If you want to treat a wound (or properly deal with a chronic wound), then you need to understand the underlying pathophysiology of the wound and the overall viability of the tissue. Understanding the viability of the wound tissue is important for managing the wound and figuring out if debridement is necessary. Debride is, of course, the removal of tissue. That goes for any type of wound including, traumatic wounds, pressure injuries, surgical wounds, deep wounds, lower-extremity ulcers, skin tears, burns, and everything in between. You need to accurately assess the wound if you diagnose it and treat it properly. The truth is, debridement is often the best course of action when it comes to helping a wound progress.
What is a Chronic Wound?
A chronic wound is a nonhealing wound that fails to progress. Chronic wounds do not take on a timely sequence of events. Often they get stuck in one part of the healing process and they remain there for a longer-than-normal period of time. During this period the wound doesn’t restore anatomical function, nor does it produce functional results. Often, the method for healing a chronic wound is the removal of tissue. When tissue is removed, the wound often progresses beautifully. Next, here are six examples of chronic wounds that may call for the removal of tissue.
- Devitalized Tissue – Devitalized tissue doesn’t help with wound healing, in fact, it stops it from progressing. This type of tissue is detrimental to healing and must be removed in order for healing to progress. When this tissue is removed it exposes viable tissue. This makes space for granulation and reepithelialization.
- Necrotic Tissue – This is dead tissue that can no longer heal on its own. It cannot be saved or restored and must be removed in order for the wound to heal. If necrotic tissue stays around, it is an actual physical barrier to the formulation of healthy tissue. Removal of necrotic tissue is essential for managing a wound’s bioburden.
- Necrotic Eschars – This results from the death and necrosis of skin tissue. Normally, necrotic eschar is black, hard, and dry. Sometimes it is raised. Necrotic eschars should be removed to make room for new tissue.
- Slough Tissue – Slough happens when the wound gets stuck in the inflammatory phase and slough accumulates, providing a pro-bacterial environment. On the other hand, necrotic tissue happens as a result of blood supply loss. Slough tissue is made up of dead white blood cells, cellular debris, liquefied tissue and fibrin. Slough tissue should be removed to make room for new tissue.
- Keratotic Tissue – This happens when hyperkeratosis occurs and thickens the epidermis. It is marked by a rolling or curling of the wound edges. This is called an epibole. When the epibole develops it is hard and often raised and round. The only solution is debridement.
- Bone and Muscle Tissue – When severe diabetic foot ulcers and other diabetic wounds happen, debridement is often the only solution. Sometimes this extends to the subcutaneous tissue and even bone or muscle.
In an effort to figure out if tissue should be removed, proper wound identification needs to occur. The wound needs to be assessed and at that point your wound care specialist will decide the best course of action. In the case of chronic wounds, debridement or the removal of tissue is often necessary for the wound to continue to heal.
Contact Wound Care OC for wound treatment in Orange County, CA
Dr. Faried Banimahd is a board-certified physician specializing in emergency medicine, wound care, and pain management. Our team will work with you to create an individualized treatment plan that meets your needs and unique conditions. Our clinic includes highly trained and experienced physicians, registered nurses, and certified medical staff who work together to provide you with the highest standards of wound care treatments.