what is wound dehiscence

Full Answer

Who is more at risk for wound evisceration?

Those most at risk for wound evisceration include individuals who are malnourished, obese, are older. adults, have anemia, DM, immunodeficient, cancer, and/or long-term use of corticosteroids. Patients who are coughing, sneezing, vomiting, and who fail to properly splint the wound while doing so are also more at risk.

What does the name dehiscence mean?

Dehiscence is the splitting at maturity along a built-in line of weakness in a plant structure in order to release its contents, and is common among fruits, anthers and sporangia. Sometimes this involves the complete detachment of a part. Structures that open in this way are said to be dehiscent.

What is the meaning of dehiscence?

Dehiscence is a surgical complication where the edges of a wound no longer meet. 1  It is also known as “wound separation.” A healthy, healing wound will have edges that meet neatly and are held closely together by sutures, staples, or another method of closure.

How long does it take for surgical wounds to heal?

This is why surgical wounds typically heal faster than other kinds of wounds. Surgery cuts normally take 6 to 8 weeks to heal, according to St. Joseph’s Healthcare Hamilton. Wounds may also heal faster or better if you keep them covered. According to the Cleveland Clinic, wounds need moisture to heal.

What causes wound dehiscence?

Why does wound dehiscence occur? Wound dehiscence is caused by many things such as age, diabetes, infection, obesity, smoking, and inadequate nutrition. Activities like straining, lifting, laughing, coughing, and sneezing can create increased pressure to wounds, causing them to split.

What does wound dehiscence look like?

A dehisced wound can appear fully open – the tissue underneath is visible – or it can be partial, where just the top portion of the skin has torn open. The wound could be red around the wound margins, have drainage, or it could be bleeding or seeping, where only a thin trickle of blood is coming out.

How do you treat a dehiscence wound?

Treatment may include:Antibiotics if an infection is present or possible.Changing wound dressing often to prevent infection.Open would to air—will speed up healing, prevent infection, and allow growth of new tissue from below.Negative pressure wound therapy—a dressing that is to a pump that can speed healing.More items...

What are the signs and symptoms of a wound dehiscence?

Signs of Wound DehiscencePain.Redness.Swelling.Bleeding.Drainage of other fluids.

How long does dehiscence take to heal?

How is dehiscence treated? The average time for an abdominal incision to fully heal is roughly 1 to 2 months. If you think your wound may be reopening, or if you notice any symptoms of dehiscence, contact your doctor or surgeon immediately.

Is wound dehiscence an emergency?

Someone with wound dehiscence might have broken sutures, pain, bleeding, swelling, redness, fever, and a visibly open wound. If an abdominal wound dehiscence is not treated, it can lead to wound evisceration — a medical emergency in which internal organs stick out through the incision.

How do nurses treat dehiscence?

If infection is suspected, there should be appropriate use of antibiotics, removal of drains, sutures or staples and surgical debridement. Following the removal of necrotic tissue, superficial dehiscence can be closed by secondary intention.

What does a nurse do for dehiscence?

To prevent dehiscence, teach patients to splint the surgical site when coughing, vomiting, or sneezing. An abdominal binder for those at risk for dehiscence may be helpful, but evidence supporting its use is still needed. Heavy lifting (10 lbs or more) should be avoided for 6 to 8 weeks after surgery.

Who is at greatest risk for wound dehiscence?

Patients with a medical history of stroke or who have chronic obstructive pulmonary disease (COPD), diabetes, or cancer also have higher rates of dehiscence. Some patient behaviors can also increase the risk of dehiscence. Smoking, for example, is a risk factor.

What are five possible causes of wound dehiscence?

The causes of dehiscence are similar to the causes of poor wound healing and include ischemia, infection, increased abdominal pressure, diabetes, malnutrition, smoking, and obesity.

How can dehiscence be prevented?

SYSTEMIC STRATEGIES TO PREVENT DEHISCENCEmaintaining blood volume through adequate fluid replacement.maintaining warmth (to prevent vasoconstriction)aggressively managing pain (to prevent vasoconstriction)using supplemental oxygen when needed to maintain normal oxygen levels.

How long does it take a surgical incision to heal?

In most cases, a surgical incision heals in about two weeks. More complex surgical incisions will take longer to heal. If you have other medical conditions or are taking certain medications, your healing time may differ.

Can an open wound be restitched?

The cut may need restitched (or glued) if gaping open. This is sometimes done if suturing was less than 48 hours ago.

Can you Resuture a Dehisced wound?

For a dehisced wound, a patient should return for medical care immediately. This may include debridement, antibiotic therapy and resuturing or use of another type of wound closure device. Following this treatment, the wound will need to be monitored extremely closely for signs of recurring dehiscence.

What is the difference between wound dehiscence and evisceration?

Dehiscence is secondary to technical failure of sutures, shear forces from tension, or fascial necrosis from infection and/or ischemia (2). Evisceration is the uncontrolled exteriorization of intraabdominal contents through the dehisced surgical wound outside of the abdominal cavity.

Why is there a hole in my wound?

Tunneling is often the result of infection, previous abscess formation, sedentary lifestyle, previous surgery at the site, trauma to the wound or surrounding tissue, or the impact of pressure and shear forces upon many tissue layers causing a “sinkhole-like” defect on the skin.

What Is Wound Dehiscence?

Wound dehiscence is when part or all of a wound comes apart. The wound may come apart if it does not heal completely, or it may heal and then open...

What Are The Signs and Symptoms of Wound Dehiscence?

Wounds may split open even when they appear to be healing. You may notice the following when your wound starts to come apart: 1. A feeling that the...

What Increases My Risk For Wound Dehiscence?

1. Wound infection, or blood or fluid under the wound 2. Diabetes, or liver, kidney, or heart disease 3. Being overweight or not getting enough nut...

How Is Wound Dehiscence Diagnosed and Treated?

Your healthcare provider will know your wound has opened by looking at it. You may need an ultrasound, x-ray, or CT to check for problems deeper in...

How Should I Care For My wound?

1. Wash your hands often. Use soap and water. Wash your hands before and after you touch your wound. This will help to prevent an infection. 2. Cle...

What Can I Do to Promote Healing?

1. Rest as directed. Do not lift anything heavier than 5 pounds. Do not do activities that may put stress on your wound, such as running or sports....

When Should I Seek Immediate Care?

1. Your heart is beating faster than usual, or you feel dizzy or lightheaded. 2. Blood soaks through your bandage. 3. You see tissue coming through...

When Should I Contact My Healthcare Provider?

1. You have a fever or chills. 2. Your wound leaks fluid or a small amount of blood. 3. Your pain gets worse or does not get better after you take...

When does a wound dehiscence occur?

Wound Dehiscence: When an Incision Reopens. Wound dehiscence occurs when a surgical incision reopens either internally or externally. It’s also known simply as dehiscence. Although this complication can occur after any surgery, it tends to happen most often following abdominal or cardiothoracic procedures.

How to tell if a wound is dehiscenced?

Dehiscence can be identified by the feeling of a sudden pulling pain. If you’re concerned about possible dehiscence, check how your wound is healing. A clean wound will have minimal space between the edges of the wound and will commonly form a straight line.

What is it called when a wound reopens?

Wound dehiscence occurs when a surgical incision reopens either internally or externally. It’s also known simply as dehiscence.

How to prevent dehiscence after surgery?

The best way to prevent dehiscence after your operation is to follow your doctor’s instructions and surgical recovery best practices. Some of these are: Avoid lifting anything greater than 10 pounds, as this may increase pressure on the wound. Be extremely cautious in the first 2 weeks of recovery.

Why do steroid injections slow down wound healing?

The use of steroid medications slows down wound healing. Infection. Wounds with an infection will take longer to heal, which makes you more susceptible to dehiscence. Surgeon inexperience. If your surgeon is less experienced, you may have a longer operating time, or sutures may not be applied properly.

What age can you have dehiscence?

Surgery to treat cancers such as head and neck cancer or colorectal cancer may result in dehiscence. Age. Adults over 65 years old are much more likely to have other conditions that slow the wound healing process. Sex.

Why is it important to keep an eye on the healing progress of your wound?

It’s important to keep an eye on the healing progress of your wound, as any openings can lead to infection.

What are the signs and symptoms of wound dehiscence?

Wounds may split open even when they appear to be healing. You may notice the following when your wound starts to come apart:

How is wound dehiscence diagnosed and treated?

Your healthcare provider will know your wound has opened by looking at it. You may need an ultrasound, x-ray, or CT to check for problems deeper in the wound. You may need any of the following to treat wound dehiscence:

How should I care for my wound?

Wash your hands often. Use soap and water. Wash your hands before and after you touch your wound. This will help to prevent an infection.

What is the term for when a wound comes apart?

Wound dehiscence is when part or all of a wound comes apart. The wound may come apart if it does not heal completely, or it may heal and then open again. A surgical wound is an example of a wound can that develop dehiscence . Wound dehiscence can become life-threatening.

How to treat a wound that is swollen and red?

Let the soap and water run over your wound. Gently pat the area dry. Look for signs of infection, such as redness, swelling, or pus. Change your bandages as directed . Replace bandages after you clean the wound or bathe. Change your bandages when they get wet or dirty. If directed, pack your wound.

What is wound vacuum?

A wound vacuum is a device that is placed over your wound. This device helps remove fluid or infection from your wound so it can heal and close. Splints or binders may be used to decrease stress on your wound and help hold it together. Surgery may be done to remove infected tissue or close the open wound.

What are the signs of infection at the wound site?

Signs of infection at the wound site, such as yellow or green pus, swelling, redness, or warmth

How to treat superficial dehiscence?

Superficial dehiscence can be managed with abdominal binders to reduce strain on the wound and prevent further dehiscence. The existing wound failure may be allowed to heal by secondary intention or can close secondarily. Deep dehiscence of the underlying fascia is a surgical emergency and must be closed in the operating room, as this can lead to evisceration. If the wound shows signs of evisceration, the wound can be covered with a sterile saline dressing until the herniating organs can be reduced back into the abdomen.

What are the risk factors for dehiscence?

Patient-specific risk factors for dehiscence include increasing age, wound infection, hypoalbuminemia, emergency surgery, cancer, and steroid use. [Level 4] Increasing risk factors appeared to be correlated for increased risk of dehiscence. Mortality for patients with dehiscence was 16%.[10]  Other factors include anemia, jaundice, COPD, and wound infection (Level 4). The risk for dehiscence increased with increasing risk factors. [11]

What is the effect of poor perfusion on wounds?

Poor Perfusion/Ischemia - Healing wounds have an increased demand for oxygen and other factors to promote proper repair . Wounds with poor perfusion or ischemia do not receive sufficient blood flow to meet demand and are unable to heal correctly. Patient comorbidities, including vascular disease or venous insufficiency, increases patient risk for wound failure and dehiscence. Careful suturing can reduce local ischemia to the wound, preventing local wound failure.

What are the risk factors for donor site wound healing complications after free DIEP flap breast reconstruction?

A retrospective investigation of abdominal visceral fat, body mass index (BMI), and active smoking as risk factors for donor site wound healing complications after free DIEP flap breast reconstructions.

What causes poor wound perfusion?

Diabetes - Microvascular disease caused by diabetes can impair blood flow, leading to poor wound perfusion. Hyperglycemia also increases the risk of wound infection, decreasing healing.

What are the phases of wound healing?

The three phases include inflammation, proliferation, and maturation. [3][4][5] The repaired wound can be expected to obtain 80% of the original tensile strength over two years, but will not achieve the same level of pre-injury strength. Poor wound healing can occur due to the disruption of any of the three phases of healing. Common risk factors for abnormal healing include the presence of necrotic tissue, infection, ischemia, smoking, diabetes, malnutrition, glucocorticoid use, and radiation exposure.

What is an infection wound?

Infection - Infected wounds are unable to heal appropriately and become 'stuck' in the inflammation phase. Without proper resolution of wound inflammation, proliferation, and maturation of the wound are unable to occur.

How to prevent wound dehiscence?

To prevent wound dehiscence, the patient must follow all post-suture instructions carefully, particularly any instructions regarding when the wound site can get wet. The patient must move carefully and protect the wound site from anything that could cause friction or pull the skin around wound site. Patients should report any redness or new pain, or pain that doesn't get better, as soon as possible so that a physician can verify whether or not the wound is still healing properly. The patient also has to take care not to tense muscles excessively, such as when the patient lifts a heavy object. Wound dehiscence can occur suddenly, and it important for patients to follow physician instructions carefully and minimize activities that may potentially impact the wound site until wound is well on its way to healing completely.

Why do wounds dehisce?

However, most cases of wound dehiscence are accidental. This can be due to excessive pulling or pressure causes the two sides of the wound to separate, or because the suturing work was not done well and stitches have broken. Sutures that are located over joints or on parts of the body with increased movement can break if the joints bend and stretch the surrounding wound tissue too much.

Why do wounds need to be monitored?

If the wound dehiscence is due to an immune or healing issue, then the wound needs to be monitored more closely to ensure any new signs of dehiscence are identified before the wound actually reopens .

What does it mean when stitches are broken?

Patients should also be aware that even if the wound looks like it is healing properly, if any of the stitches are broken, that could be a sign the wound either has minor dehiscence or is about to dehisce.

What is the treatment for a dehisced wound?

Much of the treatment for a dehisced wound is similar to the treatment for a new wound: any infection must be treated with antibiotics, dead tissue must be removed (possibly debrided), and the wound needs interventions to support closure. If a clear cause why the wound dehisced can be established, these factors must be addressed.

Can a dehisced wound be open?

A dehisced wound can appear fully open – the tissue underneath is visible – or it can be partial, where just the top portion of the skin has torn open. The wound could be red around the wound margins, have drainage, or it could be bleeding or seeping, where only a thin trickle of blood is coming out. The wound will likely be painful and may become increasingly so. The wound might also look moist well after the sutures have been added. Some wound tissue may appear to be necrotic.

Is dehiscence a risk?

Causes of Wound Dehiscence. Wound dehiscence is always a risk. The patient's health, the amount of physical activity impacting the wound site, the wound location, and the physician's skill all increase or decrease the chances of wound dehiscence. However, everyone is at risk of this condition, no matter how healthy the person may be.

What is dehiscence in wound healing?

Dehiscence is a partial or total separation of previously approximated wound edges, due to a failure of proper wound healing. This scenario typically occurs 5 to 8 days following surgery when healing is still in the early stages. The causes of dehiscence are similar to the causes of poor wound healing and include ischemia, infection, ...

How long does it take for a wound to dehisce?

This scenario typically occurs 5 to 8 days following surgery when healing is still in the early stages. The causes of dehiscence are similar to the causes of poor wound heali ….

What is dehiscence in surgery?

Dehiscence is a surgical complication where the edges of a wound no longer meet. 1  It is also known as “wound separation.”. A healthy, healing wound will have edges that meet neatly and are held closely together by sutures, staples, or another method of closure. As an incision heals, the wound fills in with new tissue, ...

How to prevent dehiscence?

These suggestioms can be used to reduce the risk of dehiscence or evisceration: 1 Bracing: When doing any activity that increases abdominal pressure (sneezing, coughing, vomiting, laughing, bearing down for a bowel movement) hold pressure over your incision using your hands or a pillow. This can both prevent dehiscence and minimize pain during activity. 2 Prevent constipation: Constipation is common after surgery and straining to have a bowel movement puts unnecessary stress on your incision. Prevent constipation with proper nutrition after surgery, or if you are already constipated, ask your surgeon for medication to help. 3 Proper incision care: Proper incision care will not only speed healing, but it helps prevent infection, which can weaken the incision and increase the chances of dehiscence. 4 Prevent coughing and sneezing: If your allergies are acting up or you have a cough, be proactive about keeping sneezing and coughing to a minimum. Repetitive coughing and sneezing can slowly weaken your incision, which can slow healing and (in some cases) lead to dehiscence. 5 Avoid lifting: If your doctor says you are not allowed to lift anything heavier than 5 pounds for two weeks after surgery, that is serious advice to be taken strictly. Lifting objects can place stress on your incision that can cause it to open.

How to reduce the risk of dehiscence?

These suggestioms can be used to reduce the risk of dehiscence or evisceration: Bracing: When doing any activity that increases abdominal pressure (sneezing, coughing, vomiting, laughing, bearing down for a bowel movement) hold pressure over your incision using your hands or a pillow.

What is evisceration in surgery?

Evisceration is a rare but severe surgical complication where the surgical incision opens (dehiscence) and the abdominal organs then protrude or come out of the incision (evisceration). 3  Evisceration is an emergency and should be treated as such.

What causes an open incision?

In severe cases, dehiscence can cause the sutures, staples, or surgical glue to completely give way and the entire incision opens from top to bottom. In these cases, the open incision is a surgical emergency and medical attention should be obtained immediately.

Why do surgeons need to discuss small breaks in the incision?

Even small breaks in the incision should be discussed because even a small opening is a gateway to infection and should be treated. If you can see a “hole” in your incision, then bacteria can easily enter the incision and cause serious problems. Always report dehiscence to your surgeon.

What is the term for the new tissue that is formed when an incision heals?

As an incision heals, the wound fills in with new tissue, called "granulation" or "granulating tissue.". This new tissue is not as strong as normal skin, as it is new and has not had time to strengthen. choja / Getty Images.

When do wounds dehiscence after surgery?

In one case the sutures were opened and the wound dehiscencewas seen on 1st week postoperatively.

How much wound dehiscence was present in interrupted X?

Wound dehiscencewas present in 35% in interrupted-X and 22.5% in Professor Hughes technique at 6 weeks but the difference was not statistically significant.

What are the most common wound complications?

Wound complication rates up to 71% have been reported, including hematoma, seroma, skin necrosis, wound infection, and wound dehiscence [1].

What is NPWT in wound healing?

In some cases, when abdominal continence has been obtained but a wound dehiscencepersists, Negative Pressure Wound Therapy (NPWT) could be a therapeutic option to obtain wound closure [2].

What is dehiscence of uterusrupture?

dehiscence of uterusrupture of the uterus following cesarean section, especially separation of the uterine scar prior to or during a subsequent labor.

What does "dehiscence" mean?

dehiscence. 1. a splitting open. 2. wound dehiscence. dehiscence of uterus rupture of the uterus following cesarean section, especially separation of the uterine scar prior to or during a subsequent labor. wound dehiscence separation of the layers of a surgical wound; it may be partial or only superficial, or complete with separation ...

How many flaps of wound dehiscence?

All the five flaps with wound dehiscencewere infected by methicillin-resistant S .

What is dehiscence of abdominal surgical wounds?

Dehiscence of abdominal surgical wounds is a medical emergency and requires immediate action to reduce further complications . Knowing who is at risk and the early signs of dehiscence can help you take measures quickly. Prevention of dehiscence by minimizing closure disruption and enhancing wound healing is key.

How to prevent dehiscence?

Prevention of dehiscence by minimizing closure disruption and enhancing wound healing is key.

Why does the surgeon order a binder?

When the surgeon arrives, he orders an abdominal binder to help prevent evisceration. After discussing treatment options with the patient, the surgeon orders negative pressure wound therapy (NPWT) due to Mr. Anderson’s chronic health conditions and increased risk of dehiscence recurrence. NPWT will provide secondary closure and enhance healing by pulling exudate and bacteria from the site while keeping the wound bed moist.

Is there evisceration of Anderson's wound?

Although no evisceration has occurred, you recognize Mr. Anderson’s wound dehiscence as a rare but severe complication of abdominal surgery and immediately request the unit secretary to contact the patient’s surgeon. You reassure Mr. Anderson that the surgeon will be in to see him soon.

Why do wounds dehisce?

Wound dehiscence can be caused by a problem with suturing. This can range from the wrong type of suture to overly-tight sutures, or simply error on the part of the clinician. Forces acting upon the wound area, like a cough, sneeze or the patient exerting a muscle by lifting a heavy object or having a bowel movement, can also cause dehiscence.

How to treat a dehisced wound?

Avoid unnecessary strain on the wound site. For a dehisced wound, a patient should return for medical care immediately. This may include debridement, antibiotic therapy and resuturing or use of another type of wound closure device. Following this treatment, the wound will need to be monitored extremely closely for signs of recurring dehiscence.

What is a dehisced surgical incision?

Surgical incisions are entry sites sutured or held together by a margin approximation dressing or device after an operative procedure. Dehisced surgical wounds are defined by the separation of the incision line prior to complete healing resulting in an open wound.

What is partial dehiscence?

Partial dehiscence of a surgical wound will present as superficial layers or a small amount of tissue layers being reopened. Complete dehiscence, however, will present as all layers being separated with underlying tissue and organs being exposed and sometimes protruding through the wound opening. Other symptoms of dehiscence include visibly broken ...

Can a weakened immune system cause a surgical wound to dehisce?

Patients who have weakened immune systems (such as those with AIDS or renal disease) or who are malnourished are at risk for this along with patients undergoing chemo- or radiotherapy. Pressure or trauma can also contribute to dehiscence of a surgical wound.

Epidemiology

• Wound dehiscence is a distressing but common occurrence among patients who have received sutures. The condition involves the wound opening up either partially or completely along the sutures basically, the wound reopens to create a new wound.

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