Medical Edge Newspaper Column

Treatment of granulation tissue depends on cause, extent of tissue formation

August 7, 2009
Dear Mayo Clinic:
I am undergoing treatment for tracheal stenosis. Please let me know the reasons and medical remedies for fast formation of granulation tissue.

Answer:
In people who have narrowing (stenosis) of the trachea, granulation tissue — the type of tissue the body produces when healing a wound — can cause serious, and sometimes even life-threatening breathing problems. Granulation tissue may form in the trachea due to ongoing physical trauma or because of an underlying medical condition. Treatment usually involves a procedure to remove the granulation tissue, or medication to shrink the tissue.

The trachea (windpipe) is the breathing tube that begins just below the voice box and leads into the lungs. The trachea is made up of pliable cartilage and connective tissue that can expand and contract. Narrowing of this tube (tracheal stenosis) can be caused when tissue within the trachea becomes inflamed due to a medical condition, such as acid reflux. Or, it may be a congenital problem present when a baby is born.

Granulation tissue may form in the trachea, and dangerously block the airway, as a result of treatment for tracheal stenosis. The body makes granulation tissue during the first stage of its healing process. This tissue contains fibrous connective tissue and new blood vessels. This type of tissue often forms quickly — sometimes within several hours, but usually over several days. Because of the blood vessels it contains, granulation tissue can bleed easily. Eventually, granulation tissue may turn into a scar as the body heals, although not always.

In some cases, granulation tissue itself may cause tracheal stenosis. This sometimes happens when a hospitalized patient requires an artificial breathing tube. The breathing tube may rub the inside of the trachea, leading to irritation and causing granulation tissue to form. When the breathing tube is removed, the granulation tissue may block the airway and result in serious breathing difficulties.

Treatment of granulation tissue depends on the underlying cause and the extent of the tissue. If a considerable amount of granulation tissue needs to be eliminated quickly, one option is to remove the tissue surgically with small instruments such as forceps or a soft tissue debrider, a tool that can cut the tissue and suction it away at the same time. Dilating the narrow part of the airway also is an option.

If the need to remove the tissue is not as urgent, medication may be a treatment option. For example, granulation tissue can form due to chronic infection. In that case, antibiotics may help minimize the tissue. At times, excessive secretions or saliva in the trachea can increase granulation tissue, so medications to dry up those secretions can help decrease the tissue. Medications to treat acid reflux, if present, may also reduce formation of granulation tissue in the airway.

Application of topical medications to shrink the granulation tissue can be effective, too.  These medications may include steroids, which can be applied directly to the tissue, or a steroid can be injected just beneath the granulation tissue. In addition, other medications decrease the number of fibroblast cells, which help to create granulation tissue. These medications inhibit fibroblast cells from moving into the affected area.

In patients who require artificial breathing tubes, formation of granulation tissue in the trachea may be avoided if the health care team takes steps to minimize mechanical trauma. For example, ensuring that a breathing tube is properly placed and is the correct size for the patient can minimize excess irritation from the tube and may decrease the risk of granulation tissue formation.

In a situation such as yours, in which the risk of granulation tissue formation in the trachea is increased, your health care team should be vigilant about monitoring your trachea closely to catch any sign of granulation tissue in its earliest stages. If granulation tissue is detected, it often can be effectively treated.

— Shelagh Cofer, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.