Wound Dehiscence
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Wound Dehiscence

(Surgical Wound Dehiscence; Operative Wound Dehiscence)

Pronounced: dē-his’ ens

En Español (Spanish Version)

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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© 2008 Nucleus Medical Art, Inc.

Risk Factors

The following factors increase your chance of developing wound dehiscence.

  • 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 due to: fluid accumulation (ascites); inflamed bowel; severe coughing, straining, or vomiting
  • Long-term use of corticosteroid medications
  • Other medical conditions, such as diabetes , kidney disease, cancer, immune problems, chemotherapy , radiation therapy

Symptoms

If you experience one or more of these symptoms in the surgical area, contact your doctor.

  • 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
    • Wound and tissue cultures to determine if there is an infection
    • Blood tests to determine if there is an infection
  • Imaging Studies
    • X-ray to evaluate the extent of wound separation
    • Ultrasound to evaluate for pus and pockets of fluid
    • CT scan to evaluate for pus and pockets of fluid

Treatment

  • Drug Therapy
    • Antibiotic therapy
  • Medical Treatment
    • When appropriate, 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
  • Surgical Intervention
    • Surgical removal of contaminated, dead tissue
    • Resuturing
    • Placement of a temporary or permanent piece of mesh to bridge the gap in the wound

Prevention

  • 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 Academy of Family Physicians
http://www.aafp.org

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

CANADIAN RESOURCES:

Canadian Association of Wound Care
http://www.cawc.net/open/wcc/index.html

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

References:

Barbul A. Wound Healing. In: Schwartz’s Principles of Surgery . 8th ed. 2005. Online Version. Available at: http://80=pm;ome=statref=cp,/;obraru/tifts/ediDpci,emt/as[xDpdd=205&Fxld=18&sessionID=5353EOZYOOBHJVKV&Scroll=1Index=6 . Accessed September 27, 2005.

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

Current Obstetric & Gynecologic Diagnosis & Treatment . 9th ed. 2003. Online edition. Available at: http://80-online-statref-com.library.tufts.edu/Document.aspx?Dodd-550&Fxld-30&sessionID=5353EOZYOOBHJVKV&Scroll=1&Index=4 . Accessed September 20, 2005.

Dorland's Illustrated Medical Dictionary. WB Saunders, Harcourt Health Sciences; 2005. Online edition. Available at: http://www.merckmedicus.com/pp/us/hcp/thcp_dorlands_content.jsp?pg=/ppdocs/us/common/dorlands/dorland/dmd-d-005.htm . Accessed September 20, 2005.

Surgery. Merck Manual–2nd Home Edition. 2004. Available at: http://www.mercksource.com/pp/us/cns/cns_search_results.jsp . Accessed September 27, 2005.



Last reviewed January 2008 by Ross Zeltser, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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