Apart from being the largest organ in the body, the skin serves a couple of very important functions that aids the body in different ways.
It provides us with sensation, regulates the body temperature, synthesizes Vitamin D, but more importantly, it protects the body from infectious pathogens and bacteria.
That being said, it’s crucial to identify and understand anatomical structures and physiological processes because injury to the muscles, tendons, and nerves may lead to bigger health problems.
Understanding the process of tissue death is essential to determine which tissue may need debriding. Below are the types of wound tissue you will encounter as you go through your patient’s wound healing process.
Epithelial tissue
Also known as epithelium, the epithelial tissue is found on top of the body’s surface effectively covering and protecting the wound surface from further injury and infection. Its color may vary from pale white to pink inside the wound bed in partial thickness or in advancing border in full thickness wounds.
Proper management of such tissue requires proper hydration while proper observation at the wound edges can help one identify the quality of the wound bed. An advancing border is usually an indication that the wound bed is healthy while rolled or unattached wound edges may be a sign that something is wrong.
Granulation tissue
Also known as scar tissue, granulation tissue is usually red and shiny and may bleed easily. It may also come in pink or pale red depending on the circulation as well as the wound’s bacterial load. A pink or red granulation tissue usually means that the wound is healing properly while dark and dusky red granulation indicates the presence of infection.
The formation of granulation tissue usually occurs during the proliferative phase while excess granulation, also known as “proud flesh” is also called hypergranulation.
Slough tissue
A devitalized and non-viable tissue, slough is a necrotic tissue that is usually yellow in color and is often mucinous and stringy. Slough tissue is usually a sign of bacterial activity and is something that should be removed immediately to allow the formation of healthy granulation tissue which is needed to repair any damage caused by the wound.
Composed of bacteria, leukocytes, macrophages, fibroblasts, and other apoptotic cells, slough also usually comes with biofilm.
Eschar
Eschar is another necrotic and devitalized tissue that appears as either black or brown in color with a hard and leathery texture. This type of tissue is brought about by inadequate blood flow resulting in cell death.
An eschar, as well as a slough, can be either non-adherent or adherent. They are considered non-adherent if they easily separate from the wound bed and adherent if they are attached firmly to the wound bed.
It’s important to note that eschar and scab aren’t one and the same. Eschar is defined as dead tissue usually found in full thickness wounds as well as burn injuries, necrotizing fasciitis, and gangrenous ulcers, among others while scabs are usually found in superficial or partial thickness wounds.