Wound Dehiscence

(Surgical Wound Dehiscence; Operative Wound Dehiscence)

Definition

Wound dehiscence is the parting of the layers of a surgical wound. Either the surface layers separate or the whole wound splits open. This is a serious condition and requires care from your doctor.

Causes

Wound dehiscence varies depending on the kind of surgery you have. The following is a list of generalized causes:
  • Infection at the wound
  • Pressure on sutures
  • Sutures too tight
  • Injury to the wound area
  • Weak tissue or muscle at the wound area
  • Incorrect suture technique used to close operative area
  • Poor closure technique at the time of surgery
  • Use of high-dose or long-term corticosteroids
  • Severe vitamin C deficiency—scurvy
Wound Infection
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Risk Factors

Factors that may increase your chance of wound dehiscence include:
  • Being overweight
  • Increasing age
  • Poor nutrition
  • Diabetes
  • Smoking
  • Malignant growth
  • Presence of prior scar or radiation at the incision site
  • Non-compliance with post-operative instructions (such as early excessive exercise or lifting heavy objects)
  • Surgical error
  • Increased pressure within the abdomen, which can occur with fluid accumulation ascites, inflamed bowel, or severe coughing, straining, or vomiting
  • Long-term use of corticosteroid medications
  • Other medical conditions, such as diabetes, kidney disease, cancer, immune problems, chemotherapy, or radiation therapy

Symptoms

Wound dehiscence may cause:
  • Bleeding
  • Pain
  • Swelling
  • Redness
  • Fever
  • Broken sutures
  • Open wound

Diagnosis

Your doctor will ask about your symptoms and examine the surgical area. Tests may include the following: Laboratory tests, such as:
  • Wound and tissue cultures to determine if there is an infection
  • Blood tests to determine if there is an infection
Imaging tests, such as:

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Treatment

Treatment may include:
  • Antibiotics if an infection is present or possible
  • Frequent changes in wound dressing to prevent infection—when appropriate
  • Wound exposure to air to accelerate healing and prevent infection, and allow growth of new tissue from below—when appropriate
  • Surgery to:
    • Remove contaminated and/or dead tissue
    • Resuture the wound
    • Place a temporary or permanent piece of mesh to bridge the gap in the wound

Prevention

To reduce your chance of wound dehiscence:
  • When appropriate, have antibiotic therapy prior to surgery
  • When appropriate, have antibiotic therapy after surgery
  • When using wound dressing, maintain light pressure on wound
  • Keep wound area clean
  • Comply with post-operative instructions

RESOURCES

American College of Surgeons
http://www.facs.org

Centers for Disease Control and Prevention
http://www.cdc.gov

CANADIAN RESOURCES

Canadian Association of Wound Care
http://www.cawc.net

The Canadian Society of Plastic Surgeons
http://www.plasticsurgery.ca

References

Bennett R. Fundamentals of Cutaneous Surgery. St. Louis, MO: CV Mosby; 1988: 498.

DeCherney AH, Nathan L. Current Obstetric & Gynecologic Diagnosis & Treatment. 9th ed. New York, NY: McGraw-Hill; 2003.

Dorland WN. Dorland's Illustrated Medical Dictionary. Philadelphia, PA: WB Saunders, Harcourt Health Sciences; 2005.

Porter RS. The Merck Manual of Medical Information Home Edition. 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2004.

Schwartz S, Brunicardi F, et al. Schwartz’s Principles of Surgery. 8th ed. New York, NY: McGraw-Hill; 2007.

Surgical site infection. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 14, 2014. Accessed September 30, 2014.

Surgical site infection—prevention. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 29, 2014. Accessed September 30, 2014.

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