Undermining wounds present a serious challenge for healthcare professionals in clinical practice because they’re often much more serious than they first appear, especially when infection sets in, delaying wound healing.
Similar to tunneling wounds, an undermining wound is a skin injury that extends parallel to the wound surface into the subcutaneous tissue, often resulting in more extensive tissue damage than initially apparent. Because they are not easily observable, and are even less accessible, undermining wounds are particularly complex to diagnose and treat effectively.
To limit the damage and patient discomfort an undermining wound can cause, and to prevent infection from spreading past the wound edges, healthcare professionals must watch high-risk wounds closely, clean surgical wounds carefully, and move quickly at the first sign of wound undermining.
What triggers wound undermining?
Undermining wounds typically develop in specific types of ulcers and pressure-related skin injuries.
Pressure ulcers, for instance, result from the prolonged pressure and shearing forces that lead to ischemia and skin necrosis—which cause the wound to extend far beyond the visible wound edge.
Neuropathic ulcers, commonly seen in diabetic patients with limited blood flow to the feet, may also exhibit undermining caused by peripheral neuropathy and impaired healing processes. Without full sensation, patients experiencing peripheral neuropathy may experience wound undermining for weeks or months before they recognize the need to seek medical care.
While undermining is more common in diabetic or pressure ulcers, any wound that is under tension or pressure, like surgical incisions or traumatic injuries subjected to stress, can develop tissue separation beneath the skin surface. Additionally, wounds that experience significant or repeated trauma while healing may undermine over time, slowing the entire healing process.
Watch for these symptoms at the wound surface
The success of healing an undermining wound largely depends on how quickly it’s discovered. The sooner an undermining wound is detected and treated, the less dead space can develop just below the surface—and the less time infection has to set in.
One key early indicator of wound undermining is tissue breakdown around or under the wound margin, which can be detected through gentle probing.
Another indicator is prolonged patient discomfort or repeated wound opening, even with careful closure techniques. That discomfort and slow healing is worsened by underlying infection and its common symptoms: redness, warmth, swelling, purulent discharge, and fever.
In some cases, advanced imaging techniques like thermography or ultrasound are necessary to detect subcutaneous tissue damage not apparent on the wound surface.
Three ways to prevent wound opening and accelerate wound closure
Effectively managing undermining wounds requires both caring for the wound bed and treating the underlying causes.
One method healthcare professionals use to stop the growth of dead space below the wound is wound packing.
Wound packing fills the dead space below the wound surface, so it doesn’t close too quickly. It also promotes the formation of healthy granulation tissue.
Some healthcare professionals use Dakin’s Solution to soak the wound pack materials before positioning them in the wound to reduce the bacterial bioburden at the wound site.
Dakin’s Solution is a buffered sodium hypochlorite solution with antimicrobial properties that help reduce infection-causing microorganisms and disrupt the biofilm in complex wounds. When used in wound packing, gauze or dressings soaked in Dakin’s Solution are gently placed into the wound cavity, so the solution reaches all areas of the wound, including undermined sections, promoting a healthier healing environment.
Wound cleansing and debridement are also critical components of undermining wound treatment.
Regular irrigation of the entire wound helps remove debris and bacteria, while debridement—whether surgical, mechanical, enzymatic, or autolytic—facilitates healing by removing necrotic tissue.
Dakin’s Solution is approved for use as a debriding and cleansing agent, and has been shown to kill 99.9999% of MRSA and VRE in just 30 seconds of exposure—all without antibiotics, steroids, or alcohol. When applied to a wound during rinsing or debridement, it aids in breaking down necrotic tissue and biofilms, which facilitates the debridement process. By removing dead tissue and debris, it promotes a cleaner wound bed, which is essential for effective healing.
Negative Pressure Wound Therapy is another method some healthcare professionals use to heal wound undermining.
Negative Pressure Wound Therapy (NPWT), also known as vacuum-assisted wound closure, is another effective treatment modality for undermined wounds.
NPWT with instillation involves the intermittent introduction of a wound-cleansing solution like Dakin’s Solution directly into the wound bed. The solution remains in the wound for a prescribed period before being removed by the negative pressure system. This combination enhances the wound-cleansing process by:
- Reducing bacterial bioburden: The antimicrobial action of Dakin’s Solution helps lower the risk of infection.
- Facilitating debridement: The solution helps to loosen and remove necrotic tissue and exudate from the wound surface.
- Promoting granulation tissue formation: By maintaining a clean wound environment, it supports the growth of healthy tissue.
Using Dakin’s Solution in NPWT can be particularly beneficial for complex or chronic wounds that have not responded to standard treatments.
Dakin’s wound care solutions support healing at every stage
When it comes to caring for undermined wounds, tunneling wounds, pressure ulcers, and other complex skin injuries, choose Dakin’s Solution for versatile care at every stage. With four flexible formulations for both acute and chronic wound care, and three convenient cap types to fit your protocols, Dakin’s offers healing in every bottle.
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