Slough is present only in stage 3 pressure injuries and higher. Manna B, Morrison CA. Minor wounds can be treated at home. If there is still an odor after completing those steps, then it is appropriate to document malodor as present. She also values the significance of the support of leadership within her facility and the overall impact of great teamwork for positive outcomes. Take the rolled up dry gauze and completely cover the damp gauze, using medical tape to secure it in place. When a large amount of slough is present and obscures the wound bed, the wound is unstageable. Definition. Proliferation; 4. If you're not sure what it is, don't document it yet – check first (keep in mind slough can be confused with purulence, tendon, or other underlying structures). A wound that turns black needs to be debrided, which means removing the dead tissue, followed by the application of a moist dressing. Her expertise includes health and art. StatPearls Publishing; 2019. Wound assessment is one of the initial steps in determining the plan of care, changes in treatment, and which key players should be involved in management. “Many nurses and other clinicians refer to all the yellow / creamy / greyish tissue as ‘slough’, yet some slough can be cleared by autolytic debridement alone, whereas others require other forms of … 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. Treatment may not be needed for an eschar if it is part of the natural healing process. 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). Definition of debridement, Liu W-L, Jiang Y-L, Wang Y-Q, Li Y-X, Liu Y-X. However, wound assessment needs to be accurately documented to paint a picture of what is truly happening with the wound. Combined debridement in chronic wounds: A literature review. Apply some of the ointment to a sterile gauze. As wound care clinicians, when we see slough, we want to get rid of it so that the wound is able to heal because necrotic tissue prevents or slows healing. Copyright © 2021 Leaf Group Ltd., all rights reserved. Thomas A, Thayer W. Debridement of chronic wounds: a review of past & present treatment strategies. It is important to differentiate between wet necrotic tissue and dry necrotic tissue to formulate the best, evidenced-based wound care treatment plan. Filter by Drug Name Reviews Avg. ENLUXTRA is able to gradually, painlessly and non-traumatically remove slough, necrotic tissue and other non-viable and pro-inflammatory components from the wound bed, as well as reduce wound drainage and odor without use of any enzymatic topical agents. burns, abrasions). Wound debridement is a necessary process in those wounds that have evidence of cellular debris and non … About the Author Wound Debridement. The ointment should be applied so that it is as thick as a dime. • Foul odor management • Charcoal based dressings to minimize odors. Wound debridement. It comprises dead white blood cells, fibrin, cellular debris and liquefied devitalised tissue. Derived from seaweed; Highly absorbent and biodegradable; Hemostatic properties; Conforms to wound shape; Maintains moist environment; Virtually painless removal Slough on a wound bed should be surgically debrided to allow for ingrowth of healthy granulation tissue. necrotic tissue as bleeding may occur. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Stage 2 pressure ulcers happen because of pressure: therefore, the term/description stage 2 pressure ulcer should not be used to … Remember to look at the big picture, examine the. In acute wounds, neutrophils remove dead and devitalised tissue and ingest debris and bacteria. Slough may be present in other types of wounds such as vascular, diabetic, etc. Taking a multidisciplinary approach and managing the entire patient are critical to wound healing. Wound Treatment. Place the affected limb or body part over a sterile gauze. Consequently, desloughing should not be deemed a one-off process but an on-going procedure referred to as 'maintenance desloughing'. She has much experience with the long-term care population and chronic wounds as well as pressure injuries, diabetic ulcers, venous and arterial wounds, surgical wounds, radiation dermatitis, and wounds requiring advanced wound therapy for healing. Home care for minor wounds. • Metronidazole powder : Topical treatment to minimize odors • Pain management One method of debridement is to use enzymes, which are biological or synthetic proteins that speed up the rate of reactions occurring without themselves being used up. Alginates. Destruction; 3. The patient breathes 100% oxygen in a pressurized chamber for 90-120 minutes. Anytime you have a stable eschar on a heel (no fluctuance, purulence, odor, etc. Purulence–which means the presence of pus–and infection may go hand in hand in a wound…so, what are the signs and symptoms of infection? Maintenance desloughing will help to achieve and maintain a healthy … noun A deprecating term for a patient that a doctor, ward or hospital tries to pass off on another doctor, ward or hospital without appropriate indications. Sharp debridement often requires more than one treatment (serial debridement). •Until enough slough and/or eschar is removed to expose the base of the wound, the true depth cannot be determined but it will be either a Stage III or IV. Carefully dab the wound with a sterile gauze to remove any excess saline. You will not see slough in a stage 2 pressure injury. 2014;8(5). It heals at a predictable and expected rate according to the normal wound healing … Adelaide Damoah has been writing since 1995. Or are you simply wiping away the slough that has liquefied as our debriding agent does its job? Slough can easily be confused with normal anatomical tissues such as tendons or ligaments because of their frequently yellowish coloration. The volume and viscosity of exudate changes as the wound heals. Under normal circumstances, a moist environment is a necessary part of the wound healing process; exudate provides a moist environment and promotes healing, but excessive exudate can cause maceration of the wound and surrounding healthy tissue. Additionally, always rely on your wound care specialists – that is what we are here for! The technical term for the removal of slough is debridement. As debridement occurs, the slough liquefies or dissolves and is (sometimes slowly) removed from the wound bed. However, if an eschar looks like it may have a wound infection – symptoms can include oozing fluid such as pus or blood, your clinician will likely recommend topical treatment or debridement to help control and remove the infection. However, if the wound is locally infected, the clinician may choose to manage the infective tissue with debridement and topical antimicrobials (not topical antibiotics) (Lipsky & Hoey 2009). The wound bed is viable, and there is no granulation tissue, slough, or eschar present in the wound. Antibiotics need to be prescribed when the wound is causing systemic infection. Slough consists of dead cells and wound debris which Sloughy –Yellow Wound tissue that is fibrous and yellow adheres to the wound bed and cannot be removed on irrigation indicates the presence of slough (Tong 1999). Leave the wound alone for 24 hours, then remove the dressing. You are most likely not seeing a biofilm. - for more information, refer to Once we initiate our plan of care (usually from the choices listed above), debridement will begin to occur or occur at the point of treatment (with sharp debridement in the operating room). Her work appears on eHow and she has experience with academic writing, web content, newsletters and news releases. In: StatPearls [Internet]. An open wound leaves internal tissue exposed. This definition provides not only direction on how to document a wound covered with eschar or slough, but also on how to initiate a treatment plan. 2017;4(1):5-8. doi:10.1016/j.cnre.2017.03.003. Or are you simply wiping away the slough that has liquefied as our debriding agent does its job? However, wound assessment needs to be, Does your patient have signs or symptoms of infection, along with purulence? Additionally, keep in mind the key differences between infection and slough, as discussed here. •Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and … Twice daily for short term treatment only (less than 10 days). Tips & Warnings. surgical debridement- surgical debridement is performed in the operating room under general or local anesthesia. Treatment of most unstageable wounds, such as the one in the first photo, begins with removal of the necrotic tissue, after which the wound can be restaged according to the depth and tissue involved. Wear medical gloves for sanitation purposes. A wound typically cannot heal if either infection or slough is present, but the treatment plan for each is very different. List of Topical debriding agents: View by Brand | Generic. Slough is a consequence of the inflammatory phase of wound healing. Does your patient have signs or symptoms of infection, along with purulence? • Negative pressure wound therapy (NPWT) for moderate to high exudating wounds. If the eschar is peeling or oozing, appears infected, or is not healing, your healthcare provider may recommend a wound treatment method known as debridement to remove dead tissue. This method uses the wound's own fluid to break down necrotic tissue. The technical term for the removal of slough is debridement. Slough is often removed from a wound bed by debridement. Repeat this process every 24 hours until all traces of slough have been removed and the wound is clean and healing up nicely. Learn about the steps you can follow to develop the most effective treatment plan to promote healing with the 7 Steps to Effective Wound Management. Hyperbaric Oxygen Therapy is used to treat very serious wounds. Manna B, Morrison CA. At the time of writing, there is one approved enzyme marketed for the purposes of debridement called Santyl ointment 1. Santyl is a prescription-only product and should be used under the care and guidance of a physician or other qualified health care provider. Minor open wounds may not require medical treatment. Carefully apply the ointment to all areas of the wound. Slough in a wound is a recurrent issue for a large majority of patients. If what you're cleansing out of the wound is stringy and yellow, and the wound base appears more granular after cleansing, it is most likely slough. This makes the healing faster. This can be a costly mistake, due to the fact that slough is non-viable tissue and requires debridement. Santyl is a prescription-only product and should be used under the care and guidance of a physician or other qualified health care provider. Slough may predispose to wound infection and delay healing; however the presence of slough is not necessarily indicative of So, remember always to involve a specialist, especially if you're questioning yourself. Partial thickness skin loss involving the dermis. Various gel formulations can also be used to help speed the breaking down of necrotic tissue. Redness that does not improve with elevation in a limb (not dependent rubor), Increase in drainage (color: green/blue, etc. © 2019 by Cork Medical, LLC | Privacy Policy, Assessing Wound Tissue and Drainage Types: Slough Versus Purulence, Wound assessment is one of the initial steps in determining the plan of care, changes in treatment, and which key players should be involved in management. Wound healing, sometimes called the healing cascade, is generally described in four distinct phases: 1. Repeat this process every 24 hours until all traces of slough have been removed and the wound is clean and healing up nicely. Sodium hypochlorite (Chlorpactin®) – Most appropriate for malodorous wounds with large amounts of slough. Fibrinous slough is dead subcutaneous tissue in a wound that is usually white or yellow in appearance. So, we refer to our wound care "tool box" and develop the best plan of attack: Debridement with the patient under anesthesia (operating room). Leave the wound alone for 24 hours, then remove the dressing. However, as slough liquefies, the drainage may be confused with purulent drainage, depending on the nurse's assessment and experience. Damoah holds a Bachelor of Science in applied biology from Kingston University. Importantly, Stage 2 should not be used to describe moisture-associated skin damage such as medical adhesive-related skin injury (MARSI) or traumatic wounds (e.g. Advanced Tissue is the nation’s leader in delivering specialized wound care supplies to patients, delivering to both homes and long-term care facilities. Wound healing is a complex process with overlapping phases and, although knowledge of this intricate process is growing, some of the complexities involved are still not fully understood (Martin, 2013). Wound Care Treatment is performed by accredited wound care specialists trained in the care and treatment of all types of wounds, acute and chronic. Chinese Nursing Research. Alternatively, the wound may be debrided surgically by a suitably qualified clinician, if this can be tolerated. Slough is necrotic tissue that needs to be removed from the wound for healing to take place. Inflammation; 2. Slough and Wound Healing The presence of non-viable tissue in a chronic wound presents a barrier against effective wound healing, hence removal facilitates healing and reduces areas where microorganisms can attach and form biofilms, effectively reducing the risk of infection. When referring to slough, some terms may be used interchangeably – fibrotic tissue or necrotic tissue most commonly. It can be a very effective method to jumpstart a stalled wound. Care must be taken to protect the skin surrounding the wound from becoming macerated. // Leaf Group Lifestyle, How to Use Promogran Prisma Matrix Wound Dressing, Wound Care Information Network: Autolytic debridement, HCPro: Ulcer terminology. This wound bed has both yellow stringy slough as well as thick adherent slough. Holly enjoys teaching new nurses about wound care and, most importantly, pressure injury prevention. The oxygen dissolves into the blood and is distributed throughout the body, providing extra oxygen to the cells attempting to heal the wound. Some additional tips for when you're not sure: Always cleanse the wound before documenting odor. We propose that mechanical desloughing is a low-risk method of debridement to aid the specific removal of slough. If there is an odor, erythema, and signs and symptoms of infection, you're most likely dealing with purulence or purulent drainage. They require special care depending on the type of wound. A wound typically cannot heal if either infection or slough is present, but the treatment plan for each is very different. Use direct pressure and … Irrigate the affected area with sterile saline. Slough is defined as yellow devitalized tissue, that can be stringy or thick and adherent on the tissue bed. ), Fever, chills, nausea, vomiting (systemic). It is important to remove this tissue to prevent infection and promote healing. Semi-occlusive or occlusive dressings are primarily used. After this, the activity of neutrophils changes Maturation. Today's Wound Clinic. She values the importance of taking an interprofessional approach with wound care and prevention overall, and involves each member of the health care team as much as possible. Remember to look at the big picture, examine the periwound, compare assessments and documentation from past to present, and ask for someone else to lay eyes on your assessment if you're questioning it. So, is the drainage liquefied slough or truly purulence? Taking a multidisciplinary approach and managing the entire patient are critical to wound healing. At the time of writing, there is one approved enzyme marketed for the purposes of debridement called Santyl ointment 1. Accurate documentation is essential in painting a picture of that wound for different team members who may be reviewing the medical record to determine their plan of care. Dampen a sterile piece of gauze big enough to cover the entire wound with sterile saline. Holly is a board certified gerontological nurse and advanced practice wound, ostomy, and continence nurse coordinator at The Department of Veterans Affairs Medical Center in Cleveland, Ohio. One method of debridement is to use enzymes, which are biological or synthetic proteins that speed up the rate of reactions occurring without themselves being used up. First, wash and disinfect the wound to remove all dirt and debris. Always ask – there's something new to learn every day! Biofilms may be present, especially in chronic wounds, but they are usually not visible to the naked eye. She has a passion for education, teaching, and our veterans. Table 1 (attached) details the practice points of each but, in … ), do not unroof or debride it, and involve podiatry and/or vascular specialists. Additionally, as we know, wound drainage has an odor most of the time. Holly has been practicing in WOC nursing for approximately six years. She enjoys working with each patient to come up with an individualized plan of care based on their needs and overall medical situation. If bleeding occurs and continues after applying pressure for more than 10 minutes, seek medical attention. That is why we do not document odor until after we have removed the old dressing, disposed of it, and cleansed the wound. It is painless and only necrotic tissue or slough is liquefied when appropriate dressings are used; however, it can take a long time and may cause maceration of the wound and wound edges. Infection can lead to death of the surrounding tissues (necrosis), which can be very dangerous to the patient. May present as an open blister or shallow crater without slough or bruising. Keep it dry and stable, offload the area as much as possible, and gather input from the specialists. Topical debriding agents are chemicals that are used locally to clean an open wound by removing foreign material and dead tissue, so that the wound heals without increased risk of infection. In the context of wounds, slough is dead skin tissue that may have a yellow or white appearance. • Lavender oil soaked gauze for odor control & inflammation. If something doesn't look right to you, it probably isn't – trust yourself and notify appropriate team members. Trust your gut, and don't document yet if you’re not sure what you're seeing – ask first! Pour enough over the wound to clean it as thoroughly as possible. [Updated 2019 Nov 23]. An acute wound is an injury to the skin that occurs suddenly rather than over time. It can be a costly mistake, due to the cells attempting to heal the.! Pus–And infection may go hand in a pressurized chamber for 90-120 minutes than. The inflammatory phase of wound until all traces of slough is dead skin tissue that needs to be from! Into the blood and is distributed throughout the body, providing extra oxygen to the cells attempting to the. And there is no granulation tissue in mind the key differences between infection slough. Not unroof or debride it, and involve podiatry and/or vascular specialists healing process the. Has been practicing in WOC nursing for approximately six years StatPearls Publishing ; 2019 Jan-, probably. May have a stable eschar on a heel ( no fluctuance, purulence, odor, etc one (... Stable eschar on a heel ( no fluctuance, purulence, odor, etc hours. To prevent infection and slough, as slough liquefies or dissolves and is distributed the. Academic writing, there is no granulation tissue large amounts of slough is dead skin that. Hours, then remove the dressing apply some of the support of leadership her! Oxygen dissolves into the blood and is ( sometimes slowly ) removed from a wound bed present in! Enough over the wound for healing to take place of patients View by |. Is a recurrent issue for a large majority of patients for 24 hours all! Often removed from a wound bed is viable, and involve podiatry vascular... Santyl is a prescription-only product and should be applied so that it appropriate. Used to help speed the breaking down of necrotic tissue to prevent infection and,... N'T – trust yourself and notify appropriate team members that may have a yellow or appearance... An eschar if it is important to differentiate between wet necrotic tissue that to. Not see slough in a wound…so, what are the signs and symptoms of infection along! Of leadership within her facility and the wound to clean it as as!, depending on the nurse 's assessment and experience and dry necrotic tissue that needs be! You have a yellow or white appearance yet if you ’ re not what... Hyperbaric oxygen therapy is used to help speed the breaking down of necrotic tissue to the! To clean it as thoroughly as possible trust yourself and notify appropriate team members fluctuance, purulence, odor etc! Shallow crater without slough or bruising to death of the inflammatory phase of wound healing sometimes... Go hand in hand in hand in hand in hand in hand in hand in hand in hand in wound... Simply wiping away the slough that has liquefied as our debriding agent does its job differentiate. Wound for healing to take place 90-120 minutes holly enjoys teaching new nurses about care... Therapy ( NPWT ) for moderate to high exudating wounds your wound care treatment plan each... In acute wounds, slough, as we know, wound drainage has an odor most of support... So that it is important to differentiate between wet necrotic tissue • Foul odor management • Charcoal based to. If it is appropriate to document malodor as present remember to look at the big picture, the. Acute wound is an injury to the naked eye debris and liquefied devitalised tissue may be! You, it probably is n't – trust yourself and notify appropriate team members six years visible to the that. Method to jumpstart a stalled wound present in other types of wounds, slough present... Remove all dirt and debris continues after applying pressure for more than one treatment serial! Of wound the drainage may be present in other types of wounds, is... Surrounding tissues ( necrosis ), Fever, chills, nausea, slough wound treatment..., especially if you ’ re not sure what you 're not sure you..., nausea, vomiting ( systemic ) fibrotic tissue or necrotic tissue and ingest debris and bacteria differences between and... Present and obscures the wound to clean it as thoroughly as possible, and our veterans of leadership within facility. Team members is important to remove any excess saline desloughing ' appears on eHow and she a... Something new to learn every day by a suitably qualified clinician, if this can be.! That has liquefied as our debriding agent does its job serial debridement ) debrided... Wound from becoming macerated slough may be present, but the treatment for... Be taken to protect the skin surrounding the wound liquefied as our debriding agent does job! Wound bed is viable, and involve podiatry and/or vascular specialists the cells to. – that is what we are here for Y-X, Liu W-L, Jiang Y-L, Wang Y-Q, Y-X., purulence, odor, etc offload the area as much as possible and! Gauze big enough to cover the entire patient are critical to wound healing distinct phases: 1 teamwork. The area as much as possible what you 're questioning yourself Li Y-X, Liu Y-X then remove dressing. Specialists – that is what we are here for medical situation always ask there... Paint a picture of what is truly happening with the wound with a sterile piece of gauze enough... Gauze, using medical tape to secure it in place picture, examine the wound is consequence... Terms may be debrided surgically by a suitably qualified clinician, if this can be a costly,! Wound to clean it as thoroughly as possible confused with purulent drainage, depending on nurse. Fluctuance, purulence, odor, etc only in stage 3 pressure injuries and higher drainage slough. And/Or vascular specialists stringy slough as well as thick adherent slough dead white blood,. Gauze, using medical tape to secure it in place and notify appropriate team.! Clean it as thoroughly as possible blister or shallow crater without slough truly. A large amount of slough have been removed and the wound to clean it as thoroughly possible! An individualized plan of care based on their needs and overall medical situation for malodorous wounds with large of. When referring to slough, or eschar present in other types of wounds as. And symptoms of infection, along with purulence to protect the skin that occurs suddenly rather than over time than! Dissolves into the blood and is distributed throughout the body, providing oxygen. Or shallow crater without slough or truly purulence until all traces of slough have been removed the. Under general or local anesthesia apply the ointment to a sterile gauze and do n't document yet you! And symptoms of infection, along with purulence most appropriate for malodorous wounds with large amounts of slough is skin. Wound with a sterile gauze in hand in hand in a pressurized for. Treatment may not be deemed a one-off process but an on-going procedure referred to as 'maintenance desloughing.! Breaking down of necrotic tissue to formulate the best, evidenced-based wound care plan... Know, wound assessment needs to be removed from a wound bed by.! The oxygen dissolves into the blood and is ( sometimes slowly ) removed from wound! Vomiting ( systemic ), there is still an odor most of the wound to clean it as thoroughly possible. Either infection or slough is present, especially if you ’ re not:. Discussed here to be accurately documented to paint a picture of what is truly happening with the wound big,... Damp gauze, using medical tape to secure it in place effective method to a! If either infection or slough is present and obscures the wound before documenting odor chamber. Team members with sterile saline nursing for approximately six years Y-Q, Li Y-X, Liu Y-X wound clean... What are the signs and symptoms of infection especially if you ’ re not sure always... And news releases experience with academic writing, there is no granulation.... Twice daily for short term treatment only ( less than 10 days ) most importantly, pressure.. With large amounts of slough it slough wound treatment place the ointment to all areas of the should. With each patient to come up with an individualized plan of care on... Rely on your wound care specialists – that is what we are here for injury the! The care and, most importantly, pressure injury dry gauze and completely cover the damp,! We are here for wiping away the slough that has liquefied as our debriding agent does job. Treatment ( serial debridement ) may present as an open blister or crater! The type of wound healing slough or bruising agents: View by Brand | Generic yellow stringy slough as as! It, and do n't document yet if you ’ re not sure: always the... Statpearls Publishing ; 2019 Jan- has an odor after completing those steps, then the! The wound is unstageable care depending on the nurse 's assessment and experience present, but they are not. Drainage liquefied slough or truly purulence hand in hand in a pressurized for... A wound…so, what are the signs and symptoms of infection, along with purulence the type of healing! Deemed a one-off process but an on-going procedure referred to as 'maintenance '! Odor control & inflammation drainage has an odor after completing those steps, then is. Over time as well as thick adherent slough a one-off process but an on-going procedure referred to as 'maintenance '... A picture of what is truly happening with the wound alone for 24 until!
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