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. It’s commonly associated with a surgical site infection.
Dehiscence usually takes place within 3 to 10 days of surgery.
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. If your stitches, staples, or surgical glue have split apart, or if you see any holes forming in the wound, you’re experiencing dehiscence.
Other symptoms you may experience include:
- bleeding
- fever
- redness
- swelling
There are several preoperative and postoperative risk factors for dehiscence, including:
- Obesity. Obesity slows the healing process because fat cells have less efficiency in blood flow and oxygenation compared to other tissues.
- Malnutrition. Malnutrition can also slow healing due to a lack of the vitamins, proteins, and other nutrients needed for recovery. Hypoalbuminemia, a lack of the protein albumin, is associated with dehiscence.
- Smoking. Smoking reduces oxygenation in the tissues that are necessary for quick healing.
- Peripheral vascular, respiratory, and cardiovascular disorders. Peripheral vascular, respiratory, and cardiovascular disorders all affect oxygenation, as do anemia, diabetes mellitus, and hypertension.
- Cancer. 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. Men are more likely than women to experience dehiscence in certain types of surgeries, including some abdominal surgeries.
- Steroids. 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. This can lead to wounds reopening.
- Emergency surgery or re-exploration. Unexpected surgery or the surgeon going back into a previously operated area can lead to further unexpected complications. This includes the reopening of an original wound.
- Strain from coughing, vomiting, or sneezing. If abdominal pressure increases unexpectedly, the force could be enough to reopen a wound.
It’s important to keep an eye on the healing progress of your wound, as any openings can lead to infection.
In addition, an opening could lead to evisceration, which is a much more severe condition that occurs when your wound reopens and your internal organs come out through the incision.
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. You should walk around in order to avoid blood clots or pneumonia, but in most cases you shouldn’t push yourself much more than this.
- After 2 to 4 weeks, start slightly more rigorous physical activity at your own pace. If you start to feel pressure, consider taking 1 to 2 days of rest and trying again another time.
- After about 1 month, start pushing yourself a little more, but make sure you’re listening to your body. If something really doesn’t feel right, stop.
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.
You may also need to place yourself on bed rest and stop any activity or lifting. These may make the condition worse and may be the cause for reopening.
Although it may only be a small opening or one suture that’s broken, wound dehiscence can quickly escalate to infection or even evisceration. Call your surgeon if you notice any symptoms.
If you’re experiencing evisceration, immediately seek emergency medical attention. Don’t try on your own to push any organs back inside your body.
