Granulation tissue fills dead space, decreases the size of the wound and provides a barrier to external contaminants in wound healing. Sometimes it is impaired by the formation of extreme granulation tissue in conditions like casted or pressure-bandaged wound, accumulated inflammatory cells which result in the production of lactic acid generating low oxygen tension and low-pH environment. Exuberant granulation tissue, commonly known as proud flesh, is a frustrating complication of wound healing. It leads to the development of significant elevation above the wound edges, causing inhibition of epithelial migration. This is mostly seen in the equine species (horses).
A 37-year-old man met with a high-velocity road traffic accident was brought to the Subharti Hospital, Meerut. Examination revealed significant head injury with clinical evidence of pan-facial fracture. Ten days post-trauma, maxillofacial fixation was performed. Postoperatively, a small exuberant growth of soft tissue was noted over the upper lip region which gradually extended to all over the face. Considering the antiangiogenic property of gentian violet stain, it was applied over the lesion subsequently along with intravenous injections of hydrocortisone. The operator later observed regression in the nature of lesion, which is resolved subsequently at the end of 4 weeks.
Definitive management of proud flesh is variable and depends upon the phase of the wound, the extent of granulation tissue and the cosmetic outcome desired. The clinicians should have a thorough understanding of wound healing so that they can apply the specific treatment at a specific time in a specific manner.
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Exuberant granulation tissue
Beta (β)-fibroblast growth factor
Epidermal growth factor
- TGF-α and TGF-β:
Transforming growth factor alpha and beta
Platelet derived growth factor
Insulin-like growth factor 1
Tumor necrosis factor alpha
Basic fibroblast growth factor
Food and Drug Administration
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Dubey, P., Bansal, V., Mowar, A. et al. Proud Flesh: a Complicated Wound Healing—Case Report and Review of Literature. J. Maxillofac. Oral Surg. (2020). https://doi.org/10.1007/s12663-020-01344-9
- Proud flesh
- Complicated wound healing
- Case report
- Hypergranulation tissue
- Exuberant granulation tissue