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.
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.
Dehiscence is essentially a form of poor wound healing, and risk factors include poor nutritional status, diabetes, obesity, smoking, immunosuppression, advanced age, infection, and poor surgical technique.
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.
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.
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.
Infection: Bacteria in the incision increase the chances of dehiscence. 3 An infection delays healing and weakens newly formed tissue, making it more likely that your wound won't close. Obesity: The inflammation period of healing may last significantly longer in people with obesity.
Some methods to prevent surgical wound dehiscence include supporting the abdomen when coughing, sneezing, or moving around/sitting up in bed, avoiding strain or pressure to the wound area (heavy lifting, exercise, coughing, constipation/straining with bowel movements), and maintaining a good diet and good oral intake ...
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 where a wound fails to heal, whereby the wound re-opens in the days following surgery. This is most common following abdominal surgery. Wound dehiscence is a costly post-operative complication and thus identification and appropriate management of the condition is key.
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.
Nursing management The patient should be put to bed immediately and complete bedrest is advised. Assessment of the degree of dehiscence and evisceration can now be made. Other nursing actions are as follows: in warm saline. Exposed viscera should be protected from drying and possible necrosis.
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.
Complications, such as hematoma, infection, and trauma, can also result in wound dehiscence. Dehiscence of a wound. Systemic factors increase a patient's risk of wound dehiscence.
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.
The doctor may close the wound separation with new stitches, or they may allow it to heal as it is. If a wound disruption is deep or complete, you may need another surgery to repair the wound.
Early signs of wound dehiscence
If associated with superficial wound dehiscence, they can be treated by absorbent dressings such as alginate dressing.
Deficiencies in oxygen utilization and increased inflammation associated with adipose tissue partially explain the mechanisms of increased wound infections prominent in obese patients. Another aspect of wound healing that is potentially affected by hypoxia is fibroblasts' capability to synthesize collagen [73, 93, 94].
Surgical risk factors include direct intraoperative trauma or stretch, vascular compromise, perioperative infection, hematoma formation, prolonged tourniquet ischemia, or improperly applied casts or dressings.
It occurs mostly between the sixth and eight day after operation. Factors relating to the incidence of burst abdomen are suture, closure, incision, coughing, vomiting, distension, obesity, jaundice, malignancy, diabetes mellitus, hypoproteinaemia, anaemia, immuno-compromised patients and wound infection.
A. Nursing interventions that are required in postoperative care include prompt pain control, assessment of the surgical site and drainage tubes, monitoring the rate and patency of IV fluids and IV access, and assessing the patient's level of sensation, circulation, and safety.
There are four basic principles of wound care: (1) debride necrotic tissue and cleanse the wound to remove debris, (2) provide a moist wound healing environment through the use of proper dressings, (3) protect the wound from further injury, and (4) provide nutritional substrates essential to the healing process.