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 )
    Wound Infection
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  • 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
      • Antibiotic 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.

    Revision Information

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