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What Is Tissue Granulation?

In the process of tissue granulation, healthy tissue replaces damaged tissue at the site of a healing wound.
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  • Written By: Daniel Liden
  • Edited By: Jenn Walker
  • Last Modified Date: 22 September 2014
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Tissue granulation is a process by which fibrous tissue rich with blood capillaries replaces blood clots formed at the site of a healing wound. Through this process, healthy and normal skin is able to replace skin that was damaged. The tissue that forms over a wound during this process is called granulation tissue. The tissue that forms usually has a light pink color and a relatively rough texture; it is also quite moist and tends to be bumpy in appearance. Granulation tends to form inside the base of the wound from which it spreads until it has filled the whole wound.

Extensive tissue granulation generally only occurs when the edges of a wound are not in direct contact with one another. A paper cut, for example, will probably not undergo a significant degree of granulation because there is no need for extensive new tissue to fill the wound. When a significant amount of granulation does occur, it often leaves a visible and wide scar because of the difference between the new and the old tissue.

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There are three main phases to the entire process of wound healing. In the first phase, known as the inflammatory phase, the body's main goals are closing the wound, stopping blood loss, and preventing infection. It usually lasts for two to five days. The second phase is known as the proliferative phase; it tends to last from two days to three weeks depending on the severity of the wound. Tissue granulation occurs in the proliferative phase, during which new, healthy tissue reforms and rebuilds the area of the wound. The final phase of wound healing is the remodeling phase, when the new tissue fully integrates with the old tissue. This phase can take weeks, months, or even years depending on the severity of the wound, and in many cases, complete remodeling is impossible and scars remain behind.

A few types of tissue are involved in the granulation process. The outer layer of the tissue is called the extracellular matrix and is formed from quickly-made structural proteins. There are also immune system cells active within the area, particularly macrophages and neutrophils, which work to prevent infection from infiltrating the wound. Vascular tissue, which carries blood, is essential and forms as a part of granulation tissue with the purpose of carrying a sufficient supply of blood to the newly forming tissue. With these and other components, tissue granulation helps protect and rebuild broken skin.

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TheGraham
Post 4

So, does the tissue being granulated serve any particular purpose, texture-wise? I mean, I know the articles says that the tissue being granulated helps to protect the regrowing skin and flesh, and that cells like macrophages (white blood cells that eat germs) go moving around in there, but does the granulation make that easier?

Or is it like aishia's assuming, and the granulation is caused by how fast the body has grown that skin and tissue to fill in any wounds? This stuff is pretty fascinating, I'm definitely going to read up on it some more.

ahain
Post 3

Granulated tissue is a kind of between phase; it doesn't necessarily always leave a scar. If the person caring for the wound uses good techniques for reducing inflammation and takes good care of the wound, often it will heal up entirely with no scar, even if granulated tissue filled out the area where the skin was lost.

The granulated tissue that most frequently causes scars like aishia was referring to is known as proud flesh. Strange name, I know. proud flesh is basically just an overcompensation by the body; when a wound fills with granulated tissue, sometimes the body creates too much granulated tissue, so the flesh and skin over the wound area bumps up higher than the surrounding undamaged skin.

This is proud flesh, so named because apparently the person who first documented it figured the regrowing granulated tissue was so proud that it stood up higher than the rest of the skin.

SkittisH
Post 2

@aishia - Right, tissue granulation is the result of the body "filling in the blanks" with proteins and other stuff too fast. The resulting flesh is better than having a gaping wound or no skint here, but it's definitely not as good as new.

WiseGEEK, thanks for the informative article -- it's pretty interesting to see how major scars work. I wonder if this information could somehow be used to create some anti-scarring substance that prevents the body from healing up the area so fast with granulated tissue and instead forces it to regenerate slowly so that it doesn't granulate the tissue?

It's certainly food for thought!

aishia
Post 1

Okay, so it sounds like granulation tissue is caused whenever surface skin is lost -- am I right? The same kinds of injuries that can get tissue infections more easily because the injury goes below the surface of the dermis and into the actual flesh are the ones that can get tissue granulation?

If that's the case, then I can think of few things that could cause tissue granulation more than severe burns. I'm guessing tissue granulation is the underlaying foundation for scars to look the way that they turn out looking, and burn victims tend to have serious amounts of scarring. They also tend to lose a lot of skin, and to get a ton of inflammation, which is the step right before tissue granulation.

So, based on all of this stuff, I think it's safe to say that tissue granulation and scarring occur not because of the extensive damage to the body, but because the body repairs it so hastily that it fills in the damaged tissue areas with granulated tissues, which are bumpier and rougher than regular tissue.

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