What Is Wound Dehiscence? In this article we’ll explore the wound disruption known commonly as “wound dehiscence.” It occurs when, after surgery, a wound reopens at the site of the incision. This type of disruption is also known as a wound breakdown or wound separation. When a wound is considered to have partial dehiscence, it means the edges of the incision have partially pulled apart in at least one or two small areas. Complete dehiscence wounds mean the wound was entirely separated. In other words, the entirety of the wound was reopened, exposing all layers of skin, muscle, and etc. Complete dehiscence is a major medical issue that requires immediate attention.
What are the Signs of Wound Dehiscence?
Wound disruption comes with certain signs and symptoms. It most commonly occurs soon after surgery, around 3 to 10 days later. The patient will notice that their wound site is getting worse, not better. Others signs of wound dehiscence include:
- Fluid drainage
- Broken stitches
- A gap where the stitches should be
- A gap where the wound was once beginning to heal
- Pain and redness at the site of the surgical incision
- Fever, in some cases
What are the Causes of Wound Dehiscence?
Wound Dehiscence has a few possible causes. It can occur at any point of wound healing. Therefore, you must first understand that wound healing occurs in three phases.
- The Inflammatory Phase is when fluid and healing cells rush to the site of an incision. This causes swelling, redness, and pain. The body does this naturally to remove dead cells and bacteria in order to jump start wound recovery and repair.
- The Proliferative Phase involves special cells called fibroblasts, which work to pull the wound together by creating new tissue.
- The Maturation Phase is when new tissue becomes strong and less fragile. This is normally the final phase of wound healing – unless the wound is chronic or dehiscence occurs. If there is disruption of any sort, the wound will pause at one phase or could even regress.
Now that you understand how wounds heal, it will be easier for you to understand how dehiscence is caused. There are a few different scenarios that can cause it.
Infection – This may happen because infection puts a pause on wound healing. When a wound is infected, it remains in the inflammatory phase. Therefore, the body continues to work at cleaning and removing bacteria, which are characteristics of the inflammatory phase. Another result of infection is that fibroblasts are never dispatched to the wound. This is significant because fibroblasts are what help seal the wound. Therefore, infected tissue is weak and fragile.
Pressure on Sutures – When the patient puts pressure on the sutures, it could cause the wound to reopen. Pressure could be caused by vomiting, severe coughing, heavy lifting or any other type of intense strain. When stitches, staples and sutures get more pressure than they can handle, they break, exposing the wound in that particular spot.
Poor Technique – When the doctor or surgeon doesn’t do a good job or is rushed, poor technique could cause the disruption.
Sutures Removed too Early – If sutures have not fully done their job, removing them could mean big trouble. Sutures should remain for the full recommended time. Don’t try to remove sutures early or wound breakdown may happen to you.
Decreased Blood Flow – Blood flow plays an important role in wound healing, by carrying oxygen to the healthy, healing cells that work to clear the wound of bacteria. If blood flow is decreased, it puts the patient at higher risk of wound splitting. Decreased blood flow may happen as a result of smoking and conditions like diabetes, obesity, and heart disease.
What Complications May Arise Due to Wound Dehiscence?
If you feel that your wound may have been disrupted due to any of the factors listed above, it’s important to get in touch with your doctor or wound care specialist as soon as possible. That’s because even minor wound disruption can become infected – and infection can lead to major problems. If the wound has completely split, you’re dealing with a medical emergency that can lead to evisceration, an occurrence where the internal organs protrude through a wound.
Treatment for Wound Dehiscence
As stated above, make sure to call your doctor, surgeon, or wound care specialist the moment you notice signs of wound breakdown. Your treatment plan may look like the following
Pain management – Your doctor or specialist may prescribe medications, including pain medication.
Wound dressing – Your doctor or specialist may show you different dressings that could help. They may also show you how to change the dressings.
Antibiotics – In addition to pain management, your doctor may prescribe antibiotics to help you heal.
Assessing risk – Your doctor will always bring you in to assess the wound and improve any risk factors you may have. For diabetics, there is a definite desire to keep blood sugar levels under control. Another risk factor is excessive blood or pus. In this case, your doctor may place a small plastic tube at the site of the suture. This tube will help drain out the fluid.
Removing dead tissue – Your doctor or specialist will remove dead and damaged cells so the wound heals properly. Removing the dead cells also decreases your risk of infection. To accomplish this, your doctor may give you a special kind of bandage.
Visit Wound Care OC for all of your Wound Care needs
Contact Wound Care OC for wound treatment in Orange County, CA
Dr. Faried Banimahd is a board-certified physician specializing in emergency medicine, wound care, and pain management. Our team will work with you to create an individualized treatment plan that meets your needs and unique conditions. Our clinic includes highly trained and experienced physicians, registered nurses, and certified medical staff who work together to provide you with the highest standards of wound care treatments.