Wound Management

Tunneling Wound: Causes and Treatment

Most wounds are superficial and tend to affect the surface of the skin. However, some wounds progress deeper into the body, reaching the underlying tissues and organs. A tunneling wound is a secondary wound that has progressed from an initial superficial wound in the skin surface to a deeper level that can include skin layers and muscle tissue. 

The tunneling wound got its name from the tunnels or channels that extend from the wound into or through subcutaneous tissue or muscle. Tunnels may be short, long, or even split into multiple tunnels. Sometimes these tunnels take twists or turns that can make wound care complicated.  

The tunneling wounds require careful wound assessment and treatment. Without treatment, they can be life-threatening. If you have a tunneling wound, see your doctor as soon as possible so they can check the wound, identify the cause, and provide the right treatment.  

The wounds can take a long time to heal, so it is important to monitor them until they are fully healed and work closely with the doctor to ensure everything goes smoothly. 

What causes a Tunneling Wound? 

Tunneling of a wound can occur for various reasons. Here are some factors that contribute to the formation of tunnels: 

• Infection: If a wound becomes infected, it can spread and destroy the surrounding skin and tissue. The wound expands and can go deeper into the skin layers and muscles, forming channels or tunnels.  
• Pressure: If too much pressure occurs on top of a wound, it causes separation of the skin and tissue resulting in tunneling. In patients who are immobile, pressure sores are common and excessive pressure can cause tunneling wounds. 
• Delayed wound healing: Stalled wound healing can lead to an extended inflammatory phase. When the wound remains inflamed for a long time, tunneling can happen. Factors that slow healing include a sedentary lifestyle, smoking, putting too much weight on the skin, or taking drugs such as corticosteroids, NSAIDs, chemotherapy, or immunosuppressants.  
• Additionally, certain health conditions, such as diabetes, rheumatoid arthritis, venous insufficiency, alcohol use disorder, etc., can slow wound healing.    
• Improper wound dressing: Improper wound packing can jeopardize healing. Too much or too little packing can make the tissue degrade. Periodically monitor the packing and adjust. 
• Hidradenitis suppurativa: Hidradenitis suppurativa is a condition that causes small, painful lumps under the skin. These lumps usually occur in the body where your skin is likely to rub together, such as the armpits, buttocks, groin, and breasts. The lumps heal slowly and can form tunnels. 
• Pilonidal cyst: A pilonidal cyst is a round sac of tissue filled with air or fluid that usually forms in the crease of the buttocks. Pilonidal cysts are a common condition and, if left untreated, can lead to tunneling.

 

Diagnosing Tunneling Wounds 

While some wounds have easily recognizable passageways, some tunnels are not visible and may only be discovered when the wound is probed. In the latter case, wound care physicians will probe the wound to determine how long and deep the tunnels are and what direction they are heading. The doctor will handle the process of assessment of a wound through the following steps: 

• In the first step of the assessment, the doctor will conduct a superficial examination of the wound and gather information from the patient and the caregiver about the progression of the wound and possible causes for tunneling. 
• In the next step, the doctor probes the wound with a soft, non-fibrous polyethylene catheter to identify the depth, direction, and number of tunnel tracts. This will enable the physician to implement an effective treatment plan to optimize wound healing. 
• Sometimes complete assessment may require sonography, a CT scan, or MRI. 

Treatment for Tunneling Wound  

Tunneling wounds are serious and require a professional approach; do not attempt to treat them on your own. Here are some ways to manage tunneling wounds: 

1. Management of pre-existing conditions  

An important first step in the treatment is to eliminate or reduce the cause of the tunneling wound. If you have any pre-existing conditions that affect your wound healing, such as diabetes, work with your physician to keep the issue under control.  

If there are other factors that slow down wound healing, talk to your doctor about improving your overall health to promote better healing. 

2. Wound dressing 

Proper care for wound sites helps optimize the healing process and reduce the risk of developing an abscess.  

The doctor will clean the wound thoroughly with skin cleansers and remove any dead tissue or foreign material. Then the wound will be packed with sterile gauze to absorb fluid and fill the empty space. The packing should be firm but be sure not to put excessive pressure that can cause more damage. 

The type of dressing the doctor uses depends on the size, location, and cause of the wound. The doctor may use hydrogel, foam, alginates, collagen dressings, or hydrocolloid dressing to cover and protect the wound. These wound dressings will help optimize tissue recovery. 

Pay attention to how your doctor dresses the wound since you have to apply fresh dressing daily or as directed by the doctor. You may need to pack a tunneling wound for a few days or even a few weeks, depending on how quickly and well it heals. Products like Derma Plastic Sterile Measure-IT Wound Measurement Kit may be useful in the assessment and packing of wounds. 

3. Medications 

• Medications for tunneling wounds may include: 
• Antibiotics for infection control  
• Analgesics for pain relief 
• Systemic drugs and antibiotic creams for hidradenitis suppurativa treatment 
• Phenol injections to treat pilonidal cysts 

4. Wound draining  

Draining the wound helps promote the formation of granulation tissue. Granulation tissue is a connective tissue that facilitates wound healing. 

If necessary, simulate granulation tissue formation using Iodoform Gauze, DuoDERM Hydroactive Gel or other hydrogels, or rope dressing like Ferris PolyMem WIC Silver Rope Wound Filler. 

5. Negative Pressure Wound Therapy 

Negative pressure wound therapy (NPWT) or vacuum-assisted wound closure is used to decrease air pressure at the wound surface to reduce swelling, remove disease-causing bacteria and improve the rate of wound recovery. 

Your doctor will dress and cover the wound with adhesive film and connect a drainage tube to a vacuum pump, which removes air pressure. 

During treatment, you must carry the vacuum pump around, and the foam dressing must be periodically changed. 

6. Surgical intervention  

In some cases, various surgical techniques are used to remove tissues and cysts, clean the tunnel and leave it open to heal. This technique allows better access to the wound tract and makes wound care easier. 

Health Products For You offers a huge collection of wound care supplies, including wound care products for treating tunneling wounds, from top manufacturers like Covidien/Medtronic, Medline Industries, McKesson, etc. Place your order today! 

 

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