Identifying Wound Tissue Types

The wound healing process must go through four steps to be successful: hemostasis, inflammation, proliferation, and remodeling/maturing. Inflammation is necessary for wound healing, but it can be harmful if it persists or is aided by other causes such as infection. Wound healing is most likely to be delayed or stall during this stage.

Chronic wounds are those that do not heal through the four stages of healing. The size, depth, location, and duration of the wound all have an impact on the wound healing process due to the presence of biofilm. In the treatment of non-healing or chronic wounds, wound bed preparation has been shown to be a substantial advantage in reaching wound healing closure. This includes things like proper wound cleansing, one or more debridement treatments as needed, moisture balance, and microbial balance. In order to identify barriers to managing and accelerating the healing of non-healing chronic wounds, practitioners must be educated on the necessity of wound bed preparation.

The best method to care for a wound is to be familiar with the different types of tissue. The color, consistency, and texture of the wound identify the tissue type.  When assessing a wound, the tissue types should always equal 100%.

Epithelial tissue is the process by which the epidermis regenerates over a partial-thickness wound surface or in scar tissue that occurs on a full-thickness incision is referred to as epithelial tissue. The epithelium is pale pink in color and has a glossy luster. Epithelial cells migrate from the wound edges outward, crawling across the wound bed to the closure site. The epithelium grows stronger over time once it is produced.

Granulation that is healthy is pink or red in color and has an uneven, mounded texture.  Unhealthy granulation is black, darkish red, and bleeds easily, which could indicate infection. Excessive granulation, also known as “proud flesh,” is referred to as hypergranulation. The wound tissue will be seen above the regular wound bed surface.

Slough is fibrinous or thickened tissue that is no longer viable or devitalized. It’s possible that one or more debridement procedures will be recommended. Yellow, gray, green, brown, and tan are some of the colors available. Slough harbors hazardous organisms, raises the risk of infection, and obstructs healing by keeping the wound in an inflammatory state; as a result, debridement therapies are required.

Eschar is found in only full thickness wounds. This is when dead tissue or debris dries out and hardens in the wound bed. The current standard of care guidelines suggests avoiding removing stable, intact eschar from the heels (dry, adherent, intact without erythema or fluctuation). If the eschar becomes insecure (wet, draining, loose, boggy, edematous, or red), it should be debrided according to facility procedure.

Scabs are only found in partial thickness wounds.  Scabs are formed when platelets and fibrinogen form a fibrin mesh, trapping red blood cells.  They form a clot that dries into a scab.

Any wound can develop a localized or systemic infection. Because it aids in the elimination of bacteria and foreign debris, wound cleansing is an important part of wound bed preparation. Regularly check wounds for signs and symptoms of infection, such as localized biofilm. Biofilm can be found in the majority of chronic wounds. Combining debridement methods like biological, enzymatic, autolytic, mechanical, and sharp can help breaking biofilms in complex wounds with pathological problems, according to research.

Chronic wounds are still a major source of concern in clinical practice, and they can have a detrimental impact on patients’ quality of life. Involving patients in their care and understanding the biological processes that occur in the wound bed can help physicians optimize these conditions and choose the best treatment for patients to overcome the obstacles that cause chronic wound healing to take longer.

Important Notice: The views and opinions stated in this blog are exclusively those of the author and do not reflect iWound Global, iWound Care USA, Inc., its affiliates, or partner companies. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.