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What Is Wound Granulation?

Mary McMahon
Mary McMahon
Mary McMahon
Mary McMahon

Wound granulation is an important stage in healing, where an injury fills with a matrix of fibrous connective tissue and blood vessels. This creates a framework for other cell types to grow, filling in the wound and restoring function. Even very large wounds can heal over time if they granulate properly. Caring for wounds includes supporting the development of wound granulation.

Injuries go through three stages of healing. In the initial defensive phase, the body uses clots and other stopgap measures to immediately address the problem. During proliferation, wound granulation starts to occur, cells grow, and the injury closes. Maturation, the final phase, involves the slow smoothing of the wound surface and completion of the healing process.

Wounds may fail to granulate because of recurrent injury.
Wounds may fail to granulate because of recurrent injury.

When an injury is closed, as seen with surgery, there is limited opportunity for granulation. For certain injuries, like surgeries and deep cuts, closing is necessary to protect the patient. In other cases, an open wound healing approach may be recommended. As long as the patient regularly cleanses the wound and allows air to circulate freely, wound granulation can occur from the deepest part up, slowly filling in the area and protecting the body from infection.

Wound granulation is an important stage in the wound-healing process.
Wound granulation is an important stage in the wound-healing process.

This tissue has a very distinctive appearance. It is pink to red, thanks to the proliferation of blood vessels inside, and tends to be moist and soft. Granulation tissue also looks slightly bumpy, explaining the name. Eventually, other cell types will fill it in, and skin will be able to creep over it, closing the wound and leaving some scarring behind.

As long as a wound remains clean and air can circulate freely, wound granulation should occur.
As long as a wound remains clean and air can circulate freely, wound granulation should occur.

Some wounds fail to granulate because of infection, recurrent injury, and other issues. In other cases, the wound granulation process goes overboard, and produces an excess of tissue that may protrude from the site of the injury. This is known as proudflesh, and may require medical treatment. If a care provider is concerned about the risk of proudflesh, special bandages may be recommended during healing to control the granulation tissue.

Surgical debridement and special bandaging are often require to ensure proper wound granulation of severe burns.
Surgical debridement and special bandaging are often require to ensure proper wound granulation of severe burns.

Depending on the nature of a wound, a patient may be able to care for it independently, or assistance may be necessary. Very severe wounds may necessitate hospitalization in the early stages to monitor the patient for infection and other complications. A specialist may supervise wound care to make sure the patient receives the best possible treatment. In some cases, special bandaging and other measures like surgical debridement to remove dead tissue may be required to promote even and safe wound healing.

Mary McMahon
Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a TheHealthBoard researcher and writer. Mary has a liberal arts degree from Goddard College and spends her free time reading, cooking, and exploring the great outdoors.

Learn more...
Mary McMahon
Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a TheHealthBoard researcher and writer. Mary has a liberal arts degree from Goddard College and spends her free time reading, cooking, and exploring the great outdoors.

Learn more...

Discussion Comments

anon275192

After a very deep melanoma removal on my heel, the wound was deep and large. The skin graft did not take. They used a wound vac to start granulation and it eventually filled in almost normally. Not pretty, but I can wear a regular shoe. It's so amazing!

Oceana

It’s amazing how the human body was designed. It can and does heal itself, and wound granulation is evidence of this miracle.

I have seen a wound growing new tissue, and it is a wondrous thing. The body responds rapidly to protect its members, no matter how small. The wound could be on a pinky toe, and granulation would still occur just as quickly.

When I injured myself by falling off a bicycle, my knee had a gaping wound. Fascinated by the healing process, I took photos of every stage, from the time I got home with the fresh wound, through granulation, all the way to maturation.

I used the photos to teach my children about the resilience of the human body. Having a visual really helped me get my point across, and it kept them interested.

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    • Wounds may fail to granulate because of recurrent injury.
      By: dmitrimaruta
      Wounds may fail to granulate because of recurrent injury.
    • Wound granulation is an important stage in the wound-healing process.
      By: Daniel Oines
      Wound granulation is an important stage in the wound-healing process.
    • As long as a wound remains clean and air can circulate freely, wound granulation should occur.
      By: wellphoto
      As long as a wound remains clean and air can circulate freely, wound granulation should occur.
    • Surgical debridement and special bandaging are often require to ensure proper wound granulation of severe burns.
      By: Photographee.eu
      Surgical debridement and special bandaging are often require to ensure proper wound granulation of severe burns.
    • Depending on the nature of a wound, a patient may be able to care for it independently.
      By: MarcoBagnoli Elflaco
      Depending on the nature of a wound, a patient may be able to care for it independently.