From the Guidelines
The best treatment for hypergranulation in a wound is thorough removal of 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 emphasizes the importance of removing excess granulation tissue to promote proper wound healing 1.
Causes and Prevention of Hypergranulation
Hypergranulation occurs when the granulation phase of wound healing becomes excessive, leading to the formation of raised, red, friable tissue that extends above the wound surface and prevents proper epithelialization. This condition is often the result of excessive moisture, friction, or bacterial colonization in the wound environment. To prevent hypergranulation, it is crucial to address any underlying causes such as infection or foreign bodies in the wound and to maintain proper wound care, including keeping the area clean and appropriately dressed.
Alternative Treatment Options
While thorough removal of granulation tissue is the recommended approach, alternative treatments may be considered in certain cases. These include:
- Applying pressure dressings such as foam or hydrocolloid dressings to compress the hypergranulation tissue
- Using corticosteroid creams like 0.1% betamethasone or triamcinolone to reduce inflammation
- Applying cauterization by silver nitrate directly onto the overgranulation tissue, as suggested by previous studies 1
- Using a topical antimicrobial agent under the fixation device or a foam or silver dressing over the affected area, which should be changed at least weekly or if there is evidence of significant exudate
Importance of Proper Wound Care
Regardless of the treatment approach, proper wound care is essential for preventing recurrence after successful treatment. This includes keeping the area clean, using antimicrobial cleansers, and protecting the surrounding skin with barrier films or creams if necessary. By prioritizing thorough removal of granulation tissue and maintaining proper wound care, healthcare providers can effectively manage hypergranulation and promote optimal wound healing outcomes.
From the Research
Treatment Options for Hypergranulation in Wounds
- Hypergranulation tissue is an abnormal accumulation of granulation tissue in a wound, commonly seen in burns, which impairs wound healing and can predispose patients to infection 2.
- There is no gold standard treatment for hypergranulation tissue, but some options include:
- Surgical debridement
- Chemical cautery with silver nitrate
- Topical steroids
Effectiveness of Topical Steroids
- A retrospective review found that a novel 50/50 mixture of triamcinolone and Polysporin topical ointment is an effective and safe treatment for hypergranulation tissue in burn wounds, with 88 out of 92 patients successfully treated until hypergranulation resolution 2.
- Another study found that topical steroid treatment with 1% hydrocortisone resulted in faster healing in hypertrophic granulation wounds compared to silver nitrate cautery treatment 3.
- A case series reported the successful use of topical hydrocortisone in the treatment of hypergranulation tissue formation resulting from burn wounds, with all five patients showing improvement and complete regression of hypergranulation tissue 4.
Comparison of Treatment Options
- A study compared wound size reduction for hypertrophic granulation wounds treated with silver nitrate cautery or topical steroid, and found that topical steroid treatment resulted in greater reduction in wound size 3.
- Another study found that a nontraumatic method of management using a polyurethane foam dressing resulted in a significant decrease in height of granulation tissue 5.
Considerations for Treatment
- The choice of treatment for hypergranulation tissue should be based on the individual patient's needs and the specific characteristics of the wound 6.
- Clinicians should be aware of the different types of hypergranulation tissue and the factors that contribute to their development in order to identify effective treatment pathways 6.