Wound Dehiscence
Reopening of a surgical wound after closure
Quick Facts
- Type: Surgical wound complication
- What it is: A closed incision that separates
- Common timing: Within days to about two weeks after surgery
- Warning sign: Increased drainage, a popping sensation, or gaping
Overview
Wound dehiscence is when a surgical wound that was stitched or stapled closed reopens, either partly or fully, along the incision line. It usually happens in the first one to two weeks after surgery, while the tissues are still healing and have not yet regained their full strength.
Dehiscence can range from a small separation of the skin edges to a deeper opening that exposes underlying tissue. A particularly serious form, called evisceration, occurs when an abdominal wound opens enough for internal organs to push through, which is a surgical emergency. Recognizing the early warning signs and getting prompt care helps prevent complications.
Symptoms
Warning signs often appear before a wound fully opens. Watch for:
- A feeling that the wound has "given way," sometimes with a popping sensation
- Increased or new drainage from the incision, which may be clear, pink, or bloody
- Visible separation or gaping of the wound edges
- Increasing pain at the wound
- Redness, swelling, or warmth around the incision
- Exposed tissue or, in abdominal wounds, organs bulging through
Seek emergency care if an abdominal wound opens and internal tissue or organs are showing, or if a wound suddenly bursts open.
Causes
Wound dehiscence happens when the strain on a wound exceeds its healing strength, or when healing is impaired. Contributing factors include:
- Infection: One of the most common causes, weakening the tissues.
- Increased pressure on the wound: From coughing, vomiting, straining, heavy lifting, or sudden movement.
- Poor healing: Due to diabetes, poor nutrition, obesity, smoking, or certain medications such as steroids.
- Technical and wound factors: Such as how the wound was closed and the amount of tension on it.
Risk Factors
- Wound infection
- Diabetes and poor blood sugar control
- Obesity
- Smoking
- Poor nutrition or low protein
- Steroid use or a weakened immune system
- Persistent coughing, vomiting, or straining after surgery
- Older age
Diagnosis
Wound dehiscence is usually diagnosed by examining the incision. Evaluation may include:
- Wound inspection: Checking how far the wound has separated and whether deeper layers are involved.
- Assessment for infection: Looking for redness, warmth, swelling, and drainage, sometimes with wound cultures.
- Blood tests: To check for signs of infection.
- Imaging: Occasionally used for deep abdominal wounds to assess the underlying layers.
Treatment
Treatment depends on how deep and extensive the separation is and whether infection is present.
- Wound care: Cleaning and dressing the wound, sometimes with packing to help it heal from the inside out.
- Treating infection: Antibiotics and drainage when infection is present.
- Negative pressure (vacuum) therapy: A special dressing that can speed healing of larger wounds.
- Surgical repair: Re-closing the wound in the operating room for deep or large separations.
- Emergency surgery: Immediately for evisceration, where organs protrude through the wound.
- Supporting healing: Good nutrition, blood sugar control, and stopping smoking.
Prevention
- Follow all post-surgery wound care and activity instructions
- Avoid heavy lifting and straining while the wound heals
- Support the incision (for example, with a pillow) when coughing or sneezing after abdominal surgery
- Keep blood sugar well controlled and eat enough protein
- Do not smoke
- Report signs of infection early so they can be treated
When to See a Doctor
Contact your surgeon or doctor promptly if your wound starts to separate, drains more than expected, becomes more painful, or shows redness, swelling, or warmth, as early treatment can prevent it from getting worse.
Seek emergency care immediately if a wound suddenly bursts open, or if an abdominal wound opens and you can see internal tissue or organs (evisceration). While waiting for help, cover the area with a clean, moist cloth and do not push anything back in.
Frequently Asked Questions
What is wound dehiscence?
It is the partial or complete reopening of a surgical wound along the incision line after it has been closed, usually within the first one to two weeks after surgery while the tissues are still healing.
What causes a surgical wound to reopen?
Common causes include infection, increased pressure on the wound from coughing, vomiting, straining, or lifting, and impaired healing from diabetes, poor nutrition, obesity, smoking, or steroid use.
Is wound dehiscence an emergency?
Small skin separations are usually not emergencies but need prompt medical attention. It becomes an emergency when an abdominal wound opens enough for internal organs to push through, called evisceration, which requires immediate care.
How is wound dehiscence treated?
Treatment ranges from cleaning and dressing the wound, sometimes with packing or vacuum therapy, to antibiotics for infection, and surgical re-closure for deep or large separations. Good nutrition and blood sugar control support healing.
How can I prevent my wound from reopening?
Follow your wound care and activity instructions, avoid heavy lifting and straining, support the incision when coughing after abdominal surgery, keep blood sugar controlled, eat enough protein, avoid smoking, and report early signs of infection.
References
- MedlinePlus, U.S. National Library of Medicine.
- American College of Surgeons. Wound Care.
- Cleveland Clinic. Wound Dehiscence.
- Agency for Healthcare Research and Quality (AHRQ).