Tunneling is opposite from undermining because it involves only a small area of the wound, however it can be deep. presenting with a pilonidal sinus wound. High-pressure irrigation can cause pain, bacterial spread (Lawrence, 1997) and may damage body defences (Wheeler, 1976). The presence of extensive bleeding within tissues and formation of localised haematoma can also cause damage to adjacent tissue due to the development of high pressure and subsequent ischaemia within tissue groups. A wound sinus is a discharging blind-ended track that extends from the surface of an organ to an underlying area or abscess cavity (Everett, 1985). âSometimes it takes something more manageable to get the message acrossâ, 10 January, 2002
In chronic cases this may be augmented with epithelial tissue. A tunneling wound or sinus tract is a narrow opening or passageway extending from a wound underneath the skin in any direction through soft tissue and results in dead space with potential for abscess formation. Their findings have been publicised at international conferences in poster presentations, but to date little has been published in peer-reviewed publications. Such wounds are best managed by the insertion of a tube drain or stud-type grommet. Guideline NOTE: The management of a person with a pilonidal sinus wound follows “The SWRWCP’s Pilonidal Sinus Assessment and Management Algorithm”. A fistula sinus tract study will examine a sinus cavity to check for communication or size of the cavity. The drainage of significant levels of fluid from a wound always raises the question of its origin. The Wound Stage/Thicknesstells the extentof tissue damage thatis visible • Only pressure injuries are staged • All otherwounds areconsideredFull Thickness or Partial Thickness. Measuring Wounds - Tunneling. The content is not intended to substitute manufacturer instructions. Procedures particularly prone to this phenomenon include abdominal surgery on people who are morbidly obese, abdominoplasty and breast reduction. Soft polythene catheters are increasingly replacing traditional silver probes for this task. Alternatively, where exudate is lower or aesthetics are a higher priority, absorbent foam dressings may be more suitable. Sinus tracts often expel drainage. The average time for wound healing to occur is approximately 6 weeks. The presence of the foam matrix within the wound prevents premature epidermal closure and so prevents bridging that might otherwise lead to recurrence. The Question is about a sinus which is not same as nasal or maxillary sinuses . The peak onset is at … Significant factors include the following: - Occupation (sedentary lifestyle increases risk of pilonidal sinus); - Previous abscess formation (high rate of recurrence in foreign body sinus); - Previous surgery at or near the site (possibility of retained material); - Recent blunt trauma (possible haematoma or ischaemic changes); - Recent history of immobility or increasing dependence (possible occult pressure sore). So I had open wound surgery a month ago (to the day) and the wound is healing pretty nicely. Patient history included a traumatic posterior knee luxation 5 years and 10 months prior to presentation with no fracture visible on x-ray examination. Figure 1 Although used for many years to pack sinuses, ribbon gauze is now not recommended, as tight gauze acts as a bung that prevents free drainage of exudate (Everett, 1985). The radiologist will insert a small foley catheter into the sinus tract, inject contrast material and then take x-ray images to evaluate the sinus cavity. Once skin integrity is lost, secondary colonisation and infection are likely to occur. The nature of the exudate, its volume, colour and consistency should also be noted. Alginate dressings can be a useful option in this type of wound care (Miller et al, 1993; Morison, 1992), as they can absorb moderate to high levels of exudate, are relatively easy to apply and cause minimal trauma on removal. This is a channel or a passageway which is often called fistula. This is therefore an area which needs further investigation. Opening the cavity prevents bridging of the wound edges and permits adequate drainage. The following section identifies specific products that are appropriate for the management or treatment of tunneling wounds or sinus tracts, according to the companies who chose to list them here. Soft polyethylene catheters or surgical stainless steel probes are frequently used for this task.