Hypergranulation (“Proud Flesh”): Understanding, Causes & Management
Hypergranulation—often referred to as “proud flesh”—is a common complication in wound healing where granulation tissue grows excessively above the wound bed. While initially part of the normal repair process, this overgrowth can inhibit epithelialization and delay closure, especially in wounds healing by secondary intention.
Key Highlights:
- Definition & Appearance: Hypergranulation presents as shiny, moist, and often raspberry-like tissue that protrudes beyond the skin surface. It is typically friable and may bleed easily when touched.
- Common Triggers: Factors include prolonged inflammation, bacterial colonization (e.g., Pseudomonas), trauma from medical devices (drains, catheters), chronic edema, fingertip injuries, or idiopathic causes.
- Impact on Healing: Although granulation is essential in wound repair, overgrowth that surpasses skin level prevents keratinocytes from migrating across the wound, thereby halting closure.
- Diagnostic Caution: If granulation tissue becomes hard, persistent, or cauliflower-like and does not respond to typical management, malignancy should be ruled out via biopsy.
Effective Management Strategies
- Identify Underlying Causes: Treat any infection, remove foreign material, address excess moisture, reduce mechanical irritation, and manage chronic edema.
- Topical Therapies: Mild corticosteroid ointments may be used for up to 10 days to suppress tissue overgrowth. Silver nitrate sticks or selective sharp debridement are alternatives when appropriate.
- Dressing Interventions: Use semi-occlusive or vapor-permeable dressings to control moisture and encourage flattening. Hypertonic saline dressings such as Mesalt® or Curasalt® help reduce edema and inhibit overgranulation.
- Surgical Options: In severe or refractory cases—particularly with burn wounds—sharp surgical removal or innovative debridement techniques may be warranted.
- Preparing for Skin Grafting: Hypergranulation must be controlled before skin grafting. Topical steroids, iodine preparations, or mechanical cleaning may be used to optimize the wound bed.
Hypergranulation is a manageable obstacle in wound care. With prompt identification and tailored treatment—combining topical, mechanical, and surgical approaches—clinicians can restore proper wound healing progression and promote epithelial coverage.
Keywords: hypergranulation, proud flesh, hypergranulation treatment, topical steroids, debridement