Pronounced: d?-his ens
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
The following factors increase your chance of developing wound dehiscence.
- 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 , radiation therapy
Symptoms
If you experience one or more of these symptoms in the surgical area, contact your doctor.
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
Wound and tissue cultures to determine if there is an infection
Blood tests to determine if there is an infection
Imaging Studies
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
American College of Surgeons
http://www.facs.org
CANADIAN RESOURCES:
Canadian Association of Wound Care
http://www.cawc.net/open/wcc/index.html
The Canadian Society of Plastic Surgeons
http://www.plasticsurgery.ca/
References:
Barbul A. Wound Healing. In: Schwartzs Principles of Surgery . 8th ed. 2005. Online Version. Available at: http://80=pm;ome=statref=cp,/;obraru/tifts/ediDpci,emt/as[xDpdd=205&Fxld=18&sessionID=5353EOZYOOBHJVKV&Scroll=1Index=6 . Accessed September 27, 2005.
Bennett R. Fundamentals of Cutaneous Surgery . CV Mosby Co: St. Louis, MO; 1988:498.
Current Obstetric & Gynecologic Diagnosis & Treatment . 9th ed. 2003. Online edition. Available at: http://80-online-statref-com.library.tufts.edu/Document.aspx?Dodd-550&Fxld-30&sessionID=5353EOZYOOBHJVKV&Scroll=1&Index=4 . Accessed September 20, 2005.
Dorland's Illustrated Medical Dictionary. WB Saunders, Harcourt Health Sciences; 2005. Online edition. Available at: http://www.merckmedicus.com/pp/us/hcp/thcp_dorlands_content.jsp?pg=/ppdocs/us/common/dorlands/dorland/dmd-d-005.htm . Accessed September 20, 2005.
Surgery. Merck Manual2nd Home Edition. 2004. Available at: http://www.mercksource.com/pp/us/cns/cns_search_results.jsp . Accessed September 27, 2005.
Last reviewed January 2008 by Ross Zeltser, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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