Eschar is a dark, hardened layer of dead tissue that forms on deep wounds, such as severe burns or pressure ulcers. This necrotic tissue is a natural part of the healing process. However, its eventual separation can lead to bleeding, which often causes concern. Understanding the source and expected timeframe of this bleeding is important for managing the wound and knowing when to seek professional help.
The Nature of Eschar and Bleeding Mechanisms
Eschar is dry, leathery, non-living tissue that forms on the surface of full-thickness wounds, often appearing black or dark brown. Since eschar is dead, it lacks a blood supply and cannot bleed on its own. Bleeding occurs when this dead layer begins to separate from the underlying, viable tissue, known as the wound bed.
Bleeding is an indication that the body is attempting to remove the dead tissue to expose the healthy, highly vascularized granulation tissue underneath. This separation process can happen in two primary ways.
Autolytic debridement is the body’s natural process, where white blood cells and enzymes break down the attachment between the eschar and the living tissue, typically causing only minor seepage as small capillaries are exposed.
The second way is mechanical or surgical debridement, where a healthcare provider manually removes the eschar using sharp instruments or chemical agents. This controlled removal exposes the wound bed fully and may lead to more immediate bleeding. The appearance of fresh, bright red blood is often a positive sign, confirming that the surgeon has reached healthy, well-supplied tissue essential for healing.
Expected Duration and Volume of Normal Eschar Bleeding
Normal bleeding from eschar separation is brief, localized, and involves a small volume of blood. During natural, autolytic separation, a patient might notice only a pink or brownish discharge, which is a mix of blood, wound fluid, and dissolved tissue. This minor seepage is low-volume and is usually absorbed by the wound dressing without soaking through.
Following a dressing change or a minor disruption of the eschar, such as trimming a loose edge, a small amount of bleeding may occur from the newly exposed capillaries. This minor bleeding should resolve quickly, stopping completely within 5 to 15 minutes of applying light, direct pressure. If the wound has undergone sharp debridement by a professional, a brief period of active bleeding is expected but is controlled during the procedure.
If you notice a small amount of fresh blood while managing a wound at home, the primary action is to apply firm pressure to the site for five continuous minutes. Bleeding that persists as a slow ooze or spotting beyond the 5-to-15-minute window should be monitored closely. If the blood flow continues and does not slow down within 30 minutes of consistent pressure, it is considered concerning bleeding.
Warning Signs and When to Seek Immediate Medical Attention
Bleeding that is excessive or prolonged requires professional evaluation. Excessive bleeding is defined as blood that soaks through the primary wound dressing and through multiple layers of reinforcement dressings quickly. This rapid saturation, particularly if it occurs within an hour, is a serious sign requiring immediate medical attention.
Any bleeding that is bright red and spurting or gushing is an emergency, as this indicates a potential arterial bleed rather than capillary leakage. Bleeding that continues without slowing down despite 30 minutes of continuous, direct pressure also warrants immediate medical intervention.
Bleeding is not the only sign of a complication; other systemic symptoms should trigger an urgent call to a healthcare provider. Signs of spreading infection include a fever above 100.4 degrees Fahrenheit, increased warmth or redness extending beyond the wound edges, or a foul odor or pus coming from the wound. Signs of significant blood loss, such as feeling dizzy, faint, or experiencing a rapid heart rate, also indicate a serious issue. These symptoms necessitate immediate medical assistance.