Eschar is generally removed since the necrotic tissue often impedes wound healing. Tissue death inactivates growth factors which normally help in tissue regeneration and slows the formation of granulation tissue in the wound bed. Additionally, when dead tissue dries out and becomes hardened eschar, it physically obstructs wound contraction and stunts epithelialization, a stage in wound healing.
Debriding eschar early in the healing process can shorten healing time. A notable exception to early debridement could be a stable eschar (i.e., an eschar that is dry, adherent, and intact) that is present on a heel or ischemic limb. Due to inherent decreased blood flow to these areas, some experts argue that the benefit of leaving the eschar in place to reduce the risk of infection outweighs the benefits of debriding.
In certain types of wounds, such as circumferential burns, constriction caused by the presence of eschar can cause compartment syndrome, which is an increase in pressure within a muscle compartment potentially leading to muscle and nerve damage. Sharp debridement with a scalpel may be difficult due to the firm, dry nature of eschar. Other techniques include surgical, enzymatic/chemical, mechanical, and biological debridement. During surgical debridement, the individual is usually placed under anesthesia to remove dead tissue. Enzymatic, or chemical debridement involves use of a topical enzyme to break down the necrotic tissue . Mechanical debridement can be performed with wet-to-dry dressing designed to soften and remove the eschar. Other mechanical options include whirlpool baths or pulse lavage. Lastly, biological debridement involves the use of sterile maggots to eat away at the dead tissue, while preserving live tissue.
