Wound dehiscence

Wound dehiscence is a surgical complication in which a wound ruptures along a surgical incision. Risk factors include age, collagen disorder such as Ehlers–Danlos syndrome, diabetes, obesity, poor knotting or grabbing of stitches, and trauma to the wound after surgery.[1]

Wound dehiscence following an inguinal hernia repair.

Signs

Signs of dehiscence can include bleeding, pain, inflammation, fever, or the wound opening spontaneously.[1] An internal wound dehiscence can occur internally as a result of hysterectomy at the site of the vaginal cuff.[2][3]

Cause

A primary cause of wound dehiscence is sub-acute infection, resulting from inadequate or imperfect aseptic technique. Coated suture, such as Vicryl, generally breaks down at a rate predicted to correspond with tissue healing, but is hastened in the presence of bacteria. In the absence of other known metabolic factors which inhibit healing and may have contributed to suture dehiscence, sub-acute infection should be suspected and the protocol of obtaining wound cultures followed by treatment with the appropriate antibiotics should be undertaken. Dehiscence can also be caused by inadequate undermining (cutting the skin away from the underlying tissues) of the wound during surgery, excessive tension on the wound edges caused by lifting or straining, or the wound being located on a highly mobile or high tension area such as the back, shoulders or legs.[4] Individuals with Ehlers–Danlos syndrome also commonly experience wound dehiscence.[5] Risk factors can include any of the above as well as obesity, smoking, previous scarring, surgical error, cancer, chronic use of corticosteroids and increased abdominal pressure. A very common cause is also use and especially overuse of nicotine in any form. Smoking should therefore be stopped a certain time before any surgery.[1]

Prevention

Dehiscence can be prevented through adequate undermining to reduce stress on the wound edges, avoiding heavy lifting and hematomas, and speeding healing through adequate nutrition, controlling diabetes, and avoiding certain medications such as prednisone. Sterile strips may also be used to cover the sutures for up to a week.[4] Antibiotics and cleaning the wound may also help.[1]

Treatment

Once wound dehiscence occurs, it can be treated by allowing granulation, re-cutting and suturing the edges, and providing prophylactic antibiotics.[4] Exposure to the air, debridement, and, if indicated, frequent dressing changes also help.[1]

Notes
  1. "Wound Dehiscence (Surgical Wound Dehiscence; Operative Wound Dehiscence)". EBSCO Industries. 2010-09-01. Retrieved 2011-06-24.
  2. Hoffman B (2012). Williams gynecology (2nd ed.). New York: McGraw-Hill Medical. pp. 1054 and 1050. ISBN 9780071716727. OCLC 779244257.
  3. Cronin B, Sung V, Matteson K (April 2012). "Vaginal cuff dehiscence: Risk factors and management". American Journal of Obstetrics and Gynecology. 206 (4): 284–288. doi:10.1016/j.ajog.2011.08.026. ISSN 0002-9378. PMC 3319233. PMID 21974989.
  4. Rusciani L, Robins P (2008). Textbook of dermatologic surgery. PICCIN. p. 183. ISBN 88-299-1898-9.
  5. Cassidy SB, Allanson JE (2005). Management of genetic syndromes. Wiley-Liss. p. 220. ISBN 0-471-30870-6.
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