Although this complication can occur after any surgery, it tends to happen most often within two weeks of surgery and following abdominal or cardiothoracic procedures. Dehiscence is also commonly associated with surgical site infection.
Dehiscence can be identified by the feeling of a sudden pulling pain. If you’re concerned about possible dehiscence, check how your wound is healing.
A clean wound will have minimal space between the edges of the wound and will commonly form a straight line. If your stitches, staples, or surgical glue have split apart, or if you see any holes forming in the wound, you’re experiencing wound dehiscence.
It’s important to keep an eye on the healing progress of your wound, as any openings can lead to infection. In addition, an opening could lead to evisceration, which is a much more severe condition that occurs when your wound reopens and your internal organs come out of the incision.
There are several pre- and postoperative risk factors for wound dehiscence, including:
- Obesity or malnutrition. Obesity slows the healing process because fat cells have less blood vessels to transport oxygen around the body. Malnutrition can also slow healing due to a lack of vitamins and proteins needed for recovery.
- Smoking. Smoking reduces oxygenation in tissues necessary for quick healing.
- Peripheral vascular, respiratory, and cardiovascular disorders. These disorders, as well as anemia, diabetes, and hypertension, all affect oxygenation.
- Age. Adults over age 65 are much more likely to have other conditions that slow the wound healing process.
- Infection. Wounds with an infection will take longer to heal, which makes you more susceptible to dehiscence.
- Surgeon inexperience. If your surgeon is inexperienced, you may have a longer operating time or sutures may not be applied properly, which can lead to wounds reopening.
- Emergency surgery or re-exploration. Unexpected surgery or going back into a previously operated area can lead to further unexpected complications, including reopening of an original wound.
- Strain from coughing, vomiting, or sneezing. If abdominal pressure increases unexpectedly, the force could be enough to reopen a wound.
The best way to prevent wound dehiscence after your operation is to follow your doctor’s instructions and surgical recovery best practices. Some of these are:
- Don’t lift anything greater than 10 pounds, as this may increase pressure on the wound.
- Be extremely cautious in the first two weeks of recovery. You should walk around in order to avoid blood clots or pneumonia, but in most cases you shouldn’t push yourself much more than this.
- Start slightly more rigorous physical activity at your own pace after two to four weeks. If you start to feel pressure, consider taking a day or two of rest and trying again another time.
- After about a month, start pushing yourself a little more, but make sure you’re listening to your body. If something really doesn’t feel right, stop.
According to the University of Utah, the average time for an abdominal incision to fully heal is roughly one to two months. If you think your wound may be reopening or you see signs of dehiscence, you should contact your doctor or surgeon immediately.
Also, you should place yourself on bed rest and stop any activity or lifting. These may make the condition worse and may be the cause for reopening.
Although it may only be a small opening or one suture that’s broken, dehiscence can quickly escalate to infection or even evisceration. Call your surgeon if you notice any symptoms or signs.
If you’re experiencing evisceration, immediately seek emergency medical attention and don’t try to push any organs back inside your body.