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.
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.
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.
Along with age, sex plays a role: men experience dehiscence at higher rates than women. Patients with a medical history of stroke or who have chronic obstructive pulmonary disease (COPD), diabetes, or cancer also have higher rates of dehiscence. Some patient behaviors can also increase the risk of dehiscence.
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).
Wound dehiscence is a surgery complication where the incision, a cut made during a surgical procedure, reopens. It is sometimes called wound breakdown, wound disruption, or wound separation. Partial dehiscence means that the edges of an incision have pulled apart in one or more small areas.
Wound dehiscence is estimated to occur in 0.5–3.4% of abdominopelvic surgeries, and carries a mortality of up to 40%.
Dehiscence is a partial or total separation of previously approximated wound edges, due to a failure of proper wound healing. This scenario typically occurs 5 to 8 days following surgery when healing is still in the early stages.
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.
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.
Dehiscence is a partial or total separation of previously approximated wound edges, due to a failure of proper wound healing. This scenario typically occurs 5 to 8 days following surgery when healing is still in the early stages.
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.
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.
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 cut may need restitched (or glued) if gaping open. This is sometimes done if suturing was less than 48 hours ago.
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.
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.
Anther Dehiscence (Figures 9.28, 9.29)
The most common, and ancestral, anther dehiscence type is longitudinal, dehiscing along a suture parallel to the long axis of the thecae.
Glucocorticoids (corticosteroids) cause dehiscence of surgical incisions, increased risk of wound infection, and delayed healing of open wounds.
Scar dehiscence has an incidence of 0.6% in pregnancies with previous caesarean section and has a more favourable outcome for both mother and fetus than does uterine rupture1. Due to the high morbidity and mortality associated with uterine rupture, it is important to identify those patients who are at risk.
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.
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.
The main ultrasonographic diagnostic features of uterine scar dehiscence are the absence of the uterine muscle layer and an anechoic area protruding through the lower segment caesarean section scar with an intact serosal layer.