Hypergranulation Tissue Evaluation & Management: Is It Evidence Based?

Problem: Inferior tissue is a category of viable tissue that is defective and prevents the wound in progressing through the healing cascade. Hypergranulation tissue is one type of inferior tissue that impedes wound healing. Little is known about the etiology, pathophysiologic characteristics and treatment for hypergranulation tissue. Certainly this is the reason for the array of treatment modalities ranging from simple polyurethane foam dressing to aggressive surgical or chemical debridement. Yet most WOC nurses and wound care clinicians treat inferior tissue frequently without knowledge of the evidence to support their treatment choices.

Purpose: The authors conducted a bibliographical search to quantify and to analyze the evidence regarding the topic of hypergranulation tissue etiology and treatment while preparing for a presentation regarding topical management in wound care.

Objective: The overall objective of this poster is to provide the WOC nurse a summation of inferior tissue references applicable to their practice to establish an evidence based practice. 

Outcomes: Many authors¹⁻⁵ proposed possible causative factors that disrupt collagen synthesis and degradation: excessive inflammation and bacterial bioburden which enhance MMP (matrix metalloprotease) activity, excessive moisture balance, foreign object irritancy such as suture material, unstabilized tube or tube material, and excessive angiogenesis due to failure of apoptosis and/or an increase of cytokine VEGF (vascular endothelial growth factor). Multiple treatments modalities¹⁻⁵ were found but none of the treatments were reliable curative. Currently, evidence to recommend one treatment over another does not exist and the problem of hypergranulation is not sufficiently described.

As wound care evolves into an evidence based practice discipline, it is essential the WOC nurse and wound care clinician have the necessary tools to base their management decisions.  WOC nurses and wound care clinicians will be given a summation of evidence for inferior tissue presented in this poster.