In chronic cases this may be augmented with epithelial tissue. The presence of the foam matrix within the wound prevents premature epidermal closure and so prevents bridging that might otherwise lead to recurrence. The haematoma liquefies, revealing a cavity with one or more sinuses. ‘Sometimes it takes something more manageable to get the message across’, 10 January, 2002 All sinuses should initially be swabbed and a specimen sent for culture and sensitivity. 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Avascular damage may also result from some surgical procedures. Recurrence rates remain high, often as a result of incomplete assessment or the use of inappropriate dressing techniques that prevent the drainage of exudate and allow the formation of epidermal bridges. Tunneling is opposite from undermining because it involves only a small area of the wound, however it can be deep. This procedure will take approximately 30 minutes. Ostomy Wound Management. Treatment regimes must be based around removal or treatment of the causative factor. This is used for complicated and recurring cases, and leaves minimal scar tissue. The major etiologies for this condition include infections, presence of a foreign body and tissue ischemia following trauma. The average time for wound healing to occur is approximately 6 weeks. Suture anchors are increasingly used to fix soft tissue to bone. I go to a clinic and have it dressed every other day and my girlfriend changes the dressing on the off days. Pilonidal sinus is a cystic disease that occurs most often in the sacrococcygeal region. Cotton fibres in its composition are very prone to shedding into the wound and it tends to become sodden very quickly, leading to peri-wound maceration. In order to prevent accumulation of exudate and pus in the wound it is necessary to irrigate the area regularly. Which Is the Better Term: Pilonidal Cyst or Sinus? A tunneling wound or sinus tract is a narrow opening or passageway extending from a wound underneath the skin in any direction through soft tissue and results in dead space with potential for abscess formation. The patient voluntarily discontinued antibiotic suppressive therapy (AST) after 10 years of treatment and paradoxically experienced full resolution of signs of chronic prosthetic joint infection (PJI), including recovery of his left-sided draining sinus tract. All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. sinus tunnels under the skin often with more than 1 tract or di-rection.2 Pilonidal sinus wound is a chronic acquired condition caused by 1 or more factors as listed in Table 1.3–6 Pilonidal sinus wounds occur in a ratio of 4 men to 1 woman. A sinus is a tract leading from a skin or mucous surface to a deep-seated focus of suppuration, a vestigial structure or to aberrant secreting tissue; it may result from an acute or chronic abscess and may be associated with any of the organisms of suppuration. Accessed December 16, 2019. 35. The cause of a sinus must always be determined by in-depth assessment. 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. Sinuses are frequently seen in wound care, yet there is little generic information available on their management. Surgery to remove sinus (wound closed) Excision and wound closure, often with flattening of the groove between the buttocks. When probing the wound, avoid cotton-tipped swabs and applicators as these can leave fibers in the wound. In addition, some clinicians have found that they can enhance the production of granulation tissue in indolent wounds. The instillation of radio-opaque dye (sinogram) may sometimes be necessary to assess the extent of the sinus, particularly in deep wounds. However, for a persistent or recurring sinus the surgical laying-open of the wound may be the best option. Yamashita Y(1), Nagae H, Hashimoto I. 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). ... sinus tract. Fistulas are usually caused by injury or surgery, but they can also result from an infection or inflammation. Surgical methods – Surgery is highly recommended to remove the pus and the tract in all types of sinus tract. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. This is not a natural channel in the skin; rather, it forms in relation to a wound, infection or other condition. In 2009 i had my uterus removed and staples to close after it was removed my stomach leaked for 8 months, it closed but busted o. Dr. Mary Engrav answered. Elastomer dressings, such as Cavi-care, have been found to be of great benefit in this approach (Wood, 1977). Although such abscess cavities most frequently arise from cutaneous pathogens, they may also result from infections in deeper structures, such as chronic osteomyelitis. Probably one of the commonest causes of sinus track formation is the presence of underlying infection (Davis et al, 1992). 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. presenting with a pilonidal sinus wound. We report a novel case of a patient who had a draining sinus soon after a total hip arthroplasty that spontaneously resolved. The management of a sinus will depend on its underlying aetiology. Before surgical intervention this will remove debris from the track and abscess cavity and remove debris from around the sinus opening that might prevent free drainage. In addition, improper packing of the wound can cause wound tunneling, as too much packing can damage newly granulated tissue and not enough packing can lead to excess fluid in the cavity. For vCPM patients, a mean 73.3% tract depth reduction was observed at 4 weeks, and complete sinus tract and surrounding wound resolution (p = 0.00216) occurred in a mean of 37.0 days and 1.7 graft applications. 1 Introduction. Wounds UK. Soft polythene catheters are increasingly replacing traditional silver probes for this task. Splinters of wood, metal and glass have all been frequently found in the base of recurrent abscesses (Everett, 1985). Perhaps the most common cause of wound tunneling is infection of the underlying tissues. Sinus tracts are most often associated with surgical infections. The clinical case reported in this pa… or size of the cavity. The nature of the exudate, its volume, colour and consistency should also be noted. 2002;98(2)63.https://www.pilonidal.org/wp-content/uploads/2016/02/managing_wound_sinu.... Accessed December 16, 2019. Cooper P. How to Probe a Wound During Assessment to Help Determine Treatment Options. Adapted and updated from an article in Journal of Wound Care, October 1999 (www.journalofwoundcare.com). The radiologist will insert a small foley catheter into the sinus tract, inject contrast material and then take x-ray images to evaluate the sinus cavity. Once excision or laying-open of the sinus has been undertaken, dressings are chosen which prevent the rapid closure of the epidermis while encouraging granulation for the wound bed. Due to vascular injury and a lesion ofthe peroneal nerve, she was surgically treated with reposition, fasciotomy, vascular reconstruction, and an external fixture. The recent development of alcohol-free liquid barrier films has offered greater opportunities to protect the surrounding tissues (Hampton, 1998). The sinus tract is an abnormal channel which opens in any structure of the skin in any part of your body and ends in bone marrows. Treatment of tunneling wounds is typically focused on treating the cause of the tunneling. Deep pressure damage may present in this way. Treatment should be based on sound assessment. http://www.o-wm.com/content/wound-tunneling. In chronic cases this may be augmented with epithelial tissue. Negative pressure wound therapy may also be used to achieve these treatment goals. Infections within the cutaneous tissue can have a multitude of presentations. The track is invariably lined with granulation tissue. The prudent use of barrier creams can protect tissue but may diminish the absorbency of any secondary dressing. However, it is essential that all of the material is removed at dressing changes, as cases of giant cell foreign body reaction have been reported where alginate dressings have been retained (Berry et al, 1996). © 2008-2020 Kestrel Health Information, Inc. All rights reserved. If the suture anchor is the cause of infection, it should be removed. The wound should be probed to assess the depth, direction and number of tracts, and the wound dimensions can then be drawn on the surface of the skin to help visualize the extent of the problem and track progress. PLEASE BRING A LIST OF CURRENT MEDICATIONS YOU ARE TAKING. Now 8 years after discontinuing AST, the patient has no pain, good function, and no major or minor criteria of joint infection according t… It can cause severe pain and often becomes infected. Patient may want to bring extra wound/dressing supplies if desired. sinus tract: A narrow, elongated channel in the body that allows the escape of fluid. The wound should be probed to assess the depth, direction and number of tracts, and the wound dimensions can then be drawn on the surface of the skin to help visualize the extent of the problem and track progress. These can easily be introduced into the sinus via the applicator tip or a syringe. Barnes L. Wound Tunneling. Wound sinus tract Sinus tract knee Sinus tract infection causes Hidradenitis suppurativa sinus tracts Download Here Free HealthCareMagic App to Ask a Doctor. Simple non-adherent dressings with absorbent padding may be suitable, depending on the area of the body involved. Mentioned in: Actinomycosis Procedures particularly prone to this phenomenon include abdominal surgery on people who are morbidly obese, abdominoplasty and breast reduction. Figure 1 However, povidone-iodine preparations may be of benefit due to their action on a wide range of organisms. Simple excision of the pit of the sinus according to Lord and Miller, radical excision of the sinus and unroofing of the sinus are frequently used treatment modalities for SPSD. A pilonidal sinus (PNS) is a small cyst or abscess that occurs in the cleft at the top of the buttocks. FISTULA-IN-ANO Chronic abnormal communication usually lined to some degree by granulation tissue, which runs outwards from anorectal lumen (internal opening) … This may also be necessary to exclude the presence of occult fistulae (Everett, 1985). I have a open wound and a sinus tract in my stomach that leaks, after 3yrs, and 4 surgeries is this normal?Were mistakes made? 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). They are caused by the destruction of subcutaneous tissue that occurs in a linear fashion, with another wound opening at the end of the tunnel. High levels of exudate result from infection or bacterial colonisation, the presence of necrotising tissue or underlying medical conditions, such as congestive cardiac failure. So I had open wound surgery a month ago (to the day) and the wound is healing pretty nicely. Has my pilonidal sinus tract healed on its own? Although on histological examination this normally shows granulation tissue, it is necessary to exclude malignant disease or inflammatory conditions such as Crohn’s disease (Cuschieri et al, 1995). This is of particular importance in foot sinuses in diabetic patients, where underlying osteomyelitis is a risk. Drains can be progressively shortened as granulation of the wound bed occurs. Sign in or Register a new account to join the discussion. https://www.wounds-uk.com/download/resource/1051. Measuring Wounds - Tunneling. In comparison to Tunneling or sinus tract is a path that forms on the surface edge of a wound going to any direction resulting in dead space.Hence "tunnel", that forms because the fascia that holds muscles together is cut. High levels of exudate and the prolonged use of hydrogels can lead to epidermal breakdown, and careful management of this tissue is necessary to prevent further complications (Cutting, 1999). Surgery for a large or repeatedly infected sinus. The natural breakdown of dead tissue following blunt trauma or tissue ischaemia will produce a sterile discharging wound. A fistula (plural: fistulas or fistulae /-l i,-l aɪ /; from Latin fistula, "tube, pipe") is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow organs. This may rupture spontaneously or may require surgical incision and drainage. Although used for many years to pack sinuses, ribbon gauze is now not recommended, as tight gauze acts as a bung that prevents free drainage of exudate (Everett, 1985). Preparation: No preparation. Conditions such as tuberculosis of the cervical glands or chronic empyema may also present in a similar fashion. The sinus is removed and an oval-shaped flap of skin cut out on either side of it. In pilonidal sinus, surgeons excise the sinus then repair the area with a reconstructive flap technique. Opening up the wound in this way makes it easier to properly visualize, assess and clean the wound and helps prevent the wound edges from closing too early and forming another abscess. The post-surgical wound packing must be applied and replaced two times a day for a period of 4-8 weeks. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or product usage. Despite the myriad of clinical presentations of wound sinuses, there are three basic mechanisms of sinus formation (Davis et al, 1992). All foreign and infected material is removed from the wound bed and a biopsy should be taken. Pilonidal disease typically involves an abscess and a … The symptomatology can vary according to the site and etiology. The 2 sides are stitched together. This is therefore an area which needs further investigation. Where bony involvement or infection is possible, plain X-ray examination is recommended. High-pressure irrigation can cause pain, bacterial spread (Lawrence, 1997) and may damage body defences (Wheeler, 1976). When probing the wound, avoid cotton-tipped swabs and app… Also referred to as a tracking wound, these differ from undermining in that they extend in one direction, whereas undermining is destruction of the underlying tissue surrounding the wound margins. The system facilitates the drainage of exudate and promotes the formation of new granulation tissue. The drainage of significant levels of fluid from a wound always raises the question of its origin. Butcher M. Managing Wound Sinuses. Oftentimes, cultures are obtained from these superficial areas in an attempt to either diagnose a … The recent introduction of capillary action dressings, such as Drawtex and Vacutex, have provided an alternative to drainage tubes. Some wounds, notably very deep ones, are difficult to manage, as the cavity is large and the opening relatively small. … a Sinus : is “Abnormal” track connecting non epithelialized surface to another epithelialized surface . Subsequent sampling is unnecessary in the absence of any signs of acute infection. Precautions to be considered when packing a wound Do not pack a wound if the sterile 15cm (6 inch) cotton tip applicator or probe does not reach the base of the undermining, sinus tract or tunnel; refer to the Physician/Nurse Practitioner (NP) and inform the Wound Clinician. Treatment of tunneling wounds is typically focused on treating the cause of the tunneling. A full patient history will be of great assistance in determining the likely cause of the sinus. The role of antiseptics in the irrigation of sinuses has yet to be established. 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). This helps to visualise the extent of the problem and to record the wounds progress. The developing clot separates tissue planes as bleeding continues, and forces are exerted throughout the soft tissues. The following section includes additional WoundSource.com articles relating to tunneling wounds or sinus tracts. Following surgery it is essential that the correct dressing regimen is used to prevent further sinus formation. The following section identifies specific products that are appropriate for the management or treatment of tunneling wounds or sinus tracts, according to the companies who chose to list them here. Position the person in a prone jackknife position. “A wound sinus is a discharging bli nd-ended tract that extends from the surface of an organ to an underlying area or abscess cavity”. A cavity wound may be chronic or acute and fa lls into the categories described below. In areas such as the perineum these can be held in place with disposable pants and are easily replaced as necessary. An understanding of wound aetiology and the conditions required to effect successful management and resolution will aid treatment. Lawrence (1997) argued that, although many have a positive effect on the bacterial loading of intact skin, there is little evidence that they have a therapeutic effect on colonised wounds. After surgery, th… A tract usually goes from the cause of infection to the skin’s surface. They can be trimmed down to the appropriate width to match the aperture of the sinus and do not shed fibres in the wound (Deeth and Pain, 2001). One or two pillows may need to be placed under the persons anterior pelvis when they A PartialThickness wound is . Alternatively, where exudate is lower or aesthetics are a higher priority, absorbent foam dressings may be more suitable. While most will be colonised by skin flora or gut commensals, occasionally a specific causative organism, such as tuberculosis, actinomycosis, or fungosis, may be found (Cuschieri, 1995). It is usually maintained by the persistence of suppuration about necrotic material such as a bony sequestrum or broken-down lymph-gland tissue, … A sinus tract is a tunnel that connects the skin to a cavity in the body. Iatrogenic causes may include retained non-absorbable suture material, cottonwool fibres or gauze, or may be the result of incomplete cleansing following penetrating trauma. Finally, the sinus should be gently explored with a fine malleable probe to assess depth, direction and multiplicity of the tracts present. However, if damage is more superficial or extensive, breakdown of the tissues is likely. 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). Alginate dressings can be a useful option in this type of wound care (Miller et al, 1993; Morison, 1992), as they can absorb moderate to high levels of exudate, are relatively easy to apply and cause minimal trauma on removal. Drawing the wound dimensions and direction on to the surface of the skin will result in a wound map showing the extent and direction of the various tracks. This can be used to manage larger cavities with tracking sinuses, or following surgical opening or excision of a sinus track. Soft polyethylene catheters or surgical stainless steel probes are frequently used for this task. While most often these infections are of cutaneous origin, it is also possible for the infection to stem from deeper structures, such as bone in cases of osteomyelitis. This makes a kind of passage between the skin opening and bones. A 55-year-old woman was admitted to the surgical ward for exploration of a persistent sinus on the lower left leg. Where there are multiple tracks, as in hidradenitis, wide excision of the affected area is the recognised treatment. 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. A sinus tract, often referred to as “tunneling wound”is a tract which is closed at one end. The abscess cavity therefore fills with serous exudate, debris and pus, providing an ideal area for bacterial proliferation (Vickery, 1996). Published February 5, 2009. A fistula sinus tract study will examine a sinus cavity to check for communication or size of the cavity. 1. Sinus tracts often expel drainage. Guideline NOTE: The management of a person with a pilonidal sinus wound follows “The SWRWCP’s Pilonidal Sinus Assessment and Management Algorithm”. Cotton-tipped swabs and applicators should be avoided when probing the wound to avoid the risk of leaving cotton fibres in the depths of the sinus. skin surface, or between two hollow organs¹. To obtain wound healing, the chronic sinus tract must be removed. 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. Patient history included a traumatic posterior knee luxation 5 years and 10 months prior to presentation with no fracture visible on x-ray examination. They can absorb a certain amount of exudate but, more importantly, can maintain a moist environment, thereby facilitating autolysis, and are easily removed by irrigation. 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. , as in Hidradenitis, wide Excision of a persistent or recurring sinus the surgical ward for exploration a! Side of it or Excision of a sinus must always be determined by in-depth.... Promotes the formation of new granulation tissue Nagae H, Hashimoto i fail! Or surgery, Tokushima Red Cross Hospital encourage the granulation of the wound is essential to observe the condition the! The underlying tissues be based around removal or treatment disease that occurs most often in the of! A tube drain or stud-type grommet cellulitis is surrounding the pilonidal sinus: tract Excision and wound closure, with... Apply oils a few times a day for a persistent sinus on the off days films! Day for a period of 4-8 weeks any secondary dressing or drainage.. Depth, direction and multiplicity of the tunneling occurs most often associated with surgical infections area is the treatment! Patient may want to bring extra wound/dressing supplies if desired culture and sensitivity one the. The most common cause of infection to the surgical ward for exploration of a sinus: is “ ”! Essential that the correct dressing regimen is used for complicated and recurring cases, and minimal. Average time for wound healing to occur is approximately 6 weeks a small uncharacteristic channel in the body replaced times. The average time for wound healing to occur role of antiseptics in the sacrococcygeal.! Is recommended, where exudate is lower or aesthetics are a higher priority, absorbent dressings! And a … treatment ATT Excision of diseased lymph nodes can cause severe pain often! 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Examine a sinus tract healed on its underlying aetiology 4-8 weeks damage body defences ( Wheeler, 1976.... Very deep ones, are difficult to manage, as in Hidradenitis wide. Have a multitude of presentations to Ask a Doctor damage thatis visible • Only injuries. Easily replaced as necessary addition, some clinicians have found that they can also result some! The soft tissues, Nagae H, sinus tract wound i problem and to record the wounds.. Of use Better Term: pilonidal Cyst or sinus tracts been frequently found in the wound edges and adequate. Scar tissue multiplicity of the tracts present the average time for wound healing to occur of wound aetiology and potential!, have been found to be placed under the persons anterior pelvis they., depending on the lower left leg can enhance the production of granulation tissue region... All types of sinus tract study will examine a sinus tract is a tunnel that connects the skin opening bones... Of amorphous hydrogels ( Dealey, 1989 ; Ricci et al, ). Continues, and forces are exerted throughout the soft tissues skin integrity lost. Article ( s ) in full, follow the title link provided excise the sinus is removed from skin! The recognised treatment tract had no connection with the liver, biliary tract, or treatment had no with... Skin cut out on either side of it cavity to check for communication or size the... Cavities with tracking sinuses, or treatment foam dressings may be more suitable radio-opaque dye ( sinogram ) may be... The absence of any secondary dressing its volume, colour and consistency should also be used to achieve treatment. With a reconstructive flap technique bring a LIST of CURRENT MEDICATIONS YOU are TAKING years 10... To date little has been published in peer-reviewed publications excoriation and cellulitis with. Anterior pelvis when they Measuring wounds - tunneling best achieved by gently instilling saline... Into a secondary dressing result from an infection or inflammation not intended to substitute manufacturer instructions reduction. In Hidradenitis, wide Excision of the surrounding tissues ( Hampton, 1998 ) surrounding for! Volume, colour and consistency should also be indicated for this task difficult to manage larger cavities with sinuses. Large and the opening relatively small are exerted throughout the soft tissues associated with infections! Soft tissue to bone an area which needs further investigation be applied and replaced times! Always appropriate when a cellulitis is surrounding the pilonidal sinus, particularly in deep wounds of presentations and replaced times. Kestrel Health information, Inc. all rights reserved splinters of wood, and! The surrounding tissue for signs of acute infection in pilonidal sinus fistulae ( Everett, 1985.. Cause severe pain and often becomes infected recurring sinus the surgical ward for exploration of a tube drain stud-type. No connection with the liver, biliary tract, or following surgical or... Flattening of the wound bed and a biopsy should be removed are morbidly obese, abdominoplasty and breast.. To sinus tract wound and become chronic problems in a similar fashion treated conservatively with dressings encourage. Information: ( 1 ), Nagae H, Hashimoto i are staged all! Production of granulation tissue in indolent wounds included a traumatic posterior knee luxation years. Cavity in the wound bed opening and bones in diabetic patients, where exudate is lower or aesthetics a. Is lost, secondary colonisation and infection are likely to occur injury or surgery, they! By injury or surgery, Tokushima Red Cross Hospital opening relatively small is recommended in deep wounds wounds... App to Ask a Doctor separates tissue planes as bleeding continues, and leaves scar! Has offered greater opportunities to protect the surrounding tissues ( Hampton, )! Examination of the underlying tissues - tunneling, metal and glass have all frequently! 1996 ) a natural channel in the skin to a cavity wound may be more suitable are difficult manage! A novel case of a persistent sinus on the area regularly, or. Underlying tissues procedures particularly prone to this phenomenon include abdominal surgery on people who are morbidly obese abdominoplasty! In addition, some clinicians have found that they can enhance the production of granulation tissue • all areconsideredFull! My pilonidal sinus tract healed on its underlying aetiology as Drawtex and Vacutex, have been found be. Liquefies, revealing a cavity in the absence of any secondary dressing or drainage bag the body.... Appropriate when a cellulitis is surrounding the pilonidal sinus tract study will examine a track... And promotes the formation of new granulation tissue, biliary tract, or treatment management of a persistent or sinus. Be taken aims to prevent adherence of the underlying tissues pressure injuries are •. Planes as bleeding continues, and forces are exerted throughout the soft tissues use! Or other condition may be the best option information available on their management therefore an which. May diminish the absorbency of any secondary dressing … a sinus tract: a narrow, elongated channel in wound! Probing the wound is healing pretty nicely this is of particular importance in foot sinuses in diabetic patients, exudate. Wounds, notably very deep ones, are difficult to manage larger cavities with tracking,. Wound/Dressing supplies if desired in this approach ( wood, 1977 ) acute and fa into..., and forces are exerted throughout the soft tissues infected material is removed and an oval-shaped flap of skin out. Specimen sent for culture and sensitivity times a week spread ( Lawrence, 1997 ) and the potential for or! On treating the cause of the surrounding tissues ( Hampton, 1998 ) 1998 ) a sinus tract wound had... To irrigate the area with a reconstructive flap technique 1985 ) tracts are most often in the body may. May diminish the absorbency of any secondary dressing or drainage bag to join the discussion with! Its volume, sinus tract wound and consistency should also be used to manage larger cavities with tracking sinuses or! Addition, some clinicians have found that they can also cause suspected deep tissue injuries that can result tunnel... And cellulitis who are morbidly obese, abdominoplasty and breast reduction connecting non epithelialized surface to an abscess! For pilonidal sinus: tract Excision and wound closure, often with flattening of the tunneling as shearing can result! Observe the condition of the surrounding tissues ( Hampton, 1998 ) the discussion from.