Wound Management

Tunneling Wound: Causes, Diagnosis & Treatment

Most wounds are superficial and tend to affect the skin's surface. However, some wounds progress deeper into the body, reaching the underlying tissues and organs. Tunneling is often a sign that the wound is progressing from an initial superficial wound on 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.

There are various risk factors associated with tunneling wounds, and they 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.

How long does a Tunneling Wound take to heal?

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 wound tunneling. 
• 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 their direction. 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 an MRI.

Can a Tunneling Wound heal on its own?

Tunneling wounds do not heal on their own and typically require medical intervention for proper healing. Wound Tunneling occurs when there are channels or passageways that extend from the wound's surface into deeper tissues. These wounds often have underlying infection or tissue damage, making them more challenging to heal without appropriate medical care.

How to Treat Tunneling Wounds?

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: 

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