Definition: the term esfacelo, describes a mixture of dead tissue.
It presents as deposits of yellow, gray to brownish-white tissue masses that adhere to the ulcer bed in bands of fibrous appearance or in the form of muciform soft tissue.
Among the causes that facilitate the formation of slough we can mention:
1. Due to a wound
A wound caused by trauma or by the action of a cutting object, destroy the skin tissue and blood vessels.
When the subcutaneous contusion is formed, it increases skin tension and reduces blood flow, which delays healing and facilitates the formation of slough.
2. Because of a very stressed suture
A suture made with excessive tension decreases the blood supply and can lead to tissue necrosis.
3. Because of infection
The acute inflammation produced by the infection causes destruction of the tissues, causing the formation of sloughing tissue.
4. Because of excessive pressure
The insufficient mobility that keeps a person in a certain body position, hinder an adequate circulation of blood flow in the tissue under pressure that exerts the bone structure that rests on it.
This pressure when it is punctual produces cell death and necrosis. Likewise, the use of bandages or other compressive devices, not controlled, can lead to the formation of necrotic tissue.
5. Because of pathologies that alter tissue circulation
This cause is observed mainly in people who have arterial occlusive diseases.
Since they develop peripheral vascular disorders that hinder circulation.
Symptoms of Esfacelo
The sloughs, are observed as a flexible, viscous and soft tissue, yellow, can vary from gray to pink.
It is composed of a large amount of fibrin and moisture.
It is common for this tissue to print that it is separated from the deeper skin of the wound, however, when you try to extract it with the tweezers, it is stretched and collected, so it is verified that it is attached to the internal skin of the wound. the wound.
These inflammatory and necrotic tissue remains must be removed to facilitate surgical cleaning and wound healing as they produce effects such as:
- Source of infections: The necrotic tissue is a potential source of infection, since they are formed by cell debris and debris that are excellent for bacterial feeding, and therefore, substrate for its growth and proliferation.
- Prolongation of the inflammatory phase: Because the body tries to eliminate these remains and bacteria in it.
- It prevents the revitalization of the wound: Because it obstructs the contraction and revitalization of the wound mechanically, since it is occupying the place that should fill the new tissue and prevents or delays its development within the healing process.
- Appearance of pathologies that can cause amputation of limbs and even death.
The distinction of the necrotic tissue with respect to the esfacelado tissue, to define the treatment, is made according to its appearance:
Necrotic tissue or eschar, is made up of proteins such as collagen, elastin and fibrin, and even other types of cells and bacteria that form a hard and dried scab, usually is brown, gray or black.
The esfacelado fabric has a structure similar to the necrotic tissue, however, has a greater amount of moisture and fibrin, forming a viscous layer, whitish or yellow, difficult to hold by its flabby and elastic consistency.
There are cases where intermediate stages can be presented between the slit and the necrotic plaque that exist within the same wound.
Treatment for Esfacelo
The goal of treatment is to remove or debride the fibrinous sloughing tissue, control secretions and apply antimicrobial therapy.
In this process, the dead tissue is separated from the living anatomical structures.
To treat a slough it is necessary to eliminate this type of tissue through the debridement method, choosing the most convenient type.
Debridement is usually used as a treatment for this injury. There are several types of debridement and it will be selected according to:
- The situation of the patient.
- The conditions of the injury.
Enzymatic debridement is indicated in cases of sloughs. The mechanism of action is based on the breakdown of protein chains, degrading collagen and fibrin, denaturing elastin.
Separate healthy tissue and dissolve the slough. It should start with a wound cleaning.
The use of enzymatic debridement for the treatment of sloughs has the advantages that it does not damage healthy or newly formed tissues and the edges of the wound can be marred by the effect of humidity.
The main objectives of this procedure are to remove exudates, organic and inorganic waste and metabolic waste that are present in the lesion, facilitate inspection of the lesion and reduce the risk of infection.
Enzyme substances must be applied directly on the area to be debrided, which must be moist and clean, and cured every 24 hours.
This treatment should not be done in conjunction with substances that interact or inactivate the chemistry of the dressing.
It can be considered a microbial therapy or the administration of antibiotics, according to the characteristics observed in the lesion.