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.
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.
Wound dehiscence is estimated to occur in 0.5–3.4% of abdominopelvic surgeries, and carries a mortality of up to 40%.
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 is caused by many things such as age, diabetes, infection, obesity, smoking, and inadequate nutrition. Activities like straining, lifting, laughing, coughing, and sneezing can create increased pressure to wounds, causing them to split.
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.
Even minor cases of wound dehiscence require immediate attention to prevent the wound from worsening. If left untreated, dehiscence can progress and lead to serious infection and life threatening complications.
Most wound dehiscences are caused by excessive stress placed on the suture line by a hematoma, effusion, or trauma. Traumatic disruption is rare. Dehiscence, without a predisposing cause, is caused by an error in surgical technique.
What Are Risk Factors for Dehiscence? A variety of underlying health conditions can increase a patient's risk for developing dehiscence after surgery. Such conditions include the patient being overweight or obese, hypertension, anemia, and hypoproteinemia.
Patients older than 65 years are more likely to develop wound dehiscence because of deterioration in tissue repair mechanism compared with younger patients [3]. Other well-known risk factors include hypoproteinemia, local wound infection, anemia, hypertension, and emergency surgery [1].
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.
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.
The cut may need restitched (or glued) if gaping open. This is sometimes done if suturing was less than 48 hours ago.
Wound dehiscence is a serious complication in which the deep and/or superficial layers of the surgical wound split open . It is indicated by broken sutures, an open wound, and pain. There are many possible causes of this emergent situation, including acts of medical negligence.
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. Due to the high morbidity and mortality associated with uterine rupture, it is important to identify those patients who are at risk.
Wound dehiscence is when part or all of a wound comes apart. The wound may come apart if it does not heal completely, or it may heal and then open again. A surgical wound is an example of a wound can that develop dehiscence. Wound dehiscence can become life-threatening.
Treatment for wound dehiscence
Pain medicine. Antibiotics to treat infection. Surgery to remove dead or infected tissue (surgical debridement) Wet-to-dry dressing.
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.
If associated with superficial wound dehiscence, they can be treated by absorbent dressings such as alginate dressing.
A non-healing surgical wound can occur after surgery when a wound caused by an incision doesn't heal as expected. This is usually caused by infection – a rare but serious complication. Causes of poor wound-healing depend on the type and location of the procedure, health condition and other factors.
Two common complications of surgical wounds are infections and wound dehiscence. As such, the following signs should be looked out for in the post-operative wound review: fever, haematoma, seroma, separation of wound edges and purulent discharge from the wound.
Treatments for Wound Dehiscence
Surgical debridement is typically performed to treat wound dehiscence by removing the dead or infected tissue to enable better healing of the wound. Next the wound must be closed properly with the appropriate surgical technique and sutures.
Tunneling is often the result of infection, previous abscess formation, sedentary lifestyle, previous surgery at the site, trauma to the wound or surrounding tissue, or the impact of pressure and shear forces upon many tissue layers causing a “sinkhole-like” defect on the skin.