Hypergranulation

Hypergranulation tissue, also called exuberant granulation tissue or proud flesh, is an abnormal overgrowth of granulation tissue that rises above the wound bed. It most often occurs in wounds healing by secondary intention, especially when moisture or inflammation persists. The tissue is bright red, friable, and bleeds easily, and it can prevent epithelialization and wound closure.

Common risk factors include prolonged moisture or occlusive dressings that keep the wound wet, persistent infection, mechanical irritation or friction, poor drainage, edema, venous insufficiency, and foreign material in the wound. It is seen in chronic wounds such as venous leg ulcers, diabetic ulcers, pressure injuries, and peristomal wounds.

Diagnosis is clinical. Hypergranulation protrudes above the wound margins and bleeds readily, whereas healthy granulation remains level with the bed. If the lesion is atypical or suspicious, biopsy or culture may be indicated to rule out infection or neoplasia.

Management aims to remove the excess tissue and address contributing factors. Treatments include gentle curettage or debridement, cauterization with silver nitrate or other agents, and using dressings that balance moisture to promote epithelialization while preventing recurrence. Treat infection, optimize perfusion and edema, and ensure proper drainage; in peristomal wounds, barrier adjustments may help.

Prognosis is generally favorable with proper wound care. Hypergranulation tends to improve when moisture balance is restored, infection controlled, and the wound is appropriately debrided. Prevention focuses on avoiding excessive moisture, protecting peri-wound skin, treating edema, and addressing underlying conditions such as venous insufficiency.