The progressive sinus tract depth reduction preceded surface area reduction of the surrounding wound bed. A tract usually goes from the cause of infection to the skin’s surface. http://www.o-wm.com/content/wound-tunneling, https://www.pilonidal.org/wp-content/uploads/2016/02/managing_wound_sinu, https://www.wounds-uk.com/download/resource/1051, How to Assess Wounds for Tunneling and Undermining, Wound Care (Still) in Crisis – Fear and Loathing in the Big City: Cries for Help Unrequited, Creative Closure of Tunneling and Undermining Wounds with Negative Pressure Wound Therapy, Negative Pressure Wound Therapy and Tunneling Wounds, Previous surgery at or around the site (as this increases the possibility of foreign bodies in the sinus), Recent trauma to the wound area (hematoma or ischemic changes). Guideline NOTE: The management of a person with a pilonidal sinus wound follows “The SWRWCP’s Pilonidal Sinus Assessment and Management Algorithm”. This is frequently due to the presence of foreign material, such as hair (as in the case of pilonidal sinus) in the base of the abscess. Probably one of the commonest causes of sinus track formation is the presence of underlying infection (Davis et al, 1992). A common cause of persistent sinus is the inability of the abscess cavity to drain adequately, either due to the shape of the track or the size of the sinus itself. Significant factors include the following: - Occupation (sedentary lifestyle increases risk of pilonidal sinus); - Previous abscess formation (high rate of recurrence in foreign body sinus); - Previous surgery at or near the site (possibility of retained material); - Recent blunt trauma (possible haematoma or ischaemic changes); - Recent history of immobility or increasing dependence (possible occult pressure sore). Negative pressure wound therapy may also be used to achieve these treatment goals. Mentioned in: Actinomycosis The developing clot separates tissue planes as bleeding continues, and forces are exerted throughout the soft tissues. The track is invariably lined with granulation tissue. Accessed December 16, 2019. http://www.o-wm.com/content/wound-tunneling. https://www.wounds-uk.com/download/resource/1051. sinus, tunnel and/or undermining with known endpoints. Definition: A tunneling wound or sinus tract is a narrow opening or passageway underneath the skin that can extend in any direction through soft tissue and results in dead space with potential for abscess formation. Treatment of tunneling wounds is typically focused on treating the cause of the tunneling. This is used for complicated and recurring cases, and leaves minimal scar tissue. TREATMENT ATT Excision of sinus tract with excision of diseased lymph nodes. However, if damage is more superficial or extensive, breakdown of the tissues is likely. The goal of treatment is to stimulate the growth of granulation tissue in the tract and to make sure that the wound edges do not close prematurely. This may rupture spontaneously or may require surgical incision and drainage. Where there are multiple tracks, as in hidradenitis, wide excision of the affected area is the recognised treatment. Where bony involvement or infection is possible, plain X-ray examination is recommended. sinus tract: A narrow, elongated channel in the body that allows the escape of fluid. In most cases, dressings that will adequately drain the cavity and promote granulation are sufficient, however in extreme cases it may be necessary to surgically lay open the wound to properly treat the wound. The post-surgical wound packing must be applied and replaced two times a day for a period of 4-8 weeks. Due to vascular injury and a lesion ofthe peroneal nerve, she was surgically treated with reposition, fasciotomy, vascular reconstruction, and an external fixture. 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