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.
References in periodicals archive ?
Wound dehiscence was present in 35% in interrupted-X and 22.5% in Professor Hughes technique at 6 weeks but the difference was not statistically significant.
The association of intra-abdominal infection and abdominal wound dehiscence. Am Surg 1998; 64:660-5.
When the overall early postoperative complications including seroma, infection, and wound dehiscence were assessed, such complications were seen approximately 3 times more in the Limberg flap group than in the oval flap group.
The wound dehiscence encompassed the inferior temporal quadrant in 4 eyes (26.7%), inferior nasal quadrant in 6 eyes (40.0%), superior nasal quadrant in 9 eyes (60.0%), and superior temporal quadrant in 10 eyes (66.7%).
In one case the sutures were opened and the wound dehiscence was seen on 1st week postoperatively.
An alternative to NPWT would be traditional gauze dressings, which can also be applied in the case of superficial wound dehiscence. These are changed up to three times a day, however, and this can result in significant patient discomfort, caregiver difficulties, and prolonged healing of weeks to months.
Four weeks postoperatively, the patient presented to an emergency department for wound dehiscence. He reported that during an airplane flight, he had performed the Valsalva maneuver and felt air under his surgical wound.
In contrast, if the sutures are too loose, then this may lead to wound dehiscence because the stitches may fall off prematurely.
Wound complication rates up to 71% have been reported, including hematoma, seroma, skin necrosis, wound infection, and wound dehiscence [1].
In some cases, when abdominal continence has been obtained but a wound dehiscence persists, Negative Pressure Wound Therapy (NPWT) could be a therapeutic option to obtain wound closure [2].