References 1. McShane D, Bellet J. Treatment of hypergranulation tissue with high potency topical corticosteroids in children. Pediatr Dermatol. Vuolo J. Hypergranulation: exploring possible management options.
Br J Nurs. Johnson S. Overcoming the problem of overgranulation in wound care. Br J Community Nurs. Treatment in an outpatient setting for a patient with an infected, surgical wound with hypergranulation tissue. Int J Low Extrem Wounds. Widgerow A, Leak K.
Hypergranulation tissue: evolution, control and potential elimination. Wound Healing Southern Africa. Potassium titanyl phosphate nm laser for treatment of a chronic nonhealing exophytic wound with hypergranulation tissue.
Dermatol Surg. Pulsed dye laser for the treatment of hypergranulation tissue with chronic ulcer in postsurgical defects. J Drugs Dermatol. Harris A, Rolstad BS. Hypergranulation tissue: a nontraumatic method of management.
Ostomy Wound Manage. Shalom A, Wong L. Treatment of hypertrophic granulation tissue with topical steroids: J Burn Care Res. Rate of healing in skin-grafted burn wounds. Plast Reconstr Surg. McGrath J, Schofield O. Clin Exp Dermatol. Borkowski S. This condition is known as hypergranulation.
Other terms for hypergranulation include exuberant granulation and "proud flesh. There also have been suggestions that fully occlusive dressings such as some hydrocolloid dressings may promote a hypergranular response in certain cases. An excess of granulation tissue in a wound can actually delay healing because epithelial cells cannot "climb" over it and are therefore arrested at the wound edge.
So, while some granulation tissue is a good thing, it is possible to have too much of a good thing. When hypergranulation is encountered, it must be removed or flattened out so the epithelial tissue can subsequently resurface the wound and restore barrier function. There are very little data in the literature concerning methods for addressing hypergranulation in human wounds. However, hypergranulation or proud flesh is rather common in canine and equine wounds, and there are a number of references concerning its management in veterinary journals.
In the human population, hypergranulation may be dealt with in a number of similar ways. Chemical cautery with a silver nitrate pencil is perhaps the most common method of removing excess granulation tissue.
When silver nitrate contacts the superficial exposed tissues, it causes them to necrose almost immediately. The necrosed layer may then be wiped off gently. Contact of silver nitrate with intact skin will cause the skin to darken but not necrose. Use of silver nitrate should be undertaken with caution and an appropriate protocol.
Healthy granulation tissue is pink in colour and is an indicator of healing. Unhealthy granulation is dark red in colour, often bleeds on contact, and may indicate the presence of wound infection. Excess granulation or overgranulation may also be associated with infection or non-healing wounds. What does it mean when a wound is granulating?
Wound granulation is the development of new tissue and blood vessels in a wound during the healing process. Once the wound receives blood, fibroblasts will begin laying down collagen and other connective tissues that will form new blood vessels, skin, and other tissues.
Why is proud flesh bad? Some of these are associated with the production of proud flesh. Infection, foreign bodies, dead tissues or movement within the wound site, chemical applications and poor blood supply to the wound are known to encourage granulation tissue and inhibit the spread of skin cells across the surface of the wound.
What causes Proud Flesh? Proud flesh occurs when the granulation step of wound repair is not properly limited, and the granulation tissue becomes excessive. The result is a non- healing wound that appears as a red, fleshy mass.
It may be a single smooth area of excessive tissue in the original wound, or may be multiple mass-like areas. How do you get rid of proud flesh on a horse's wound? How to treat it: Trim. Ask your vet to trim the tissue back to skin level, so your horse's skin can begin to grow across the wound.
You should cover the wound with a non-stick pad and some type of conforming gauze bandage. Depending on the wound location, that can be followed by a thick cotton bandage and an elastic bandage to prevent contamination of the wound from bedding and dirt. The pressure from the bandage helps prevent the granulation tissue from becoming exuberant.
The treatment of wounds that have developed exuberant granulation tissue usually depends on the extent of the overgrowth. Mild overgrowth of tissue--just protruding above the surface of the wound--might require only steroid ointment applied directly to the granulation tissue to inhibit the growth of the exuberant tissue, then bandaging of the wound to prevent further growth of the granulation tissue and to encourage wound epithelialization.
Moderate to severe overgrowth of granulation tissue requires surgery to remove the excessive tissue. The excessive tissue must be removed to allow the skin at the edge of the wound to grow over the wound.
The surgery often is performed with the horse standing, since the granulation tissue has no nerve supply. A moderate amount of exuberant tissue can be removed easily with a scalpel blade. Severe overgrowth of granulation tissue presents a special problem, as very large granulating masses must be removed either under general anesthesia or in several stages, since blood loss can be quite significant.
Following surgical treatment of moderate to large granulating large wounds, a splint or a cast might be necessary to prevent the granulation tissue from regrowing and to enable the skin edges to advance and cover the wound.
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