Esfacelo: Causes, Symptoms, Effects, Diagnosis and Treatment

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 the form of muciform soft tissue.


Among the causes that facilitate the formation of sloughs we can mention:

  1. Due to a wound

A wound caused by trauma or by the action of a cutting object destroys the skin tissue and blood vessels.

When the subcutaneous contusion is formed, it increases skin tension and reduces blood flow, delaying healing and facilitating the slough formation.

  1. Because of a very stressed suture

A suture made with excessive tension decreases the blood supply and can lead to tissue necrosis.

  1. Because of infection

The acute inflammation produced by the infection destroys the tissues, causing the formation of sloughing tissue.


  1. Because of excessive pressure

The impaired mobility that keeps a person in a particular body position hinders an adequate circulation of blood flow in the tissue under pressure that exerts on 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 controlled compressive devices can lead to necrotic tissue formation.

  1. 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, dense, 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 wound’s deeper skin; 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:

  • 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, a substrate for its growth and proliferation.
  • Prolongation of the inflammatory phase: The body tries to eliminate these remains and bacteria.
  • It prevents the revitalization of the wound: It obstructs the contraction and regeneration of the damage mechanically since it occupies the place that should fill the new tissue and prevents or delays its development within the healing process.
  • The appearance of pathologies that can cause amputation of limbs and even death.


The distinction between the necrotic tissue concerning the esfacelado tissue to define the treatment is made according to its appearance:

Necrotic tissue, or eschar, comprises proteins such as collagen, elastin, fibrin, and even other types of cells and bacteria that form a challenging and dried scab, usually brown, gray, or black.

The esfacelado fabric has a structure similar to the necrotic tissue. However, it has a more significant amount of moisture and fibrin, forming a dense 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 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.

The dead tissue is separated from the living anatomical structures in this process.

To treat a slough, it is necessary to eliminate this type of tissue through the debridement method, choosing the most suitable kind.

Debridement is usually used as a treatment for this injury. There are several types of debridement, and they will be selected according to:

  1. The situation of the patient.
  2. 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, and 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 advantage that it does not damage healthy or newly formed tissues, and the effect of humidity can mar the edges of the wound.

The main objectives of this procedure are to remove exudates, organic and inorganic waste, and metabolic waste that is present in the lesion, facilitate inspection of the lesion and reduce the risk of infection.

Enzyme substances must be applied directly to the area to be debrided, 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.

According to the characteristics observed in the lesion, it can be considered a microbial therapy or the administration of antibiotics.