Dressing a Tunnel Wound
Wash your hands with a mild cleanser for 15-30 seconds. Wet your hands with warm water, add cleanser, and lather up for at least 15 seconds to remove any bacteria from your hands. Be sure to get in between your fingers and under your nails! Rinse the cleanser away thoroughly and dry your hands off on a clean towel. Infection caused by bacteria is one of the main causes of tunneling, so it’s crucial that you wash your hands and work in a sterile environment. An alcohol-based cleanser is a good option if you want to be certain that you've killed all the bacteria on your hands.
Remove the old dressing carefully and put it in a plastic bag. Remove the medical tape holding the gauze in place and pull away the gauze carefully. If the gauze sticks to the wound, gently dampen the area with warm water and try again. To prevent the spread of bacteria, put the old dressing into a plastic bag immediately, seal it up, and throw it away quickly. Wash your hands again after removing and disposing of the old dressing. Your doctor will tell you how often to apply a fresh dressing to your wound. You may need to do it every day or every 48-72 hours.
Dampen sterile gauze or a soft cloth with saline or soap and water. Your doctor will tell you what to clean your wound with. If you haven’t seen your doctor yet, any mild cleanser will do the trick. Mix up a solution of warm water with a few drops of the mild soap, soak the gauze or cloth in the solution, and wring out the excess. Always follow your doctor's instructions for cleaning and dressing a tunnel wound.
Dab gently around the wound with the gauze or cloth to clean the area. Wipe away any blood, pus, and drainage from the wound and the surrounding area. Go slow and dab gently since tunnel wounds can be painful. If you have a deep tunnel wound, your doctor will instruct you to irrigate it with saline solution when you change the dressing. Do not irrigate the wound unless your doctor tells you to. Hold the saline irrigation tip 4–6 inches (10–15 cm) from the wound. Squeeze the bottle or plunger to release a steady stream of saline. Sweep the tip from 1 end of the wound to the other and then back again to flush loose tissue, debris, and bacteria out of the wound. Aim to use at least 100 ml of saline fluid. Never apply any type of lotion, cream, or herbal remedy on or around the wound unless your doctor specifically tells you to do so.
Apply a fresh dressing according to your doctor’s instructions. The kind of dressing you use depends on the wound’s size, location, and drainage amount. Your doctor will tell you what kind of dressing to use and show you exactly how to apply it properly. If you haven’t seen your doctor yet, cover the wound with anti-microbial gauze for now and make an appointment as soon as possible. Some tunnel wounds require packing with gauze to promote healing. Your doctor will show you how to pack your wound and how to order packing supplies. If you do need to pack your wound, soak the gauze in sterile solution or use pre-moistened sterile gauze. Gently push the gauze into the wound to fill the empty space inside the tunnel. Then, cover the entire wound with dry gauze.
Keep your wound covered at all times to promote healing. It’s important to keep your tunnel wound protected from bacteria, so keep it covered with gauze or another type of dressing according to your doctor’s instructions. Try to change the dressing as quickly as possible to minimize how much time the wound is uncovered and only remove the gauze and packing to change the dressing.
Seeking Medical Treatment
See your doctor immediately if you develop a tunnel wound. You can easily identify a tunnel wound by its “sink-hole” appearance near a primary wound. The “tunnel” appears as the infection eats through the top layers of skin and develops into a curved or S-shaped hole. Tunnel wounds are serious and require medical treatment, so it’s important to see your doctor right away. Tunnel wounds are notoriously difficult to treat and can take weeks or months to fully heal. Don’t attempt to treat a tunnel wound on your own.
Tell your doctor your medical history and any details about your wound. Clearly explain to your doctor how you got the primary wound, when the tunneling began, what dressings you’ve been using, all of your current medications, and how much pain you’re in. Use as much detail as possible. If you have any medical conditions, like diabetes or anemia, it’s crucial that you tell your doctor about them. For example, conditions like diabetes can inhibit the healing of wounds. Your doctor won't be able to properly treat your wound without this information.
Allow the doctor to irrigate the wound and diagnose the cause. The doctor will irrigate the wound with a saline solution to clean it out and examine the wound closely for symptoms that help them make a diagnosis. For example, tunneling caused by infection will be inflamed and continually ooze fluid. Measuring the wound's width and depth helps the doctor fully assess the severity of the tunneling. Your doctor may need to order a CT or MRI to complete the assessment. Then, they will diagnose the cause of the tunneling and prepare a tailored treatment plan for you. Common causes of tunneling are infection, improper dressing, diabetes, and prolonged use of antibiotics. The type of treatment you need depends on the cause of the tunneling. If your doctor suspects infection, they may perform a swab to identify the type of bacteria present. They can then prescribe the best antibiotic for that type of bacteria. They’ll need to swab the inside of the wound to avoid picking up other bacteria on the surface of your skin. Blood testing is common, especially if you're diabetic or if your doctor suspects you might be. X-rays and ultrasounds can be helpful when diagnosing wounds that won't heal, especially for diabetics or people with chronic bone issues. In addition to irrigating the wound, the doctor might wish to debride it (remove any damaged tissue or foreign materials) with a scalpel or other surgical tools. While this sounds alarming, don’t worry—they’ll give you anesthesia to keep the procedure painless.
Watch the doctor dress the wound so you can do it at home. The type of dressing your doctor uses depends on the wound’s size, location, and cause. It’s typical to pack the “tunnel” with sterile gauze to fill the empty space and absorb fluid before applying a covering to protect the wound. However, your doctor may use another kind of dressing, like a hydrogel, foam, collagen, iodine-based, or hydrocolloid dressing, depending on the situation. Pay attention to how your doctor dresses the wound and ask any questions you have since you’ll have to apply fresh dressings at home. Use the type of dressing that your doctor recommends and apply a fresh dressing when your doctor tells you to. You may need to apply a fresh dressing daily or every 48-72 hours. You may need to pack a tunnel wound for a few days or even a few weeks, depending on how fast the wound closes. You may need to keep the wound covered for 1-6 weeks, or possibly even longer, depending on how quickly and well it heals.
Follow your doctor’s instructions for treatment and follow-ups. Avoid putting unnecessary pressure or weight on the wounded area as it heals. Clean the wound and apply a fresh dressing every 24-72 hours, depending on your doctor's instructions. Be sure to take any prescribed antibiotics or other medications exactly as directed! The wound must be monitored regularly by your doctor as it heals, so be sure to ask about follow-up appointments and go ahead and schedule them, if possible. Weekly measuring and monitoring of a tunnel wound is necessary to make sure it closes and heals properly, so don’t skip your follow-ups! Your doctor may prescribe a powerful oral antibiotic like penicillin or amoxicillin if your tunneling is caused by an infection. Topical antibiotics may be given. Follow your doctor's instructions for applying these medications. Prescription painkillers and anti-inflammatory medications are often prescribed to help patients manage pain and swelling.
Manage any underlying conditions that might slow healing. If you have an underlying condition that affects how well your wounds heal, such as diabetes, work with your doctor to keep the issue under control. This will help ensure that your wound heals as quickly as possible. If you’re diabetic, take any prescribed medications and monitor your diet carefully to keep your blood sugar under control. Talk to your doctor about how to monitor your blood sugar and what to do if it gets too high. Other factors that can slow down wound healing include high stress levels, a poor diet, certain medications, obesity, and alcohol or tobacco use. Talk to your doctor about how to improve your overall health to promote better healing.
Discuss surgical treatment if your wound isn’t healing. In some cases, you may need surgery to help a tunnel wound heal properly. If you’ve tried more conservative treatments and your wound still isn’t improving, ask your doctor if surgery might be helpful for you. The surgeon may open up the wound so that they can clean it out thoroughly or remove any damaged tissue or foreign objects that might be preventing the wound from healing. Always follow any special instructions from your surgeon about what to do before and after the operation. These instructions will help prevent complications and ensure that your wound heals as quickly and safely as possible.
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