Overview
Dehiscence is a common surgical complication where a wound fails to heal and re-opens following surgery. It is most common following abdominal surgery and is often seen between 7-10 days post-operatively. It can be divided into:
- Superficial wound dehiscence – only the skin wound fails to close
- Full thickness (complete) dehiscence – all layers fail to close and abdominal contents protrude through
Abdominal wound dehiscence often has preceding serosanguineous discharge (composed of serum and red blood cells) before dehiscence occurs.
It should be treated as if the defect involves the whole of the wound.
Risk Factors
- Malnutrition – inadequate protein availability and impair wound healing
- Increasing age – slower wound healing
- Smoking – induces vasoconstriction and reduces wound perfusion and healing
- Diabetes mellitus – microvascular disease can impair wound perfusion and hearing
- Poor perfusion/ischaemia to the wound site – causes reduced healing rates
- Infection – inflammation can impair wound healing
- Corticosteroids – thought to slow wound healing
- Connective tissue disorders (e.g. Ehlers-Danlos syndrome) – due to slow wound healing
- Poor surgical technique
- Lengthy operations (>6 hours) or emergency surgery
Management
Overview
Initial management includes:
- Covering the wound with gauze soaked in saline, giving IV antibiotics, IV fluids, and analgesia, and returning the patient to theatre
Prognosis
- Wound dehiscence is a serious surgical complication with a mortality of up to 30% and should be managed promptly if it occurs.
