Beauty Biz

DERMAL
NECROTIC TISSUE
WHAT IS IT? WHAT CAUSES
IT? HOW CAN WE HELP?
WHAT IS IT?
By Gay Wardle
Skin tissue that has died is known as necrotic tissue or necrosis of the tissue. Necrotic tissue
can be anything from acute to chronic depending on the surrounding tissue, skin health and
overall wellness of the individual. The circulatory systems also have impact as well as internal
and topical nutrition.
Necrotic tissue varies and is affected by the
consistency of the wound and the adherence
wound bed. As tissue dies, the wound changes
in colour. This happens as necrosis increases
with severity. Initially the tissue colour will be
a whitish/grey and as the consistency increases
the colour will change to light brown or yellow
with a final change to dark brown / black. The
colour becomes darker, the longer the necrosis
continues and increases in severity. In the
early stages the tissue may have a high-water
content and become mucoid, as it becomes
more consistent and progresses it becomes
dry and has a stringy, clumpy appearance. As it
advances, it becomes very dry and hard with a
leathery appearance and feel.
The consistency is related to the wound retaining
moisture in the wound bed. As the wound is
exposed to air, the necrotic debris dehydrates,
hence it becomes leathery, dry and hard. The
level of tissue death can occur in both epidermal
and dermal tissue as well as advancing to
subcutaneous and muscle tissue.
When there is necrosis to subcutaneous, the fat
tissue dies and there is a stringy, yellow slough
formed, whereas necrosis to muscle causes
muscle degeneration and the tissue becomes
thicker and tenacious.
Fat and dermal necrosis and the formation of
slough may be compounded by infection from
previous contamination of normal skin bacteria.
What is slough? The colour is yellow to very
light brown, it is a thin mucous consistency and
at times may appear stringy.
Where there is full thickness destruction to
tissue, eschar is formed. Eschar may be soft or
hard and is a dark brown to black colour and is
more adherent than slough.
When debris such as eschar is embedded in
the wound it is referred to as adherence. As
moisture in a wound decreases and the level
of damage increases, necrotic tissue becomes
more adherent to the wound bed. A wound
will take a long time to heal if there is necrotic
tissue as it becomes a medium for bacterial
growth as well add to this, the barrier function
is severely impaired. With necrosis you have
prolonged inflammation, therefore, you will not
have granulation over the wound site therefore
the wound does not heal.
WHAT CAN BE DONE?
Depending on the severity of the wound and
amount of necrotic tissue will give way to the
treatment protocols. Most of the time eschar
needs to be removed daily where possible, this
is done by debriding and removing the eschar.
There are a number of debridement techniques,
and they will depend on the severity and the
amount of necrotic tissue. Debridement requires
a high level of skill so to not create further
damage to the wound.
Mechanical debridement involves the use of
force to remove the eschar. The most common
types of mechanical debridement would be a wet
to dry gauze dressing, whirlpool action to remove
the tissue and wound irrigation.
Wet and dry gauze are the most common of the
three.
Wound irrigation would be using a syringe filled
with a solution to flush the necrotic tissue, this
is also a good way to remove bacteria from the
wound site.
It is the same with the whirlpool action only this
tends to soften the eschar more so.
In conjunction with the above techniques they
also use enzymes or chemicals which degrade
the eschar. Enzymes will not work on dry,
hardened eschar hence they work well with the
irrigation technique. They seem to take a little
longer to get the results.
The third option is to use a sharp instrument
to cut and remove the necrotic tissue from the
wound site. This technique seems to work faster
with wound healing.
All of these techniques must be performed in a
very clean environment so as to not allow further
bacteria growth in the wound.
The reason for removing necrotic tissue is so
that the wound will eventually heal with hopefully
less scar tissue. It is important that we stay in
scope of practice and all removal techniques are
conducted by a person that is trained and skilled
to do so.
One important factor to remember is the as soon
as the wound bed is clean, the faster the healing
process will happen.
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38 Beauty Biz Year 14 Issue 1