Wound bed preparation: the importance of rapid and effective desloughing to promote healing

Chronic wounds such as venous leg ulcers have an underlying pathogenesis that contributes to the build-up of devitalised tissue. While it is vital to address the underlying pathology, it is essential to effectively remove devitalised tissue.¹Removal of slough and dead tissue is imperative for successful wound management, with some authors claiming that healing is compromised without it.^2,3 Shultz et al.¹ argued that the presence of devitalised tissue increases the risk of wound infection, osteomyelitis, sepsis, protein depletion and delays healing. The devitalised tissue also limits the ability to visualise the base of the wound and measure or estimate its depth.

Literature frequently refers to slough and necrotic tissue under the umbrella term of devitalised tissue. However, this article evaluates the evidence on slough alone. This is based on the premise that, given the differences in the formation, manifestations and treatment of slough and necrotic tissue, the two can be studied and considered separately. The causes and constituents of slough are explained, along with its links with the inflammatory phase of wound healing and why slough is an ideal environment for bacterial proliferation. The article also addresses the relationship between slough and biofilm development/proliferation and wound chronicity. Finally, it emphasises that the rapid and selective removal of slough can avoid these deleterious effects, thereby promoting efficient wound healing and improved patient outcomes.