Wound dehiscence is a surgical complication in which a wound ruptures along a surgical incision. Wound dehiscence discharge care what you need to know. The percentage of patients with difficult and prolonged healing of the wound is still high, while the immediate complications such as. The etiology of sternal wound complications is multifactorial. Dehisced surgical wound, abdomen in obese patient figure 2.
This can range from simple to complex depending on what tissue layers are involved figures 1, 2. Wound dehiscence risk factors include age, collagenrelated disorders e. Wound dehiscence was defined as a 2mm separation of the wound edge. New surgical wound dehiscence consensus document aims to. Preventing and managing surgical wound dehiscence doughty, dorothy b.
Despite the increased knowledge of wound healing mechanism before and after surgery, wound. Removing skin staples and prob ing the incision at the bedside to determine the source of. You should report this repair using 160 secondary closure of surgical wound or dehiscence,extensive or complicated. Ehlerdanols syndrome, diabetes, obesity, poor suture knotting, and trauma to the surgical site. Wound healing involves a complex series of interactions among cells and. This may occur on the skin surface, or along a deeper suture line. Fascial dehiscence after intraabdominal surgery occurs after about 0. Definitions and guidelines for assessment of wounds and evaluation of healing. To evaluate pro qr powder as an alternative to traditional wound dehiscence treatment. Wound dehiscence is the separation of the edges of a surgical wound. Wound dehiscence is one of the most common complications of surgical wounds, involving the breaking open of the surgical incision along the suture.
Closure of dehiscence general surgery coding ask an expert. Feb 03, 2020 wound dehiscence is when part or all of a wound comes apart. Disruption of external operation surgical wound, not elsewhere classified, initial encounter. Other symptoms of dehiscence include visibly broken sutures before the wound has healed completely, as well as renewed pain, bleeding and drainage from the surgical wound site. The purpose of this study was to treat wound dehiscence in elderly patients who were subjected to orthopaedic surgical interventions. A high risk of wound infection after apr has been well described. Abdominal wound dehiscence nebraska surgical research. The wound may come apart if it does not heal completely, or it may heal and then open again. In the most commonly used breast reduction surgery technique, the skin is typically removed in the wise pattern. Wound dehiscence after apr for low rectal cancer is. It is not uncommon for wounds from surgery to under go a delayed healing. Rigenera protocol in the treatment of surgical wound dehiscence. Surgical wound dehiscence is a postoperative complication involving breakdown of surgical incision site. Pdf determining risk factors for surgical wound dehiscence.
Some patients may seek care or a second opinion due to loss of confidence in the primary clinician. The sandy grading system for surgical wound dehiscence. Incisional hernia lie under a well healed skin incision. Management of abdominal wound dehiscence following. Infection and other complications can inhibit complete healing of the incision, resulting in superficial wound dehiscence. Postoperative wound healing plays a significant role in facilitating a patients recovery and rehabilitation. Scurvy is a condition developed by deficiency of vitamin c, and it can also be the reason for wound dehiscence. A prospective randomized clinical trial four weeks postoperatively, the patient presented to an emergency department for wound dehiscence. If wound continues to bleed excessively, apply wet saline gauze and then pressure contraindication to pressure would be the presence of a foreign body such as a sliver or glass etc. Nov 07, 2009 abdominal wound dehiscence burst abdomen, fascial dehiscence is a severe postoperative complication, with mortality rates reported as high as 45%. Complex repairs 100160 involve more than layered closure, such as extensive undermining, stents, or retention sutures.
Dehiscence is more likely to occur in males and in. The national institute for health and care excellence nice in the united kingdom has made recommendations for postoperative wound management so as to reduce the rate of ssis table 1. Do not initiate avastin for at least 28 days after surgery and until the surgical wound is fully healed. There is a high associated morbidity and mortality rate of 15% in adults, usually caused by the associated factors that predisposed to dehiscence.
You may need medicine, wound care, surgery, or wound devices to help treat your wound. Management of superficial wound dehiscence tips from other. Mann, dpm surgical wound dehiscence is a postsurgical complication that involves the breakdown of the surgical incision site. Wound dehiscence can be caused by a problem with suturing. Discontinue at least 28 days prior to elective surgery. Best practice principles for cleansing, debridement and. Determining risk factors for surgical wound dehiscence. Frequency and risk factors for wound dehiscenceburst abdomen in midline laparotomies. The condition involves the wound opening up either partially or completely along the sutures basically, the wound reopens to create a new wound. Abdominal wound dehiscence wound failure wound disruption evisceration and eventration. Evaluation of risk factors of surgical wound dehiscence in adults. The incidence, as described in the literature, ranges from 0. Wound dehiscence usually happens within 310 days after the operation.
Types of wound dehiscence there are two basic types of wound dehiscence, partial or complete. Conservative management of wound dehiscence following. Dehisced wounds find wound care doctors and answers on. This syndrome disables the production of collagen that plays important role in wound healing. World union of wound healing societies wuwhs consensus document. In partial dehiscence, only the superficial layers or part of the tissue layers reopen. Wound dehiscence is a distressing but common occurrence among patients who have received sutures.
This can be due to infections, injuries, early stitch removal, weak tissue in the area of the wound, incorrect suture technique, or stretching of the wound due to lifting, vomiting, or coughing violently. It should be considered in such patients before proceeding to more invasive. This dst is a controlled document and has been prepared as a guide to assist and support practice for staff working within the province of british columbia. Partial dehiscence of a surgical wound will present as superficial layers or a small amount of tissue layers being reopened. Pdf surgical wound dehiscence in an australian community. The surgical wound appears healthy and in the process of healing from the pictures. A patient with an ongoing leak of sero sanguinous fluid from the wound should be monitored closely. Proper identification of patients at risk, prevention of surgical site infections, and appropriate postsurgical wound assessment and help decrease the incidence.
Dehisced surgical wounds are defined by the separation of the incision line prior to complete healing resulting in an open wound. A surgical wound is an example of a wound can that develop dehiscence. Postoperative surgical wound dehiscence is a serious complication wherein a surgical wound does not close or heal. Wound dehiscence definition of wound dehiscence by medical.
Management of superficial wound dehiscence tips from other journals. Adult male circumcision with a circular stapler versus conventional circumcision. Prevention and treatment of wound dehiscence jama surgery. In pediatric patients with wound dehiscence postcavus foot surgery, conservative management with minimal surgical debridement and regular cleaning and dressing of the wound is a viable treatment option that has been shown to be effective in 7 cases. Your surgeon might have dealt with hundreds of cases like this by now. Complication of surgery the split surface layers deep layers whole wound 4. Wound dehiscence free download as powerpoint presentation. Typically, the sutures or closures around wound edges should stay intact while new tissue, known as granulation tissue, starts forming to help heal the wound.
Abstract wound healing is a long and complex process and can be affected by many different preexisting health conditions and complications. Wound dehiscence refers to the significant wound breakdown, which usually causes delay in wound healing more than 2 weeks. Abdominal wound dehiscence can result in evisceration, requiring immediate treatment. Your heart is beating faster than usual, or you feel dizzy or lightheaded. The term dehiscence, from the verb, dehiscere, to gape, is graphic and descriptive. As used throughout this paper, it applies to that condition in which any portion of the contents of the peritoneal cavity is extruded from that cavity and presents itself in the operative wound. However, postoperative wound infection of the sternum is common.
The cause may vary depending on the type of surgery. Time and cost to healing article pdf available in journal of wound care 257. Wound dehiscence means that the two sides of a surgical site have come apart. It may be just the surface layer or the whole wound. Surgical wound dehiscence in an australian community nursing service. One of the reasons for this complication is a hereditary defect called ehlersdanlos syndrome. Risk factors include age, collagen disorder such as ehlersdanlos syndrome, diabetes, obesity, poor knotting or grabbing of stitches, and trauma to the wound after surgery. Wound dehiscence may be associated with increased discomfort and the need for closer monitoring. Surgical wound dehiscence swd impacts on mortality and morbidity rates and. Abdominal wound dehiscence jama surgery jama network. Persistent wound drainage should raise the suspicion for wound dehiscence. Cleanse the wound with normal saline or wound cleanser or take the patient to a scrub sink to remove debris prior to physician intervention. Any factor that contributes to poor wound or bone healing eg, osteopenia, malnutrition or increases the risk for surgical site infection eg, diabetes, immunosuppression may be clinically important, especially if two or more factors are present. The sides of the wound are wellapproximated, or close together, overall.