Granulation tissue in horses is a type of connective tissue that forms during the wound healing process. It is characterized by the presence of new capillaries, fibroblasts, and extracellular matrix. This tissue serves as a temporary framework over which new skin can develop, playing a significant role in the repair of tissue injuries. In equine medicine, excessive granulation tissue, commonly referred to as "proud flesh," can be a complication, particularly in wounds located on the limbs. The management and treatment of granulation tissue are important for promoting effective healing and preventing further complications. This page compiles peer-reviewed research studies and scholarly articles that explore the formation, regulation, and clinical management of granulation tissue in horses.
Bertone AL, Sullins KE, Stashak TS, Norrdin RW.Preformed collagen gel was topically applied to cutaneous wounds of the equine dorsal fetlock (thoracic limb) and metatarsal regions to evaluate the effect on exuberant granulation tissue production and wound healing. In 6 horses and 3 ponies (less than 140 cm high at the withers and less than 365 kg), 36 standardized cutaneous limb wounds were surgically induced (4 wounds/animal); 18 wounds were treated topically with collagen gel, and 18 wounds were not treated (controls). Collagen gel was initially applied to the wound at 0, 2, or 7 days after wound formation (groups 1, 2, and 3, respective...
Acland HM, Gunson DE, Gillette DM.Seven foals aged 18 days to 3 1/2 months had either single or multiple full-circumference segments or long antimesenteric bands of necrotizing duodenitis, sharply delineated from adjacent viable duodenum. Perforation of the necrotic wall had occurred in all foals, leading to acute fibrinous peritonitis. On the mucosal surface severe diffuse, acute inflammation and ulceration involved the anterior half of the duodenum. Two further foals, aged 28 and 30 days, had lesions that are believed to be a chronic form of this disease. Both foals had a thickened duodenal wall, with large areas of mucosa r...
Miller RI, Campbell RS.A survey of granulomatous and neoplastic diseases of the skin of horses of tropical north Queensland was carried out during the period 1970-1980. Of 338 horses affected, 46.4% suffered from equine fibrosarcoma (sarcoid), 30.2% from phycomycosis, 7.4% from squamous cell carcinoma, 6.8% from other tumours, 4.7% from cutaneous habronemiasis and 4.4% from exuberant granulation tissue. Most specimens were submitted during the first half of the year after the wet monsoonal season and significantly more diseases originated during the first quarter. There was minor variations with breed, age and sex s...
Booth LC.Single or multiple split-thickness autogenous skin transplants were applied to 20 limb wounds of 17 horses. The surface area of the wounds ranged from 25 to 200 sq cm. Grafts 0.635-mm thick were collected by use of an electric dermatome and were expanded on a mesh dermatome. The expanded mesh grafts were applied to wounds on 3 horses 4 days after injury. For the other 14 horses, grafts were applied after a granulation tissue bed had formed. The grafts were secured to the recipient beds with sutures and a dressing composed of a foam pad and elastic adhesive tape or with the dressing alone. Furt...
Silver IA.Wound healing is part of the normal general repair process of the body. Its efficient completion depends on many factors, some physical, eg, pH, oxygen tension and tissue tension, and some biological, eg, cell-cell interaction and feedback of extracellular matrix on to the cells which produce it. The factors which affect healing are discussed and failures and anomalies in the process described. New techniques which may improve the quality of healing in specialised tissues are explained. Recent research on wound healing has concentrated on the role of the different cell types in the process and...
Herd RP, Donham JC.Thirty-one horses with naturally occurring summer sores were given a single IM injection of 0.2 mg of ivermectin (22,23-dihydroavermectin B1)/kg during the summer of 1980. Larvae of Draschia and/or Habronema spp were recovered from biopsy samples taken from 21 of 25 horses (84%) on the day of anthelmintic treatment. There was a marked clinical improvement in 26 horses (84%) 7 days after ivermectin was given. The typical summer sore was replaced by healthy pink granulation tissue at 7 days and this healed after 1 to 5 weeks. Biopsy samples were taken from 21 of these horses 1 to 6 weeks after t...
Carakostas MC, Moore WE, Smith JE, Johnson D.The functional capacity of the marrow granulocyte reserve (MGR) in 4 adult horses was studied, using 51Cr-labeled leukocytes. The mean increase in the peripheral granulocyte count following injections of etiocholanolone (0.3 mg/kg) was 870 granulocytes/mm3, and the mean increase following prednisolone administration (200 mg) was 5,880 granulocytes/mm3. Etiocholanolone failed to mobilize the MGR and decreased the rate of granulocyte egress from the blood. Prednisolone rapidly mobilized the MGR and markedly decreased the granulocyte specific activity during the first 3 hours after injection.
Mackay RJ, Iverson WO, Merritt AM.A 4-year-old stallion was examined because of a 2-month history of inappetance and weight loss. Diarrhoea had also developed a month before presentation. Abnormal clinical findings were emaciation, diarrhoea, ventral oedema, palpable mesenteric lymph node enlargement and a large mass in the left cranial portion of the abdomen. Significant laboratory findings were anaemia (packed cell volume 0.21 litres/litre), hypoalbuminaemia (16 g/litre) and xylose malabsorption. The horse was euthanased and at necropsy a 10.5 kg pendunculated mass composed of granulation tissue was found within and attached...
Haynes PF, Snider TG, McClure JR, McClure JJ.Chronic chondritis of the arytenoid cartilage was diagnosed in 7 male Thoroughbred horses examined for obstructive upper airway disorders. The history of the cases was characterized by a 3- to 6-month progression of exercise intolerance and inspiratory dyspnea during exercise. Endoscopy revealed marked asymmetry of the rima glottidis, partial or complete inability to abduct the involved cartilage, and axial displacement of the involved arytenoid cartilage. In less severe cases, the disorder was confused with laryngeal hemiplegia. Focal elevated lesions of the involved cartilage, which were fre...
Stünzi H, Ehrensperger F, Wild P, Leemann W.A 9-year-old horse had numerous firm, painless nodules of the skin and subcutis. Moderately vascular granulation tissue with numerous uni- or multinuclear reticuloendothelial cells was in the nodules and the regional lymph nodes but not in the viscera. By using special stains and electron microscopy, widespread amyloid deposits, mainly in the cytoplasm of reticuloendothelial cells, were identified. Amyloid was probably produced within the reticuloendothelial cells, then expelled from the dying cell and deposited in the intercellular space.
Bertone AL, Sullins KE, Stashak TS, Norrdin RW.Preformed collagen gel was topically applied to cutaneous wounds of the equine dorsal fetlock (thoracic limb) and metatarsal regions to evaluate the effect on exuberant granulation tissue production and wound healing. In 6 horses and 3 ponies (less than 140 cm high at the withers and less than 365 kg), 36 standardized cutaneous limb wounds were surgically induced (4 wounds/animal); 18 wounds were treated topically with collagen gel, and 18 wounds were not treated (controls). Collagen gel was initially applied to the wound at 0, 2, or 7 days after wound formation (groups 1, 2, and 3, respective...
van den Boom R, Wilmink JM, O'Kane S, Wood J, Ferguson MW.Wound healing in horses is often complicated by wound infection, exuberant granulation tissue, and hypertrophic scars, especially when wounds are located on the limbs. Wound healing in ponies is less problematic, characterized by a greater degree of wound contraction and a more intense initial inflammatory response. Because both processes are influenced by transforming growth factor-beta (TGF-beta), it was hypothesized that the better wound healing in ponies was associated with different TGF-beta profiles. A series of small wounds was created on the distal limbs and hindquarters of ponies and ...
Theoret CL, Olutoye OO, Parnell LK, Hicks J.To compare histopathologic features of a fibroproliferative disorder in horses (exuberant granulation tissue-EGT) and people (keloid). Methods: Archival tissue samples of EGT (n = 8) and keloid (12). Methods: After automated hematoxylin and eosin, histochemical (Gomori trichrome, Verhoeff-van Gieson elastin) and immunohistochemical (vimentin, α-smooth muscle actin, CD34, CD68, CD117) stainings, tissue sections were evaluated using a semi-quantitative grading scale for presence or absence of ulceration, keloidal collagen, myofibroblasts, and elastic fibers as well as degree of inflammation, fi...
Yuda Y, Kasashima Y, Kuwano A, Sato K, Hattori S, Arai K.Upregulation of hyaluronidase 2 (HYAL2), one of somatic hyaluronidase (HAase), was demonstrated in granulation tissue during the healing of equine superficial digital flexor tendon injuries. The activity of HAase was assessed by hyaluronan (HA)-containing gel zymography and in situ zymography using frozen sections obtained from normal and injured tendon tissues. Elevated HAase activity was identified in the extract from the tendinopathic tissues, with lower levels of the activity in normal tendons. In situ zymography using fluorescently-labeled HA demonstrated HAase activity in the granulation...
Hardcastle MR, Pauwels FE, Collett MG.To report morphologic findings associated with laryngoplasty failure in a horse. Methods: Clinical report. Methods: A 9-year-old Thoroughbred cross gelding. Methods: Necropsy and histopathology were performed on a horse that died peracutely during anesthetic recovery after correction of a right dorsal displacement of the ascending colon. Three weeks earlier the horse had left laryngoplasty and ventriculocordectomy. Results: Dissection of the larynx revealed that the laryngoplasty suture had pulled through the muscular process of the left arytenoid cartilage, which appeared grossly normal. Hist...
Wilson DA, Adelstein EH, Keegan KG, Barrett BA, Kutz RR.To determine whether monokines produced by activated rabbit peritoneal macrophages can inhibit development of exuberant granulation tissue formation in distal limb wounds in ponies. Methods: Randomized block. Methods: 5 castrated male ponies, 2 to 6 years old and weighing 140 to 190 kg. Methods: In vitro activity of cell-free rabbit peritoneal macrophage supernatant was determined after incubation of fibroblasts from the flank and the distal portion of limbs of horses and ponies. Tritiated thymidine was then added, and after reincubation, radioactivity was measured. After creation of a 4-cm2, ...
Tulleners EP, Harrison IW, Mann P, Raker CW.Left-sided partial arytenoidectomy was performed in eight horses to evaluate healing. Four horses underwent conventional partial arytenoidectomy with suture apposition of the mucosa. In four horses, most of the arytenoid cartilage, including overlying mucosa, vocal fold, and laryngeal saccule, were excised en bloc without mucosal closure. The horses were monitored clinically by endoscopic examination. One horse from each group was euthanatized at weeks 2, 4, 8, and 16. Complete necropsies with gross and histologic examination of the arytenoidectomy sites were performed. Postoperative complicat...
Acland HM, Gunson DE, Gillette DM.Seven foals aged 18 days to 3 1/2 months had either single or multiple full-circumference segments or long antimesenteric bands of necrotizing duodenitis, sharply delineated from adjacent viable duodenum. Perforation of the necrotic wall had occurred in all foals, leading to acute fibrinous peritonitis. On the mucosal surface severe diffuse, acute inflammation and ulceration involved the anterior half of the duodenum. Two further foals, aged 28 and 30 days, had lesions that are believed to be a chronic form of this disease. Both foals had a thickened duodenal wall, with large areas of mucosa r...
Silveira A, Koenig JB, Arroyo LG, Trout D, Moens NM, LaMarre J, Brooks A.To determine effects of extracorporeal shock wave therapy (ESWT) on healing of wounds in the distal portion of the forelimb in horses. Methods: 6 horses. Methods: Five 6.25-cm2 superficial wounds were created over both third metacarpi of 6 horses. Forelimbs were randomly assigned to treatment (ESWT and bandage) or control (bandage only) groups. In treated limbs, each wound was treated with 625 shock wave pulses from an unfocused electrohydraulic shock wave generator. In control limbs, each wound received sham treatment. Wound appearance was recorded weekly as inflamed or healthy and scored for...
Baj A, Beltramini GA, Romano M, Lauritano D, Gaudio RM, Palmieri A, Cura F, Giannì AB.BIOPAD® is an ivory-white soft sponge, made exclusively of lyophilized type I native heterologous collagen extracted from horse flexor tendon, gelatine free, that keeps its native structure specific to the body’s skin tissue. BIOPAD® is an active dressing, playing an active role in all stages of wound healing process, stimulating granulation tissue growth and enhancing regeneration tissues. It ensures balance between absorption and humidity at wound surface, gaseous exchange of soft tissues during healing process, barrier to prevent bacterial infections and it is completely non-adherent. T...
Corapi WV, Birch SM, Carlson KL, Chaffin MK, Snowden KF.CASE DESCRIPTION-A 22-year-old American Paint Horse gelding from the Gulf Coast region of Texas was evaluated for regrowth of a perirectal squamous cell carcinoma that had been surgically removed 11 months previously. CLINICAL FINDINGS-A necrotic and ulcerated mass was present below the anus. The horse had paraphimosis and was having difficulty with urination. Histologic examination of the mass revealed that it was squamous cell carcinoma, and the horse was euthanized because of the unlikelihood that the mass could be adequately resected and its close proximity to the urethra. OUTCOME-At necro...
Charlotte C P, Benoit B, Olivier M L.To evaluate secondary intention wound healing in the horse's limbs when treated with the synthetic epidermis spray (Novacika®, Cohesive S.A.S, France) or with a standard bandaging technique. Methods: Six Standardbred mares were included in the study. Four 2.5 x 2.5 cm full-thickness skin wounds were created on each thoracic limb. Two wounds were located on the dorsoproximal aspect of the cannon bone and the other two at the dorsoproximal aspect of the fetlock. Six hours after creation, wounds were randomly treated with synthetic epidermis spray or standard bandaging. The wounds were assessed ...
Salciccia A, de la Rebière de Pouyade G, Caudron I, Ponthier J, Serteyn D, Sandersen C, Deleuze S, Grulke S.Although rarely fatal, complications of ventral midline laparotomy incision in equine patients increase hospitalization cost and duration and may jeopardize return to athletic function. Therefore, many techniques have been developed to reduce their occurrence and expedite their resolution when they occur. Our technique of celiotomy incision closure includes the use of tension sutures (vertical U mattress) of polyglactin 910 on the linea alba, which is then apposed by polyglactin 910 interrupted sutures or a simple continuous pattern suture with a stop midway before routine closure of the super...
Pressanto MC, Bombonato C, Foote AK, Coomer RPC.To describe dermoid cyst formation as an uncommon complication of the pinch grafting technique in horses. Methods: Case report. Methods: A 8 year old Arabian gelding. Methods: Clinical presentation, imaging, treatment, and histopathology records were reviewed. The horse originally presented due to delayed healing of a laceration to the distal aspect of the metatarsus. The wound was treated initially with debridement and it was allowed to fill with healthy granulation tissue prior to pinch grafting. Two months after grafting, the horse started to show self-mutilation behavior targeting the woun...
Williams ZJ, Pezzanite LM, Hendrickson DA.Skin grafting is a simple technique that can be performed by equine practitioners to improve cosmetic outcomes in wounds with large skin defects that would not heal functionally or cosmetically with standard wound therapy interventions. Successful skin grafting is not difficult but relies upon appropriate preparation of the wound bed and effective immobilisation of the grafted area after skin graft placement. Prior to grafting, the wound bed should be treated with a moist wound healing dressing to prepare the granulation tissue bed to receive the graft. For best results, skin grafts should be ...
Holz N, Suárez J, Hetzel U, Rampazzo A, Stoppini R.A 15-year-old Swiss Warmblood gelding was presented to the ophthalmology service of Zurich University due to severe visual impairment. Ophthalmic and neurologic examinations were performed, raising suspicion of post-retinal blindness. Standing contrast computed tomography (CT) of the head revealed a partially calcified, soft tissue attenuating mass in the sphenopalatine sinus with concurrent compression of the optic nerves and chiasm. Differential diagnosis included neoplasia and granulomatous disease. The horse was euthanized, and the head was subsequently examined by magnetic resonance imagi...
Kamm JL, Odegaard J, Gaida J, King N.This tutorial aims to illustrate and instruct on the technique of punch skin grafting in the horse. Unassigned: A 10-year-old paint gelding with a 9 X 6-cm chronic granulating wound to the left forelimb was utilized for this tutorial. Unassigned: The chronic wound was debrided with sharp dissection, and the limb was pressure bandaged overnight. Twenty-four hours later, the horse was sedated for punch skin grafting. The ventral pectoral region was aseptically prepared for skin harvest and locally anesthetized. An 8-mm biopsy punch was used to harvest the grafts. The subcutaneous tissue was then...
