Wound dehiscence is a surgical complication in which a wound ruptures along a surgical incision. Risk factors include age, collagen disorder such as Ehlers–Danlos syndrome, diabetes, obesity, poor knotting or grabbing of stitches, and trauma to the wound after surgery.
The risk factors reported for scar dehiscence are multiparity, diabetes, emergency surgery, infection, and incision placed too low in the uterine segment [2]. Two out of these, i.e., multiparity and diabetes were present in our patient.
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.
Results: Among 588 patients included in this study, 27 cases of uterine scar dehiscence were identified with an incidence of 4.6%.
Complete wound dehiscence is a medical emergency, as it can lead to evisceration, where internal organs protrude through the wound.
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.
Postpartum uterine dehiscence is the opening of the incision line after cesarean section. It is a rare clinical condition. Risk factors include diabetes, emergency surgery, infection, suture technique, hematoma on the uterine incision line, and retrovesical hematoma.
There is no appropriate screening method for the detection of uterine scar dehiscence. Using ultrasound examination, measuring the thickness of the uterine wall at the previous uterine incision site could be used to predict the occurrence of uterine dehiscence during pregnancy or in labor.
The main ultrasonographic diagnostic features of uterine scar dehiscence are the absence of the uterine muscle layer and an anechoic area protruding through the lower segment caesarean section scar with an intact serosal layer.
The patient should be advised the wound will heal by secondary intention as a result of the dehiscence and that this can take several weeks.
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.
A dehisced wound can appear fully open – the tissue underneath is visible – or it can be partial, where just the top portion of the skin has torn open. The wound could be red around the wound margins, have drainage, or it could be bleeding or seeping, where only a thin trickle of blood is coming out.
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].
In contrast to frank uterine rupture, uterine scar dehiscence involves the disruption and separation of a preexisting uterine scar. Uterine scar dehiscence is a more common event than uterine rupture and seldom results in major maternal or fetal complications.
Women with uterine scar dehiscence often fear pregnancy because they are advised it may increase the risk of uterine rupture. It is generally recommended that women undergo transvaginal or laparoscopic repair of the uterine dehiscence before any future pregnancies.
Symptoms of early uterine dehiscence range from heavy bleeding in the postpartum period to mild pelvic pain and suprapubic sensitivity [5].
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.
Early complications include hematoma, infection, wound dehiscence, and thrombus formation. Long-term complications include placenta accreta, peritoneal adhesions, infertility, and myometrial thinning with uterine rupture 2-4.
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.
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.
If associated with superficial wound dehiscence, they can be treated by absorbent dressings such as alginate dressing.