Dehiscence is a partial or total separation of previously approximated wound edges, due to a failure of proper wound healing. This scenario typically occurs 5 to 8 days following surgery when healing is still in the early stages.
Wound dehiscence typically occurs a few days after surgery, when healing is still in the early stages. It can be either partial, where the wound pulls apart in small areas, or complete, where the entire wound reopens. Separation of the wound can lead to severe complications, such as infection or evisceration.
While this occurs most often with surgical wounds, it can also happen with sutures. Wound dehiscence can occur on just the top layer of the wound at the skin's surface, internally where the wound cannot be seen, or potentially both in severe cases.
Along with age, sex plays a role: men experience dehiscence at higher rates than women. Patients with a medical history of stroke or who have chronic obstructive pulmonary disease (COPD), diabetes, or cancer also have higher rates of dehiscence. Some patient behaviors can also increase the risk of dehiscence.
Risk factors for dehiscence and evisceration include age, diabetes, obesity, malnutrition, corticosteroid therapy, and sepsis. Wound infection is directly associated with over 50% of eviscerations [1]. Surgical technique can contribute to wound dehiscence.
Risk factors in the unadjusted analysis for wound dehiscence were wound infection, male gender, BMI 30–35, cardiovascular disease and chronic obstructive pulmonary disease (COPD). The risk factors for incisional hernia were wound infection and BMI 25–30, BMI 30–35 and BMI >35 (Table 2).
Dehiscence and evisceration can be a life threatening emergency; do not leave the client immediately call for help and, using a clean, sterile towel or sterile saline dampened dressing, cover the wound. Under no circumstance should reinserting the organs be attempted.
The main risk factor for uterine scar dehiscence is a previous caesarean section.
Additional systemic risk factors that were found to be significant included hypoproteinemia, systemic infection, obesity, uremia, hyperalimentation, malignancy, ascites, steroid use, and hypertension.
You may notice the following when your wound starts to come apart: A feeling that the wound is ripping apart or giving way. Leaking pink or yellow fluid from the wound. Signs of infection at the wound site, such as yellow or green pus, swelling, redness, or warmth.
To prevent dehiscence, teach patients to splint the surgical site when coughing, vomiting, or sneezing. An abdominal binder for those at risk for dehiscence may be helpful, but evidence supporting its use is still needed. Heavy lifting (10 lbs or more) should be avoided for 6 to 8 weeks after surgery.
Dehiscence is secondary to technical failure of sutures, shear forces from tension, or fascial necrosis from infection and/or ischemia (2). Evisceration is the uncontrolled exteriorization of intraabdominal contents through the dehisced surgical wound outside of the abdominal cavity.
The splitting of the plant structures in order to release its contents is called dehiscence. It is most commonly seen in anther to release pollens. The point where the anther breaks is called the line of dehiscence.
It is rare for the stitches to simply to come undone. However, occasionally an infection or pressure on the stitches from bleeding underneath can cause the stitches to breakdown, leaving an open or gaping wound. This is called perineal wound dehiscence, or breakdown.
The complicated mechanism of wound healing occurs in four phases: hemostasis, inflammation, proliferation, and remodeling.
Wound dehiscence can be accidental or done intentionally. If a sutured wound becomes infected, for example, physicians may have to surgically reopen the wound to debride the wound of infected tissue; this is a form of dehiscence.
The three phases include inflammation, proliferation, and maturation.
Infection also limits the number of fibroblast cells that are able to move to the area. Any repair tissue that is able to develop will be weak and fragile. Poor suture technique. Wound disruption may be caused by stitches or staples that are improperly applied.
The causes of dehiscence are similar to the causes of poor wound healing and include ischemia, infection, increased abdominal pressure, diabetes, malnutrition, smoking, and obesity. [1] Superficial dehiscence is when the wound edges begin to separate and by increased bleeding or drainage at the site.
Wound dehiscence is estimated to occur in 0.5–3.4% of abdominopelvic surgeries, and carries a mortality of up to 40%. Postoperative wound dehiscence has been adopted as a surrogate safety outcome measure since it impacts morbidity, length of stay, healthcare costs and readmission rates.
Scar dehiscence has an incidence of 0.6% in pregnancies with previous caesarean section and has a more favourable outcome for both mother and fetus than does uterine rupture1.
Superficial dehiscence usually just requires washing out the wound with saline and then simple wound care (e.g. packing the wound with absorbent ribbon gauze). The patient should be advised the wound will now be required to heal by secondary intention and that this can take several weeks.
Practice bracing: When doing any activity that puts stress on the wound (sneezing, coughing, vomiting, laughing, bearing down for a bowel movement) apply pressure over your incision using your hands or a pillow. This can both prevent wound dehiscence and minimize pain.