International Wound Infection Institute - Slough: Composition, analysis and effect on healing

Slough can be found in both acute wounds, such as dehisced surgical wounds, skin tears and other traumatic wounds and skin grafts, as well as in chronic wounds, such as diabetic foot ulcerse (DFUs) pressure ulcers and venous leg ulcers). A simple explanation of slough for patients is generally a “yellow/white layer of dead skin [tissue] in the wound, that can prevent or slow down healing”.

Slough can be unpleasant and disturbing for the patient, and difficult to manage clinically as it prevents dressings and topical treatments from supporting the underlying viable tissues (Pritchard and Brown, 2013). Slough or necrotic tissue can promote bacterial growth and biofilm formation, inhibit the penetration of antibiotics, prevent the formation of granulation tissue, and subsequent re-epithelialisation, and interfere with wound contraction.

Management of Slough in Practice

Debridement is regarded as an essential component of wound preparation and management and is defined as “the removal of devitalised (non-viable) tissue from or adjacent to a wound”. Debridement promotes a stimulatory environment by removing and managing exudate, while also creating a window of opportunity where biofilm defences are temporarily interrupted, allowing for increased efficacy of topical and systemic management strategies (Wolcott et al, 2010; World Union of Wound Healing Societies.

Debridement should not be confused with wound cleansing, which is “actively removing surface contaminants, loose debris, non-attached non-viable tissue, microorganisms or remnants of previous dressings from the wound surface and its surrounding skin.

Lindsay Kalan
Lindsay Kalan, PhD, Associate Professor, Biochemistry and Biomedical Sciences, McMaster University, Canada; Visiting Assistant Professor, University of Wisconsin-Madison, USA

Gregory Schultz
PhD, Emeritus Professor of Obstetrics and Gynecology, University of Florida, USA

Matthew Malone
PhD, FFPM, RCPS (Glasg), Conjoint Associate Professor, Infectious Diseases and Microbiology, Western Sydney University, Australia

Kalan L, Schultz G, Malone M et al (2023) Slough: Composition, analysis and effect on healing. Wounds International