragement. 
    	Does your note title refer to avoiding the accident - or 
    	preventing the problems in healing ?
    	(We're still trying to find the cause  - wish they could talk).
    
	I had a good look at the wound last night with my friend
	and her comment was that it was definitely closing up.
	The light was rather poor, so she wasn't sure whether there was
	any proud flesh.  If there was it was minimal.  There is now no
	depression.

	This morning I had a better look and there is what might be the
	beginnings of proud flesh at the corners of the wound.
    	In other words the level of the granulated flesh may just be on a
        level with the white line, or slightly higher.
	It is so slight that it might not be, but I guess I'm now
	in the 'danger period.'

    	(Unfortunately we don't have Equus over here so I can't 
    	have a look at the 'photo and compare it).
    
	The wound appears to be closing from the bottom, rather more 
	than the top, but that might just be my perspective.  
	(Because she's only 14.1 it's difficult to see the site straight
	on - prehaps I should borrow a jack and lift her up to my eye
	level (-:   )

	Judy

	P.S. Was the mare who had the injury Charity ?
    

Melinda,

the wound is about 7 cm long, 2 cm wide, 1.5 cm deep.  It is located at her 
right back foot and I'm riding her outside as well as indoor nearly daily.  I 
just bought a pair of protections you fix with velcro during the exercise and 
it was adapted by adding an extra plastic flap (stitched to the protection) 
that protects the wound from being hit again by the other foot.  The flap 
stays at 1 cm from the wound so that there is no friction during movement.

About the active components, I'll give you the formulae tomorrow.

Philippe.

    >Does your note title refer to avoiding the accident - or
    >preventing the problems in healing ?
    
    The latter! Isn't the full name of the horse species, Equus Accidentus
    Caballus? ;-) I was tempted to say Equus AccidentsRus Caballus as a
    play on the name of a US toy store (Toys R Us) but I figured those
    outside the US wouldn't get it.....
    
    I know what you mean about not being able to figure out how they injure
    themselves. Jan's mare(Ellie, not Charity) has cut her eyelid twice and 
    her lip once *in her stall* and we have never found the cause or even 
    any clues...no blood anywhere! When Ellie cut her knee on the fence all 
    those years ago, we saw it happen. We looked at the fence at the exact
    spot and couldn't find anything sharp or any blood on the fence(there
    was plenty on her!). If we hadn't seen it happen, we'd never have known 
    how she did it. Her other major injury came from a fall in a rocky
    pasture but that's another story.
    

Melinda, here is the list of active components of Vulketan :

3.45 mg ketanserin tartrate (R 49 945) (= 2.5 mg ketanserin) per g gel.

Other components :

propylenglycol, hypromellose, methyl-parahydroxybenzoate, 
propyl-parahydroxybenzoate, water.

For more information I'm giving you the full coordinates of the manufacturer 
:	Janssen Pharmaceutica NV
	Turnhoutseweg 30
	B 2340 - Beerse
	Belgium
	Telephone 32-14/60.21.11
	Fax nmbr  32-14/60.28.41

Good luck,

Philippe.

    Melinda,
    
    How is your horses injury.
    We had a good look at Crunchies leg at the weekend and there is no
    doubt now that proud-flesh has arrived.
    
    I have started to make enquiries about Philippe's gel and believe
    that it's available over here, but under another name.  Also it is
    VERY expensive.  (Prices of around �25 have been mentioned).
    I'm still waiting to hear from the vets about this.
    Opinions appear to differ as to whether it is worth using on the smaller 
    wounds.
    
    Good luck
    
    Judy
    
    

	Well folks, Crunchie now has her bandages off and the
	wound, very much improved is being treated with a mild
	steriod cream.  
	I'll be honest and admit that I would have prefered to 
	have avoided this but I was fighting a loosing battle
	against pressure sores, in a effort to keep the wound
	moist and covered.

	(The knee joint has so many knobbly bits and vunerable
	areas that keeping any dressing on meant applying pressure
	somewhere.  - Maybe someone ought to invent a type
	of suspender belt for this type of problem (-: )

	It's now a question of waiting to see how much skin and
	how much scar we will be left with, once things have dried
	up.
	
	Crunch has strict instructions from the vet not to injure 
	a knee again.  If she must maintain her reputation and 
	keep them in work - then at least avoid the 'bendy bits' 
	of her anatomy.

	How are others with this problem progressing ?

	Judy
    

Judy,

I'm glad to hear Crunchie has made some good progress.  My horse
is also making good progress, although its been very slow.
At least the proud flesh/swelling/infection is all under control.
I'm still waiting for the skin to close over the wound... about 3 cm left,
which, at the rate things have been closing, equates to a few more months
of healing.

Philippe, how is your horse doing?

Melinda

Melinda, 

I can hardly see where the wound was, coming from a several cm gap I could 
never imagine that it wouldn't leave more traces.  My horse is dark bay, 
which might give less visibility to wounds, especially on the lower inner 
part of her back leg.

Philippe.

    Folks might be pleased to hear that Crunchie's wound has now healed
    over.  All that remains to be seem is how much hair will grow.
    
    She's now back to a normal 'Winter Routine' which is the best
    Christmas present I could have ever hoped for.
    
    My thanks to everyone who helped and supported us through the past
    three months.
    
    Best wishes to every one for a very happy 1994
    
    Judy

	Judy,

	I'm glad Crunchie's back into her routine.  My vet was curious
	about one of the treatments you mentioned - Callendula?  She
	plans to take some homeopathic classes soon, but in the mean time
	was curious what it was made up of.

	My horse has made progress, but its been so slow, that I
	figured at the rate it was going, he'd need 5-6 more months
	time to be completely healed.   So yesterday I finally dropped
	him off for a week or two 'Christmas vacation' at the vets where
	he'll get some skin grafts.   Thats his Christmas present this year!
	I sure hope its successful.  

	Melinda

    Congrats to Crunchie! Best wishes to Kapriole(Melinda's injured
    critter). Hope things go well for all of you.

    Melinda,
    
    Our fingers and hooves are crossed that the skin grafts prove
    successful.  Please keep us posted if you have the time.
    
    Calendular is derived form the Marigold flower.  I'll bring
    my book ('bible') in tomorrow and mail you off-line with the
    details  (unless other folks want them as well).
    
    All the best
    
    Judy
    

    Has anybody heard of putting cayenne pepper on a cut below the
    knee to prevent proud flesh?
    
    Thanks,
    	  Carl