What is a ”Tunneling” Bed Sore?

Most wounds, such as pressure sores, tend to simply grow on the surface of the skin. However, a tunneling bedsore instead progresses deeper into the body. While the bedsore’s outward appearance indicates otherwise, the wound involves a greater area and can affect other organs.

Definition of Tunneling Wound

A tunneling bedsore is essentially a version of a tunneling wound. A tunneling wound is a wound that goes deep in the body and snakes through layers of tissue, creating a curved tunnel that makes the wound difficult to heal. Tunnel wounds are usually a side effect of an infection or complication with a primary wound. For example, the application of more pressure in a bedsore reduces the volume of the layers compared to the surrounding tissues, creating a sinkhole-like structure within the skin.

What Causes Tunneling?

Before a health practitioner applies treatment for a tunneling wound, he or she must assess the cause for the tunneling. Several factors play into the tunneling of the wound, some of which include:

• Infection that is destroying the tissue
• Dehydration from a wound dressing
• Prolonged use of antibiotics that led to a resistant secondary infection
• Application of pressure or shear on the wound
• Inadequate packing of the wound
• Impaired blood flow that increases infection and delays healing
• Certain pain relief or swelling-reducing medications suppressing wound contraction
• Corticosteroids that can slow down collagen formation
• Stalled wound healing that leads to an inflammatory phase

Assessment of Tunneling Wounds

Due to the curved nature of tunneling wounds, examination and treatment is potentially difficult. A doctor usually handles the process of assessment of a tunneling wound through careful steps.

1. The physician investigates the wound by performing a superficial examination, as well as gathering information from the patient or caregiver over the wound’s progress and causes for the tunneling.
2. The doctor probes the wound by using a soft, non-fibrous tool, like a polyethylene catheter, to discover characteristics such as depth and direction of the tunnel. The doctor can also accomplish the assessment through sonography, an MRI, or a CT scan.
3. The physician performs tunnel wound measurements by using a clock face for position. The measurement unit for the wound is centimeters.

Treatment of Tunneling Wounds

Now that the doctor has assessed the tunneling wound, he or she can apply the appropriate treatment. Treatments will vary depending on the wound, but they generally follow the same steps:

1. Eliminate the root causes of the tunneling wound.
2. Clean the wound to prevent bacterial infection.
3. Pack the wound carefully to avoid pressure on the sides, but also prevent the wound from becoming concave.
4. If necessary, simulate granulation tissue formation by using iodoform gauze, VAC therapy, DuoDERM Hydroactive Gel or other hydrogels, or medicated ropes.
5. Keep pressure and weight off from the wound and instruct patients and caregivers to do the same.
6. Check a wound site weekly to track progress and change dressing selection if there is no progress.

Due to the curved nature of tunneling wounds, not every mainstream treatment method for wound curing is effective. Physicians may have to resort to unique treatments and other drastic methods such as:

• Applying negative pressure therapy (such as VAC therapy, SNaP, and Pico)
• Opening and debridement of tunnels for cleansing and treatment
• Draining of the wound to promote granulation

The consequences of tunneling wounds include complications and death, so assessment and treatment of the wound is a priority. Healthcare providers should approach treatments with flexibility, as the methods may need to change if the situation with the wound changes as well.

Contact Nursing Home Law Center LLC if you believe the tunneling pressure sore you or a loved one has is a result of nursing home neglect. Get your free consultation today.

Sources

• Tunneling Wound Assessment and Treatment
• Current Perspectives On Dressings, Tunneling Wounds And Infected Ulcers