From the Guidelines
Necrotic sacral wounds can be identified by their characteristic black, brown, or gray tissue that is dry, leathery, and devitalized, with a clear demarcation from healthy tissue, and should be differentiated from reabsorbing hematomas through careful examination of color progression, texture, and history. To differentiate necrotic sacral wounds from reabsorbing hematomas, it is essential to examine the color progression and texture of the wound. Necrotic tissue typically appears as black, brown, or gray and is dry, leathery, and devitalized, often with a clear demarcation from healthy tissue 1. In contrast, hematomas typically show color changes from red-purple to green-yellow-brown as they resolve, maintain some tissue elasticity, and gradually decrease in size.
Key Differentiating Features
- Color progression: necrotic tissue remains black, brown, or gray, while hematomas change color as they resolve
- Texture: necrotic tissue is dry and leathery, while hematomas maintain some elasticity
- History: necrotic wounds often result from prolonged pressure, while hematomas follow trauma or anticoagulation
- Palpation: necrotic tissue feels hard and insensate, while hematomas may be fluctuant with some tenderness According to the 2014 practice guidelines for the diagnosis and management of skin and soft tissue infections 1, surgical intervention is the primary therapeutic modality in cases of necrotizing fasciitis, and features suggestive of necrotizing fasciitis include skin necrosis with easy dissection along the fascia by a blunt instrument.
Management
- Necrotic wounds require debridement to promote healing
- Hematomas generally resolve with conservative management If uncertain, it is crucial to consult a wound specialist, as misdiagnosis could lead to inappropriate treatment 1. Proper identification is vital because necrotic wounds require debridement to promote healing, while hematomas generally resolve with conservative management 1.
From the Research
Appearance of Necrotic Sacral Wounds
- Necrotic sacral wounds can appear as large, open wounds with substantial morbidity due to the underlying necrotizing soft tissue infections (NSTIs) 2.
- The wounds may have fibrinous debris and may require surgical debridement to promote granulation tissue formation 3.
Differentiation from Reabsorbing Hematoma
- A reabsorbing hematoma may appear as a collection of blood that is being resorbed by the body, whereas a necrotic sacral wound is a result of an underlying infection or tissue damage 4, 5.
- The presence of necrotic tissue, fibrinous debris, and signs of infection such as redness, swelling, and purulent discharge can help differentiate a necrotic sacral wound from a reabsorbing hematoma 2, 3.
- Imaging studies such as X-rays or CT scans may also be helpful in differentiating between a necrotic sacral wound and a reabsorbing hematoma, as they can show the extent of tissue damage and the presence of any underlying fractures or other abnormalities 5.
Clinical Assessment
- A thorough clinical assessment is necessary to diagnose and manage necrotic sacral wounds, including a complete medical history, physical examination, and laboratory tests to identify any underlying infections or other conditions 2, 3.
- The use of negative pressure wound therapy with instillation (NPWTi) has been shown to be effective in promoting wound healing and reducing the risk of complications in patients with necrotic sacral wounds 2, 3.