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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.

Revision Information

  • American Academy of Family Physicians

    http://www.aafp.org/online/en/home.html

  • American College of Surgeons

    http://www.facs.org

  • Canadian Association of Wound Care

    http://www.cawc.net

  • The Canadian Society of Plastic Surgeons

    http://www.plasticsurgery.ca

  • 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.