The G Word

Artwork: “Persistent Colour” by Kathryn Lean

Clinical education specialist Robyn Wortel gives us the low-down on a very common stoma issue – granulation tissue – and how to wave it goodbye.

WORDS // ROBYN WORTEL

Granulation tissue has a few names. It could be called granulation. It could be called hyper-granulation. It could be called proud flesh – which always makes me think of it standing up there proudly, like Captain America.

It all means the same thing, which is a proliferation of cell growth coming from within the stoma tract itself. That proliferation is the body’s way of trying to heal itself, because the stoma is not a natural body opening – it’s a created opening – and the body is clever in trying to heal things that it thinks shouldn’t be there.

While the jury is out on the precise cause of this phenomenon – and it doesn’t happen in every person, or in any one person all the time – generally, clinicians agree that it seems to be caused by irritation. If a feeding tube doesn’t fit well, chances are it’s irritating the stoma and the stoma is probably going to react and try to protect itself.

The problem with the granulation tissue is that it’s moist, tender and, usually, painful. It will leak, it will stain clothes and it might have a bit of an odour. All of these irritations are really unpleasant and uncomfortable.

So, how do we treat granulation tissue? The answer will come from your healthcare professional, who’ll have their own tips and tricks they like to use.

Here are some of the common approaches that will be in their toolkit:

Find the right fit

First of all, you’ve got to make sure that your tube fits well. If you’ve got a low-profile tube, the stoma needs to be measured for length. If you’ve got a long tube that has a moveable skin disc, you need to make sure that skin disc is sitting approximately 2-4mm above skin level.

If you’ve got a well-fitted feeding

tube, chances are you won’t see a lot of granulation tissue. But if you do happen to have some, you need to treat it. And there are a couple of things that can be done at the discretion of the healthcare

professional who’s looking after you.

Dress to compress

One option for treating granulation tissue is a hydrocolloid dressing applied underneath the skin disc of the tube to apply skin-touch pressure, which helps to flatten granulation tissue. This needs to be applied to that flesh until the red, elevated, excessive tissue has flattened and no longer appears at the mouth of the stoma.

Slather up

Certain topical creams can work, like a hydrocortisone cream, which can be prescribed by the healthcare professional looking after you.

A clinician might also choose to do a hypotonic saline solution – we’re talking about 18 per cent saline, so it’s really, really salty – and that salt helps to draw the moisture out of the tissue.

Feel the burn

Silver nitrate sticks are another option – although they can sting. These burn the granulation tissue away, but you also need to make sure that the good skin around the stoma is protected so that you don’t end up with burnt skin, extending the issue further.

The incidence of granulation tissue is fairly high. Florida-based paediatrician Astrid Leon reported on hypergranulation in children, suggesting it’s the most common complication in paediatric patients.

Meanwhile, alongside her team at Melbourne’s Northern Health, dietitian and nutritionist Emily Farrugia did a systematic review and analysis around hypergranulation, infection and misplacement, finding that one in 10 adults with a gastrostomy will experience a complication related to one of these issues.

In my own experience, more often than not, granulation tissue will arise when a tube isn’t a good fit. So like I said, it’s best to get this right at the start.

This article was made in partnership with Avanos. For easily digestible information about tube-feeding at any age and any stage, visit TubeFed by Avanos.