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What Is Wound Dehiscence? - Definition & Treatment

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  • 0:00 Causes of Wound Dehiscence
  • 3:47 Treatment of Wound Dehiscence
  • 4:33 Lesson Summary
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Lesson Transcript
Instructor: Rachel Torrens
While surgery most often leads to the resolution of a serious health problem, sometimes a surgical incision can dehisce and cause complications. Keep reading to learn what wound dehiscence is and how it occurs, as well as how it can be treated.

Understanding Wound Dehiscence

The word 'dehiscence' just sounds unpleasant, almost like a snake hissing, and it is an unpleasant event! Usually the two sides of a surgical wound are bound together by sutures (commonly known as stitches) or staples, which allows the skin to heal back together more quickly. However, sometimes part or all of the wound can separate, resulting in partial or complete wound dehiscence. Wound dehiscence means that the two sides of a surgical site have come apart.

Above is a surgical site closed with sutures. The sides of the wound are well-approximated, or close together, overall. There is no evidence of wound dehiscence.
Wound closed with surgical sutures, well-approximated.

Causes of Wound Dehiscence

There are several reasons why a wound may dehisce. Most often wound dehiscence is caused by too much stress being placed upon the sutures. After a surgical procedure, you are given a long list of things NOT to do. On this list you will note restrictions on physical activity. This is not to make you miserable, but rather to protect the surgical site. The skin surrounding the sutures needs to remain still in order for the miracle of skin regeneration to occur. So, when a patient either intentionally or accidently disregards these instructions by bending, stretching, or even coughing, the pressure placed on the wound may be too great, and it may pop open.

The location of the surgical site can also impact the overall stress on the wound. For example, your stomach typically has lots of extra skin; you can easily pinch an inch of it between forefinger and thumb, but what about on your ankle bone or flexed elbow? Not so easy. Therefore, areas with limited skin coverage are more likely to dehisce due to the stress on the skin. It's like trying to zip a size 4 dress on a size 8 woman; there is just not enough fabric, and the seams will pop!

Complete wound dehiscence of a surgical site following abdominal hernia repair
Complete wound dehiscence of a surgical site following abdominal hernia repair.

Wound dehiscence may also occur due to unhealthy tissue. In order to repair something, whether it be bridge, building, or surgical site, you need to start with sound materials. If you tried to repair a bridge with rotting wood, no one would be surprised when the first truck to drive over it ended up in the river! It's the same with skin. Any condition that weakens the integrity of the skin can contribute to wound dehiscence. The major contributor here is infection at the surgical site, which can cause redness, inflammation, and pus formation. All of these factors decrease the skin's ability to heal properly and hold together.

Additionally, poor patient health can cause wound dehiscence. For example, those with diabetes, scurvy, conditions that require long-term corticosteroids, conditions that require chemotherapy or radiation, or even those who suffer from obesity, are at a much higher risk for wound dehiscence. Why? Because their skin's integrity is weakened by their condition(s) or the medications they need to take.

Lastly, wound dehiscence may be due to improper surgical technique. The surgeon may pull the sutures too tightly together or use the wrong kind of thread. Such mistakes cause more pressure at the wound site, increasing the likelihood of surgical site separation.

In the image above, a surgeon is carefully suturing a hand. If he uses improper technique to close the wound, the patient has a higher risk of wound dehiscence occurring.
Surgeon suturing a patient

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