Search

Hypergranulated wounds from thermal injury remain a complex and debilitating problem for burn patients. Currently, there is no standard therapy to prevent or treat hypergranulation following burn injury. Many centers use topical corticosteroids; however, their use seems to be geographically dependent and controversial. The primary aim of this study was to quantify the current use of topical corticosteroids for post-burn hypergranulation in North America (NA) and Europe, while secondarily assessing for perceptions of safety and efficacy. We designed a survey that was distributed to the members of the European and American Burn Associations. Data was extracted and analyzed using SPSS software. A total of 165 respondents completed the survey (90 and 75 for the European and NA members, respectively). Seventy-one of the 90 (78.9%) European respondents reported they routinely use topical steroids for suppression of hypergranulation tissue in burns, versus 25 of the 75 (33.3%) NA respondents (p<0.001). European respondents, compared to NA respondents, were significantly more likely to consider topical steroid use safe (100% vs. 74.4%, p <0.001) and effective (98.6% vs. 66.7%, p < 0.001) for treatment of hypergranulated burn wounds. There was no significant difference in reported systemic effects seen after topical steroid use when comparing NA respondents and European respondents (6.5% vs. 6.9%, p > 0.10). The results of this study suggest that the use of steroids for hypergranulation tissue in burn care is more prevalent in Europe than NA, which may be due to discordant views on safety and efficacy despite minimal reported adverse effects., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Exuberant granulation tissue (EGT) is a frequently encountered complication during second intention healing in equine distal limb wounds. Although it is still unknown what exactly triggers the formation of this tissue, previous research has revealed a persistent inflammatory response in these wounds. In this preliminary study we examined this inflammatory response in EGT-developing wounds as well as in experimental induced wounds. Immunohistological stainings were performed to detect primary inflammatory immune cells (MAC387 staining) as well as pro-resolution immune cells (CD163 staining). Our results show a significantly higher amount of MAC387+ and CD163+ cells in the fibrotic regions of EGT compared with the 19-day-old experimental wounds. This persistent high amount of fibrosis-promoting CD163+ cells in EGT suggests that the wound healing processes in EGT-developing wounds are arrested at the level of the proliferation phase.

Marie Jaeger,1,* Moti Harats,1,* Rachel Kornhaber,2 Uri Aviv,1 Amir Zerach,1 Josef Haik1,3 1Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel; 2School of Health Sciences, Faculty of Health, University of Tasmania, Sydney, NSW, Australia; 3Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel *These authors contributed equally to this work. 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: hypergranulation, overgranulation, proud flesh, burns, hydrocortisone, wound healing

Proud flesh is composed of excessive granulation tissue in an exuberant manner. A grey female horse aged about 4 yrs was presented with chronic wound along with proud flesh at buttock region. Initial treatment was refractory. The proud flesh was trimmed surgically and Topically Haemocoagulase solution and tincture Iodine solution was applied. Post operatively parenteral antibiotic, anti-inflammatory and oral Serratopeptidase are administered. Alternative day wound dressing was followed with lukewarm normal saline, Liquor Acriflavin (0.01%) and TCDO (Tetrachlorodecaoxide) and wound bandage was done with boric ointment impregnated gauge and cloth bandage. Cicatrix formation was completed by 42nd day.

Two equines with exuberant granulation tissue at dorsal hock region and granulation mass firmly attached to skin at dorsal fetlock region were presented. Surgical resection of granulation mass was attempted in one while another was treated medically with topical astringents. Both horses recovered uneventfully without relapse of granulation tissue. [ABSTRACT FROM AUTHOR]

Simple Summary: Horses are prone to develop a wound healing disorder on their limbs called exuberant granulation tissue (EGT). The exact mechanism for the formation of this tissue remains unknown but the inflammatory response is supposed to be an important contributing factor. In this article, we investigated this inflammatory response in both EGT wounds as well as in control horse wounds. In biopsies, we detected two types of immune cells: (1) immune cells involved in early inflammation (MAC387+ cells) and (2) immune cells important in the later phases of inflammation (CD163+ cells). We detected a higher number of immune cells in EGT wounds compared with the control wounds of 19 days old. This suggests that EGT wounds may not be able to proceed through further phases in the wound healing process or that the inflammation phase is prolonged. Exuberant granulation tissue (EGT) is a frequently encountered complication during second intention healing in equine distal limb wounds. Although it is still unknown what exactly triggers the formation of this tissue, previous research has revealed a persistent inflammatory response in these wounds. In this preliminary study we examined this inflammatory response in EGT-developing wounds as well as in experimental induced wounds. Immunohistological stainings were performed to detect primary inflammatory immune cells (MAC387 staining) as well as pro-resolution immune cells (CD163 staining). Our results show a significantly higher amount of MAC387+ and CD163+ cells in the fibrotic regions of EGT compared with the 19-day-old experimental wounds. This persistent high amount of fibrosis-promoting CD163+ cells in EGT suggests that the wound healing processes in EGT-developing wounds are arrested at the level of the proliferation phase. [ABSTRACT FROM AUTHOR]

Wound healing in horses is complicated by the excessive growth of granulation tissue, commonly known as proud flesh and is similar to keloids in human beings. At present, there is no satisfactory treatment for proud flesh in horses. In this study, we, for the first time, demonstrated that leaf extract of Aerva javanica suppresses excessive growth of granulation tissue in horses. Many plant flavonoids are claimed to have antiproliferative properties. Kaempferol is a natural flavonoid containing 3-hydroxy flavone backbone found in many plants in its aglycone form and attached with various sugars. Ecdysteroids are steroidal analogs of invertebrate steroidal hormones found in plants. Both flavonoids and ecdysteroids accumulate more in plants during abiotic stress. We hypothesized that Aerva javanica may have high levels of ecdysteroids and kaempferols for surviving in stressful conditions of desert. Those kaempferols may suppress the growth of granulation tissue by their antiangiogenesis property. Ecdysteroids may control the larvae of habronema if associated with proud flesh. Extract was prepared using solvent-based fractionation and silica gel column flash chromatography. Application of the leaf extract in horses suppressed growth of granulation tissue along with restoration of normal skin function. Various purification steps and mass spectrometry were used to identify the active components in the study. • Clinical cases of excessive growth of granulation tissue in horses were successfully treated by using topical application of leaf extract of Aerva javanica. • Kaempferol and its derivatives were identified as probable active principle. [ABSTRACT FROM AUTHOR]