Wound undermining happens when tissue beneath the surface of a wound erodes, creating a pocket under the skin around the visible edges of the wound. This can slow down healing and create a breeding ground for infection.
When healthcare professionals catch wound undermining early and treat it properly, it can significantly improve the outcome. It’s important to be aware of the signs and symptoms so that you can seek help from your doctor or wound care specialist.
This article provides a comprehensive overview of wound undermining, including what causes it, how it’s diagnosed, and the best ways to manage it.
Wound undermining and tunneling: What are they?
When assessing a wound, healthcare professionals may look for signs of undermining or tunneling. But what exactly do those terms mean?
What is wound undermining?
Wound undermining refers to the separation of the skin from the underlying tissue. This separation creates a kind of pocket or shelf around the edge of the wound. It’s a sign that there’s been significant tissue erosion beneath the visible margins of the wound.
Undermining tends to be complex, and its spread can be difficult to predict.
What is wound tunneling?
Wound tunneling, on the other hand, describes narrow passageways that extend from the surface of the wound into deeper tissues.
The main difference between tunneling and undermining is that tunneling creates linear channels, while undermining creates a wider area of separated tissue.
What causes wound undermining?
Wound undermining happens when the tissue under the skin erodes. This can occur because of a few factors:
- Pressure on the skin: Sitting or lying in the same position for too long cuts off blood flow and can cause tissue to break down.
- Shear forces: Shear force is when layers of tissue separate, like when the skin slides in one direction and the bone underneath slides in another.
- Infection: Infections can eat away at tissue.
- Improper wound care: If a wound isn’t cleaned and dressed correctly, it won’t heal well, and undermining becomes more likely.
Certain health conditions also increase the risk:
- Diabetes
- Peripheral arterial disease
- Chronic hypertension
- Conditions that weaken the immune system
What are the signs of wound undermining?
When a wound undermines, it can be hard to tell how deep it is just by looking. Here’s what to watch out for:
- Skin separation: You may see that the skin around the wound is pulling away from the tissue underneath. If you gently press around the edge of the wound, you might feel a shelf-like edge.
- Hidden depth: The wound might be much larger under the surface than it appears. A healthcare provider can gently use a sterile swab to probe the wound and assess its true size.
- Changes in drainage: Pay attention to any changes in the amount or type of fluid coming from the wound.
- Periwound Appearance: Changes to the tissue surrounding the wound.
How is wound undermining diagnosed?
Diagnosing wound undermining usually involves a physical exam, although imaging techniques are sometimes used.
Clinical Examination
To check for undermining, a healthcare provider will:
- Visually inspect the wound and the skin around it, looking for subtle signs of undermining.
- Gently feel around the edges of the wound, using a sterile instrument to check for separation between the layers of tissue.
- Measure the depth and extent of the undermining, using a sterile probe and noting the measurements in centimeters.
Imaging Techniques
Sometimes, imaging can help healthcare providers assess the extent of the undermining. They may use:
- Wound sound ultrasonography to get a better look at the tissues.
- MRI and CT scans in more complex cases to see how deep the tissue involvement might be.
How to manage undermining wounds
Treating an undermining wound involves a multi-pronged approach. Here’s a look at some of the techniques your healthcare team may use:
Find and treat the root cause
It’s important to figure out what’s causing the undermining in the first place, whether it’s pressure, infection, or poor circulation. Pressure redistribution strategies are often used to keep the wound from getting worse. Conditions such as diabetes or poor circulation may also need to be managed as part of the treatment plan.
Control symptoms
Pain is often a factor with undermining wounds, so analgesics may be prescribed. If there’s an infection, antibiotics will be used.
Local wound care
This involves several steps:
- Wound cleansing. The wound needs to be cleaned with appropriate solutions.
- Debridement. Any dead or necrotic tissue has to be removed to help the wound heal.
- Wound packing. The undermined area needs to be packed with materials that will support the growth of new tissue.
- Dressings. Dressings should be chosen to keep the wound moist and protect the wound bed.
Fill the dead space
The undermined space needs to be filled to keep fluid from building up and to help the tissues come together.
Negative pressure wound therapy (NPWT)
NPWT may be used to help the wound close and reduce undermining.
Undermining in Pressure Ulcers
Undermining in a pressure ulcer means there’s advanced tissue damage. It’s a sign that the wound is more serious than it appears on the surface.
Undermining slows down the healing process and significantly raises the risk of infection in pressure ulcers because bacteria can hide and thrive in these hidden pockets.
If you have a pressure ulcer with undermining, it’s essential to redistribute pressure to the area and get specialized wound care to help it heal and prevent further complications.
In Closing
Wound undermining can be a tricky complication to manage. That’s why it’s so important to assess wounds carefully and treat them properly.
If you catch undermining early, treat the underlying causes, and provide the right wound care, you’ll give the wound the best chance to heal.