Pearls for Practice: Wound Tunneling
Tunneling wounds have channels that extend from a wound into and through subcutaneous tissue or muscle. They often are difficult to manage and may persist for long periods of time.
Tunnels occur for a variety of reasons. Commonly, they are associated with infection that has resulted in destruction of the tissues. Pressure ulcers can have tunnels because shear and pressure forces frequently are concentrated at the tissue layer interfaces, resulting in tunnel creation. In stalled wounds, tunneling occurs because of the extended inflammatory phase. Tunneling also is associated with use of wound dressings that dehydrate wounds. Too much or too little packing also can lead to tunnel formation.
When initiating treatment of a tunneling wound, it is important to cleanse the wound to reduce the microbial load that can play a role in tunnel creation and maintenance. The tunnel should be packed appropriately to enhance healing and reduce the risk for possible abscess development at the site. The packing should be placed to avoid creating pressure on the sides of the tunnel to reduce the risk of damaging healthy tissue. It is particularly important to measure and closely monitor the tunneling area at least weekly so dressing selection can be modified quickly if healing progress is not appropriate.
Patients frequently have tunneling wounds that have not progressed even though they have been managed for many months with alginates, hydrogels, or iodine-based dressings. When presented with challenging wounds, I consult my colleagues, published literature, conference presentations, and peer-reviewed case studies. I apply what I learn to my patient — often, what has worked for one patient will work for another similar patient.
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This article was not subject to the Ostomy Wound Management peer-review process.