Necrotic tissue that is present in a wound bed causes a physical obstruction to healing. Simply put, wounds cannot heal when necrotic tissue is present. In this article, we’ll define necrotic tissue and describe ways to effect its removal from the wound bed.
What is necrotic tissue?
Necrotic tissue is dead or devitalized tissue. This tissue cannot be salvaged and must be removed to allow wound healing to take place. Slough is yellowish and soft and is composed of pus and fibrin containing leukocytes and bacteria. This tissue often adheres to the wound bed and cannot be easily removed. Eschar is black, dry and leathery and may form a thick covering similar to a scab over the wound bed below it.
Necrotic tissue comprises a physical barrier that must be removed to allow new tissue to form and cover the wound bed. Necrotic tissue is a vital medium for bacterial growth, and its removal will go a long way to decreasing wound bioburden.
Managing necrotic tissue
Necrotic tissue must be removed. How can this be accomplished? There are several methods to remove necrotic tissue:
- autolytic debridement- autolytic debridement leads to softening of necrotic tissue. It can be accomplished using dressings that add or donate moisture. This method uses the wound’s own fluid to break down necrotic tissue. Semi-occlusive or occlusive dressings are primarily used. Various gel formulations can also be used to help speed the breaking down of necrotic tissue. Care must be taken to protect the skin surrounding the wound from becoming macerated. Autolytic debridement should not be used (or should be used with great caution) on diabetic wounds or wounds caused by arterial insufficiency.
- mechanical debridement- this method is used less often. It involves the use of wet-to-dry dressings that permit the top layer of devitalized tissue to be peeled away when the dressing is removed. Unfortunately, this method can remove healthy tissue as well. This method may also be more painful for the patient. It requires frequent dressing changes, so this method may not be suitable for all patients.
- sharp debridement- this method involves the trimming away of necrotic tissue using sterile scissors and forceps; it may be done at the patient’s bedside or in a treatment room. Obviously, the clinician performing this type of debridement must have adequate knowledge of debridement technique and anatomy to avoid cutting into vital structures. Sharp debridement often requires more than one treatment (serial debridement). It can be a very effective method to jumpstart a stalled wound.
- surgical debridement- surgical debridement is performed in the operating room under general or local anesthesia. It is used when a large area of necrotic tissue must be removed and clear margins are needed, as may be the case with infection. This method may create a much larger wound, but the wound will be clean and may heal much faster. This method is much more expensive and is usually reserved for large and badly infected wounds.
- larval (maggot) therapy- maggots that have been raised in a sterile environment have been used successfully to debride necrotic wounds. The maggots secrete an enzyme which breaks down necrotic tissue so that it can be ingested by the maggots. The maggots will not consume healthy tissue. Many patients find the mere idea of maggot therapy distasteful- obviously, these patients are not suitable candidates for this type of therapy.
Wounds that have necrotic tissue present will not heal, therefore one of the above methods will be required to remove the devitalized tissue. Removal of necrotic tissue will decrease wound bacterial bioburden and will allow healthy tissue to grow in its place.
If you are considering a career in wound care, visit WoundEducators.com to see how wound care certification can benefit you and your patients.
Source:
Leak, Kathleen. How to… Ten top tips for wound debridement. Wounds International. February 22, 2012.
Looking forward to gaining more experience and knowledge in woundcare to obtain certification. Thank you
Thank you for your interest in in becoming wound certified. Since you are looking to improve your knowledge in advanced wound management, and since wound care certification is your goal, then WoundEducators.com can help you.
The following presentation provides a brief overview of our program: wound care course preview
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“The importance of an Accredited Certification in Wound Care”
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Please let me know if I can be of any further assistance.
What kind of cream should be applied it is a wound that started as a blister most of them have healed but one looks like it is going deeper
Hi, my mum has a necrotic wound on her heel, shes in hospital but all they are doing with it is off loading the pressure by putting her foot in S a foam boot and putting betaine paints on it!, i asked them to try hydrocolloid dressings on it and they wont, shes already lost her right foot becase the hospital she was in befroe this left it, and did nothing, im using antiseptic cream Germaline and after that dries in i put on oxegenated olive oil when they aren’t looking, as i dont think leaving the pressure is right on its own especially since i read this article can someone please give me some advise on what to do
Hi rose, The standard of care for Necrotic dry heal ulcers is as follows:
Intact eschar on the heels should not be removed.
The current standard of care guidelines recommends that stable intact (dry, adherent, intact without erythema or fluctuance) eschar on the heels should not be removed. Blood flow in the tissue under the eschar is poor and the wound is susceptible to infection. The eschar acts as a natural barrier to infection by keeping the bacteria from entering the wound. https://advancedtissue.com/2014/08/appropriate-treatment-black-heels/
I also recommend that she has a consult with a certified wound specialist. You can search for wound specialist in your area here http://portal.abwmcertified.org/ABWMweb/Directory/ABWMcontent/Directory.aspx
I have been to several hospitals and I had an infection on calf and now has a scan that appears to be necrosis and I am and have been on antibiotics and am going to hospital tomorrow itbappears to be a scab like could it be deeper then it appears etc
Hi Tara, I recommend a consult with a certified wound care professional. Best of luck.
it is very useful for nuses who are in clinical setup like us.i hope u will publish other type of wound and management.thank u very much.
Very interesting . Very informative! Thanks!
Does this certification allow nurses to do sharp debridement?
The wound care certification course includes an entire module on debridement, however, your state license determines the actual procedure nurses are allowed to perform.
Hi. What debridement is recommended for a 2yrs old? My niece got a pressure sore on heel due to tight cast. And it is necrotic.
Hi Aii, I recommend a consult with a certified wound care specialist. For a list of specialists in your area visit: http://www.abwmcertified.org/abwm-certified
Best of luck!
Please clarify, there are times when it is best to leave stable eschar in place, correct?
Yes, you are correct. The current standard of care guidelines recommends that stable intact (dry, adherent, intact without erythema or fluctuance) eschar on the heels should not be removed. https://www.advancedtissue.com/appropriate-treatment-black-heels/
also: http://www.woundsource.com/blog/debride-or-not-debride-not-question
Can necrotic tissue surrounding a pain pump eventually cause sepsis? I am confused and it would seem this would occur at come point. Could you explain more about this?
Cathy,
Sepsis is always a concern and should not be treated lightly. We recommend a specialist evaluate the wound to determine the best plan of action. Find one in your area here: https://portal.abwmcertified.org/ABWMweb/Directory/ABWMcontent/Directory.aspx
Best of luck!
I have necrosis cell in neck area ?? What should i do?
Manisha, We recommend finding a wound care specialist ASAP. Search for a wound specialist in your area here: https://portal.abwmcertified.org/ABWMweb/Directory/ABWMcontent/Directory.aspx