The term “proud flesh” is commonly used in veterinary medicine, especially for wound healing in horses. In human medicine, this problematic tissue overgrowth is known by a different name. This condition is a complication where tissue generation becomes excessive and counterproductive to the natural healing process. This article defines the human medical condition analogous to proud flesh, explains why it occurs, and details the current management strategies.
The Medical Terminology for Excessive Tissue Growth
The medical term for what is colloquially called proud flesh in humans is hypergranulation or overgranulation. Granulation tissue is a normal and necessary part of the body’s repair mechanism, forming during the proliferative phase of wound healing. This tissue is composed of new connective tissue, tiny blood vessels, and fibroblasts that fill the defect in a wound healing by secondary intention. Healthy granulation tissue typically appears pink or bright red, has a bumpy texture, and remains flush with the surrounding skin surface, providing a stable bed for new skin to grow over.
Hypergranulation is an excessive accumulation of this tissue that protrudes above the level of the skin. When the tissue grows too high, it creates a physical barrier that prevents epithelialization, the final step where skin cells migrate across the wound to close it. Visually, this tissue is often described as a raised, beefy-red or dark purple mound that may look shiny or moist. A defining characteristic is its friability, meaning it bleeds very easily upon light contact or during routine dressing changes.
This raised, exuberant tissue signals that the wound’s microenvironment is dysfunctional and the healing process has stalled. The overgrowth traps the wound in the proliferative phase, preventing it from transitioning into the final maturation phase. Proper identification is necessary because this tissue, while resembling healthy tissue, actively inhibits the wound from achieving complete closure.
Mechanisms Driving Overgranulation
Hypergranulation develops when biological signals controlling tissue growth become unbalanced, leading to a prolonged inflammatory response. The continuous presence of inflammation overstimulates the production of fibroblasts and the formation of new blood vessels (prolonged fibroplasia and angiogenesis). This sustained stimulation results in the overproduction of the connective tissue matrix, causing the characteristic mound of excess tissue.
A frequent trigger for this overgrowth is excessive moisture or maceration in the wound bed, often caused by high levels of wound fluid (exudate). This constant wetness disrupts the balance of growth factors needed for normal healing and promotes overproduction of granulation tissue. Chronic infection or a high microbial burden within the wound can also lead to persistent inflammation, keeping the inflammatory cascade running and resulting in tissue overgrowth.
Foreign bodies, such as retained suture fragments, deep debris, or the persistent presence of a feeding tube or drain, also act as irritants. The tissue around these irritants reacts defensively, leading to an exaggerated tissue response. Wounds subjected to continuous mechanical irritation, like excessive friction or pressure from ill-fitting dressings, are also at a higher risk of developing this issue.
Management and Treatment Strategies
Effective management of hypergranulation requires reducing the excessive tissue and addressing the underlying cause of the overgrowth. Controlling the moisture level in the wound is a foundational step, often involving switching to highly absorbent dressings to manage exudate and prevent maceration of surrounding skin. Reducing moisture helps restore the proper chemical signaling environment necessary for healing to progress.
For direct reduction of the raised tissue, chemical cautery with silver nitrate is a common and effective non-invasive treatment. Silver nitrate is applied to oxidize and destroy the excess cells, which helps flatten the mound and allow epithelial cells to migrate. Another approach involves topical corticosteroids, such as triamcinolone or hydrocortisone cream, which suppress the localized inflammatory response driving the tissue overgrowth.
In cases where the tissue is dense or unresponsive to chemical or topical treatments, more invasive methods are used. This may involve sharp debridement, where a healthcare provider uses instruments like a scalpel or scissors to remove the excess tissue down to the level of the surrounding skin. Compression therapy may also be beneficial for wounds prone to swelling, as it helps reduce local edema that contributes to the overgrowth. Ultimately, long-term success relies on identifying and eliminating the root cause, such as treating an underlying infection with appropriate antimicrobial agents.