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

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:

• X-ray
• Ultrasound
• CT scan

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 help 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

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

The Canadian Society of Plastic Surgeons http://www.plasticsurgery.ca

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