How does granulation tissue look like

Matrix metalloproteinases MMPs , which are so helpful in removing damaged tissue and bacteria from the inflammatory phase, have started to allow the formation of new blood vessels at the wound bed.

The number of MMPs is now starting to drop, which is a good thing because chronic MMPs can actually cause degradation of healthy proteins and growth factors and may delay healing. Cytokines, which are cells that are triggered by macrophages, are starting to increase in numbers and are telling the fibroblasts to get to work to start forming new tissue and blood vessels.

You will also likely see a reduction in the four classic signs of inflammation: edema and erythema of the periwound, pain, and heat, which also indicate that the wound is progressing into the proliferative phase of healing. Hypotrophic Granulation Tissue There are several variations of granulation tissue that you may encounter. You may find that the wound is filling in with new tissue; however, unlike the classic moist, beefy red tissue, it may appear smooth, pink, or even slightly pale.

This is hypotrophic granulation tissue. I think of this as a wound that is desperately trying to heal, but something is standing in the way. It indicates poor perfusion and often is caused by pressure, poor circulation, trauma, or infection. Make sure to offload any pressure, evaluate for potential trauma, and assess for and treat infection if present. This should help to alleviate hypotrophic granulation tissue and allow for healthier granulation tissue to develop.

Hypertrophic Granulation Tissue Another type of granulation tissue that you will likely observe is hypertrophic granulation tissue. I think of this as granulation tissue growth on overdrive. It will still have that classic moist, beefy red appearance, but it will be raised above the surface of the wound. This will prevent the migration of epithelial cells across the center of the wound and will hinder healing.

It is often a sign of excessive moisture or even infection, so make sure that you evaluate for this. After assessing for and treating these factors, some other interventions that you may consider are:.

You may be wondering whether there are any interventions that you can implement to help encourage the formation of granulation tissue. You can help encourage the proliferation of granulation tissue by:. With these factors in mind, once you do start to observe granulation tissue formation, it is important to ensure that the wound is protected. This is a good time to start applying a collagen dressing or, for deeper wounds, negative pressure wound therapy.

Hypergranulation or proud tissue is an overgrowth of granulation tissue above the height or border of the skin edge. It is unclear why this process actually happens in wounds. Hypergranulation tissue is usually friable and bleeds and must be dealt with. Wounds cannot heal with hypergranulation because it limits the ability for epithelial cells to migrate across the wound bed and lay down collagen and epithelium. As shown left, application of silver nitrate to the tissue bed cauterizes the hypergranulation tissue and causes it to regress.

The picture on the left is post application of silver nitrate. Wounds may also be debrided to remove the hypergranulation tissue. As wounds heal, epithelium forms on top of granulation tissue. In the wound pictured to the left, a large area of epithelium has formed where there was previously a large open sacral ulcer. What if the white stuff near your wound doesn't look like tissue? Make a quick call to your dentist if you have any concerns about the healing process, especially if you experience pain.

The "white stuff" you see could also be one of the following:. Wounds inside the mouth tend to heal more quickly than wounds elsewhere on the body.

Still, oral wounds can sometimes heal improperly. Look out for these issues:. Be on the lookout for persistent inflammation, unpleasant smells, white or yellow pus, a reopened wound, or dead tissue. If you experience any of the conditions listed above, contact your dentist immediately for treatment. Wounds inside the mouth might feel uncomfortable, but with the right care, they will heal quickly.

Follow your dental professional's instructions for cleaning and protecting your oral wound if you receive an injury or undergo an operation. The formation of granulation tissue — with the absence of pain — is a great sign that the wound is healing properly. This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment.

Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Shop Now. Our Mission. Contact Us.

United States US English. Submit an Idea. Once malignancy is ruled out, these are different conditions that can trigger overgranulation in the wound bed:. Given the paucity of research work in this area, there is no standardized management of overgranulation in chronic skin wounds.

Different treatments have been suggested based on small case series, but well-designed clinical trials are needed to determine and compare their usefulness. Here you can find a summary of the available alternatives according to the suspected triggering problem:. What is your experience? How do you handle overgranulation in the wound bed? Save my name, email, and website in this browser for the next time I comment. All publications General concepts Types of wounds and pathophysiology Conventional treatment Advanced therapy Venous ulcers Clinical cases.