Healing rates for hypertrophic granulation treated with topical steroid or with silver nitrate chemical cautery

Introduction

Hypertrophic granulation tissue (HG), is an abnormal overgrowth of granulation tissue, and is known to slow wound healing. Treatment of HG varies, and there is little published data on the efficacy of treatments for HG.

Purpose

At a Midwestern burn and wound clinic, the practice of using topical 1% hydrocortisone on HG wounds was introduced in 2017. Concurrently, some of the clinic providers used chemical cautery (CC) with silver nitrate sticks as the primary treatment for HG. A QI project was developed to determine whether there was a difference in healing or infection with the two treatments.

Methods

Patients with wounds treated either with CC or hydrocortisone were identified from the clinic registry. Charts were audited to determine the type of wound, location, dates of treatment, and wound dimensions documented. Infection was defined as treatment with antibiotics or I&D of the wound during this period.

Results

Eighteen patients treated with CC and sixteen patients with HC had sufficient data for inclusion. Wounds treated with CC had a median size of 2 cm² (.25-6.75), and mean duration of treatment 25 days. Sixty-six percent had surgical wounds, 6% burns, 28% chronic wounds. The median size wound treated with HC was 5.3 cm² (0.5-225), and mean duration of treatment was 23 days. Thirty-eight percent were burns, 19% surgical, and 43% chronic wounds. Reduction in wound area was 57% for CC treatment, 87% for HC treatment (ns). Reduction in length and width was greater for HC (p. < .05). Three CC-treated wounds required treatment for infection, while none of the HC-treated wounds did.

Conclusion

In this retrospective chart review, topical 1% hydrocortisone treatment resulted in wound size reduction comparable with those treated by chemical cautery. No infections were associated with the hydrocortisone treatment. Further study of hypertrophic granulation treatment is indicated.