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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

Factors that may increase your chance of wound dehiscence include:

  • Being 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, which can occur with fluid accumulation ascites, inflamed bowel, or 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

Wound dehiscence may cause:

  • 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 tests, such as:

Treatment

Treatment may include:

  • Antibiotics if an infection is present or possible
  • 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—when appropriate
  • Surgery to:
    • Remove contaminated and/or dead tissue
    • Resuture the wound
    • Place a temporary or permanent piece of mesh to bridge the gap in the wound
Prevention

To reduce your chance of wound dehiscence:

  • 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 College of Surgeons
http://www.facs.org

Centers for Disease Control and Prevention
http://www.cdc.gov

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.

Surgical site infection. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 14, 2014. Accessed September 30, 2014.

Surgical site infection—prevention. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 29, 2014. Accessed September 30, 2014.



Last reviewed August 2014 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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