An enormous load is placed on the health care system by chronic wounds. In addition to determining the cause of the wound, it is critical to do an accurate wound assessment. The best way to manage a wound is determined by the color, consistency, and texture of the surrounding tissue. Collagen plays a major role in all phases of wound healing. Collagen is a firm, white fiber that serves as the foundation for new tissue. Red blood cells aid in the formation of collagen. The wound begins to heal by forming new tissue known as granulation tissue. Over this tissue, new skin begins to grow. As the wound heals, the borders of the wound pull inward, shrinking the wound.
Epithelialization is the process through which the epidermis regenerates over a damaged surface. The epithelium is a pale pink, pearl-like substance. Epithelial cells migrate outward from the wound margins, creeping across the wound bed to the point of closure. Once the epithelium is formed, it gradually becomes stronger.
The term “eschar” is NOT synonymous with “scab.” Eschar is decomposing tissue that is discovered in a full-thickness wound. Eschar may develop as a result of a burn injury, gangrenous ulcer, fungal infection, necrotizing fasciitis, spotted fevers, or anthrax exposure. The current standard of care recommendations recommends against removing stable undamaged (dry, adherent, and without erythema or fluctuance) eschar on the heels. Blood flow is inadequate in the tissue underneath the eschar, making the lesion prone to infection. By preventing bacteria from accessing the wound, the eschar acts as a natural barrier to infection. If the eschar becomes unstable (wet, draining, loose, boggy, edematous, or red), it should be debrided in accordance with the clinic’s or facility’s policy.
The proliferative phase is when granulation tissue is formed. Granulation that is healthy is pink or red in hue and has an irregular mounded texture. Capillary loops or granulation buds form these mounds. Dark dark granulation is indicative of ischemia, inadequate perfusion, or infection. The proliferative phase will conclude when myofibroblasts assist in wound contraction and epithelial cells begin to resurface across the wound bed. Granulation tissue that is healthy is pink or red in color and is an excellent indicator of healing. Unhealthy granulation is dark darkish red in color, quickly bleeds, and may suggest the presence of infection in the incision.
Hypergranulation refers to excessive granulation or “proud flesh.” Above the regular wound bed surface, the wound tissue will be visible. Hypergranulation is defined by the appearance of bright red or dark pink flesh that is smooth, bumpy, or granular and extends beyond the stoma opening’s surface. It is a common non-life-threatening phenomena.
The term “scab” refers to a crust that has formed as a result of blood or exudate coagulation. Scabs are found on wounds that are superficial or partial in-depth. Scab is a rusty brown, crusty crust that appears within 24 hours of damage on any wounded surface of the skin. The outside surface of this blood clot dries (dehydrates) to produce a rusty brown crust known as a scab, which acts as a cap over the underlying healing tissues. Scabs normally remain firmly in place until the underlying skin is restored and new skin cells emerge, at which point they come off spontaneously.
Slough is non-viable or devitalized tissue that may be fibrinous, sticky, stringy, or thickened. The color varies between yellow and tan. Slough houses harmful organisms, raises the risk of infection, and impairs healing, making debridement treatments necessary. Exposure of live tissue accelerates the healing process.
Wound bed preparation in the treatment of a wound to promote endogenous healing or to improve the efficacy of subsequent therapeutic procedures. According to wound treatment experts, wound bed preparation is an essential idea with tremendous potential as an educational tool in wound management. Once the cause has been discovered, necrotic tissue must be removed to allow wound healing to begin. Unless the eschar is removed, healing will be slowed since healing cannot occur efficiently without a moist wound environment.
The views and opinions stated in this blog are exclusively those of the author and do not reflect iWound, its affiliates, or partner companies.
Future Reading and References
Schultz GS, Sibbald RG, Falanga V, Ayello EA, Dowsett C, Harding K, Romanelli M, Stacey MC, Teot L, Vanscheidt W. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003 Mar;11 Suppl 1:S1-28. doi: 10.1046/j.1524-475x.11.s2.1.x. PMID: 12654015.
Izadi K, Ganchi P. Chronic wounds. Clin Plast Surg 2005;32: 209-22.
Falanga V, Phillips TJ, Harding KG, Moy RL, Peerson LJ, eds. Text atlas of wound management. London: Martin Dunitz, 2000
Grey, J. E., Enoch, S., & Harding, K. G. (2006). Wound assessment. BMJ (Clinical research ed.), 332(7536), 285–288. https://doi.org/10.1136/bmj.332.7536.285
Knowing the Difference Between Scab and Eschar http://www.woundsource.com/blog/knowing-difference-between-scabs-and-eschar