Tunneling refers to passageways underneath the skin surface that extend from a wound and can take twists and turns Slough and eschar may also be present in Stage 3 and 4 pressure injuries Slough is inflammatory exudate that is usually light yellow soft and moist Eschar is dark brown/black dry thick and leathery dead tissue
These wounds may have slough or eschar but minimally Extensive slough or necrosis would be better defined as a Stage 4 Pressure Injury or Unstageable If needed these wounds may be debrided both surgically or with topical applications Epibole rolled edges undermining and/or tunneling often occur Depth varies by anatomical location
Subcutaneous fat may be visible but bone tendon or muscle is not exposed Slough may be present but does not obscure the depth of tissue loss May include undermining and tunnelling Category/Stage IV Full‐thickness tissue loss with exposed bone tendon or muscle Slough or eschar may be present on some parts of the wound bed
3 While initiating the treatment of tunneling wounds the first and most crucial step is cleansing the wound to avoid the microbial load that plays a role in tunnel formation and its maintenance To avoid any abscess development at the
Wound slough is a common challenge in wound care particularly in chronic wounds ulcers and those resulting from severe burns or infections Understanding the nature and implications of slough in wounds is crucial for effective treatment and recovery Managing slough wounds is paramount to promoting optimal healing outcomes
a Full thickness tissue loss in which the base of the ulcer is covered by slough yellow tan gray green or brown and/or eschar tan brown or black in the wound bed b Unable to visualize true depth of tissue destruction c Until enough slough and/or eschar is removed to expose the base of the wound the true depth and
Stage 4 Full thickness tissue loss with exposed bone tendon or muscle Slough or eschar may be present on some parts of the wound bed Often include undermining and tunneling What causes undermining of a wound Undermining is caused by erosion under the wound edges resulting in a large wound with a small opening
Full thickness loss of skin in which adipose fat is visible in the ulcer and granulation tissue and epibole rolled wound edges are often present Slough and/or eschar may be visible The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds Undermining and tunneling may occur
fat undermining tunneling slough exposed bone with osteomyelitis and rolled wound edges 2 Stage 2 Ischial Pressure Injury 3 Unstageable Pressure Injury with Slough and Eschar The following wounds and pressure injuries are presented on Seymour IITM Wound Care Model 4 3 7 8 1 6 5 2
found in wounds Tunnel Dressing characteristics • A unique antibacterial wound dressing that can be used for Sinus Tracks and Tunnels • Wicks bacteria laden exudate slough and debris out of the wound • High tensile strength easy one piece removal Hydrofera Blue Specialty Dressings Hydrofera CLASSIC offers specialty dressings for
Undermining occurs when the tissue under the wound edges becomes eroded resulting in a pocket beneath the skin at the wound s edge Tunneling refers to passageways underneath the surface of the skin that extend from a wound and can take twists and turns Slough and eschar may also be present in Stage 3 and 4 pressure injuries
Full thickness loss of skin in which adipose fat is visible in the ulcer and granulation tissue and epibole rolled wound edges are often present Slough and/or eschar may be visible The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds Undermining and tunneling may occur
bone in the ulcer Slough and/or eschar may be visible Epibole rolled edges undermining and/or tunneling often occur Depth varies by anatomical location If slough or eschar obscures the extent of tissue loss this is an Unstageable Pressure Medical Device Related Pressure Injury This describes an aetiology Medical device related
Wound Management Undermining/ Tunneling necrotic tissue wound edges wound drainage periwound infection irrigation tools
the edge of the wound • Describe by clock face with patients head at 12 undermining is 1 cm from 12 to 4 o clock Tunneling Channel that runs from the wound edge through to other tissue • tunneling at 9 o clock measuring 3 cm long
dehisced surgical wounds diabetic wounds lower extremity venous wounds trauma wounds and burns Contraindications for NPWT include exposed vital organs blood vessels and nerves; inadequately debrided wounds generally if the wound bed is obliterated with eschar or slough ; untreated osteomyelitis
full thickness skin loss involving damage to or necrosis of subcutaneous tissue subcutaneous fat may be visible; but bone tendon or muscles are not exposed slough may be present; wound may include undermining and tunneling depth of a stage III ulcer varies by anatomic location because of variation in presence and depth of subcutaneous tissue
Understanding Wound Tunneling Understanding wound tunneling plays a vital role in effective care impacting healing outcomes significantly Picture a treasure hunt where clues reveal your wound s condition That s the essence of wound assessment Upon noticing a tunnel forming it feels like the wound is concealing something critical
Damage or disruption of living tissue s cellular anatomical and/or functional integrity defines a wound [1] Acute and chronic wounds are technically categorized by the time interval from the index injury and more importantly by the evidence of physiological impairment [2] Accordingly specific treatments including biofilms would be planned to
3 A tunneling wound is a type of wound characterized by narrow passageways extending from the wound surface into deeper tissues These tunnels can be complex and may branch out in different directions Unlike other wounds tunneling wounds present with distinct channels within the wound bed
