Tissue types

Hello, my name is Cindy Broadus. I am the Executive Director of the National Alliance of Wound Care and Osteomy. Our organization works with our sister foundation, the International Alliance of Wound Care Scholarship Foundation, to promote and enhance education and certification in wound care. Our health shared community will provide education and information that is specific to wound care for both clinicians and patients. Thank you for viewing this video and visiting our community. In this section, we will take a look at the different types of tissue that would normally be seen in the wounds that we treat on a day-to-day basis. Being able to identify tissue types is conducive to positive wound healing. So let's get started. The first type of tissue we will discuss is granulation. Granulation tissue is a collagen rich tissue that forms at the site of an injury. It's shiny bright red, it can be pale, sometimes it's dusky red or dark pink, and it's soft to the touch. It looks bumpy and granular and has a cobblestone-like appearance. This bumpy appearance is actually visible tops of capillary loops, which we often refer to or call granulation buds. It's highly vascularized and bleeds easily with minimal trauma. Healthy granulation tissue is moist and is a good indicator of healing. Dark, dusky granulation is a sign of ischemia and poor perfusion. Unhealthy granulation can bleed easily and may also indicate the presence of wound infection. The next type of tissue is eschar. Eschar is dead, devitalized tissue that we see in full thickness wounds. Now when you take a look at this picture you can see that a wound can have several types of tissue visible in the wound bed at any given time. You may see eschar after a third degree burn, gangrenous ulcer, prolonged pressure, fungal infections or necrotizing fasciitis. Eschar can be tan, it can also be gray and you'll see eschar that's brown or black as well. guidelines recommend that stable intact eschar on the heels should not be removed due to the possible poor circulation of the tissue, making the wound more susceptible to infection. Eschar acts as a natural barrier actually to infection by keeping the bacteria from entering the wound. So when we talk about stable what does that mean? It means that eschar is adherent, intact without erythema or fluctuants. Now if eschar becomes unstable, in other words if it becomes wet, if it's draining, it's loose, boggy, if it's edematous or red, it should be debrided according to the clinic or facility protocol. The term mascar is not interchangeable with scab. The term scab is used when a crust is formed by coagulation of blood or exudate. Scabs are found on superficial or partial thickness wounds. That scab is that rusty brown dry crust that forms over an injured surface on the skin within 24 hours of the injury. Whenever our skin is injured as a result of any cut or abrasion, it'll start bleeding secondary to that blood flowing from those severed vessels. This blood containing platelets and fibrin and blood cells soon clots to prevent further blood loss. Now the outer surface of this blood clot dries up or dehydrates to form that rusty brown crust which we call a scab and this is covering the underlying healing tissues. A scab is like a natural band-aid to protect the wound from infections and to prevent any entry of contaminants from the external environment. Scabs normally stay in place until the skin underneath has been repaired and new skin cells have appeared after which it'll just naturally fall off. The next type of tissue is slough. Slough is devitalized avascular moist necrotic tissue that can be pale yellow, yellow, tan, it can be green, gray, or even brown in color. It can be viscous, slimy, soft, stringy, or fibrous. Slough can be loosely or firmly adhered and difficult to separate from healthy tissue. Slough can present as a thin coat covering the entire wound bed or it can cover the wound bed in patches all over. It can be easily confused with other body structures like tendons and ligaments because of its color. Slough harbors pathogenic organisms like biofilm colonies, increasing the risk of of infection and impeding wound healing. This keeps the wound in the inflammatory phase. Therefore, debridement methods are warranted. Exposing viable tissue will expedite the healing process. The next type of tissue is hypergranulation tissue. This is granulation tissue that grows above the wound margin and is often referred to as proud flesh. It's typically light red or dark pink in color. It's friable. It can be smooth. You can also see it where it's shiny, soft. It can be bumpy or granular. Hypergranulation prevents epithelialization and wound healing. Therefore, it must be treated. To treat hypergranulation, you'll need to eliminate the causative factor. Reducing bioburden, applying compression, removing it physically with sharp or chemical debridement, and steroid therapy are all treatment options for eliminating hypergranulation tissue. The last issue we'll discuss is epithelial tissue. Epithelial tissue is tissue that covers the wound when the epidermis regenerates. Epithelial cells travel from the outward wound edge as they actually crawl across the wound bed to close the wound. They're light pink or pearly in color and they're very, very fragile. Epithelial tissue is vulnerable to damage from friction and shearing and pressure. It usually takes about two to three weeks for the cells to become stronger and waterproof. This is known as becoming keratinized. When epithelialization is complete, the wound is closed. Accurate identification of tissue types is integral for proper dressing selection and to promote wound healing. Confusing one type with another can lead to negative outcomes, including poor wound healing and wound deterioration. Thank you for viewing this video. We hope you found it to be informative and helpful.