Tunneling Wounds

WoundSource Editors's picture
tunneling wound assessment

By the WoundSource Editors

Perhaps the most difficult type of wound for health care professionals to treat is a tunneling wound. Tunneling wounds are named for the channels which extend from the wound, into or through subcutaneous tissue or muscle. These tunnels sometimes take twists or turns that can make wound care complicated. Tunneling is often the result of infection, previous abscess formation, sedentary lifestyle, previous surgery at the site, trauma to the wound or surrounding tissue, or the impact of pressure and shear forces upon many tissue layers causing a “sinkhole-like” defect on the skin. Tunneling wounds need careful wound assessment and management.

Laurie Swezey's picture
Tunneling Wound

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

As part of a thorough wound assessment, in addition to noting location and measuring size, the entire wound bed should be probed for the presence of tunneling and/or undermining. If you are unsure what tunneling and undermining are and how to recognize these phenomena, here's an explanation of these terms and how to assess wounds for their presence.

Laurie Swezey's picture

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

The measurement of a wound, and the plotting of its size over time, is the only estimate that can be used to accurately predict wound healing. This includes such variables as wound exudate, the presence of necrotic tissue, slough and granulation tissue, as well as undermining and tunneling.

Michael Miller's picture

By Michael Miller DO, FACOS, FAPWCA, WCC

RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 16

As I write my blog, I wonder whether anyone really reads it. I know that my wife and daughters do, because they have no choice. For all the foibles my 24 year old is quick to point out --Dad, you’re not really going to wear that; Dad, you have a stain on your shirt; Dad, you need to empty the cat litter (to which I reply, “why, they didn't eat what I poured them yet!”)--, she has commented on an occasion or two, “That was funny” or, “Yeah, it’s pretty good this time.”

Beth Hawkins Bradley's picture

By Beth Hawkins Bradley RN, MN, CWON

Wounds treated with negative pressure wound therapy (NPWT) are not often straightforward. They occur in interesting places, have anything from slough to hardware visible in the bases, and have nooks and crannies that are not visible to the clinicians peering into the wound. A gentle probe is necessary during wound assessment to identify tunnels and undermined areas. I prefer to gently probe first with my gloved finger (I have small hands) because I can identify hidden structures and other oddities. Then I will use a swab to measure how far the tunnel or undermining extends. Once hidden dead spaces have been identified, clinicians can select the best strategy to bring them to closure. Herein are several techniques employed by clinicians to close undermined and tunneled areas.