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Section 12: Overgranulation (Under Review by WMFG)
Overgranulation can sometimes occur in the latter stages of healing and clinical action can help reduce the granulation.
Type	Indicator/descriptor	Management aims	Treatment options
	Overgranulation, also referred to as proud flesh, hypergranulation, hypertrophic granulation, hyperplasia of granulation tissue or wound oedema, occurs at the proliferative stage of the wound healing process. It presents clinically as granulation tissue raised above the level of the surrounding skin. The presence of overgranulation tissue prevents progress to the maturation stage of the wound healing process and so delays wound healing.	To reduce further development of granulation tissue To promote epithelialisation over the surface of the wound To effectively manage wound exudate To provide a dressing that is comfortable and acceptable to the patient	LYOFOAM

Other considerations

Topical steroids: may retard wound closure. Use for a maximum of 7 days. Requires a secondary dressing. Seek specialist advice.
Silver nitrate sticks 75% caustic applicators (unlicenced). Seek specialist advice: Caustic and a potential cause of metabolic disturbances with prolonged use. Only use when all other options fail. Will damage healthy tissue. Protect with hydrocolloid template or white soft paraffin.
Surgical excision: re-traumatises the wound, re-initiating the wound healing cycle

References:

Borkowski S. G Tube Care: Managing Hypergranulation Tissue. Nursing 2005; 35(8):24.
Hawkins-Bradley, Walden. Treatment of a Non-healing Wound with Hypergranulation Tissue and Rolled Edges. Journal of Wound, Ostomy and Continence Nurse Society 2004; 29(6): 320-324.
Nelson L. Points of Friction. Nursing Times 1999;95(34).
Rollins H. Hypergranulation Tissue at Gastrostomy Sites. Journal of Wound Care 2000;9(3): 127-129.