How to manage a wound with hypergranulation tissue and active infection?

Management of Hypergranulation Tissue with Active Infection

For wounds with hypergranulation tissue and active infection, treatment should include daily cleaning with antimicrobial cleanser, topical antimicrobial agents, and consideration of topical corticosteroids, with advanced interventions such as silver nitrate cauterization reserved for refractory cases. 1

Initial Management

• Clean the affected wound at least once daily using an antimicrobial cleanser to reduce bacterial load and control infection 1
• Apply a topical antimicrobial agent under any fixation device to address the active infection 2, 1
• Use foam dressings rather than gauze to reduce skin maceration, as foam lifts drainage away from the skin 2
• Apply a barrier film or cream to protect surrounding skin, especially if the hypergranulation tissue is exuding 1
• For fungal infections, apply topical antifungal agents 2

Treatment Options for Hypergranulation Tissue

• Apply a foam or silver dressing over the affected area, changing only when significant exudate is present (at least weekly) 2, 1
• Consider topical corticosteroid cream or ointment for 7-10 days in combination with a foam dressing to provide compression to the treatment site 2, 1
• A novel 50/50 mixture of triamcinolone and Polysporin topical ointment has shown effectiveness for hypergranulation tissue in recent studies 3
• For persistent hypergranulation, consider cauterization with silver nitrate applied directly onto the overgranulation tissue 2, 1
• Avoid excessive manipulation of granulation tissue, which can cause bleeding and pain 1

Advanced Interventions

• For refractory cases, consider surgical removal of the hypergranulation tissue 2, 1
• Argon plasma coagulation has been described as an effective treatment in literature for persistent cases 2
• Negative Pressure Wound Therapy (NPWT) may be beneficial for extensive wounds with hypergranulation tissue to promote healthy granulation and wound healing 2
• When using NPWT, include a wound contact layer between the NPWT wound filler and the wound bed to prevent damage to granulation tissue during dressing changes 2

Special Considerations for Tube-Related Hypergranulation

• Verify proper tension between internal and external bolsters if hypergranulation is around a tube site 2
• Avoid unnecessary tube movement or excessive pressure 2
• Consider stabilizing the tube using a clamping device or switching to a low-profile device if side torsion is contributing to hypergranulation 2
• Ensure correct balloon size and tube length are being used if a balloon retaining device is present 2

Common Pitfalls to Avoid

• Avoid using gauze dressings directly on hypergranulation tissue as they can adhere to the tissue and cause trauma upon removal 1
• Do not replace tubes with larger-diameter tubes as this is generally ineffective and can result in an enlarged stoma tract with more leakage 2
• Minimize dressing changes to prevent disruption of the healing process, especially with NPWT 1
• Be aware that topical steroids, while effective, should be used judiciously to avoid potential side effects such as skin atrophy 4
• Silver nitrate treatment, while effective, can be painful and may lead to scarring 3

Monitoring and Follow-up

• Regularly assess the wound for signs of improvement or deterioration 1
• If hypergranulation persists despite treatment, consider alternative approaches or combinations of treatments 2, 1
• For persistent infection despite appropriate antimicrobial therapy, consider wound culture to guide targeted antibiotic therapy 5
• Document changes in wound appearance, size, and characteristics to track progress 5