Identifying and Treating Hypergranulation and Epibole


Wounds should heal in a systematic, regulated fashion. Normal wound healing occurs when the damaged area’s shortfall is filled with granulation tissue as it shrinks. Contraction brings the wound edges closer together. Additionally, the wound begins to resurface as epithelial cells move across it, forming a new epithelial layer to cover the wound.



Hypergranulation sometimes referred to as “proud flesh,” is granulation tissue that has grown above the typical wound bed surface level. It is distinguished by its crimson, friable, wet, and shiny appearance. By rolling the silver nitrate stick’s tip over the injured tissue, hypergranulation can be reduced. As an acute wound, this application method will re-ignite the healing cascade.



Epibole is a common complication of full-thickness wounds. Normally, wounds fill in from the bottom up, while the wound borders pull together as epithelial cells migrate from all directions across the wound surface and meet in the center. When epidermal cells migrate sideways rather than across the wound, the wound margins are rolled or curled under; this is referred to as epibole. Epibole-type wound edges can be treated in a variety of methods to expedite healing.


Treatment Considerations

Silver Nitrate

Silver nitrate is an antibacterial agent that is used to promote anti-inflammatory healing. A silver nitrate stick is a cautery agent composed of 75% silver nitrate and 25% potassium nitrate. When wound fluid is applied to the tip of the applicator stick, a chemical reaction occurs that kills germs, removes necrotic tissue, reduces hypergranulation, inhibits fibroblast development, and coagulates tissue.


Treatment Techniques

  1. Application of silver nitrate to the wound edges
  2. Sharp debridement of wound edges or reinjuring the edges
  3. Debridement mechanically, by abrading the wound edges with a gauze dressing or monofilament fiber dressing.


When feasible, combine debridement procedures to enhance faster healing timeframes. Not all wounds require debridement. Sharp debridement is the most aggressive type of debridement, whereas autolytic debridement is the least aggressive type. The enzymatic approach expedites the inflammatory phase of delayed wounds. When determining the optimal plan of care to fulfill treatment goals, the patient’s health status, wound infection, wound size, wound exudate, and wound location should all be addressed. Because debridement and wound healing can occur concurrently, it is always prudent to take efforts to hasten the healing process.


The views and opinions stated in this blog are exclusively those of the author and do not reflect those of iWound, its affiliates, or partner companies.


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