Wound dehiscence refers to a surgical complication where a surgical incision, or the cut from a surgical procedure, reopens either internally or externally.
Also known as wound breakdown, wound disruption, or wound separation, these terms describe when a surgical incision reopens after closure, which can pose a threat to wound healing and the individual’s overall health.
During surgery, a doctor may need to make an incision, which is a clean, straight cut in the skin. However, various factors, such as infection, may inhibit healing and cause the wound to reopen.
This article discusses wound dehiscence, including its definition, potential causes, and treatment options.
The word dehiscence means splitting or bursting open. As such, the term wound dehiscence refers to the separation of a wound due to improper wound healing. This scenario usually occurs
In some cases, only the edges of an incision may pull apart in one or more small areas. Health experts refer to this as partial dehiscence. In other cases, known as complete dehiscence, the entire wound reopens through layers of skin and muscle, which may expose internal tissues and organs.
The Agency for Healthcare Research and Quality (AHRQ) states that the following symptoms after a surgical incision warrant immediate attention to help reduce the risk of wound dehiscence and further complications:
- broken sutures
- open wound
- a pulling or ripping sensation
Proper wound healing typically occurs in
- Hemostasis: This refers to a constriction of blood vessels in the area of trauma to help slow blood loss. Additionally, components in blood, such as platelets and fibrin, will form a thrombus, or blood clot, to further try and prevent any blood loss.
- Inflammation: This phase describes the dilation of blood vessels after closing the wound to help encourage the removal of debris and bacteria.
- Proliferation: This stage involves the formation of granulation tissue. This refers to the process of new connective tissues and blood vessels replacing damaged tissue from the trauma.
- Maturation: Also known as the remodeling phase, this describes the final stage of wound healing as new tissue gains strength and elasticity to enable the wound to heal.
Poor wound healing can occur when there is disruption to any of these healing phases. Evidence notes that many different risk factors may contribute toward a higher chance of wound dehiscence. According to a 2018 study, risk factors can include:
- older age
- hypoproteinemia, or low levels of protein in the blood
- wound infections
- hypertension (high blood pressure)
- emergency surgery
- experience of the surgeon
- operation time
- type and size of incision
- suture material
- chronic obstructive pulmonary disease (COPD)
Additionally, not following aftercare instructions or situations that place additional strain on the area of the wound can increase the risk of wound dehiscence. For example, for an abdominal wound, excessive coughing, vomiting, and constipation can all increase the possibility of wound dehiscence after surgery.
Even minor cases of wound dehiscence require immediate attention to prevent the wound from worsening. If left untreated, dehiscence can progress and lead to
In some cases, complete wound dehiscence may result in evisceration. This term refers to a rare but severe surgical complication where internal organs, most often those in the abdomen, protrude from the incision site and poke through the open wound. This complication is an emergency and requires immediate medical attention.
Treatment for wound dehiscence may include:
- antibiotics if there is an infection
- regularly changing the wound dressing to prevent infections
- allowing open air to reach the wound to speed up healing and prevent infection
- negative pressure wound therapy, which is a type of wound dressing that uses a pump to gently draw out fluid from the wound area
- further surgery, to either
- remove damaged, infected, or dead tissue
- place new sutures in the wound
- put a piece of mesh to help close the wound
A doctor will also help lower and manage any risk factors that may be contributing toward poorer wound healing. Additionally, they may also prescribe pain medications to help manage any discomfort.
To help reduce the risk of wound dehiscence, a person’s care team will provide instructions to assist with wound healing and reduce the risk of complications. Typically, these guidelines will include:
- avoiding excessive exercise or activities that involve lifting
- taking antibiotics before and after surgery
- avoiding smoking
- optimizing nutrition, such as increasing protein intake
- keeping the wound clean
- using appropriate technique when applying dressing
Wound dehiscence describes a potential complication of surgery. It refers to when a surgical incision fails to heal correctly, resulting in the wound reopening. Wound dehiscence typically occurs a few days after surgery, when healing is still in the early stages. It can be either partial, where the wound pulls apart in small areas, or complete, where the entire wound reopens.
Separation of the wound can lead to severe complications, such as infection or evisceration. As such, a care team will closely monitor the healing of the wound and apply the appropriate treatment. They will also provide a person with instructions to help maintain proper wound healing.