Redefining Slough: A New Classification System

Background: Slough is a non-specific term used to describe several different presentations of nonviable tissue in the wound bed. The prolonged inflammation in chronic wounds, leads to the production of slough. Delay in the removal of slough slows wound healing, therefore identifying and treating slough quickly promotes faster healing. Because slough is such a nonspecific term we felt there was a need for a slough classification system, to assure accurate diagnosis and guide clinicians in choosing the appropriate treatment.

 Purpose: We have proposed four subtypes of slough, each with its own set of defining characteristics and recommended treatment: Necroslough, Fibroslough, Leukoslough, and Bioslough.

Necroslough is necrotic tissue that cannot otherwise be classified as eschar, arising from previously viable anatomic tissue. Treatment consists of aggressive surgical debridement augmented with enzymatic removal of residual tissue.

Fibroslough is composed of collagen and fibrin, caused by repetitive deposition and breakdown of the wound bed. Treatment consists of selective surgical debridement, augmented with enzymatic/autolytic dressings.

Leukoslough is a gelatinous, easily removed collection of collagen, fibrin, and WBC’s recruited to the wound bed by a recurrent inflammatory state. Treatment consists of gentle mechanical debridement augmented with autolytic dressings.

Bioslough is colonization of the wound bed complicated by biofilm formation. Treatment consists of gentle surgical or mechanical debridement, topical antiseptics, and antimicrobial dressings. 

Conclusion: All forms of slough are not the same. Often our decisions regarding our approach to the wound bed are somewhat arbitrary and lead to a “2 steps forward and 1 step backwards approach to wound closure.” Percival & Suleman (2015) Hopefully this classification system will help clinicians better evaluate wounds and lead to improved treatment choices for chronic wounds.