Equis ISSN 2398-2977

Wound: granulation tissue management

Synonym(s): Exuberant granulation tissue management Excessive granulation tissue management Proud flesh management

Contributor(s): Graham Munroe, Rachel Murray, Patrick Pollock

Exuberant granulation tissue

Definition
  • Granulation tissue which is significantly elevated above wound edges and has delayed wound healing.

Problems

  • Impedes wound healing by obstructing epithelial migration and contraction.
  • Commonly affects equine wound healing.
  • May form secondary to arrested contraction and epithelization or may proliferate and contribute to arrested contraction and epithelization.
  • Unsightly.
  • Infected granulation tissue.
  • Trauma.
  • Phycomycoses.
  • Exuberant granulation tissue in wounds selected for secondary closure: creates excessive tension on sutures and leaves a thickened limb.
  • Formation of equine sarcoid within wound.

Factors affecting

Body size

  • Horses with larger body weight and height more likely to be affected.
  • Ponies are almost never affected.

Wound location

  • Exuberant granulation tissue is usually confined to wounds of the lower extremities (from the carpus or tarsus distally).
  • It occasionally develops on the inner aspect of the forearm and gaskin where there is little soft tissue covering the radius and tibia, respectively.

Wound care

  • Anything that delays wound healing can promote the production of exuberant granulation tissue.
  • Frayed and damaged tendons, ligaments and fascia are slow to debride and therefore delay completion of the granulation tissue process.
  • Exposed bone that develops a sequestrum similarly delays granulation process.
  • Mechanical disruption of the granulating wound bed can occur from joint movement and gliding tendons.

Infection

  • Wound infection may contribute to the development of exuberant granulation tissue.

Treatment of exuberant granulation tissue

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Control of exuberant granulation tissue

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Quinn G (2010) Management of large wounds in horses. In Pract 32 (8), 370-381.


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