• 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.

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