When observing a healing injury, the sight of new, bumpy, reddish tissue can cause concern, particularly when people wonder if this material, known as granulation tissue, is meant to flake or “fall off.” Understanding the specific function and progression of this tissue is key to recognizing a healthy wound. Granulation tissue is a temporary, foundational structure, and its presence indicates that the body has moved past the initial inflammatory response and into the active rebuilding phase.
What Granulation Tissue Is and Its Role
Granulation tissue is a temporary, specialized tissue that forms to fill the void created by a full-thickness wound, which extends through the dermis. This tissue is typically bright pink or beefy red, moist, and has a distinct granular or bumpy texture. The granular appearance comes from the dense network of newly formed capillary loops (angiogenesis), which supplies the rebuilding site with oxygen and nutrients.
The primary components of this temporary matrix are new, thin-walled capillaries, fibroblasts, and a loose extracellular matrix. Fibroblasts are cells that begin synthesizing collagen, initially a weaker form known as Type III collagen.
This collagen acts as a scaffold to provide structure to the wound bed. This foundational layer physically fills the defect from the base upward and provides a protective barrier against external contamination and infection.
The Fate of Granulation Tissue Maturation and Scarring
Healthy granulation tissue does not detach, slough off, or fall away from the wound bed. This temporary tissue undergoes a process of maturation and remodeling to become permanent scar tissue. This transformation is a gradual biological event that begins once the wound is filled and the edges start to pull closer together.
This phase involves the differentiation of fibroblasts into specialized cells called myofibroblasts. These cells contain contractile fibers that actively pull the wound margins inward, a process known as wound contraction. Simultaneously, the initial Type III collagen scaffold is systematically broken down and replaced by the stronger, more durable Type I collagen.
As remodeling occurs, the wound becomes less vascular, causing the tissue to lose its vibrant red color and become paler and flatter. The process results in a mature scar, which is composed of dense, reorganized Type I collagen fibers. This final, less cellular, and less vascularized tissue achieves a maximum tensile strength of about 80% of the original uninjured skin.
Distinguishing Granulation Tissue from Other Wound Materials
Slough
The confusion about granulation tissue “falling off” often arises because other, unhealthy materials in a wound bed are designed to be shed or removed. Slough is non-viable or devitalized tissue resulting from the inflammatory process. It appears as a stringy, sticky, or thickened mass, ranging from yellow or tan to white.
Eschar
Eschar is composed of hard, leathery, necrotic tissue, typically black or brown. This dead tissue may detach naturally or be surgically removed to reveal the healthy tissue beneath. The presence of either slough or eschar is a sign of tissue death, contrasting sharply with healthy granulation tissue.
Hypergranulation Tissue
Hypergranulation tissue, sometimes called “proud flesh,” is an overgrowth of otherwise healthy granulation tissue. This tissue grows above the level of the surrounding skin, often appearing spongy, very dark red, and bleeding easily. Its excessive nature prevents epithelial cells from migrating across the wound surface to close it. This overgrowth may require specific medical intervention, such as chemical cauterization, to allow the healing process to complete.