The wound bed may be covered with necrotic tissue (non-viable tissue due to reduced blood supply), slough (dead tissue, usually cream or yellow in colour), or eschar (dry, black, hard necrotic tissue).
Slough refers to the yellow/white material in the wound bed; it is usually wet, but can be dry, and generally has a soft texture. It can be thick and adhered to the wound bed, present as a thin coating, or patchy over the surface of the wound.
Slough is considered the by-product of the inflammatory phase of wound healing. An essential component of wound bed preparation is the removal of slough from a wound bed. Slough not only contributes to delayed wound healing, it also prevents an accurate wound assessment and can also harbour biofilms.
The process of removing slough from a wound is referred to as 'desloughing'. We propose that mechanical desloughing is a low-risk method of debridement to aid the specific removal of slough. Slough in a wound is a recurrent issue for a large majority of patients.
It is imperative that slough be debrided to kick-start the healing process and allow for the ingrowth of healthy granulation tissue. Keratotic Tissue: In many wounds, hyperkeratosis occurs, which thickens the epidermis. It can cause a rolled or curled-under appearance around the wound edges, called epibole.
We've all heard about slough… most of us have seen it, debrided it, and even watched it change from wet (stringy, moist, yellow) to dry eschar (thick, leathery, black). Slough is necrotic tissue that needs to be removed from the wound for healing to take place.
AIM: Remove slough and absorb exudate. Use hydroactive dressings, or alginate dressings covered by a foam dressing. Primary dressing examples: alginate; hydrofiber; or hydroactive.
There are dressings specifically designed to promote autolytic debridement, which include thin films, honey, alginates, hydrocolloids, and PMDs. Hydrogels and hydrocolloids are additional dressing choices that may be effective in removing slough.
SANTYL Ointment is an FDA-approved prescription medicine that removes dead tissue from wounds so they can start to heal. Proper wound care management is important to help remove non-living tissue from your wound.
Collagenase is used to augment the normal autolytic process the body uses to remove slough from the wound surface.
Slough is a specific type of nonviable tissue that occurs as a byproduct of the inflammatory process. It is more common in chronic wounds and presents as a yellowish, moist, stringy substance. It can delay healing and increase the risk of infection.
Stage 4: Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.
The wound bed may be covered with necrotic tissue (non-viable tissue due to reduced blood supply), slough (dead tissue, usually cream or yellow in colour), or eschar (dry, black, hard necrotic tissue). Such tissue impedes healing.
This can be either: dry and leathery in appearance, known as eschar (Fig 1); or soft and brown, grey or yellow in colour, known as slough. Slough is made up of white blood cells, bacteria and debris, as well as dead tissue, and is easily confused with pus, which is often present in an infected wound (Figs 3 and 4).
Slough will always show signs of stringy textures, yellow coloring, and will be more granular after cleansing. Purulence will always emit an odor after cleansing and will show signs of infection and erythema. When in doubt, consult with the Cork Medical wound care team for further evaluation. Contact us at 866.551.
If any yellow tissue (slough) is noted in the wound bed, no matter how minute, the ulcer cannot be a Stage II. Once there is visible slough in the wound bed, the ulcer is at least a Stage III or greater.
Manuka honey promotes autolytic debridement by drawing water from skin cells via osmosis, which rehydrates, softens and liquefies hard eschar and slough (Wounds UK, 2013; Atkin and Rippon, 2016).
The water activity of honey is less than 0.91 aw, which prevents and controls the growth of bacteria on the wound surface [17,18] and causes fluid flow that flushes slough, debris, and necrotic tissue as well as microorganisms out of the wound.
Owing to the differences in appearance, composition, and formation of slough, the authors propose 4 subtypes of slough—necroslough, leukoslough, fibroslough, and bioslough—to ensure accurate assessment and guide clinicians in choosing the appropriate treatment.
A simple non-sticky dressing will be used to dress your ulcer. This usually needs to be changed 1 to 3 times a week. Many people find they can manage cleaning and dressing their own ulcer under the supervision of a nurse.
Purulent drainage: Purulent drainage, the thickest of the three types, is white, yellow or brown fluid. It indicates that bacteria entered your wound and caused an infection. Infections can be harmful to your body, so this fluid needs treatment.
The presence of slough may indicate the wound is stuck in the inflammatory phase (chronic wounds) or the body is attempting to clean the wound bed in preparation for healing.
Hydrogels are recommended for wounds that range from dry to mildly exudating and can be used to degrade slough on the wound surface. Hydrogels have a marked cooling and soothing effect on the skin, which is valuable in burns and painful wounds.
Disadvantages of hydrogels
Hydrogels cannot absorb large amounts of fluid and therefore are not suitable for very wet wounds which could become macerated and infected. Also, their low mechanical strength makes them liable to tearing easily which may make it difficult for patients to change their own dressings.