Summary

Wound dehiscence is the separation or opening of a surgical wound after closure, which can range from superficial (skin separates) to complete (all layers separate, organs exposed). Think of a surgical wound as layers of tissue stitched together—when these layers separate, the wound opens, exposing underlying tissues or organs. This is a serious complication that can occur after any surgery, but is more common after abdominal surgery. The most common causes are infection, increased abdominal pressure (coughing, straining), poor wound healing (malnutrition, diabetes), and technical factors (poor closure technique). The key to management is recognizing the dehiscence (wound opens, may have drainage, may expose organs), assessing severity (superficial vs complete), treating infection if present (antibiotics, debridement), and surgical repair (re-closure, may need mesh if large defect). Most superficial dehiscence can be managed with wound care, but complete dehiscence with evisceration (organs exposed) is a surgical emergency requiring urgent repair.

Key Facts

• Definition: Separation or opening of surgical wound after closure
• Incidence: Common (5-10% of abdominal surgeries)
• Mortality: Low (<1%) unless complications (infection, evisceration)
• Peak age: All ages, but more common in older adults
• Critical feature: Wound opens, may expose organs
• Key investigation: Clinical diagnosis (usually obvious)
• First-line treatment: Wound care (superficial), surgical repair (complete)

Clinical Pearls

"Evisceration is an emergency" — If organs are exposed (evisceration), this is a surgical emergency. Cover with sterile dressing, keep moist, and urgent surgery.

"Infection is a common cause" — Wound infection is a leading cause of dehiscence. Always assess for infection (redness, discharge, fever).

"Increased pressure increases risk" — Anything that increases abdominal pressure (coughing, straining, vomiting) increases the risk of dehiscence. Prevent these if possible.

"Superficial vs complete matters" — Superficial dehiscence (skin only) can often be managed with wound care. Complete dehiscence (all layers) usually needs surgical repair.

Why This Matters Clinically

Wound dehiscence is a serious post-operative complication that can lead to infection, evisceration, and prolonged recovery. Early recognition, assessment for evisceration (surgical emergency), treatment of infection, and appropriate repair are essential. This is a condition that surgeons manage frequently, and prompt treatment prevents serious complications.

Structured Approach: ABCDE

A - Airway

• Assessment: Usually patent
• Action: Secure if compromised

B - Breathing

• Look: Usually normal
• Listen: Usually normal
• Measure: SpO2 (usually normal)
• Action: Support if needed

C - Circulation

• Look: Usually normal (may have signs of sepsis)
• Feel: Pulse (usually normal), BP (usually normal)
• Listen: Heart sounds (usually normal)
• Measure: BP (usually normal), HR
• Action: Monitor if sepsis

D - Disability

• Assessment: Usually normal
• Action: Assess if severe

E - Exposure

• Look: Wound examination
• Feel: Tenderness, assess depth
• Action: Complete examination

Specific Examination Findings

Wound Examination:

• Inspection:
  • Open: Wound open
  • Depth: Assess depth (superficial vs complete)
  • Organs: Check for evisceration
  • Drainage: Check for discharge
• Palpation:
  • Tenderness: Painful
  • Depth: Feel depth of separation
• Measure: Size of defect

Assess for Evisceration:

• Look: Organs visible?
• Action: If yes, urgent surgery

Assess for Infection:

• Look: Redness, discharge
• Feel: Warmth, tenderness
• Action: If yes, treat infection

Special Tests

Natural History (Without Treatment)

Untreated Wound Dehiscence:

• Infection: High risk
• Evisceration: High risk if complete
• Poor outcomes: If not treated

Outcomes with Treatment

Factors Affecting Outcomes:

Good Prognosis:

• Early treatment: Better outcomes
• Superficial: Usually heals well
• No infection: Better outcomes
• Good nutrition: Better healing

Poor Prognosis:

• Delayed treatment: Higher risk of complications
• Complete dehiscence: Longer recovery
• Infection: Worse outcomes
• Poor nutrition: Poor healing

Prognostic Factors

Key Guidelines

1. NICE Guidelines (2019) — Surgical site infections: prevention and treatment. National Institute for Health and Care Excellence

Key Recommendations:

• Prevent infection
• Treat infection early
• Evidence Level: 1A

Landmark Trials

Multiple studies on wound care, surgical repair techniques.

Evidence Strength

What is Wound Dehiscence?

Wound dehiscence is when a surgical wound opens or separates after it was closed. Think of a surgical wound as layers of tissue stitched together—when these layers separate, the wound opens, exposing underlying tissues or organs. This is a serious complication that can occur after surgery.

In simple terms: Your surgical wound has opened. This is serious, but with proper treatment, most wounds heal well.

Why does it matter?

Wound dehiscence is a serious post-operative complication that can lead to infection, evisceration (organs exposed), and prolonged recovery. Early recognition and appropriate treatment are essential. The good news? With prompt treatment, most wounds heal well.

Think of it like this: It's like a wound coming apart—it needs to be fixed, but once it's fixed, most people recover well.

How is it treated?

1. Assessment:

• Examination: Your doctor will examine the wound to see how serious it is
• Why: To see if it's just the skin (superficial) or deeper (complete, may expose organs)

2. If Organs Exposed (Evisceration):

• Urgent surgery: You'll need urgent surgery to put the organs back and close the wound
• When: Usually within hours
• Why: This is a medical emergency

3. If No Organs Exposed:

• If superficial: You'll get wound care (dressings) and the wound may heal on its own
• If deeper: You'll need surgery to re-close the wound
• If infection: You'll get antibiotics

4. Prevent Recurrence:

• Treat causes: Your doctor will treat any underlying causes (infection, malnutrition)
• Prevent pressure: Avoid things that increase pressure (coughing, straining)
• Support healing: Good nutrition, wound care

The goal: Close the wound, treat any infection, and help it heal properly.

What to expect

Recovery:

• Superficial: Usually heals within weeks with wound care
• Complete: Usually needs surgery, recovery takes longer
• Full recovery: Most people recover completely

After Treatment:

• Wound care: You'll need regular wound care
• Surgery: If you had surgery, you'll recover from that
• Monitoring: Your doctor will monitor to make sure it's healing
• Follow-up: Regular follow-up to monitor healing

Recovery Time:

• Superficial: Usually weeks
• Complete: Usually weeks to months

When to seek help

Call 999 (or your emergency number) immediately if:

• Your surgical wound has opened and you can see organs inside
• Your surgical wound has opened and you feel very unwell
• Your surgical wound has opened and you have a high fever

See your doctor if:

• Your surgical wound has opened
• Your surgical wound has increased drainage
• Your surgical wound is red, painful, or has discharge
• You have concerns about your surgical wound

Remember: If your surgical wound has opened, especially if you can see organs inside, call 999 immediately. Wound dehiscence is serious, but with prompt treatment, most wounds heal well. Don't delay—if you're worried, seek help immediately.