wound dehiscence


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dehiscence

 [de-his´ens]
1. a splitting open.
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 of all layers and total disruption. Complete dehiscence of an abdominal wound usually leads to evisceration.
Patient Care. Patients most at risk for wound dehiscence are those who are obese, malnourished, or dehydrated or have abdominal distention, a malignancy, or multiple trauma to the abdomen. Infected wounds are also prone to dehiscence. Those patients who smoke or have a chronic cough are also at risk. Careful monitoring of patients with a predisposition to delayed healing is essential for prevention or mitigation of wound separation, especially between the fifth and twelfth postoperative days, when dehiscence most often occurs. In about half the cases of dehiscence there is a noticeable increase in serosanguineous drainage on the wound dressing before separation of the outer layers becomes apparent. Patients also may report the feeling that something has “given way” in the wound.

If evisceration has not occurred, the wound may be splinted with reinforced dressings, sterile towels, or a binder. This could prevent further separation and allow time to notify the surgeon. The patient should be instructed to lie quietly and, if it is an abdominal wound, to try to avoid increasing intra-abdominal pressure by coughing or straining in any way.

Should splinting an abdominal wound fail to prevent further separation and a spilling of the viscera through the opening, emergency surgery is imperative. Until the patient goes to surgery, the protruding intestines should be covered to prevent drying. Some authorities recommend that only dry sterile towels be used while others prefer covering the entire wound with a sterile towel moistened with povidone-iodine (Betadine). Warming the solution to body temperature can help avoid shock to the intestines, but is not necessary if there is not time to do this.
 The sutures are unable to keep the wound closed and the edges are no longer approximated. Dehiscence can lead to wound evisceration. From Ignatavicius and Workman, 2002.

wound de·his·cence

disruption of apposed surfaces of a wound.

wound

a bodily injury caused by physical means, with disruption of the normal continuity of structures.

avulsive wound
blowing wound
open pneumothorax.
wound contracture
contused wound
one in which the skin is unbroken.
wound débridement
wound dehiscence
wound drain
any device by which a channel or open area may be established for the exit of material from a wound or cavity. See also drain, drainage, wound healing (below).
wound healing
the restoration of integrity to injured tissues by replacement of dead tissue with viable tissue. The process starts immediately after an injury and may continue for months or years, and is essentially the same for all types of wounds. Variations in wound healing are the result of differences in location, severity of the wound, and the extent of injury to the tissues. Other factors affecting wound healing are the age, nutritional status and general state of health of the animal and its body reserves and resources for the regeneration of tissue.
In healing by first intention (primary union), restoration of tissue continuity occurs directly, without granulation; in healing by second intention (secondary union), wound repair following tissue loss (as in ulceration or an open wound), is accomplished by closure of the wound with granulation tissue. This tissue is formed by proliferation of fibroblasts and extensive capillary budding at the outer edges and base of the wound cavity. Healing by third intention (delayed primary closure) occurs when a wound is initially too contaminated to close and is closed surgically 4 or 5 days after the injury.
The insertion of drains can facilitate healing by providing an outlet for removing accumulations of serosanguineous fluid and purulent material, and obliterating dead space.
wound healing agents
topical agents which stimulate healing; includes preparations containing zinc, trypsin, neomycin, dyes and iodine.
incised wound
one caused by a cutting instrument.
lacerated wound
one in which the tissues are torn.
wound nonhealing
failure to heal despite appropriate treatment being given.
open wound
one that communicates directly with the atmosphere.
penetrating wound
one caused by a sharp, usually slender object, which passes through the skin into the underlying tissues.
perforating wound
a penetrating wound which extends into a viscus or bodily cavity.
pocket wound
chronic, nonhealing wound in which there is granulation tissue but the overlying skin does not adhere. Seen most commonly in the axillae or groin of cats.
puncture wound
penetrating wound.
sucking wound
a penetrating wound of the chest through which air is drawn in and out.
surgical wound
one deliberately produced during a surgical procedure, e.g. the original incision.
tangential wound
an oblique, glancing wound which results in one edge being undercut.
traumatopneic wound
sucking wound.
References in periodicals archive ?
1) Although small sized incision increases the stability of the surgical wound, traumatic wound dehiscence after blunt trauma has been reported after phacoemulsification.
Patients who are well perfused rarely get wound infections, a contributing factor for wound dehiscence (West & Gimbel, 2000).
Data suggest that wound dehiscence found to be more common with continuous method 32% than interrupted method 13.
6, 21 It was interesting to note that the only worthwhile complica- tion encountered by us was wound dehiscence, and we contend in all three cases was due to sinus infection.
These complications were managed conservatively except for the patient with CSF leak through small wound dehiscence, but was resolved by simple suture placement.
At each follow-up, both groups were observed for the evidence of hypertrophy, which was defined as raised scar above the level of adjacent skin limited to or extending beyond the original borders, and complications like hypopigmentation, telangiectasia, necrosis, ulceration and wound dehiscence in the healed scar.
When comparison of post operative complecations of both groups was done although the wound dehiscence was reported in both groups but in a very small num- ber.
That said, episiotomies are needed in some cases, and sometimes wound dehiscence requires additional repair, said Dr.
Complications have included a 12% incidence of fat necrosis and a 5% rate of return to the operating room for problems such as wound dehiscence, hernia, or acute arterial or venous shutdown.
1-6] Grillo et al reported a large series in which the incidence of tracheal wound dehiscence or tracheal stenosis was 2.
Patients who are hypoproteinemic have a greater risk of postoperative wound dehiscence (Riou, Cohen, & Johnson, 1992).