Treatment of hypergranulation tissue in burn wounds with topical steroid dressings: a case series

Abstract

Hypergranulation tissue (or also known as overgranulation) may negatively influence burn wound healing time and contribute to recurrence of contractures in burn wounds and grafts. Subsequently, the treatment of hypergranulation tissue remains controversial and problematic. In this case series, we aimed to examine the feasibility and document the use of topical hydrocortisone in the treatment of hypergranulation tissue formation resulting from burn wounds. We report five cases where hypergranulation tissue developed following deep dermal/full-thickness burns. Initial burn wound treatment included necrotic tissue debridement, wound cleansing, and Flaminal(®). All five cases underwent surgical debridement and split-skin grafting. Upon identification of hypergranulation tissue, hydrocortisone acetate 0.25% was applied topically as usual care for the treatment of hypergranulation tissue. All five patients had deep dermal/full-thickness burns with a total body surface area ranging from 22% to 61% and were aged from 3-41 years. All five cases developed hypergranulation tissue during their admission after debridement and split-thickness skin grafts. All patients showed an improvement in the treated areas with a complete regression of hypergranulation tissue and closure of the burn wounds. No clinically apparent local or systemic side effects of the treatment were observed. Topical hydrocortisone can be utilized as an effective, inexpensive, and noninvasive practical option in the treatment of hypergranulation tissue resulting from burn wounds.

Keywords: burns; hydrocortisone; hypergranulation; overgranulation; proud flesh; wound healing.

Figure 1

Case 5. Notes: (A) Hypergranulation tissue to occipital/parietal region prior to treatment with topical hydrocortisone; (B) 5 weeks after treatment regime with topical hydrocortisone acetate 0.25% solution.

Figure 2

Case 4. Notes: (A) Hypergranulation tissue to the right iliac region prior to treatment with topical hydrocortisone; (B) 1 week after treatment regime with topical hydrocortisone acetate 0.25% solution.

Figure 3

Case 1. Notes: (A) Hypergranulation tissue to the left dorsum prior to treatment with topical hydrocortisone; (B) 3 weeks after treatment regime with topical hydrocortisone acetate 0.25% solution.