Wound Dehiscence
(Surgical Wound Dehiscence; Operative Wound Dehiscence)
Definition
Wound dehiscence is the parting of the layers of a surgical wound. Either the surface layers separate or the whole wound splits open. This is a serious condition and requires care from your doctor.
Causes
Wound dehiscence varies depending on the kind of surgery you have. The following is a list of generalized causes:
- Infection at the wound
- Pressure on sutures
- Sutures too tight
- Injury to the wound area
- Weak tissue or muscle at the wound area
- Incorrect suture technique used to close operative area
- Poor closure technique at the time of surgery
- Use of high-dose or long-term corticosteroids
-
Severe vitamin C deficiency (
scurvy
)
Risk Factors
The following factors increase your chance of developing wound dehiscence.
-
Overweight
- Increasing age
- Poor nutrition
-
Diabetes
-
Smoking
- Malignant growth
- Presence of prior scar or radiation at the incision site
- Non-compliance with post-operative instructions (such as early excessive exercise or lifting heavy objects)
- Surgical error
- Increased pressure within the abdomen due to: fluid accumulation (ascites); inflamed bowel; severe coughing, straining, or vomiting
- Long-term use of corticosteroid medications
-
Other medical conditions, such as
diabetes
,
kidney disease
,
cancer
,
immune problems,
chemotherapy
, or
radiation therapy
Symptoms
If you experience one or more of these symptoms in the surgical area, contact your doctor.
- Bleeding
- Pain
- Swelling
- Redness
- Fever
- Broken sutures
- Open wound
Diagnosis
Your doctor will ask about your symptoms and examine the surgical area. Tests may include the following:
-
Laboratory tests, such as:
- Wound and tissue cultures to determine if there is an infection
- Blood tests to determine if there is an infection
-
Imaging studies, such as:
- X-ray
—to evaluate the extent of wound separation
- Ultrasound
—to evaluate for pus and pockets of fluid
- CT scan
—to evaluate for pus and pockets of fluid
Treatment
-
Drug therapy
-
Medical treatment
- When appropriate, frequent changes in wound dressing to prevent infection
- When appropriate, wound exposure to air to accelerate healing and prevent infection, and allow growth of new tissue from below
-
Surgical intervention
- Surgical removal of contaminated, dead tissue
- Resuturing
- Placement of a temporary or permanent piece of mesh to bridge the gap in the wound
If you are diagnosed with wound dehiscence, follow your doctor's
instructions
.
Prevention
- When appropriate, have antibiotic therapy prior to surgery.
- When appropriate, have antibiotic therapy after surgery.
- When using wound dressing, maintain light pressure on wound.
- Keep wound area clean.
- Comply with post-operative instructions.
RESOURCES
American Academy of Family Physicians
http://www.aafp.org/online/en/home.html
American College of Surgeons
http://www.facs.org
CANADIAN RESOURCES
Canadian Association of Wound Care
http://www.cawc.net
The Canadian Society of Plastic Surgeons
http://www.plasticsurgery.ca
References
Bennett R.
Fundamentals of Cutaneous Surgery
. St. Louis, MO: CV Mosby; 1988: 498.
DeCherney AH, Nathan L.
Current Obstetric & Gynecologic Diagnosis & Treatment
. 9th ed. New York, NY: McGraw-Hill; 2003.
Dorland WN.
Dorland's Illustrated Medical Dictionary
.
Philadelphia, PA: WB Saunders, Harcourt Health Sciences; 2005.
Porter RS.
The Merck Manual of Medical Information Home Edition
.
2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2004.
Schwartz S, Brunicardi F, et al.
Schwartz’s Principles of Surgery
. 8th ed. New York, NY: McGraw-Hill; 2007.