Hypertrophic granulation tissue refers to abnormal wound healing due to an aberrant inflammatory response, resulting in overgrowth of granulation tissue. There are 3 phases during normal wound healing: the inflammatory, proliferative, and remodeling phases. The formation of granulation tissue occurs during the proliferative phase at days 3-5 postinjury. If this process continues without the migration of epithelial cells across the wound bed, friable, highly vascular tissues known as hypergranulation, overgranulation,
hypertrophic granulation, hyperplasia of granulation tissue, or proud flesh could form. Hypergranulation could result in impaired wound healing, predisposition to infection, and an increased risk of scarring. Hypertrophic granulation tissue is typically not painful or tender.

Risk factors for hypergranulation include healing by secondary intention, excessive moisture, infection or high bacterial burden, reaction to foreign bodies (eg, around stoma or catheter sites), friction, medications (eg, retinoids), and use of occlusive dressing.