Wound Dehiscence: A Comprehensive Guide for Providers

Wound dehiscence is a worrisome complication that wound care providers need to be confident in identifying and treating. Why? Because it’s a potentially dangerous condition that can lead to further complications and risks. Most importantly, prevention is what’s best for patients. It gives them a chance for less pain, faster recovery, and a better overall outcome.

Recognizing wound dehiscence symptoms early is crucial as it can help mitigate potential risks associated with post-operative care.

Virtually any patient could have a wound reopened. However, some open wounds have higher risk factors. Because this is so often a preventable condition, let’s look at the causes, effects, risk factors, and best practices for identifying, treating, and stopping this roadblock to proper wound healing.

What is Surgical Wound Dehiscence?

Wound dehiscence is the reopening of a wound or surgical incision after it has been sutured or stapled, and most commonly occurs within the first 10 days following an operation, according to the National Library of Medicine. The two categories of dehiscence are partial dehiscence when only a wound’s edges pull apart and complete dehiscence when the entire site reopens and exposes layers of underlying tissue, muscle, and sometimes, organs. Complete dehiscence (as opposed to partial dehiscence) is a serious complication where the entire surgical incision reopens. Complete dehiscence involves the full separation of wound edges, posing severe complications.

Factors that contribute to wound dehiscence include:

• Improper suturing, or poor technique that can leave a wound vulnerable to reopening.
• Failure to properly align and approximate tissue, meaning the sides of the incision are neatly lined up**,** leaves an incision vulnerable to reopening.
• Certain types of surgery that can increase the risk of dehiscence, like abdominal procedures (think hernia repair) have a greater risk of wound dehiscence.

Why Is Understanding the Wound Healing Process Important?

Understanding wound dehiscence is crucial for providers because it affects so many things, from health to resources to quality of life and more.

Wound breakdown, often referred to as wound dehiscence, is a condition where an incision reopens, potentially leading to serious health risks.

Let’s look at it from a patient’s perspective. If you’ve just had a surgery, the reopening of a wound can be a serious setback. It exposes you to a greater risk of infection as bacteria can easily enter the body through the open wound, jeopardizing overall health. The healing process is also slowed, leading to increased physical pain, longer hospital stays, or even rehospitalization, which in turn raises medical costs.

In severe cases, particularly with an abdominal wound, dehiscence can lead to evisceration, where internal organs protrude through the reopened wound site, a condition that is both scary and dangerous. Beyond the physical implications of an open wound, wound dehiscence can take a heavy toll on your mental health, causing significant stress, depression, and anxiety, all of which can hinder not just recovery from the wound, but overall well-being, too.

Providers are also affected by wound dehiscence. It places a strain on resources as additional time and supplies are required to manage the condition. This can lead to extended hospital stays, rehospitalizations, and increased costs. Look at it this way: when a wound reopens, the providers must spend extra time on documentation, patient care, reporting, and other administrative duties that most don’t have time to handle.

Incidents like that adversely affect a facility’s quality ratings, a physician’s reputation, and reimbursement, especially for organizations participating in value-based programs or getting paid by Medicare or Medicaid.

What Are the Risk Factors for Wound Dehiscence?

Wound care is complicated and challenging, and treating a patient who has suffered wound dehiscence must be done with the utmost diligence. Poor surgical technique is a significant contributing factor to wound dehiscence, which has an estimated incidence of 3%. Each case must be approached individually; it’s not one-size-fits-all.

Poor wound healing can disrupt the normal phases of the healing process, leading to complications like wound dehiscence. Risk factors such as necrotic tissue, infection, and specific comorbid conditions can hinder recovery, making it crucial for clinicians to assess and manage these issues to prevent further complications.

Why is it important to understand a patient’s situation? Each patient’s circumstances are unique, and some patients are at greater risk than others for dehiscence to occur.

A Study in Diabetes

Let’s take a hypothetical patient: Maggie, a 49-year-old abdominal surgery patient who also has diabetes. Wound dehiscence occurred at her incision site six days after her hernia repair operation and one day after she’d been discharged. Diabetes is one of many factors that can increase the risk of dehiscence and impede wound healing in general. The disease can impact blood circulation, slow wound healing, and affect the immune system, making these patients more susceptible to complications like infection.

Maggie’s wound reopened at home, and she was taken back to the emergency room at the hospital. Another surgery was performed to re-suture the wound, and she spent an additional four days in the hospital for recovery and observation.

Other Risk Factors

In addition to diabetes, other patient-related risk factors include:

• Obesity, which causes strain on the body and tension on skin and tissue and can put additional pressure on the incision site.
• Chronic conditions such as heart disease reduce blood flow, impede health, and impact healing.
• Poor nutrition can slow the healing process, depriving the body of vital nutrients. 
• Smoking can reduce the body’s ability to fight infection and increase inflammation.
• Patients over the age of 65 are at greater risk of wound dehiscence due to more fragile tissue.
• Patient actions, which can even include picking at the wound site or trying to remove sutures on their own (it happens!).

Signs and Symptoms of Wound Dehiscence

Remember Maggie? Her incision site reopened in two small places. Although she was not in significant pain, her surgeon had warned her about the risks associated with wound dehiscence, and she knew to return to the hospital for medical treatment immediately. Up to 3.4% of patients who receive abdominopelvic surgeries experience wound dehiscence.

Early recognition and proper diagnosis and treatment of even minor signs of wound dehiscence is essential. Patients should look out for early signs of dehiscence like a noted increase in pain around the wound, changes in appearance of the wound (anything from redness or discoloration to gaps to bleeding and other discharge), changes in general health (think: fever or increased tiredness), or the wound generally not improving.

Treatment for Wound Dehiscence

Like all other complications in wound care, wound dehiscence involves a multi-faceted approach.

Immediate Care:

• Protect the Wound. Cover the wound with a sterile dressing to prevent contamination that could lead to infection.
• Minimize movement and stress. Avoid tension and further disturbance of the wound site to cut down on the risk of additional trauma.

Medical Intervention: negative pressure wound therapy is a treatment option that enhances healing and prevents infection.

• Treatment for wound dehiscence involves assessing the severity of the condition, which influences the treatment approach. Mild cases may require only proper wound care and monitoring, while more severe instances could necessitate surgical intervention.
• Debridement. The National Institutes of Health (NIH) recognizes wound debridement as a standard in wound management. Removing necrotic tissue helps prevent infection and promotes the growth of new, healthy tissue.
• Antibiotics. If infection is present, appropriate antibiotic therapy is necessary.
• Surgical Repair. The NIH classifies cases of severe wound dehiscence, or deep dehiscence, as a surgical emergency due to the risks associated, including evisceration.

What Are Some Wound Dehiscence Prevention Strategies?

Preventing wound dehiscence is a critical goal for wound care providers, given its potential severity and implications. NIH-funded studies show that severe wound dehiscence carries a mortality rate of up to 40%, which increases with evisceration. Several strategies are recommended to promote proper wound healing and avoid additional instances of dehiscence. Proper wound healing is crucial in the wound healing process, as it involves various phases and factors that ensure effective recovery and prevent complications.

Optimizing patient health is the first step. Preoperative preparation is crucial, as addressing modifiable risks like nutritional deficiencies and smoking can significantly reduce the risk of dehiscence. Additionally, managing chronic diseases like diabetes and hypertension is vital for reducing complications. Effectively controlling these conditions can make a substantial difference in the wound healing process by addressing factors that impair healing.

Surgical Intervention

During surgery, adhering to best practices is essential. StatPearls (Internet) explains that surgeons with lower dehiscence rates use meticulous suturing techniques. Minimizing tissue trauma is also critical, as avoiding unnecessary damage to the wound edges can prevent complications.

Postoperative care plays a significant role in preventing wound dehiscence. Regular wound assessments allow for early intervention at the first signs of dehiscence, avoiding further complications. Patient education is equally important. Teaching patients and their caregivers about proper wound care, signs of complications, and activity restrictions empowers them to participate in their own care.

One practical tip from The American Nurse Journal is to teach patients to splint their wound site while coughing, vomiting, or sneezing. One option is for the patient to use a pillow, a folded towel, or their hands to gently press against the wound site. This support helps to absorb the pressure and reduce strain on the wound when they cough, sneeze, or move.

Nutritional Support

Nutritional support is another crucial factor in recovery. Post-surgery patients should frame their diet around calories, protein, vitamins, and minerals that provide the strength and nutrients needed for a quick recovery. For diabetic patients, maintaining control of glycemic levels is essential. Blood glucose control is crucial to the body’s healing process, as Medical News Today highlights.

Caregivers play a vital role in patients recovering at home. Ensuring the wound is monitored, kept clean, and protected can differentiate between emergencies like infection or reopening and a successful outcome. With these strategies in place, patients can significantly reduce the risk of wound dehiscence and promote proper healing.

Wound Care Specialists Make a Difference in Dehiscence

Wound dehiscence is a challenging and potentially dangerous complication that no patient – or provider – wants to face after surgery. The pain and delayed healing it causes are often needless, but with the right knowledge and strategies, it can be effectively prevented and managed. By staying informed, adhering to best practices, and leveraging innovative technologies, healthcare providers can significantly reduce the risks associated with wound dehiscence. A patient-centered approach is crucial in ensuring that each patient receives the care and attention they need to heal properly.

Conclusion

Dedicated wound care specialists play a vital role in this process. By understanding the causes, signs, and treatment options, they can help patients achieve the best possible outcomes. You and your colleagues, combined with the right resources and solutions, can make a difference in the lives of those affected by wound dehiscence.

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