sloughing

Sloughing refers to the shedding or detachment of tissue, typically dead or nonviable tissue, from living tissue. In clinical contexts, slough most often describes necrotic tissue attached to a wound or ulcer. Slough is usually moist and can be yellow, gray, tan, or white; it may be stringy or adherent. It contrasts with eschar, which is dry, hard, and often darker. Slough can occur with pressure injuries, venous or arterial ulcers, burns, infections, and after surgical procedures. It can result from tissue death due to ischemia, inflammation, infection, or trauma. The presence of slough can impede wound healing by preventing reepithelialization and by sheltering bacteria; it is also used as a marker of wound chronicity in some assessment systems.

Management focuses on debridement to remove dead tissue and create a clean wound bed, alongside measures to promote a moist yet not macerating environment. Debridement methods include surgical or sharp debridement, enzymatic debridement, autolytic techniques with moisture-retentive dressings, and mechanical or biophysical methods where appropriate. Treat underlying factors such as infection, edema, poor perfusion, and nutritional deficits, and monitor for signs of infection or progression to eschar or necrosis requiring different approaches. In some conditions, slough may be shed spontaneously as part of healing, while in others persistent slough indicates the need for medical intervention.