From the Research
When a patient has a deep 2nd degree burn and the lesion starts turning yellowish-white after a couple of weeks, this is called eschar formation. Eschar is the thick, leathery, dead tissue that forms over severe burns as part of the body's healing process. This yellowish-white appearance represents devitalized tissue that has lost its blood supply. Eschar formation is significant because it can impair wound healing and may require debridement (removal of the dead tissue) to promote proper healing and prevent infection. In clinical practice, the presence of eschar often indicates the need for specialized wound care, possibly including surgical debridement, enzymatic agents like collagenase, or autolytic debridement using appropriate dressings. The formation of eschar occurs because the thermal injury causes protein denaturation and cell death in the affected skin layers, leading to this characteristic appearance as the body attempts to wall off the damaged area from healthy tissue. Some studies, such as 1, have shown that enzymatic debridement can be an effective tool for eschar removal, reducing the need for autografting and promoting wound healing. However, the decision to use enzymatic debridement or other treatments should be based on the individual patient's needs and the severity of the burn, as noted in 2 and 3. It's also important to consider the experience of the healthcare provider in evaluating and treating eschar, as noted in 1, which found that physicians with high experience in enzymatic debridement achieved significantly more consensus in post-intervention wound bed evaluation and therapy decision. Overall, the management of eschar formation requires a comprehensive approach that takes into account the patient's overall health, the severity of the burn, and the most effective treatment options available, as discussed in 4 and 5. Key considerations in the management of eschar formation include:
- Early recognition and evaluation of the burn wound
- Prompt initiation of appropriate treatment, including debridement and wound care
- Consideration of enzymatic debridement as a treatment option
- Close monitoring of the patient's progress and adjustment of treatment as needed
- Collaboration with experienced healthcare providers to ensure optimal care.