What is slough in a wound and how is it treated?

From the Guidelines

Slough in a wound must be removed through a process called debridement to promote proper healing, with sharp debridement being the preferred method, as it is the most definitive and controllable technique, according to the most recent guidelines 1. Debridement involves the removal of dead and devitalised tissue, including slough, from wounds to create a clean wound bed and promote wound healing.

• Slough is dead tissue that appears as a yellow or white stringy, fibrous material on the wound surface, consisting of dead white blood cells, bacteria, and damaged tissue that accumulates during the inflammatory phase of wound healing.
• Several debridement methods can be used, including:
  • Sharp debridement performed by healthcare professionals using sterile instruments
  • Enzymatic debridement using products like collagenase (Santyl) applied daily until slough is removed
  • Autolytic debridement using moisture-retentive dressings like hydrogels or hydrocolloids changed every 1-3 days
  • Mechanical debridement using wet-to-dry dressings or wound irrigation Maintaining a moist wound environment after debridement is essential, typically using appropriate dressings like foam, alginate, or hydrocolloid dressings changed according to manufacturer recommendations and wound drainage. The most recent guidelines on interventions to enhance healing of foot ulcers in people with diabetes recommend debridement as a crucial step in promoting wound healing, with sharp debridement being the preferred method 1. Although other methods of debridement, such as enzymatic and autolytic debridement, may also be effective, the evidence supporting their use is limited, and sharp debridement remains the most widely recommended technique 1. Overall, removing slough through debridement is crucial to promote wound healing, reduce the risk of infection, and improve patient outcomes.

From the FDA Drug Label

When clinically indicated, crosshatching thick eschar with a #10 blade allows Collagenase Santyl◊ Ointment more surface contact with necrotic debris It is also desirable to remove, with forceps and scissors, as much loosened detritus as can be done readily Use Collagenase Santyl◊ Ointment in the following manner: 1 - Prior to application the wound should be cleansed of debris and digested material by gently rubbing with a gauze pad saturated with normal saline solution, or with the desired cleansing agent compatible with Collagenase Santyl◊ Ointment

• Slough in a wound refers to a type of necrotic tissue that is usually soft, moist, and grayish in color.
• To get rid of slough, the wound should be cleansed of debris and digested material by gently rubbing with a gauze pad saturated with normal saline solution.
• Collagenase Santyl◊ Ointment can be applied to the wound to help break down necrotic tissue, and it is desirable to remove loosened detritus with forceps and scissors as much as possible.
• The use of Collagenase Santyl◊ Ointment should be terminated when debridement of necrotic tissue is complete and granulation tissue is well established 2.

From the Research

Definition of Slough in a Wound

• Slough in a wound refers to dead tissue that can delay healing and promote infection if not removed 3.
• It is a type of devitalized tissue that can be present in a wound, along with necrosis, and can hinder the healing process.

Treatment of Slough in a Wound

• Debridement is the process of removing dead tissue, including slough, from a wound to promote healing 3, 4.
• There are various methods of debridement, including autolytic, enzymatic, and surgical debridement, each with its own advantages and disadvantages.
• Hydrogels are considered a standard treatment for necrotic or sloughy wounds, as they promote autolytic debridement and keep the wound moist to facilitate natural enzymatic reactions 5.
• Desloughing is a priority in modern wound care, and effective removal of slough involves eliminating dead and devitalized tissue as quickly and safely as possible to enable the wound to return to a healthy state that supports healing 6.
• Monofilament wound debridement pads, such as Debrisoft, have been shown to be effective in removing biofilm and slough from wounds, and can contribute to improved healing and a clean wound bed 4.
• Hydrosurgery is another method of debridement that combines physical and surgical debridement, and has been shown to be effective in selectively removing necrotic tissues without disseminating contaminants 7.

Removal Techniques

• The choice of removal technique depends on the type and amount of slough present, as well as the patient's overall health and wound care goals.
• Conservative techniques, such as autolytic debridement, may be used for smaller amounts of slough, while more aggressive techniques, such as surgical debridement, may be necessary for larger amounts of slough.
• It is essential to follow proper wound care protocols and seek professional medical attention if unsure about the best course of treatment for a wound with slough.