Peritonitis, wound infection and failure to close the abdominal wall properly are most important causes of wound dehiscence.
The causes of dehiscence are similar to the causes of poor wound healing and include ischemia, infection, increased abdominal pressure, diabetes, malnutrition, smoking, and obesity. [1] Superficial dehiscence is when the wound edges begin to separate and by increased bleeding or drainage at the site.
Dehiscence is the separation of the fascial closure of the reoperated abdominal wound with the exposure of intraabdominal contents to the external environment. Dehiscence is secondary to technical failure of sutures, shear forces from tension, or fascial necrosis from infection and/or ischemia (2).
To prevent dehiscence, teach patients to splint the surgical site when coughing, vomiting, or sneezing. An abdominal binder for those at risk for dehiscence may be helpful, but evidence supporting its use is still needed. Heavy lifting (10 lbs or more) should be avoided for 6 to 8 weeks after surgery.
Burst abdomen (abdominal wound dehiscence) is a serious, difficult, and frustrating postoperative complication experienced by many surgeons worldwide associated with high morbidity and mortality up to 36%, with significant effect on health care cost, for both the patients and the hospitals [1].
Abdominal wound dehiscence (burst abdomen, fascial dehiscence) is a severe postoperative complication, with mortality rates reported as high as 45% [1–3]. The incidence, as described in the literature, ranges from 0.4% to 3.5% [4–17]. Abdominal wound dehiscence can result in evisceration, requiring immediate treatment.
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.
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.
The wound may come apart if it does not heal completely, or it may heal and then open again. A surgical wound is an example of a wound can that develop dehiscence. Wound dehiscence can become life-threatening.
New or markedly increased wound drainage or a new abdominal wall bulging are indicators of dehiscence of the fascia. The clinician should ask the patient about obstructive symptoms, including nausea, vomiting, or obstipation.
The key to the treatment of superficial abdominal incision dehiscence lies in the combination of surgical debridement, NPWT, and Z-plasty. Negative-pressure wound therapy can facilitate the generation of healthy wound tissue, increase local nutrition and blood supply, and reduce wound infection.
Abdominal surgical wound dehiscence with bowel exposure and infection carries a risk of intestinal fistula, making it extremely difficult to treat. The objective at this time is to heal such wounds safely and absolutely with using intrawound continuous negative pressure and irrigation treatment and artificial dermis.
Intra-abdominal infection is the most important factor in predicting burst abdomen. Patient factors like anemia, diabetes, smoking, peritonitis due to bowel perforation act as determinant for wound dehiscence.
Risk factors for dehiscence and evisceration include age, diabetes, obesity, malnutrition, corticosteroid therapy, and sepsis. Wound infection is directly associated with over 50% of eviscerations [1]. Surgical technique can contribute to wound dehiscence.
Peritonitis, wound infection and failure to close the abdominal wall properly are most important causes of wound dehiscence. Malnourishment and malignant obstructive jaundice predispose a patient to wound dehiscence by slowing the healing, and increasing rate of wound infection.
Some methods to prevent surgical wound dehiscence include supporting the abdomen when coughing, sneezing, or moving around/sitting up in bed, avoiding strain or pressure to the wound area (heavy lifting, exercise, coughing, constipation/straining with bowel movements), and maintaining a good diet and good oral intake ...
Wound dehiscence is estimated to occur in 0.5–3.4% of abdominopelvic surgeries, and carries a mortality of up to 40%.
Additional systemic risk factors that were found to be significant included hypoproteinemia, systemic infection, obesity, uremia, hyperalimentation, malignancy, ascites, steroid use, and hypertension.
The risk factors of wound dehiscence can be predicted early and their number can be decreased before and after surgery by an experienced surgeon, leading to a lowered incidence of wound failure.
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. It uses 100% oxygen to stimulate accelerated healing capabilities within the body.
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.
Abdominal wound dehiscence (AWD) is a terminology used to explain separation of different layers of an abdominal wound before complete healing occurs. Other terms used interchangeably are acute laparotomy wound failure, burst abdomen, abdominal wound disruption, and evisceration.
Depending on your state of health, it can be shorter or longer. An average time length that a lot of people say with an abdominal incision is about one to two months or even just six weeks to where you really want to let it heal and you try not to put too much pressure on your abdomen during that time.
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.