Wound undermining occurs when significant erosion occurs underneath the outwardly visible wound margins resulting in more extensive damage beneath the skin surface . Consequently, while the external wound might appear small, large areas of tissue loss will be detected beneath the surface when the opening is probed.
What causes undermining of a wound?
Undermining is caused by erosion under the wound edges , resulting in a large wound with a small opening. Much like an iceberg, what you see on the surface is not indicative of what lies below.
What does undermining mean in wound care?
Undermining means cutting the fibrous septae that connect the skin to the underlying fascia , and generally this is accomplished by using the scalpel to cut the septi just beneath the dermis as shown here.
What does tunneling mean in wound care?
A tunneling wound is a wound that’s progressed to form passageways underneath the surface of the skin . These tunnels can be short or long, shallow or deep, and can take twists and turns. Tunneling can occur in stage 3 and stage 4 pressure ulcers.
What does undermining ulcer mean?
[ ŭn′dər-mī′nĭng ] n. A chronic skin ulcer having overhanging margins, caused by bacterial infection .
What does wound exudate look like?
Serosanguinous drainage is the most common type of exudate that is seen in wounds. It is thin, pink, and watery in presentation . Purulent drainage is milky, typically thicker in consistency, and can be gray, green, or yellow in appearance. If the fluid becomes very thick, this can be a sign of infection.
What is the yellow fluid that leaks from wounds called?
Wound drainage that has a milky texture and is gray, yellow, or green is known as purulent drainage . It could be a sign of infection. The drainage is thicker because it contains microorganisms, decaying bacteria, and white blood cells that attacked the site of the infection.
What does it mean when a wound is tracking?
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). The track is invariably lined with granulation tissue. In chronic cases this may be augmented with epithelial tissue.
What is Epibole in a wound?
Epibole refers to rolled or curled-under closed wound edges that may be dry, callused , or hyperkeratotic. Epibole tends to be lighter in color than surrounding tissue, have a raised and rounded appearance, and may feel hard, rigid, and indurated.
How do you describe a wound edge?
Wound edges can be described as diffuse, well defined or rolled . The pattern or distribution refers to the location of the lesions within a certain area. Arrangement refers to the position of nearby lesions. The arrangement of lesions can assist in confirming a diagnosis.
What is the fastest way to heal an open wound?
- Small cuts and scrapes can be left uncovered; however, moisture is usually needed to help speed up the healing process. ...
- Deep open wounds may require stitches or staples. ...
- Keep the large open wounds covered and moist to fasten the healing process by the rapid growth of new skin tissues.
What is the best practice to clean a tunneling wound?
In order to promote healing, the wound must be kept clean. Soft-tipped irrigation cannulas can be used to gently cleanse the tunnels and the wound itself. If infection is suspected to be the reason for tunneling, appropriate antimicrobial therapy should be instituted. Any dead (necrotic) tissue should be debrided.
When do you stop packing an open wound?
If a gauze packing was put in your wound, it should be removed in 1 to 2 days . Check your wound every day for any signs that the infection is getting worse. The signs are listed below.
How do you undermine a wound?
Measure the undermining by inserting the cotton tip applicator into the area of undermining and grab the applicator at the wound edge . Measure the applicator against the ruler. When measuring undermining, use ranges. For example, if the undermining is 2 cm from 12:00 to 3:00, document it that way.
Is Slough normal?
Slough is present in the large majority of chronic wounds . Slough recurrence is common post-debridement/desloughing, therefore ongoing desloughing needs to be maintained 1 . There is no single method able to remove all devitalised tissue. Instead, evidence suggests that a combination of methods is required 7 .
What is considered extensive undermining?
Complex repair includes EXTENSIVE undermining defined as a distance EQUAL TO or GREATER THAN the maximum width of the defect, measured perpendicular to the closure line .”
