Wound Dehiscence: Symptoms, Causes and Treatments
Wound dehiscence can be alarming when it happens while you are recovering from surgery. It can happen right after you cough, sneeze, or even unexpectedly while you rest, and you would not realise it until the early symptoms appear. But what exactly does wound dehiscence entail?
What is Wound Dehiscence?
Wound dehiscence (pronounced “dih-his-uhns”) occurs when the edges of a wound (such as an incision) separate due to a poorly healing or infected wound, poor wound suturing, and reduced blood flow to the wound. A wound dehiscence may either be partial (a small part of the wound opens up) or complete (the entire wound reopens). A wound dehiscence does not close neatly during your recovery, so prompt medical attention is needed to address it.
After surgery, a wound will form new granulating tissue as it heals. It usually takes six to 21 days for the new tissue to mature and strengthen. However, stress on the wound or other factors can complicate the formation of this granulating tissue, causing it to tear open or form improperly. The risk of wound dehiscence is greater in the first two weeks after your surgery, and the wound may also be at higher risk of infection.
Causes of Wound Dehiscence
When your wound separates, it may indicate that one (or more) of the following has occurred.
- Post-surgical stress on the wound that prevents it from healing or causes it to tear. Even coughing, sneezing, or lifting an object can trigger wound dehiscence.
- Improper wound closure.
- Poor nutrition, which prevents granulating tissue from properly forming and resisting post-surgical stress.
- A bacterial infection that weakens granulating tissue and slows your recovery.
- Surgical sutures that dissolved much too soon, while your wound is still healing.
- Obesity, which can delay post-surgical healing.
Wound dehiscence can occur at any time, though it may typically occur three to ten days after surgery.
Risk Factors of Wound Dehiscence
The more common risk factors that can cause wound dehiscence include:
- Age: Older people may need longer for a wound to heal completely.
- Anaemia: A low red blood cell count can slow the wound healing process.
- Certain medications: Steroids and other medications can impede the wound healing process.
- Diabetes: High blood sugar levels can affect white blood cell functions, impairing their ability to fight harmful bacteria and promote wound healing.
- Medical conditions: Some medical conditions can impair oxygenation, which is necessary to promote wound healing.
- Smoking: Nicotine can have adverse effects that can impair your wound healing.
Symptoms of Wound Dehiscence
The most common symptoms of wound dehiscence include:
- Partial or complete opening of your wound
- Feeling as though something has torn or come apart
- Sudden bleeding or pus/fluid discharge (or both) from the wound
- Fever
- Pain at or around the wound
- Noticeable swelling and redness around the wound
- A foul odour emanating from the wound may indicate a bacterial infection
In some instances, your internal organs may protrude from the wound, a condition known as evisceration. When this occurs, immediately contact your surgeon for prompt medical attention, as it is considered a medical emergency.
Treating Wound Dehiscence
If you are waiting for treatment by your doctor, apply a clean bandage or dressing to the wound to prevent further blood or fluid discharge and minimise the risk of infection. Ensure you have additional clean bandages/dressings ready, as you may need to change bandages/dressings to prevent infections.
Your doctor may outline a comprehensive treatment plan to address the wound dehiscence. Since it is typically considered a new wound, your medical and surgical history will be noted to inform the treatment plan.
Treating with Medications
Antibiotics will be prescribed to help treat potential bacterial infections or reduce the risk of one. Pain medications, like aspirin, may also be given to help relieve the pain caused by the wound’s reopening.
Treating with Wound Care Techniques
You will have to use new bandages or dressings to cover the wound and allow it to heal properly. Your doctor will advise you on the frequency of bandage/dressing changes to ensure positive recovery outcomes. If needed, they may prescribe a special bandage to help the body remove dead cells that prevent the wound from healing.
Treating with Negative Pressure Wound Therapy
Negative pressure wound therapy, or NPWT for short, promotes wound healing by using a special device to remove fluid and bacteria from a wound. NPWT is a versatile treatment method that has been beneficial in managing wound healing outcomes, such as reducing swelling and improving blood circulation, which promotes further wound healing.
Treating with Surgery
Surgery is a last resort when dead or infected tissue needs to be removed from the wound, or if you are experiencing an evisceration. Your surgeon may also place new sutures or a mesh to let the wound heal properly. They may also attempt to close the wound once again; you may need to stay in the hospital so that they can observe your condition while you recover.
Can You Prevent Wound Dehiscence?
You can still take steps to prevent wound dehiscence from happening.
- Ensure you stay nourished with a well-balanced meal to facilitate your wound healing. Include lean proteins to promote tissue growth and cell renewal.
- Quit smoking and cut down on your caffeine and alcohol consumption.
- Avoid lifting heavy objects for the first two to four weeks post-surgery to prevent a wound dehiscence episode.
- Use bracing techniques if you do anything that stresses the wound. Before performing the activity, gently apply pressure with your hands or a pillow over your incision.
- Start with short walks to maintain your physical health and reduce the risk of blood clots.
- Reintroduce exercise gradually and start at a slow pace. As you recover, slowly increase your physical activity, but avoid overexerting yourself.
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