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Wound granulation is an important stage in healing, where an injury fills with a matrix of fibrous connective tissue and blood vessels. This creates a framework for other cell types to grow, filling in the wound and restoring function. Even very large wounds can heal over time if they granulate properly. Caring for wounds includes supporting the development of wound granulation.
Injuries go through three stages of healing. In the initial defensive phase, the body uses clots and other stopgap measures to immediately address the problem. During proliferation, wound granulation starts to occur, cells grow, and the injury closes. Maturation, the final phase, involves the slow smoothing of the wound surface and completion of the healing process.
When an injury is closed, as seen with surgery, there is limited opportunity for granulation. For certain injuries, like surgeries and deep cuts, closing is necessary to protect the patient. In other cases, an open wound healing approach may be recommended. As long as the patient regularly cleanses the wound and allows air to circulate freely, wound granulation can occur from the deepest part up, slowly filling in the area and protecting the body from infection.
This tissue has a very distinctive appearance. It is pink to red, thanks to the proliferation of blood vessels inside, and tends to be moist and soft. Granulation tissue also looks slightly bumpy, explaining the name. Eventually, other cell types will fill it in, and skin will be able to creep over it, closing the wound and leaving some scarring behind.
Some wounds fail to granulate because of infection, recurrent injury, and other issues. In other cases, the wound granulation process goes overboard, and produces an excess of tissue that may protrude from the site of the injury. This is known as proudflesh, and may require medical treatment. If a care provider is concerned about the risk of proudflesh, special bandages may be recommended during healing to control the granulation tissue.
Depending on the nature of a wound, a patient may be able to care for it independently, or assistance may be necessary. Very severe wounds may necessitate hospitalization in the early stages to monitor the patient for infection and other complications. A specialist may supervise wound care to make sure the patient receives the best possible treatment. In some cases, special bandaging and other measures like surgical debridement to remove dead tissue may be required to promote even and safe wound healing.