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. Complete dehiscence is when the entire cut reopens through all layers of skin and muscle.
Signs of Wound Dehiscence
Wound disruption is most common within 3 to 10 days after a surgery. Symptoms at the incision site start getting worse instead of better and may include:
- Drainage of other fluids
You may also have a fever. You or your doctor might be able to see broken stitches or a gap where the edge of the incision used to meet.
Causes of Wound Dehiscence
Wound healing involves three phases:
- Inflammatory: The body rushes fluid and healing cells to the incision site, causing swelling, redness, and pain. The goal is to clear out dead cells and bacteria so that repair of the wound can begin.
- Proliferative: Special cells called fibroblasts pull the edges of the wound together. The body makes new tissue to repair the cut.
- Maturation: The new tissue gets stronger and less fragile.
Wound separation can happen at any phase and can be caused by one or more of the following.
Infection. When a wound is infected, healing cannot move past the inflammatory phase. The body must focus on clearing bacteria from the area. Infection also limits the number of fibroblast cells that are able to move to the area. Any repair tissue that is able to develop will be weak and fragile.
Pressure on sutures. Vomiting, severe coughing, or heavy lifting can strain the stitches or staples used to hold the wound closed while it heals. If one or more of the sutures break, the incision may pull apart at that spot.
Poor suture technique. Wound disruption may be caused by stitches or staples that are improperly applied. Sometimes wound separation will occur when sutures are removed too early in the healing process.
Decreased blood flow. Good blood flow is important to move oxygen and healing cells to the wound and to clear away bacteria and dead cells. Anything that decreases blood flow puts you at a higher risk of wound breakdown. This includes smoking and conditions such as diabetes, obesity, and heart disease.
Complications of Wound Dehiscence
Even minor wound disruption needs to be treated right away to keep it from getting worse. An open wound is easily infected, and infection can lead to further separation.
Complete wound dehiscence is a medical emergency, as it can lead to evisceration, where internal organs protrude through the wound.
Treatment for Wound Dehiscence
Call your doctor if you notice signs of wound breakdown. Possible treatment options include:
Pain management. Your doctor may prescribe medication if you are in pain because of the wound disruption, dressing changes, or infection. They may tell you to use a different kind of dressing or explain how to care for the wound in a way that causes less pain.
Antibiotics. If you have an infection or are at high risk of infection because of the open wound, your doctor may prescribe antibiotics. This is a kind of medicine that stops or slows the growth of the germs that cause infection.
Management of risk factors. Your doctor will work with you to improve any risk factors that helped cause the wound separation. For instance, if you have diabetes, they will help you get your blood sugar levels under control. If the wound breakdown was caused by blood or pus collecting under the sutured area, the doctor can put in a small plastic tube to drain the fluid.
Removal of dead tissue. Dead or damaged cells can keep the wound from healing properly and increase your risk of infection. Your doctor may give you a special kind of wound bandage to help the body remove dead cells. If there is a lot of dead tissue and the wound separation is deep, you may need further surgery to remove it.
Negative pressure wound therapy. Negative pressure wound therapy (NPWT) is used to treat wounds that are not healing well, especially if there is a lot of fluid draining from the wound. It can help prevent infection, increase blood flow, remove extra fluid, and encourage the growth of new tissue. The wound is covered with a special dressing that has a small opening. A tube is attached to this opening and hooked up to a pump. When the pump is turned on, it gently draws fluid and infection out of the wound.
Closure. 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.
If you notice any of these symptoms, contact your doctor immediately.