Eschar Removal

This is Dr. Randy Wolcott and what we want to talk about on this wound is Removing tissue and layers. So this is an escar. This is also a diabetic foot ulcer And what we're going to do is just simply tease away layer after layer until we get down into good host tissue You can do this With a blade with scissors just any sharp method that works for you in this Demonstration what we'll be using is scissors the question always comes up is how much do you remove and this is going to be based on feel?

Touching it with your instruments touching it with your finger and getting a feel for what's normal tissue It's going to be based on sight is it

Do we see bleeding? Do we see that the colors of normal tissue when we're going down to the different layers?

Also, there's we'll hear the different tissues as we Use our scissors or a cure at or whatever you can hear more fibrotic You can feel more fibrotic tissue with your scissors. So we're hearing we're seeing We're feeling Through multiple different modalities and we're just trying to get into good tissue Dr. Flange once told me during a conference that it's hard for him to imagine taking off too much tissue Because if we get into good host tissue it always regenerates itself. He said that in the context of

We just talked about bobsies and one of the thing about Bob seeing chronic wounds is that the Bobsy into the good tissue will heal up to the level of the chronic wound quite quickly and And then stop at that level. So if we do get into too much good host tissue It's going to heal right back to the wound before it stops healing what we're doing now is we're just kind of taking a time out I'm getting the the Hyperkeratosis around the wound that's caused by the wound inflammation and and just letting things bleed

Just you know get in a field for you know, what's

Producing blood and what's not if you just keep going It takes a while before all the bleeding declares itself. So we're just this is a timeout To let things bleed What we're going to do after we get this off is we're going to go back in field the wound with our scissors field the wound with the finger Use whatever Senses are appropriate and and just try to get back into good tissue and with the topicals and the systemic antibiotics the Specific selective bobsies we feel like we don't have to go into host tissue near as deeply

As we used to and that limits some of the bleeding But if you do get into bleeding there's products such as quick clot products such as silver nitrate now both of those can cause some wholesale damage, but You occasionally you have to stop the bleeding with those kind of products The other thing is you sometimes have to over so with a suture if you get into an arterial Bleeder or sometimes in venous leg ulcers if you get into the vein But with the newer topical products We don't go near as deep as we used to try to get all the black off the wound

For no other reason than the next time you see that wound you know what's died back and what hasn't died back if you leave a lot of black Tissue on the rim or in the base of the wound then there's you don't know what's died back in between Even with the pitchers it makes it too difficult to get all the necrotic tissue off Go down into host tissue Anything that's soft and friable has to come out anything that's hard and fibrous should come out We open up all undermining we open up all tunneling so you can see that the bereavement is the foundation of our wound care