Eschar is dry, dead tissue that can form within a wound. It often appears dark, leathery, or crusty, indicating damage to underlying skin and potentially deeper tissues. The approach to its management varies depending on the wound’s characteristics and overall condition.
When Eschar Requires Treatment
Not all eschar requires immediate removal; sometimes, a stable, dry eschar can protect a healing wound. It shields underlying tissue from external contaminants and minor trauma. However, a healthcare professional must assess the eschar to determine the appropriate course of action.
Intervention becomes necessary when signs emerge, indicating the eschar is hindering healing or posing a risk. These signs include the eschar peeling away from wound edges, oozing fluid, or emitting a foul odor. Other signs are redness, swelling, or warmth around the wound, which can suggest inflammation or infection. Pus, fever, or increasing pain also signal a need for prompt treatment.
Common Methods for Eschar Removal
Removing dead tissue, a process known as debridement, is a necessary step in promoting wound healing. One gentle approach is autolytic debridement, which uses the body’s moisture and enzymes to break down necrotic tissue. This method involves applying occlusive or semi-occlusive dressings, such as hydrogels or hydrocolloids, to create a moist wound environment. The moisture helps soften the eschar, allowing phagocytic cells and endogenous enzymes to liquefy the dead tissue.
Enzymatic debridement involves applying a topical ointment with specific enzymes directly to the wound. Collagenase, for example, selectively digests collagen in necrotic tissue without harming healthy granulation tissue. This dissolves the eschar over days or weeks, useful when surgery is not feasible or desired.
Mechanical debridement uses physical force to remove dead tissue from the wound surface. Techniques include wet-to-dry dressings, where wet gauze is applied and allowed to dry before removal, pulling away loose tissue. Hydrotherapy, such as whirlpool baths, also uses water agitation to loosen and remove debris. While effective, mechanical methods can sometimes be non-selective, potentially removing healthy tissue and causing discomfort.
Sharp debridement uses sterile instruments like scalpels or scissors to excise dead tissue. This method allows for precise and rapid removal of necrotic material, reducing the bioburden in the wound. It effectively prepares a wound bed for healing or grafting, requiring skilled practitioners and performed at the bedside or in a clinical setting.
Specialized Surgical Interventions
When eschar is extensive or causes severe complications, surgical interventions may be necessary. Escharotomy is a specialized procedure for full-thickness burns where rigid eschar encircles a limb or torso. Its inelastic nature can act like a tourniquet, constricting underlying tissues, impairing blood circulation (leading to compartment syndrome), or restricting chest expansion (causing respiratory distress).
During an escharotomy, a surgeon makes an incision through the full thickness of the eschar, extending down to the subcutaneous fat. These incisions are made along the long axis of the affected area to relieve pressure, restore blood flow, or allow chest wall movement. This intervention is performed as an emergency procedure to prevent irreversible tissue damage or respiratory failure.
More extensive surgical debridement is required for large, deep areas of eschar, especially for severe pressure injuries or gangrene. It involves removing dead tissue down to healthy, bleeding margins. This procedure is performed in an operating room under anesthesia, often followed by skin grafting or other reconstructive procedures to close the resulting wound.
Holistic Care and Recovery
Beyond the direct removal of eschar, comprehensive patient care is important for successful wound healing. Managing pain associated with the wound and its treatment is a high priority, often requires scheduled analgesics or specific pain management strategies. Adequate pain control improves patient comfort and allows better participation in care.
Controlling or preventing infection is an important aspect of care, especially when eschar is present or has been removed. Topical antimicrobial agents or systemic antibiotics may be prescribed if infection signs or high bacterial colonization risk exist. Regular wound assessments monitor for infection and guide treatment.
Nutritional support plays an important role in the body’s tissue repair and regeneration. Patients with significant wounds, especially those with extensive eschar, often have increased metabolic demands. Adequate protein, vitamins (such as C and A), and minerals (like zinc) are important for collagen synthesis, immune function, and wound closure.
Proper wound dressing and ongoing care are important for recovery. This involves regular wound cleaning, applying appropriate dressings to maintain a moist environment, and protecting new tissue from trauma. In severe cases, after healing, reconstructive surgery may restore function or improve appearance.
Preventing Eschar Formation
Preventing eschar formation is a proactive strategy, especially for high-risk individuals. For those susceptible to pressure injuries, consistent repositioning is key. This involves regularly changing a person’s position in bed or a chair to redistribute pressure and prevent prolonged tissue compression, typically every two hours for bedridden individuals.
Specialized support surfaces, such as pressure-relieving mattresses and cushions, also reduce the risk of tissue damage. These surfaces distribute weight more evenly, minimizing pressure points that can lead to eschar formation. Meticulous skin care, including keeping skin clean and moisturized, further supports skin integrity.
Managing underlying health conditions that impair circulation or healing capacity also prevents eschar. Conditions like diabetes, peripheral vascular disease, or malnutrition increase vulnerability to tissue damage and eschar. Addressing these systemic issues through medical management significantly reduces risk.