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Eschar removal?

Discussion in 'Diabetic Foot & Wound Management' started by MrBen, Sep 17, 2009.

  1. MrBen

    MrBen Active Member


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    I was just wondering what people thought about the removal of eschar? Given moist wound theory it is optimal to remove an eschar to help with movement of cells and to maintain a moist environment. However, i feel that that with some patients it would be of detriment to remove a healthy eschar (so no signs of infection around the eschar, eschar is firm and no exudate when probed). The removal would break a sealed site and give rise to possible infection.
    Thoughts?
     
  2. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    All non-viable tissue must be removed from a wound. I prefer surgical debridement as it is very fast, usually painless, and very cheap.

    An eschar promotes wound senescence and traps bioburden, and debridement allows a chronic wound to 'kick-start' back into an acute wound action of tissue regeneration.

    If its dead, cut it out.

    LL
     
  3. toughspiders

    toughspiders Active Member

    Allows angiogenesis and epithelialisation. I always tell them its like a barrier/plug and it prevents new cells forming across the wound bed, same with the slough thats comes off too!!
     
  4. toughspiders

    toughspiders Active Member

    oh and the promotion of granulation tissue!!
     
  5. Graham

    Graham RIP

    While I agree with above, removal of the eschar should only be done with a viable arterial circulation. If there is significant palor on elevation and rubor on dependency I leave it in place, t/t with 10% poviodine and dry gauze. Send for vascular consult.

    You can not promote anything except deterioration if the circulation can not deal with the wound once the eschar is removed.
     
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