What Does a Tunneling Wound Look Like? Sinus Tract Identification
What does a tunneling wound look like?
The Quick Answer
**Tunneling wounds feature narrow channels** (sinus tracts) extending from the surface wound into deeper tissue—visible as small openings at wound edges with probing revealing depth beyond surface dimensions. Unlike undermining (circumferential separation under edges), tunnels follow linear paths through subcutaneous tissue or muscle. Probe measurement using clock-face notation (e.g., '2cm tunnel at 3 o'clock') documents extent for targeted packing and monitoring.
Why We Ask This
Clinicians miss tunneling during superficial wound assessment, treating only surface dimensions while hidden tracts harbor infection and prevent healing—leading to recurrent abscesses or unexpected wound deterioration weeks after apparent surface improvement.
The Practical Science
Tunneling results from pressure/shear forces creating 'sinkhole' defects, previous abscess drainage tracts, or infection tracking along tissue planes. Probing with sterile cotton-tipped applicator (never finger) measures depth while avoiding false passages. Imaging (ultrasound/MRI) may be needed for complex tracts exceeding 5cm depth.
In Clinical Practice
A stage 4 pressure ulcer appears 3cm×4cm superficially but probing reveals a 6cm tunnel extending laterally toward the hip—requiring iodoform gauze packing to maintain drainage and prevent premature surface closure over unhealed depth. Without tunnel identification, surface closure would trap infection causing recurrent abscess.
References & Context
Tunneling Wounds: Risk Factors, Treatment and Healing"A tunneling wound, also known as a sinus tract, is a type of chronic wound characterized by a narrow channel or tract extending from the wound's surface into deeper tissue. This channel or tunnel can be shallow or deep and may create pockets or dead-end passages within the wound.Oct 12, 2023"