Table Of Contents
Wound dehiscence
Wound dehiscence is separation of wound along incision line. Fascial dehiscence is the separation of a fascial closure following abdominal surgery. ****Risk can be reduced by good surgical technique and avoidance of heavy lifting for 4-6 weeks after laparotomy.
Can lead to evisceration. Diagnosis is clinical.
Fascial dehiscence
| Fascial dehiscence | Description |
|---|---|
| Partial fascial dehiscence | Partial failure of sutures e.g. deep sutures have failed but superficial sutures are still intact (or vice versa) |
| Complete fascial dehiscence | All suture layers have failed |
- Risk factors for fascial dehiscence Most are factors that impair normal wound healing
- Surgical site infection
- Increased intra-abdominal pressure
- Distension
- Valsava
- Chronic cough
- Malnutrition
- Diabetes
- Malignancy
- HIV/AIDS
- Trauma to the incision site
- Emergency surgery
- Anaemia
- Advanced age
- Signs and symptoms
- Seeping of serosanguineous (”salmon-colored”) fluid
- “Popping” or “Tearing” sensation
- Buldge during asava
- Evisceration in case of complete dehiscence.
- Bleeding
- Pain
- Inflammation
- Rarely fever
- Prophylaxis
- Retention sutures at the time of initial abdominal closure
- Malnourished or hypoalbuminemic
- Immunocompromised
- Massive contaminaiton
- Previous fascial defect or for patients expected to have increased tension on the wound
- Retention sutures at the time of initial abdominal closure
- Treatment
- Place temporary support (sterile tape, mesh)
- Restrict movement until resuturing can be done (under sterile conditions, with debridement and re-approximation of edges)
- Complications of wound dehiscence
- Wound evisceration
- Incisional hernia
- Sepsis
Wound evisceration
Wound evisceration is separation of wound along incision line along with expulsion of internal organs. A complication of wound dehiscence. Diagnosis is clinical. This is a surgical emergency.
- Cause of wound evisceration
- Undiagnosed, unaddressed or poorly addressed wound dehiscence
- Signs and symptoms
- Internal organs are visible…
- Treatment
- Place moist sterile dressing over the evisceration.
- Restrict movement.
- Emergent repair
- Do not attempt to manipulate expulsion until the patient is in theatre
