Wound Dehiscence Flashcards
What is wound dehiscence?
Where a wound fails to heal, often re-opening a few days after surgery.
Especially common in abdominal surgery.
Explain superficial dehiscence
The skin wound alone fails
The rectus sheath is intact still however.
Why might superficial dehiscence happen?
Secondary to local infection
Poorly controlled diabetes
Poor nutritional status
Explain full thickness dehiscence
Rectus sheath fails to heal and bursts with protrusion of abdominal content.
Also called burst abdomen.
Why might full thickness dehiscence happen?
Secondary to raised intra-abdominal pressure like a patient with Ileus.
Poor surgical technique
If the patient is critically unwell.
Patient factors that increase the risk of wound dehiscence
Increasing age
Male
Co-morb like DM
Steroids
Smoking
Obesity
Malnutrition
Intra-op factors that increase the risk of wound dehiscence
Emergency surgery
Abdominal surgery
Length of operation >6h
Wound infection
Poor surgical technique
Post-op factors that increase the risk of wound dehiscence
Prolonged ventilation
Post-OP blood transfusion
Poor tissue perfusion
Excessive patient coughing
Radiotherapy
Clinical features
Visible opening of the wound
Poor healing around 5-7 days post-OP
Full thickness can show new bulging of the wound and seepage of pink serous or blood-stained fluid.
A sudden increase in wound discharge should be considered as deep dehiscence until proven otherwise.
Investigations
Clinical diagnosis
Wound swabs should be take for culture if there is concurrent surgical site infection.
Management of superficial dehiscence
Washing out with saline and then simple wound care
It should then be allowed to heal by secondary intention, which can take several weeks.
More extensive wounds may be treated with a Vacuum-Assisted Closure device (VAC)
Management of full dehiscence
Suitable analgesia
Broad spectrum IV abx should be started
Cover the wound in saline-soaked gauze and arrange urgent return to theatre for re-closure of the wound.
Closure is usually done with large interuppted sutures
Vacuum dressing might be needed
Prevention
Optimise co-morbidities
Avoid heavy lifting
Post-op nutrition.
