Wound dehiscence

Wound dehiscence is a surgical complication in which a wound ruptures along surgical suture. Risk factors are age, diabetes, obesity, poor knotting or grabbing of stitches, and trauma to the wound after surgery.^[1]

Symptoms

Symptoms of dehiscence can include bleeding, pain, inflammation, fever, or the wound opening spontaneously.^[1]

Cause

Wound dehiscence can 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.^[2] Individuals with Ehlers–Danlos syndrome also commonly experience wound dehiscence.^[3] 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.^[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, controlled diabetes and avoiding certain medications such as prednisone. Sterile strips may also be used to cover the sutures for up to a week.^[2] 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.^[2] Exposure to the air, debridement and if indicated, frequent dressing changes may also help.^[1]

Notes