Excessive granulation tissue

During wound healing, the proliferation of granulation tissue is normal, but excessive growth can become a hindrance to healing. This excessive growth, which protrudes from the wound edge, has a moist, dark red surface and bleeds easily, not only delaying healing but also increasing the risk of infection. Let's explore how to manage and prevent it.

What causes excessive granulation tissue growth?

Generally, chronic irritation is the main cause. Foreign matter or necrotic tissue remaining in the wound will continue to trigger an inflammatory response, stimulating excessive growth of granulation tissue. Excessive wound tension will also cause problems. The continuous traction of the skin edge causes compensatory proliferation of granulation tissue. The presence of infection cannot be ignored. The formation of bacterial biofilms will hinder the migration of epithelial cells and lead to disordered proliferation of granulation tissue. In addition, certain special parts, such as fingers and joints, are more prone to this situation due to their rich blood supply and susceptibility to friction. The physical factors of individual patients, such as scar constitution or abnormal nutritional status, will also affect the growth of granulation tissue.

How to determine whether granulation tissue is excessively proliferating?

Normal granulation tissue is bright red, uniformly granulated, and has a smooth surface. It lies slightly below the level of the skin and bleeds easily, but is not painful to the touch. Excessive granulation tissue protrudes significantly beyond the wound edge, sometimes rising several millimeters above the skin, forming a mushroom-like growth. Its color often changes to dark red or purple, and its texture becomes fragile, bleeding easily with the slightest touch. Edema and redness may develop around the wound, and epithelial cells may not grow from the edges to the center for a long time. In this condition, the wound appears to be stuck in a certain stage of healing and is no longer progressing.

What are the effective treatment methods?

Applying appropriate pressure to the wound using an elastic bandage can reduce local blood perfusion and inhibit overgrowth. Apply even pressure and continue using the bandage for 8-12 hours daily, while closely monitoring the surrounding skin.

Silver nitrate cautery is a common clinical procedure. A silver nitrate stick is gently tapped on the surface of the granulation tissue to induce chemical coagulation necrosis. This procedure is performed 1-2 times weekly until the granulation tissue flattens. Afterward, excess solution should be rinsed off with saline to avoid damaging the surrounding healthy tissue.

Surgical revision is reserved for more severe cases. Under local anesthesia, sterile scissors or a curette are used to remove excess granulation tissue until it is flush with the surrounding skin. This method can be effective immediately but requires aseptic technique and intensive postoperative care after dressing changes.

Dressing selection is also crucial. Silver-containing dressings can control bacterial load and reduce inflammatory irritation. Hydrocolloid dressings provide a moderately moist environment while applying gentle pressure. Alginate dressings are suitable for wounds with high exudate levels to help absorb excess exudate.

How to prevent excessive proliferation of granulation tissue?

Promptly remove necrotic tissue and foreign matter, keep the wound clean, and reduce chronic irritants. Appropriately control wound moisture, select appropriate dressings based on exudate volume, and avoid an overly moist environment. Reduce wound tension by using tension-reducing tape or a brace to reduce mechanical irritation. Strengthen nutritional support and ensure adequate protein and vitamin C intake to promote a normal healing process. For those with a predisposition to the disease, early use of pressure therapy may help prevent excessive proliferation.

When do you need professional medical help?

may indicate a worsening infection. Increasing wound pain or increased redness and swelling around the wound may indicate the need for medical attention. Those with underlying medical conditions such as diabetes or a weakened immune system should seek professional attention promptly. Prolonged wound healing or recurring excessive granulation may require further evaluation to exclude other causes.

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Editor: kiki Jia