Hotline Topic: Hypergranulation
How to address stubborn granulation that can cause bigger problems
Hotline is where we take common concerns that crop up for nurses around the country, and ask our in-house subject matter experts for their advice.
Problem: The granulation tissue in my resident’s wound has risen above the skin level. When I clean it, it starts to bleed. Is there something I can do to get that tissue back to normal?
Answer It sounds like there is hypergranulation tissue in your resident’s wound bed. This occurs during the transition
into the proliferative phase of wound healing when granulation tissue forms and abnormally rises above the wound surface and edges, making it impossible for re-epithelialization to occur.
Hypergranulation tissue can also be called hypertrophic granulation, proud flesh, overgranulation and granulation hypertrophy. The development of hypergranulation tissue is associated with excessive moisture, infection, exposure of the area to external friction and the presence of any type of foreign body in the wound (e.g., retained dressing fibers). Assess the wound for those conditions because determining the reason for the presence of the hypergranulation tissue and eliminating it must occur for proper wound healing to progress.
If excessive moisture is the issue, look at the current treatment being used. Is an occlusive dressing being used
(transparent film, hydrocolloid, gauze impregnated with petrolatum, oil, etc.) in the wound treatment? How much fluid accumulates underneath it? How saturated is the cover dressing when it is changed? If this is a problem, controlling that environment will help. Using a more absorbent product and/or employing more frequent dressing is a good attempt to regulate moisture (calcium alginates, superabsorbents, superabsorbent aquaconductives, polyurethane foams and polyvinyl alcohol foam dressings).
The bleeding (friable granulation tissue) may indicate the presence of infection. Consider using antimicrobial dressings (silver gelling fibers, silver alginates, antimicrobial polyurethane foams and antimicrobial polyvinyl alcohol foam dressings) that provide enough absorbency to match the amount of exudate.
External friction over the wound area can be addressed by using dressings that lower surface friction (5-layer foams) and by minimizing the external forces on the skin through turning, boosting, repositioning and transferring.
Finally, conduct a thorough wound bed inspection while cleansing and assessing the wound bed, using good lighting and complete removal of soiled dressings.
Changing the local wound treatment for one to two weeks should provide you with some visible progress. If there’s no response, and the hypergranulation tissue continues to “bloom,” consider provider interventions.