Wound healing follows a specific sequence of phases which result ultimately in connective tissue repair and the formation of a fibrous scar. The first phase is the inflammatory (reaction) phase which is followed by the proliferative (repair) phase, and finally by the maturation (regeneration) phase. These phases are not independent and overlap throughout the entire wound healing process. Wound healing may take from three weeks to two years, with granulation tissue beginning to develop about four days after the original injury. In the distal limb, particularly of horses, large tissue deficits may lead to the production of excessive, exuberant granulation tissue. The precise cause of this condition is not known but some of the factors involved are thought to be increased movement, lack of soft tissue covering, excessive contamination, and a reduction in blood supply. The use of effective pressure bandaging or cast application should be encouraged. The management of excessive granulation tissue varies and includes application of topical steroid/antibacterial ointments, pressure bandaging, sharp excision, or caustics (silver nitrate). Many wounds of the trunk and upper limbs heal well by secondary intention with good cosmetic results but those of the distal extremities tend to heal slowly with production of excessive scar tissue and skin grafting is often useful.
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