Soft tissue necrosis

The timelines followed for the treatment of soft tissue necrosis are clearly dependent on the techniques used.

Biological techniques

If biological techniques are used, then the process is simply repeated until healing is evident by the wound shrinking to an epithelial covered scar which can be left open to the air without causing discomfort.

So, with biological techniques the debridement and healing are a continuing simultaneous process over a period of several weeks.

Short term: almost no change other than the wound is being actively treated. This may be quite uncomfortable or entirely painless, depending on the wound and the techniques used and analgesia is used as and if it is needed.
Medium term: over a 2 to 3 week period a gradual improvement in the appearance and sometimes odour of the wound is noticed, and if no superinfection occurs this should be a progressive improvement.
Long term: these wounds tend to heal as quite obvious lumpy red scars which will require a considerable amount of scar modification to get the best appearing outcome.

Surgical interventions

Débridement

The cutting, scraping or otherwise removal of dead tissue is by far the quickest solution to the presence of dead soft tissue. It is the preferred approach in healthy people, able to undergo an anaesthetic.

The healing can be by secondary intention underneath antiseptic packs or dressings, or primary intention if healthy tissue in the form of flaps or grafts are used to repair the defect (flaps which carry their own blood supply are preferred to grafts, but in some instances a graft on a healthy recipient site can work well).

Using packs or dressings

Short term: the dressing or pack will often alleviate pain but is uncomfortable and awkward.
Medium term: healing underneath the pack will proceed more slowly as epithelium has to migrate from the wound edges. Over a 2 to 3 week period the wound will close, often with itching.
Long term: the wounds heal but with an evident scar.

Using flaps and grafts

The advantage here is that the wounds heal in 5 to 10 days depending on site of defect, but a donor site defect is created.

Short term: there are now two troublesome sites, the repaired formerly necrotic wound site and the new donor site for the flap or graft. Both are uncomfortable usually until stitches are removed.
Medium term: sutures are removed at 6 to 10 days depending on site and dressings, not before 10 days if a split skin graft is used. While the formerly necrotic site heals much more quickly using these techniques, the donor site can be a frustrating problem in the medium term.
Long term: both sites heal in the best way possible for this kind of treatment, that is by primary intention and only the suture lines are visible as small linear scars. This approach produces the quickest healing and the one with the best long term appearance and function, but requires more surgery and the disadvantage of the donor site.