Wound Dehiscence

Question 1

What is wound dehiscence?

Answer 1

Failure of a wound to close properly

Question 2

What is simple dehiscence?

Answer 2

Skin wound alone fails

Often secondary to infection, diabetes, poor nutrition, or any co-morbidity that would impede normal wound healing

Question 3

what is burst abdomen?

Answer 3

The separation of abdominal wall closure with protrusion of the abdominal contents .
This may occur secondarily to raised intra-abdominal pressure (for example, in patients with intra-abdominal compartment syndrome or patients with an ileus) or from surgical technical failure (poor suture technique or choice).

Question 4

What are patient risk factors fro wound dehiscence?

Answer 4

Age
Male
Co-morbidities - DM
Steroids
Smoking
Obesity/malnutrition

Question 5

What are intraoperative risk factors for wound dehiscence?

Answer 5

Emergency surgery
Abdominal surgery 
Length of operation (>6 hours)
Wound infection
Poor surgical technique

Question 6

What are post-operative risk factors for wound dehiscence?

Answer 6

Prolonged ventilation
Post-operative blood transfusion
Poor tissue perfusion (e.g. post operative hypotension
Excessive patient coughing
Radiotherapy

Question 7

What are clinical features of wound dehiscence?

Answer 7

Visible opening of the wound healing poorly following the operation, around day 5-7 post-op.
Bleeding and increased pain

Question 8

What investigations for wound dehiscence?

Answer 8

Swabs taken for culture - infection is most common cause of dehiscence
Bloods for infection markers

Question 9

How is wound dehiscence managed?

Answer 9

May require return to theatre
Occasionally managed with closure by secondary intention

Contaminated or dead tissue should be surgically derided and prophylactic antibiotics given.
Re-suturing the wound using deep retention sutures

If immediate closure is not possible, non-surgical temporary closure techniques such as saline soaked gauze packing

Question 10

How is burst abdomen managed?

Answer 10

Analgesia
IV fluids
Broad spectrum IV abs
Urgent return to theatre

Question 11

What is a wound abscess? How/when do they present post-op? How are they managed?

Answer 11

Mass of necrotic tissue with dead and viable neutrophils suspended in liquefied tissue necrosis.
Post-op wound abscesses tend to present within a week of operation, with cardinal signs of inflammation and potential signs of underlying pus or a puncture. As with any infection, cultures are essential + routine bloods.

ManagementL drainage, abs prescribed, regular changing of sterile dressing.