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A 36-year-old member asked:

how do undermining and tunneling differ in regards to stage 4 pressure ulcers?

3 doctor answers3 doctors weighed in
Dr. Krishna Narayanan
Specializes in Plastic Surgery
Undermining: Undermining occurs beneath the skin surface in continuation with the ulcer. Tunneling can occur in a deeper plane f the wound base.
Dr. Michael Miller
Wound care 36 years experience
Different etiologies: Our skin is made to take direct pressure, the deep tissues are not. When pressure is applied, it spreads out and depending on the direction "kills" the tissues under the skin causing undermining. A tunnel occurs when there is lateral force to the deep tissues disrupting the tissue planes in the direction of that force creating a "tunnel". Treatment is the same...Stay off it !
Dr. David Hardin
Wound care 36 years experience
Semantics: The process is the same for both, pressure damageto softer tissue underlying the comparatively tough skin. Undermining leaves a shelf of skin over a cavity while tunneling is a relatively straight line as its name would suggest covering possibly a great distance under the skin.

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A 39-year-old member asked:

What is the difference between undermining and tunneling in regards to stage 4 pressure ulcers?

4 doctor answers11 doctors weighed in
Dr. Oliver Aalami
Vascular Surgery 23 years experience
Length of tunnel: Undermining is when a wound diameter is wider at its base (deep in the wound) than at the wound's skin edge. For example, the hole in the skin may be 5mm, but the base of the wound cavity is 10mm. Tunneling is when the wound tracks under the skin to another opening in the skin or to a deeper cavity. Tunnels are sometimes referred to as a "sinus" or "tract".
A 35-year-old member asked:

Which cream can I use to treat pressure ulcers stage 2-3?

4 doctor answers4 doctors weighed in
Dr. Johnnie Alston
Podiatry 15 years experience
Depends: If the wound is clean i would use a collagen dressing of some sort. If you need a cream i would try medihoney gel or santyl. Both of these medications can help keep the wounds clean.
A 24-year-old member asked:

Why do pressure ulcers have to be elevated?

4 doctor answers9 doctors weighed in
Dr. William Purtill
Specializes in Vascular Surgery
Pressure relief: Pressure ulcers need relief of the pressure as the primary treatment. A moist wound environment, treatment of infection, removal of dead tissue and treatment of poor nutrition/ diabetes/ poor circulation (pad) are also very important. Elevation of a leg pressure ulcer would be to relieve pressure or if there is swelling. It depends on the location of the wound.
A 45-year-old member asked:

How long does it take for pressure ulcers to form?

1 doctor answer1 doctor weighed in
Dr. Scott Bolhack
Wound care 35 years experience
Duration for PUs: Pressure ulcers are due to 'enough' pressure to occlude the blood pressure of the microscopic capillaries. No one is sure how long it you must occlude these capillaries so that a pressure injury results in changes in the skin. It will vary from person to person because of multiple factors in addition to time: repeated episodes, moisture, nutrition, protein stores, ability to heal, diabetes mellitu.
A 32-year-old member asked:

How do pressure ulcers form?

4 doctor answers7 doctors weighed in
Dr. George T Tsai
General Surgery 27 years experience
Multifactorial: Pressure ulcers are rare, though possible in the young - as in a 10 hour back surgery. It is more common in the elderly / infirmed with issues like stroke related paralysis/paresis, cachexia, metabolic problems like diabetes and chronic illness like kidney disease. Add prolonged pressure to the above, even healthy looking tissue will breakdown and not heal properly.

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Last updated Sep 29, 2016
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