ConditionInjuries & poisoning
Wound Dehiscence
Wound dehiscence is when a surgical wound partly or completely splits open along the incision, usually 5 to 10 days after surgery. It is most common after abdominal operations. Warning signs include pinkish, watery fluid leaking from the wound, a popping or tearing feeling, and a gap between the edges. Infection, obesity, diabetes, smoking and strain from coughing or lifting are the main causes. If organs or bowel are visible (evisceration), cover the wound with a clean, moist dressing and call 911 or your local emergency number.
Also called: Wound separation, surgical wound breakdown, incision opening, wound rupture, burst abdomen
At a glance
- What it is
- Separation of the edges of a surgical incision after it was closed.
- When
- Usually 5 to 10 days after surgery, but can occur up to a few weeks later.
- Warning signs
- Pink, watery drainage, a pop or tearing feeling, a widening gap, new pain.
- Main causes
- Infection, high tension on the wound, obesity, diabetes, smoking, malnutrition, steroids.
- Treatment
- Wound care, negative pressure dressings, or surgical re-closure. Evisceration is an emergency.
When to get help
Call 911 or go to the ER
- Organs, bowel or fatty tissue visible through the wound (evisceration): do not push them back. Cover with a clean cloth or sterile dressing soaked in saline or clean water, lie down with knees bent, and call 911
- A sudden gush of pink fluid from an abdominal wound followed by the wound opening
- Fever with confusion, fast heartbeat or feeling faint after surgery (possible sepsis)
See a doctor within a day or two
- The incision edges have pulled apart, even a little, or stitches or staples have come out early
- Increasing redness, warmth, swelling, pus or foul smell from the wound, or fever above 38 °C (100.4 °F)
- Increasing pain at the wound site after it had been improving
Book a routine appointment
- A small amount of clear or slightly pink drainage at a wound check
- A bulge near a healed abdominal scar (possible incisional hernia)
What to do if your wound opens
- Stay calm and lie down. For an abdominal wound, lie on your back with knees bent to reduce tension.
- Do not push anything back in if tissue or organs are visible.
- Cover the wound with a clean, moist dressing or cloth (sterile saline if available, or clean water).
- Call your surgeon for a small separation, or call 911 or your local emergency number if the wound is widely open or organs are visible.
- Do not eat or drink if you may need surgery.
Types of dehiscence
| Type | Description |
|---|---|
| Superficial (partial) | Only the skin and fat layers separate. The deeper layers are intact |
| Complete (fascial) | All layers separate, including the strong fascia that holds the abdominal wall together |
| Evisceration | Complete dehiscence with organs or bowel coming through the wound, a surgical emergency |
Signs and symptoms
- serosanguinous drainage: pinkish, watery fluid leaking from the wound, often the earliest sign of fascial dehiscence
- a feeling that something has "given way," popped or torn, often when coughing, sneezing or straining
- a visible gap between the wound edges
- new or increasing pain
- bleeding
- signs of infection: redness, warmth, swelling, pus, fever
Causes and risk factors
Patient factors
- wound infection (surgical site infection), the most common cause
- obesity, which increases tension and reduces blood flow in fatty tissue. See obesity
- diabetes, especially when poorly controlled. See diabetes
- smoking, which reduces oxygen to healing tissue
- malnutrition and low protein levels
- older age
- steroids, chemotherapy and immune-suppressing medicines
- chronic cough (COPD), constipation with straining, vomiting
- previous radiation to the area
- kidney or liver disease and anemia
Surgical factors
- emergency surgery
- abdominal surgery, especially midline incisions
- contamination during surgery, such as bowel surgery
- excess tension on the closure
- fluid collections such as a seroma or hematoma
After surgery
- heavy lifting or strenuous activity too soon
- forceful coughing, sneezing or vomiting without supporting the wound
Diagnosis
A surgeon examines the wound to see how deep the separation is and whether the fascia is intact. Tests may include:
- wound swabs to identify infection
- blood tests for infection, blood sugar and nutrition
- ultrasound or CT scan to look for fluid collections, abscesses or a fascial defect
Treatment
Superficial dehiscence
- cleaning and debridement of dead tissue
- moist dressings changed regularly, letting the wound heal from the bottom up (healing by secondary intention), which can take weeks
- negative pressure wound therapy (a wound vacuum) to speed healing
- antibiotics if there is infection
- delayed closure once the wound is clean in some cases
Fascial dehiscence or evisceration
- emergency surgery to return organs, wash out the abdomen and re-close the fascia, sometimes with mesh or a temporary closure
- intensive care may be needed
Supporting healing
- control blood sugar
- good nutrition with enough protein, calories, vitamins and minerals
- stop smoking
- treat cough and constipation
Prevention
Before and after surgery:
- stop smoking ideally at least 4 weeks before planned surgery
- keep blood sugar well controlled
- eat a nutritious diet
- splint the wound by holding a pillow firmly against it when coughing, sneezing or laughing
- avoid lifting anything heavier than about 10 lb (4.5 kg) or straining for the period your surgeon advises, often 4 to 6 weeks after abdominal surgery
- follow wound care instructions and keep the wound clean and dry
- use an abdominal binder if recommended
- report redness, drainage or fever promptly
Outlook
Superficial dehiscence usually heals completely, though it may take several weeks and leave a wider scar. Fascial dehiscence and evisceration are serious, with a higher risk of complications, but most people recover with prompt surgery. Later incisional hernias are common after fascial dehiscence.
Frequently asked questions
What is wound dehiscence?
Wound dehiscence is when a surgical incision splits open after it has been closed. It can involve just the skin or all layers of the wound. It usually happens 5 to 10 days after surgery and is most common after abdominal operations.
What are the signs of wound dehiscence?
Signs include pinkish watery drainage from the wound, a feeling of popping or tearing, a gap between the wound edges, bleeding and new pain. Redness, pus and fever suggest an infection, which is a common cause.
What should I do if my incision opens?
Lie down, cover the wound with a clean, moist dressing and call your surgeon right away. If organs or bowel are visible, do not push them back. Call 911 or your local emergency number.
What causes a surgical wound to open?
The most common causes are wound infection and too much tension on the wound, from obesity, coughing, vomiting or lifting. Diabetes, smoking, poor nutrition, steroids and older age slow healing and increase the risk.
How long does it take for a dehisced wound to heal?
A superficial dehiscence left to heal from the bottom up often takes several weeks to a few months, depending on size and health. Negative pressure therapy can speed healing. Fascial dehiscence needs surgery, with recovery over several weeks.
Sources
This guide was written from current patient and clinical guidance, including:
- American College of Surgeons: Wound care after surgery patient education
- MedlinePlus (US National Library of Medicine): Surgical wound dehiscence; Surgical wound infection
- CDC: Surgical site infection prevention guideline
- World Health Organization: Global guidelines for the prevention of surgical site infection
- StatPearls (NCBI Bookshelf): Wound dehiscence