If left untreated, dehiscence can progress and lead to serious infection and life threatening complications. In some cases, complete wound dehiscence may result in evisceration.
Even minor wound disruption needs to be treated right away to keep it from getting worse. An open wound is easily infected, and infection can lead to further separation. Complete wound dehiscence is a medical emergency, as it can lead to evisceration, where internal organs protrude through the wound.
Abdominal wound dehiscence (burst abdomen, fascial dehiscence) is a severe postoperative complication, with mortality rates reported as high as 45% [1–3]. The incidence, as described in the literature, ranges from 0.4% to 3.5% [4–17]. Abdominal wound dehiscence can result in evisceration, requiring immediate treatment.
Deep dehiscence of the underlying fascia is a surgical emergency and must be closed in the operating room, as this can lead to evisceration. If the wound shows signs of evisceration, the wound can be covered with a sterile saline dressing until the herniating organs can be reduced back into the abdomen.
Research has found that one of the most predictive risk factors for dehiscence is surgical site infection. Surgical incisions have a higher chance of opening if the wound becomes infected.
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.
Hyperbaric Oxygen Therapy can help reduce the potential complications of wound dehiscence. Hyperbaric wound care is a safe, natural, and efficient medical therapy for wounds that may need additional support to properly heal. It uses 100% oxygen to stimulate accelerated healing capabilities within the body.
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.
Symptoms of wound dehiscence
Pain. Feeling of pulling or ripping like something popped. Drainage or bleeding from the wound, most often a clear to pink fluid. Signs of wound infection such as fever, redness, swelling, bad smelling discharge, or chills.
Wound dehiscence is estimated to occur in 0.5–3.4% of abdominopelvic surgeries, and carries a mortality of up to 40%.
Wound reopening: If sutures are removed too early, or if excessive force is applied to the wound area, the wound can reopen. The doctor may restitch the wound or allow the wound to close by itself naturally to lessen the chances of infection.
If associated with superficial wound dehiscence, they can be treated by absorbent dressings such as alginate dressing.
On the scene. To decrease intra-abdominal pressure and stress on the wound, you place Mr. Anderson supine in the low Fowler's position with his knees slightly bent and cover the wound with a saline-moistened, sterile gauze dressing.
Because the initial 48 hours are the most critical for successful wound healing, postoperative radiation is often administered 3 to 4 weeks after surgery.
The three phases include inflammation, proliferation, and maturation. [3][4][5] The repaired wound can be expected to obtain 80% of the original tensile strength over two years, but will not achieve the same level of pre-injury strength.
Wound dehiscence is a distressing but common occurrence among patients who have received sutures. The condition involves the wound opening up either partially or completely along the sutures – basically, the wound reopens to create a new wound.
If you incision breaks open, call your doctor. Your doctor may decide not to close it again with stitches. If that happens, your doctor will show you how to care for your incision a different way. This will likely involve the use of bandages to absorb the drainage that comes from the incision.
For a dehisced wound, a patient should return for medical care immediately. This may include debridement, antibiotic therapy and resuturing or use of another type of wound closure device. Following this treatment, the wound will need to be monitored extremely closely for signs of recurring dehiscence.
Typically, the sutures or closures around wound edges should stay intact while new tissue, known as "granulation tissue," starts forming to help heal the wound. However, when wound dehiscence occurs, the edges starts to separate and the wound reopens instead of healing closed as planned.
Also known as a skin tear, an avulsion is a deep break to the skin, tearing it away from the underlying tissue. Wounds of this type are usually more serious and extensive.
Glucocorticoids (corticosteroids) cause dehiscence of surgical incisions, increased risk of wound infection, and delayed healing of open wounds.
Purulent drainage is a sign of infection. It's a white, yellow, or brown fluid and might be slightly thick in texture. It's made up of white blood cells trying to fight the infection, plus the residue from any bacteria pushed out of the wound. There may be an unpleasant smell to the fluid, as well.