During surgery, an incision is made into the skin and underlying structures in order to open them up. This incision is a surgical wound that must be closed, either with sutures or staples, at the conclusion of the surgery. Wound dehiscence is the medical term for a surgical site that does not heal or that opens before it is completely healed. Wound dehiscence can occur along any part of the surgical wound or along all of it, as stated by MedlinePlus. It is a possible complication of any surgery but is most often seen after abdominal surgery. There are a number of risk factors that can increase the chances for wound dehiscence. These risk factors include obesity, increased age, poor nutrition, a history of smoking and some medical conditions such as diabetes, kidney disease or immune problems. Wound dehiscence is a serious complication and must be treated by a medical professional.
Problems With Sutures
Wound dehiscence can be caused by sutures that are put in too tightly, sutures that are too loose or sutures that are placed incorrectly, according to the Doctors of USC website. In order to heal properly, the two edges of the wound must meet and be held together snugly without too much or too little pressure. Removing the sutures too early, before the skin edges have completely healed, can also cause a wound dehiscence.
Infection and Inflammation
Other wound complications such as an infection or excessive inflammation at the surgical incision site can cause the wound edges to separate and dehisce, according to The Merck Manuals. In order to decrease the chances of an infection, special surgical dressings are applied over the incision site. These dressings include sterile gauze and wrap along with an antibiotic ointment or cream, which create a barrier to protect the incision from infection. These dressings must be kept clean and be changed frequently in order to be effective. Inflammation is another common complication of surgery that can result in the incision site opening up, so use of an ice pack is often recommended just above, but not over, the surgical site.
Medical Conditions
Some medical conditions can adversely affect the ability of the body to heal. According to the Doctors of USC, diabetes can result in poor blood supply to some areas of the body, causing a delay in healing. In diabetics and those with kidney disease, there can also be a decreased synthesis of collagen, which is needed for scar formation. Vitamin C is needed to create strong cross-links between collagen fibers. A vitamin-C deficiency, called scurvy, impairs the body's ability to make strong collagen, which can lead to weak scar formation and wound dehiscence.
Corticosteroids
Certain medications can impair the body's natural ability to heal. Long-term use of corticosteroid medication, such as prednisone and dexamethasone, can cause skin to become fragile, requiring a longer healing time. This can result in a wound dehiscence, according to the American Academy of Family Physicians.
Pressure
Any increase in pressure on the surgical site, especially within the abdomen, can cause a wound dehiscence to occur. The pressure increase can be the result of a fluid accumulation called ascites, an inflamed bowel, severe coughing or sneezing, straining while voiding, or vomiting. In the first few days following any surgery, care should be taken not to do anything that could cause increased pressure on the surgical site.
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