Wound Dehiscence
(Surgical Wound Dehiscence; Operative Wound Dehiscence)
Definition
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
- 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
- Bleeding
- Pain
- Swelling
- Redness
- Fever
- Broken sutures
- Open wound
Diagnosis
-
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
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.
