Is eschar typically associated with stage 1 or stage 2 wounds?

Eschar Cannot Be Staged as Stage 1 or 2

Wounds covered by eschar are classified as "unstageable" until the eschar is removed, at which point they reveal their true depth and are staged as either Stage III or Stage IV—never Stage 1 or 2. 1

Why Eschar Indicates Deeper Tissue Destruction

• Eschar represents full-thickness tissue necrosis, which by definition means destruction has extended beyond the dermis into deeper tissue layers 1, 2
• The staging system is based on the depth of tissue loss/destruction, not simply what tissue layer is currently visible on the surface 1
• Stage I wounds involve only intact skin with non-blanchable erythema, while Stage II wounds are partial-thickness loss of dermis presenting as shallow open ulcers with viable red-pink wound beds—neither of these stages involves the necrotic tissue that forms eschar 1

Understanding the Unstageable Classification

• Before eschar removal, the wound must be classified as "unstageable" because the extent of tissue damage is obscured by the necrotic tissue covering 1
• The presence of eschar indicates that deeper tissue layers were destroyed, creating the devitalized tissue mass that comprises the eschar 3, 2
• Eschar has a definite tissue structure consisting of fibrous regions, fine fibrillar elements, and areas of irregular amorphous tissue, representing degraded extracellular matrix proteins 4

Staging After Eschar Removal

• Once the eschar is removed through debridement, the wound reveals its true depth and can then be staged appropriately 1
• Stage III wounds involve full-thickness tissue loss exposing subcutaneous fat, with bone, muscle, and tendon not visible, and slough or eschar may have been present before removal 1
• Stage IV wounds show full-thickness tissue loss with exposed or palpable bone, muscle, ligament, or tendon, and slough or eschar may have been present before removal 1
• The key principle is that true depth must be determined by what tissue layers were actually destroyed, not just what is currently visible after debridement 1

Clinical Assessment Approach

• Use a sterile, blunt metal probe to determine the actual depth of the wound, looking for exposed or palpable subcutaneous fat, muscle, tendon, ligament, or bone 1
• The presence of these deeper structures indicates the wound is Stage III or IV 1
• Palpable bone indicates Stage IV regardless of what is visible on the surface 1

Common Pitfall to Avoid

• Never assume that eschar-covered wounds are superficial—the presence of eschar itself indicates significant tissue destruction that extends at minimum through the full thickness of the dermis 1, 2
• Failing to recognize that eschar requires the "unstageable" classification until removal can lead to inappropriate wound management decisions 1