Nurses who participate in wound care will be familiar with the term hypergranulation. Hyper-granulation is also referred to as over granulation or proud flesh.Whilst the exact aetiology is not clear, a prolonged inflammatory response is thought to facilitate this outcome.
We understand that the appearance of hyper-granulation tissue may vary depending on the site.The tissue can vary from being soft and pliable to being firm and brawny. The hyper-granulation tissue may appear as soft and pliable e.g. in surgical incisions, percutaneous tubes and around indwelling devices. The hyper-granulation tissue may also present as firm and brawny e.g. chronic wounds – leg ulcers.
Factors Linked to hyper-granulation tissue development
- Any increase in exudate volume
- Infection or critically colonised (biofilm) wound
- Location of the wound (granuloma occur commonly at umbilicus, stoma edges)
- Concomitant treatments such as negative pressure wound therapy
- Totally occlusive dressings
- Ill-fitting dressings or garments
- Excess moisture
It is important to note that hyper-granulation tissue growth does not always require treatment as it will often resolve spontaneously. Hyper-granulation tissue only needs to be removed if it is preventing the wound from healing (as it may prevent epithelisation) or negatively impacts the patient from a self-image perspective.
Management of hyper-granulation tissue
When the management of hyper-granulation tissue is required,hyper-granulation can be managed by:
Hypertonic saline impregnated dressings
Sharp wound debridement
Silver nitrate and Copper sulphate
We have created a good info sheet that you can download which identifies 5 facts you should know regarding wound biofilms. Download it and pop it up in your workplace as a reminder!
The Nurses for Nurses Network provides great information and CPD on an array of nursing topics including wound care in a range of easy learning ways including webinars and quizzes on the latest information that Nurses need to know – remember the Nurses for Nurses Network was created by Australian Nurses for Nurses! www.nursesfornurses.com.au