Our Clinical Director Vicki Fischenich offers an expert advice.
Common cause of wound tunneling is infection of the underlying tissues. Infections could be of cutaneous origin or from deeper structures, such as bone in cases of osteomyelitis. Undermining is really the result of shear force when the patient is being moved or transferred, or sliding in resting position.
Treating the causes of these types of complications should be one of the first priorities: treating infection, offloading, exercising careful patient handling. It’s important to properly lift the patient with an existing wound rather than use dragging or pulling motions to avoid shear forces when transferring or repositioning them. Follow up with offloading the wound site as much as possible for faster healing.
The purpose of filling a cavity, tunnel, sinus tract, etc. is to avoid dead space that may create further wound complications: seromas, or the upper part of wound closing on the surface and leaving an open space underneath. The caregiver should fill the undermining spaces, tunnels or cavities with regular or AMD gauze using a Q-tip or a similar tool. It is important not to overstuff these spaces, just lightly place the gauze so it reaches the farthest points.
The important consideration is selecting a product that retains its shape so it can stay in contact with the undersurface of Enluxtra dressing. Any product selected as a filler material must not shrink or decrease in size with the moist wound environment that may cause it to retract back from Enluxtra dressing. This situation often leads to maceration, foul odor; stalling of wound progress, wound decline.
Any filler material that DOES NOT consist of cellulose fiber (such as an alginate or Aquacel Ag or honey alginate) SHOULD BE AVOIDED.
Bring the end piece of gauze out and spread it across the periwound to create as much surface area that will touch the undersurface of Enluxtra dressing. This will aid in wicking the exudate away from the wound and into the dressing. The gauze spread across the periwound must be covered completely by Enluxtra with a 1” overlap onto the healthy skin. Be sure that the removal of the dressing is done before drainage reaches the dressing edge . Review the correct application techniques in this short video.
Apply Enluxtra dressing and ensure that its undersurface is in full contact with the wound bed, including any areas of the wound that are not covered with gauze, especially sloughy parts. This will expedite the removal of non-vital tissue from the wound.
Change Enluxtra dressing and wound filler every 2-3 days until the wound is clear of slough and non-vital tissue. Then gradually increase the time between changes to up to 5-7 days, depending on the exudate level.
Nutrition is important!
Another important thing to keep in mind is making sure the patient’s nutrition is adequate. Wounds like this consume a lot of calories, therefore the patient’s caloric requirements may be higher.
Enluxtra dressing application on the recent case of deep tissue injury that progressed to unstageable wound with black eschar and then to an open wound with undermining (now completely healed!):
To self-educate, check out our mini-tutorials, attend a live clinical webinar, take a basic application mini-course, or, if you’re extra-ambitious, get certified!
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