Ask the treatment expert: treating eschar and blisters on the heels

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What is xerosis?
What is xerosis?
We have several clinicians at our facility who insist eschar on the heels should always be debrided and heel blisters should be popped. What are the correct interventions?

Stable intact (dry, adherent, intact without erythema or fluctuance) eschar on the heels should NOT be removed. The reason? Blood flow in the tissue under the eschar is virtually non-existent. Therefore, the wound is susceptible to infection with limited to no ability to fight off invading bacteria.

The eschar acts as a natural barrier to infection, keeping the bacteria from entering the wound. The following are treatment options for intact stable eschar: wrap the heel in dry gauze, paint with Betadine or liquid barrier film, and relieve the pressure. However, should the eschar become unstable (wet, draining, loose, boggy, edematous, red), the eschar should be debrided.

Blisters usually form because the outer layer of a patient's skin has become damaged. Fluid collects under the damaged layer of skin, cushioning the tissue below, protecting it from further damage and allowing it to heal.

There is controversy about whether to aspirate or de-roof a pressure ulcer blister or to leave it intact. However, general consensus leans toward leaving the blister roof intact.Benefits to leaving it intact include faster re-epithelialization, reduced pain, and reduced bacterial infection.

Detrimental effects of debriding blisters include increased risk of sepsis, eschar development, the promotion of an ideal medium for bacteria and an increased inflammatory response.

Treatment options for an intact blister: protect from trauma, leave open to air or paint with Betadine or liquid barrier film. If a dressing is required, then a transparent film dressing is recommended, as these dressings allow for visualization of the wound.
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