Wound Dehiscence

What is wound dehiscence?

Wound dehiscence (pronounced “duh-hi-since”) is when the incision (cut) a surgeon makes opens or pulls apart after surgery. (Think of closed zipper that separates in the middle.) The condition happens when an incision doesn’t heal as it should. Healthcare providers may call this condition wound disruption or wound separation.

A wound dehiscence can be partial or complete:

• Partial wound dehiscence. A small area of the wound reopens. It can also happen when the surface of your skin (epidermis) and the next layer (dermis) separate.
• Complete wound dehiscence. The entire surgical wound reopens. This can mean the entire incision opens or it opens through all layers of your skin and muscle at the surgery site.

It can be scary when an incision opens. You may wonder why it happened and what it means for your recovery. Wound dehiscence can occur for several reasons. For example, stress on the incision can affect healing. So can infection or having certain medical conditions. But healthcare providers have ways to manage wound dehiscence and get you back on the road to recovery.

What are the symptoms of wound dehiscence?

The most significant symptoms are:

• Bleeding
• Broken sutures
• Fever
• Pain
• Swelling around the incision
• Reddish skin or darker skin color around the surgery site
• The feeling that something is pulling or ripping in the incision

Wound dehiscence symptoms can develop at any time during the healing process. The healing process is complex and takes time. You probably won’t notice the initial steps in the process. Healthcare providers may call these wound healing phases. They include:

• Hemostasis. This is your body’s natural reaction to injury, including an incision. Your body begins to slow down bleeding and form a blood clot at the incision. Hemostasis takes about two days to complete.
• Inflammation. This happens after a blood clot closes the incision. Your blood vessels get bigger. This helps them to remove debris and bacteria.
• Proliferation. Your body is building new cells to make new tissue. This is granulation tissue. If you’re checking your incision, you may notice bumpy pink or reddish skin. The proliferation phase lasts six to 21 days.
• Maturation. This is the final stage. Your new tissue gains strength and elasticity as the incision continues to heal. Maturation can take several weeks up to a year.

What causes wound dehiscence?

A surgical wound infection is the most common cause of wound dehiscence. This happens when you have incisions (cuts) in your skin. Surgical wound infections happen when bacteria get into your body through the incisions (cuts) that your surgeons make. This can happen during surgery, during recovery in the hospital or while you’re recovering from surgery at home.

Sometimes, post-surgery complications like severe vomiting or coughing can also make an incision open.

What are the risk factors for wound dehiscence?

Certain medical conditions or medical treatments may increase your risk for wound dehiscence. For example, anything that affects your blood or blocks its flow can slow down healing.

Medical conditions that increase wound dehiscence include:

• Anemia. Anemia is low levels of healthy oxygen-rich red blood cells. Your body needs oxygen to heal. Low red blood cell levels can slow down that process.
• COPD. This condition affects the amount of oxygen in your blood, so an incision doesn’t heal.
• Diabetes. People with diabetes have high blood sugar levels. High blood sugar levels can affect white blood cells that help with healing.
• Hypoproteinemia. This is low protein in your blood. Your body uses protein to build and repair your tissues and skin. Having hypoproteinemia can make it hard for your body to build new tissue to close an incision.
• Obesity. Research shows having obesity causes chemical changes in your body. These changes can affect healing.

Your healthcare team will treat underlying conditions that increases your wound dehiscence risk. They’ll do that before your surgery. But there may be times when pre-surgery treatment isn’t possible. That can be the case if you need emergency surgery for a traumatic injury or a sudden serious medical issue.

Medical treatments that can increase wound dehiscence risk include:

• Radiation therapy. Radiation therapy to treat cancer can cause scar tissue. Scar tissue in an incision can affect healing.
• Corticosteroids. Your body may not make new tissue and blood vessels. That can happen if you need to take a corticosteroid for a long time.

What are the complications of wound dehiscence?

The most serious complication is evisceration. This is the medical term for when internal organs poke through an incision.

This is a rare complication that may happen if you have surgery on your abdomen. Evisceration is a medical emergency. If this happens to you, you’ll have surgery right away.

How do healthcare providers diagnose wound dehiscence?

A healthcare provider will look at the incision. They may take a fluid sample from your incision. If they do, a medical pathologist will test the sample to find out what bacteria may be responsible. In some cases, they may do a computed tomography (CT) scan.

How do you fix a dehiscence wound?

Treatment for wound dehiscence may include:

• Antibiotics. You may receive intravenous antibiotics to treat bacterial infections.
• Negative pressure wound therapy. A bandage on the wound connects to a pump. The pump sucks fluid away from the wound.
• Surgery. Your surgeon may remove damaged, infected or dead tissue. They may place new sutures or place a piece of mesh to help close the wound.

Will a dehiscence wound heal on its own?

It can, but that depends on your specific situation. For example, your healthcare provider may not do surgery to replace broken sutures. They may instead recommend that you cover the incision to protect it from infection as the wound heals.

Can wound dehiscence be prevented?

You may not be able to prevent all things that can cause an incision to open. But there are some steps you can take to reduce your risk:

• Eat well. Everyone needs calories for energy. We need protein, vitamins and minerals to build and repair tissue. Eating well-balanced meals before surgery may set you up for healing success.
• Quit smoking. Smoking raises the level of carbon monoxide in your body. This robs your tissues of oxygen that they need to heal.
• Take care of your incision. Your care team will explain how to care for an incision. They’ll explain any extra steps you should take. For example, some medical issues increase your wound dehiscence risk. Your team may tell you to check the incision twice a day.
• Take it easy. Your body needs rest to recover from surgery. Lifting increases the chance that sutures or stitches will break. Your healthcare team will explain what kind of activities you should avoid.

How long does a dehiscence wound take to heal?

Healing takes time. How much time depends on your situation. In general, it may take several weeks for smaller dehiscence wounds to heal. But healing may take several months. That can happen if you need follow-up surgery for a larger incision that reopens.

When should I see my healthcare provider?

Contact your surgeon right away if the incision from your surgery opens. Even a small opening, like a single broken suture, is information your surgeon should have.

What kind of surgery typically involves wound dehiscence?

Wound dehiscence can happen anytime you have an incision (cut) in your skin from surgery, but it most often happens after abdominal or heart surgery.