The slough tissue, or simply slough, it is a mixture of dead cells and inflammatory fluid that is deposited in and around the wounds. It is considered devitalized tissue and is counterproductive in the healing process of ulcers or other similar injuries.
Caution is necessary in the presence of slough tissue. It must be able to differentiate itself from the usual scar lining to avoid surgical removal and thus delay the normal resolution of the wound. Some doctors or health professionals may mistake slough for fibrin, and by eliminating it, they hinder the improvement of the condition.
The appearance of slough tissue is mediated by different factors inherent to the patient himself, the treatment and the environment; it may be related to other signs and symptoms that help make the correct diagnosis. Depending on its origin and the accompanying clinical picture, the appropriate management and treatment will be established..
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More than symptoms, we must talk about characteristics of slough. Some of the most important include the following:
The most common is that it has a yellowish or grayish tone, but it can be found in a wide range of colors. Some authors describe it as brown, black, green, purple and even pink.
It is very soft and flexible, similar to mucus but less firm. This consistency is one of the most important differences with fibrin, which is more solid and rigid..
Both can be attached to deep planes of the wound, but fibrin is more easily detached due to its firmness, as opposed to slough, which stretches and shrinks without detaching..
Fibrin is naturally odorless or has an odor sui generis. When slough tissue is accompanied by infection (which is common) there may be stench, as in any decomposed tissue.
As mentioned above, there are causes inherent to the patient, the treatment, and the environment. Among the most important we have the following:
Certain chronic diseases such as diabetes, hypertension or liver and kidney failure can alter the healing process. In most cases it is due to circulatory disorders, although there are also other causes.
One of the most feared complications of diabetes is angiopathy, which affects large and small vessels. As circulation is altered, many cellular and humoral elements that act in the healing of injuries are unable to reach the affected site, including antibiotics when indicated.
On the other hand, sustained hyperglycemia causes modifications in the cell membrane and in the inflammatory response. The excessive entry of glucose into the cell does not allow its normal functioning. In addition, the erythrocyte loses fluidity and cannot reach the less vascularized tissues..
The loss of elasticity of the arteries as a result of continuous high pressure compromises local blood flow and thus the normal healing process. Some antihypertensive medications negatively affect the response to aggression of certain tissues.
The deficient production of proteins in the liver (mainly transport) compromises the arrival of the healing elements to the affected area.
Other proteins that act directly on the local inflammatory response and at the start of healing are also decreased in quantity and quality, delaying improvement..
Kidney failure inadequately filter certain toxins in the blood, perpetuating their presence and damage in the body. Many medications indicated to help in the non-generation or elimination of slough tissue lose their effectiveness due to kidney damage..
When the wound compromises local circulation due to vascular injury, there is a high risk of tissue sloughing. The same occurs when a hematoma is generated in the area, which presses on the surrounding tissues, decreases blood flow and favors infection.
On some occasions, when the wound allows it, sutures are made to close it. A sloppy technique or the use of inappropriate material can favor the presence of bacteria and infection and, therefore, the appearance of slough tissue.
Pressure ulcers or pressure sores are often a good example of slough tissue. When the patient is not permanently mobilized, the areas where it rests can be damaged by circulatory compromise, necrotizing and unduly healing. They are very common in elderly, bedridden or with significant spinal cord injuries.
Depending on the environmental and care conditions, there is less or greater risk of contamination of the wound. Some authors state that, along with circulatory problems, the main cause of sloughing is infection.
Certain bacteria can be more aggressive than others in generating necrosis. This phenomenon is due to the response of the germ to antimicrobial treatment, the wound cleaning conditions, the type of bacteria (aerobic or anaerobic, gram-positive or gram-negative) and the presence or absence of comorbidities..
There are three fundamental aspects regarding the treatment of slough tissue: surgical, pharmacological and hygienic..
It consists of removing the devitalized tissue while respecting the healthy structures; this process is known as debridement.
It is carried out after a thorough cleaning of the affected area and, if possible, under anesthesia, since the manipulation of healthy tissue is very painful.
Antimicrobial therapy in the presence of a contaminated wound is vital to prevent sloughing. The selection of the antibiotic will depend on the characteristics of the lesion, results of cultures and antibiograms, general conditions of the patient and medical criteria..
In addition to antibiotics, treatments that improve circulation and the healing process may be indicated. Vitamin and other nutrient therapies, natural remedies, blood thinners, and vasotonics have been studied with inconsistent results.
Cleaning the wounds is the third basic step in the management of slough tissue. Proper cleaning of lesions with antiseptic products maintains a germ-free environment without appropriate conditions for the proliferation of bacteria or other pathogenic microorganisms..
There are numerous specialized dressings on the market that help in the proper care of wounds. Many of these have specialized substances capable of dissolving slough tissue, a process known as enzymatic debridement, which does not damage normal tissues and favors the formation of new local vessels..
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