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The second abscess has hypergranulation tissue trying to cover over the top. That will actually prevent the epithelial cells from closing in from the edges of the wound by sending chemical signals to the surrounding tissue that tell the epithelial cells they arenβt needed. so it needs to be disrupted by removing it. You can do this in a few different ways; one is to put a temporary pressure dressing on it which will kill the new overgrown tissue where it can be cleaned away or you can use a scalpel to cut it away or silver nitrate stick to cauterize the hyper-granulation tissue. All of these things are usually done by a physician or a certified wound care nurse. On a side note, Hypergranulation tissue is highly vascularized and full of nerve endings and touching, cleaning or manipulating it usually causes excessive bleeding and a lot of pain for the patient. I performed a lot of complicated wound care management during my 35+years as an RN and also have had a severe wound ( minor amputation of the tip of one of my fingers close to the bone.) I went to the ER initially because I was concerned about just how close to boney tissue the wound was and that I might need preventative antibiotics and special dressings that I didnβt have at home. They initially placed a special high tech piece of dissolvable material on the wound that looked and felt like a sheet of flexible styrofoam. I took over dressing changes from there but after a week developed a pad of hyper-granulation tissue that I treated myself with a temporary pressure dressing. It ached and burned like hell for 24 hours until the tissue died along with the nerve fibers inhabiting it. Then happily when I did the dressing change the next day the devitalized tissue wiped away with saline moistened gauzes leaving a fresh healthy wound bed again. My finger healed rapidly from that point but didnβt fill in the amputated area. I guess I was hoping somehow it would regenerate like a lizards tail. I have a decided slant to,that fingertip and because the wound was so close to the bone my fingertip was very tender for about a year due to the loss of protective tissue/ muscle over the bone. Now I have this odd, soft pale white circle over that area that seems to be acting like a protective layer between my skin and the bone end and it doesnβt hurt to touch hard surfaces now. Apologies for the long story.
