Simple wound care is all that is required in the majority of cases, with regular wound packing and cleaning with sterile saline. The patient should be advised the wound will heal by secondary intention as a result of the dehiscence and that this can take several weeks.
Even minor cases of wound dehiscence require immediate attention to prevent the wound from worsening. If left untreated, dehiscence can progress and lead to serious infection and life threatening complications. In some cases, complete wound dehiscence may result in evisceration.
The three phases include inflammation, proliferation, and maturation. [3][4][5] The repaired wound can be expected to obtain 80% of the original tensile strength over two years, but will not achieve the same level of pre-injury strength.
The doctor may close the wound separation with new stitches, or they may allow it to heal as it is. If a wound disruption is deep or complete, you may need another surgery to repair the wound.
For a dehisced wound, a patient should return for medical care immediately. This may include debridement, antibiotic therapy and resuturing or use of another type of wound closure device. Following this treatment, the wound will need to be monitored extremely closely for signs of recurring dehiscence.
Hyperbaric Oxygen Therapy can help reduce the potential complications of wound dehiscence. Hyperbaric wound care is a safe, natural, and efficient medical therapy for wounds that may need additional support to properly heal.
Wound reopening: If sutures are removed too early, or if excessive force is applied to the wound area, the wound can reopen. The doctor may restitch the wound or allow the wound to close by itself naturally to lessen the chances of infection.
If associated with superficial wound dehiscence, they can be treated by absorbent dressings such as alginate dressing. Fluid should be sent for culture and sensitivity, and antibiotics commenced empirically in the presence of systemic features of an infection, as mentioned previously.
Dehiscence and evisceration can be a life threatening emergency; do not leave the client immediately call for help and, using a clean, sterile towel or sterile saline dampened dressing, cover the wound. Under no circumstance should reinserting the organs be attempted.
Symptoms of wound dehiscence
Fever. Inflammation. Pain at the wound site with high sensitivity to touch.
Once the wound has formed a scab, there is no longer the need to cover it with a bandage as the scab now acts as a protective barrier. Keep the area clean, but be gentle so that you do not accidentally remove the scab.
A dehisced wound can appear fully open – the tissue underneath is visible – or it can be partial, where just the top portion of the skin has torn open. The wound could be red around the wound margins, have drainage, or it could be bleeding or seeping, where only a thin trickle of blood is coming out.
Superficial dehiscence usually just requires washing out the wound with saline and then simple wound care (e.g. packing the wound with absorbent ribbon gauze). The patient should be advised the wound will now be required to heal by secondary intention and that this can take several weeks.
Research has found that one of the most predictive risk factors for dehiscence is surgical site infection. Surgical incisions have a higher chance of opening if the wound becomes infected.
A non-healing surgical wound can occur after surgery when a wound caused by an incision doesn't heal as expected. This is usually caused by infection – a rare but serious complication. Causes of poor wound-healing depend on the type and location of the procedure, health condition and other factors.
Leave your dressing in place for as long as possible, or as long as your nurse recommends. Normally a dressing is changed between 1 and 3 times a week.
Bactigras and flamazine are changed daily.
Alginate
Alginate dressings are made to offer effective protection for wounds that have high amounts of drainage, and burns, venous ulcers, packing wounds, and higher state pressure ulcers. These dressings absorb excess liquid and create a gel that helps to heal the wound or burn more quickly.
A small opening may not need medical attention, but your surgeon should be the judge of whether or not you should be seen in the office. A small opening will likely need close monitoring as the wound closes on its own. It often will take longer to close and leave a larger scar.
Good incision care can help ensure that it heals well and infection doesn't develop. In most cases, a surgical incision heals in about two weeks. More complex surgical incisions will take longer to heal. If you have other medical conditions or are taking certain medications, your healing time may differ.
Wound dehiscence is one of the most common complications of surgical wounds, involving the breaking open of the surgical incision along the suture.
If you incision breaks open, call your doctor. Your doctor may decide not to close it again with stitches. If that happens, your doctor will show you how to care for your incision a different way. This will likely involve the use of bandages to absorb the drainage that comes from the incision.
In the days and weeks after surgery your body needs time to repair the incision. During this time, the incision will likely become inflamed and there may be some drainage. A mild amount of drainage from the incision is normal.
Serous Drainage
Serum is also known as serous fluid or serous exudate. With serous drainage, the fluid seeping from a wound is thin and watery with a slightly yellowish hue. There may be crusting around the wound due to the clumping of fibrinogens. Serous drainage typically occurs in the first few days after surgery.