Dehisced Wounds

Wound dehiscence is one of the most common complications of surgical wounds, involving the breaking open of the surgical incision along the suture. Typically, the sutures or closures around wound edges should stay intact while new tissue, known as "granulation tissue," starts forming to help heal the wound. However, when wound dehiscence occurs, the edges starts to separate and the wound reopens instead of healing closed as planned.

Causes

Wound dehiscence can be caused by poor surgical techniques such as improper suturing, over-tightened sutures or inappropriate type of sutures. Wound dehiscence can also be caused by increased stress to the wound area as a result of strenuous exercise, heavy lifting, coughing, laughing, sneezing, vomiting or bearing down too hard with bowel movement. In some cases, wound dehiscence could be secondary to wound infection or poor healing as seen in patients with chronic diseases, malnutrition or weak immune systems. Secondary wound dehiscence can occur in patients with AIDS, renal disease, diabetes mellitus and those undergoing chemotherapy or radiotherapy.

Types

There are two basic types of wound dehiscence, partial or complete, depending on the extent of separation. In partial dehiscence, only the superficial layers or part of the tissue layers reopen. In complete wound dehiscence, all layers of the wound thickness are separated, revealing the underlying tissue and organs, which may protrude out of the separated wound. This can be seen in some cases of abdominal wound dehiscence.

Signs and Symptoms

Signs and symptoms of wound dehiscence are clear and easy to identify by the patient and may present as one or more of the following:

  • Open wound
  • Broken sutures (without healing)
  • Pain at the wound site
  • Wound bleeding
  • Pus and/or frothy drainage in infected wounds

Who Is at Risk

Every person who has a surgical wound has at risk of dehiscence, especially in the first two weeks after surgery, when the tissue is still weak and not completely healed. The two most important  factors controlling the risk of wound dehiscence are:

  • The patient's health status - the risk is higher in patients with a weak immune system, malnutrition or chronic medical illness.
  • The surgical procedure - the risk of dehiscence increases with over-tightening of sutures, poor suturing technique, inappropriate surgery site or suturing material.
  • Other factors - the risk is greater with smoking, obesity, premature post-surgery exercise, heavy lifting, recurrent vomiting, coughing or an improper diet that leads to constipation.

Treatment

All wound dehiscence cases are surgical emergencies that require immediate attention. A wound dehiscence is treated as a new wound, and takes into consideration the surgical history of the wound. The antibiotic therapy used to treat the patient is considered, along with any ongoing infection that might have caused the dehiscence. Antibiotics may be used to prevent any future infections if none were present, as wound
dehiscence increases the risk of wound infection.

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. Finally, the patient's wound should be closely monitored to prevent dehiscence from reccurring. Frequent dressing change is recommended to reduce the risk of infection, while allowing exposure to air to help the wound heal faster.

Prevention

Wound dehiscence can be prevented by taking the following measures:

  • Complying with the doctor's post-operative instructions and prescribed medication
  • Good wound care and hygiene (with appropriate dressing and cleaning as instructed by your doctor)
  • Maintaining good hydration and a healthy diet (to help the wound heal faster and to prevent constipation)
  • Avoid unnecessary stress or strain to wound area (like heavy lifting, exercise, vomiting, coughing, constipation)
  • Bracing body with a hand or a pillow at the wound site may help relieve stress to wound when doing an activity

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