From the Guidelines
Hypergranulation in wounds should be treated by thoroughly removing all granulation tissue, with the use of a degranulation bur being highly recommended. This approach is supported by the most recent and highest quality study available, which provides instructions for the use of l-prf in different clinical indications 1.
Key Considerations for Treatment
- Removing excess granulation tissue is crucial for promoting wound healing and preventing further complications.
- The use of a degranulation bur is specifically recommended for this purpose, as noted in the 2025 study published in Periodontology 2000 1.
- It is essential to address the underlying causes of hypergranulation, such as excessive moisture, infection, or foreign bodies in the wound, to ensure effective treatment and prevent recurrence.
Additional Treatment Options
- While the primary treatment involves removing granulation tissue, other methods like applying pressure with compression bandages or dressings, silver nitrate cauterization, and topical corticosteroids may be considered in specific cases.
- However, these alternatives should be chosen based on the individual patient's needs and the wound's characteristics, always prioritizing the most effective and least invasive approach.
Importance of Evidence-Based Practice
- The treatment of hypergranulation in wounds should be guided by the most recent and highest quality evidence available, such as the 2025 study 1, to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Definition of Hypergranulation
- Hypergranulation, also known as overgranulation, is an excess of granulation tissue beyond the amount required to replace the tissue deficit incurred as a result of skin injury or wounding 2.
- It is an abnormal accumulation of granulation tissue in a wound, commonly seen in burns, which impairs wound healing and can predispose patients to infection 3.
Treatment Options for Hypergranulation
- There is no gold standard treatment for hypergranulation tissue, but some options include:
- Surgical debridement
- Chemical cautery with silver nitrate
- Topical steroids 3
- A novel 50/50 mixture of triamcinolone and Polysporin topical ointment has been found to be an effective and safe treatment for hypergranulation tissue in burn wounds 3.
- Topical hydrocortisone can be utilized as an effective, inexpensive, and noninvasive practical option in the treatment of hypergranulation tissue resulting from burn wounds 4.
- Silver nitrate sticks or topical steroid can be used to treat hypertrophic granulation wounds, with topical steroid showing faster healing rates 5.
- A nontraumatic method of management using a polyurethane foam dressing can also be effective in reducing hypergranulation tissue 6.
Effectiveness of Treatment Options
- A study found that 88 out of 92 patients were successfully treated with a topical 50/50 mixture of triamcinolone and Polysporin until hypergranulation resolution, with an average time to resolution of 27.5 ± 2.5 days 3.
- Another study found that topical hydrocortisone resulted in complete regression of hypergranulation tissue and closure of burn wounds in all five cases treated 4.
- A quality improvement project found that wound size reduction was greater with 1% hydrocortisone treatment compared to silver nitrate cautery treatment 5.