OVERGRANULATION

(A Case Report)

A. Muhammad Reva A.M

 Introduction
Wound healing:
Inflammatory phase: Stop bleeding and preparing places of wounds
starts the healing process.

Proliferation phase/granulation: the wound is rebuilt with new

granulation tissue which is comprised of collagen and extracellular
matrix

Maturation phase : Involves remodelling of collagen from type III to

type I.

Widgerow AD, MBBCh, FCS(SA Plast), et all. Department of Plastic Surgery, University
of the Witwatersrand and Irvine CA, USA 2010
 Over granulation also described as Hypergranulation,
exuberant granulation, hyperplasia of granulation,
hypertrophic granulation or proud flesh

Excess of granulating tissue beyond the amount required to

replace the tissue deficit of a wound

Overgranulation has a high risk of infection

Widgerow AD, MBBCh, FCS(SA Plast), et all. Department of Plastic Surgery, University of the
Witwatersrand and Irvine CA, USA 2010
 A Case Report
Male, 26 years old, with wound at anterior of
chest, shoulder, left arm, left thigh, right thigh
cause of burn injury since oct 2013
 Thorax and left shoulder
region
October 2015, 5th

Plan : Burnazin zalf + STSG at Dec 5 th 2015 STSG after 26 days

Dressing + STSG

Courtesy of dr. Amru Sungkar, Sp.B, Sp.BP-RE

Left upper extremity, October 2015, 5th

Plan: Corticosterid 50 mg inj + Dressing

Corticosteroid inj. after 46 days

Courtesy of dr. Amru Sungkar, Sp.B, Sp.BP-RE

 Both femur region
October 2015, 5th

Plan : Albothyl + dressing + STSG on the right femur at STSG on the right femur
STSG November 2015, 26th after 9 days

Courtesy of dr. Amru Sungkar, Sp.B, Sp.BP-RE

Courtesy of dr. Amru Sungkar, Sp.B, Sp.BP-RE
This patient was died after 3 month therapy
with the cause of death is septic shock
 DISCUSSION
Granulation

Healthy Unhealthy
Red, shiny and no bleed Dark red/blue, growing and exceeding
Epithelization (+) above the skin, bleed easily
Epithelization (-)

Jackie Stephen-Haynes Tissue Viability for Worcestershire Primary Care Trusts and
University of Worcester
 The built of granulation tissue is essentially
that of immature proliferative tissue
consisting of an extracellular matrix of
proteins,such as collagen type III, a precursor
to type I collagen which replaces it as the
tissue matures

Stephen, journal of Reconstructive & Aesthetic Surgery (2014)

 Continued minor trauma or pressure, excessive
inflamation, infection process bleeding and
exudate moist overgranulation

Low oxygen levels and high moisture can

stimulate granulation tissue formation

Widgerow AD, et all. a Department of Plastic Surgery, University of the

Witwatersrand and Irvine CA, USA 2010
 Wound Management
Non Operative

Antibiotics topical

- Burnazine (Silver sulfadiazine): broad antimicrobial

activity; it is active against gram-positive and gram-
negative bacteria as well as some yeasts and fungi

- Albothyl consist of policresulen (metacresolsulfonic

acid and methanol) : local haemostatic, cleansing
and tissue regeneration in burns, wounds, chronic
inflammatory processes

Louise Brown, Hypergranulation, Armadale Health Service. March 2011.

 Wound Management
Non Operative
Corticosteroids
Reduces the cell division
and production of
granulation tissue and to
promote collagen
breakdown
This method of treatment is
rarely successful.

Moir J, et all.Haelan Tape for the treatment of overgranulation tissue. Wounds UK 2007
 Wound Management
Non operative
Silver nitrate : inhibit the process
of proliferation of fibroblasts and
functions as a strong oxidizing
agent and can take off free
radicals, it reacts with organic
material oxidizes, coagulation of
tissue and eliminate bacteria.
Moir J, et all.Haelan Tape for the treatment of overgranulation tissue. Wounds UK 2007
 Wound Management
Non operative
Dressing :low oxygen levels and high moisture
can stimulate granulation tissue formation
vapour permeable dressings (increased
oxygen) with low moisture (absorbent
dressing) to replace any occlusive dressing
that may have been used

Moir J, et all.Haelan Tape for the treatment of overgranulation tissue. Wounds UK 2007
 Wound Management
Operative

Excision : granulation tissue is very delicate, and

easily bleeding Debridement in surgical action
is an option and this should only be done by a
surgeon to excise granulation tissue can make
bleeding and infection.

Widgerow AD, MBBCh, FCS(SA Plast), et all. Department of Plastic Surgery, University
of the Witwatersrand and Irvine CA, USA 2010
 Wound Management
Operative

Skin graft
If the overgranulation wounds had a good
capillary blood vessels. (appears pink as well
as not easily bleed when touched and without
pus)

Widgerow AD, MBBCh, FCS(SA Plast), et all. Department of Plastic Surgery, University
of the Witwatersrand and Irvine CA, USA 2010
 Overgranulation Management Flow Chart
Ramstadius B, Blanchfield D, (2009) Common treatments for hypergranulation
 CONCLUSION
Male, 26 years old, with overgranulation
wound at chest, shoulder, left arm, left thigh,
right thigh cause of burn injury since oct 2013
Wound management for this case are
Burnazin zalf, corticosteroid inj, albothyl,
dressing and skin graft
Skin graft is still one of the methode of choice
with the good result
THANK YOU