Get Physical: A New Option in Managing Hypergranulation

Background: Reported methods of managing hypergranulation tissue include silver nitrate sticks, silver impregnated dressings, foam dressings, or low dose steroid creams.¹  A critical component in the formation of hypergranulation is wound bioburden.^2,3  Culturing is often an inaccurate exercise as swab cultures only reflect planktonic, not sessile, bacteria. Though fungal colonization is often a critical component of wound bioburden, fungal cultures are rarely taken. The use of bacterial binding agents in the management of hypergranulation tissue has not been examined.

Methodology: Wound colonization occurs as a result of bacterial hydrophobicity adhering to wound tissue. Dialkylcarboylchloride (DACC) in vivo and in vitro dressing* data suggested that bacterial and fungal populations can be reduced through irreversible binding.⁴ Using a physical, rather than chemical, means to reduce bacteria is a novel approach in the management of hypergranulation tissue. Application in the clinical setting was evaluated in a variety of wound types with hypergranulation and an algorithm for use was developed based on the mechanisms of action and a critical review of the literature.

Conclusions: The use of DACC dressings that use a physical, non-traumatic means for the management of hypergranulation tissue is an innovative option in a variety of wound types. Further study is warranted.

*Cutimed^® Sorbact^®, BSN medical, Inc. Charlotte, NC