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Surgical Wound Dehiscence and Evisceration








































































































































Dehiscence and Evisceration



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Surgery



Recovery

Dehiscence and Evisceration


By Jennifer Whitlock, RN, MSN, FN | Reviewed by Richard N. Fogoros, MD
Updated November 28, 2018

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     Dehiscence is a  surgical complication  where the edges of a wound no longer meet. It is also known as “wound separation.” A healthy, healing wound will have edges that meet neatly and are held closely together by sutures, staples or another method of closure. As an incision heals, the wound fills in with new tissue, called “granulation” or “granulating tissue.” This new tissue is not as strong as normal skin, as it is new and has not had time to strengthen.

    1

    What Is Surgical Incision Dehiscence?

    A wound is at the greatest risk of dehiscence in the first two weeks after surgery, when the wound is still fresh and very fragile. Dehiscence can be mild, where a small area of the incision begins to pull apart and leave a gap between the two sides. This can happen if a suture or staple comes free or after stress on the incision, caused by something as simple as a sneeze or a cough.

    In severe cases, dehiscence can cause the sutures, staples or surgical glue to completely give way and the entire incision opens from top to bottom. In these cases, the open incision is a surgical emergency and medical attention should be obtained immediately.

    What to Do If Dehiscence Happens

    As dehiscence can easily become evisceration, a very serious complication where the organs begin to push outside of the open incision, all instances of dehiscence should be reported to your surgeon. Even small breaks in the incision should be discussed because even a small opening is a gateway to infection and should be treated. If you can see a “hole” in your incision, then bacteria can easily enter the incision and cause serious problems.

    In the short term, if you have been covering your incision with a bandage or have clean bandage supplies, cover the incision until you receive further instructions from your surgeon.

    2

    The Causes of Dehiscence After Surgery

    Dehiscence can be caused by many factors. A patient who is malnourished or unable to eat may not be able to heal their wound quickly or in a way that is strong enough to withstand normal stress. In other cases, a wound may be healing well, but a sudden increase in abdominal pressure, due to coughing , sneezing, vomiting, bearing down to have a bowel movement or lifting a heavy object, causes an abdominal wound to open.

    An infection in the incision increases the chances of dehiscence. The infection delays healing, which extends the amount of time where the incision is vulnerable to injury. An infection can also weaken the newly formed tissue as the body works to close the incision and fight infection instead of focusing on healing.

    Obese patients are more likely to have problems with wound closure and healing, as the wound has more difficulty closing and the healed incision must be stronger to support the additional weight of the fatty tissue.

    In all cases, dehiscence should be reported to your surgeon, as it can become an even more serious complication called “evisceration.”

    3

    What Is Evisceration of a Surgical Wound

    Evisceration is a rare but severe surgical complication where the surgical incision opens (dehiscence) and the abdominal organs then protrude or come out of the incision (evisceration). Evisceration is an emergency and should be treated as such.

    Evisceration can range from the less severe, with the organs (usually abdominal) visible and slightly extending outside of the incision to the very severe, where intestines may spill out of the incision.

    4

    What to Do If Your Incision Eviscerates–Emergency Treatment

    In all circumstances of evisceration, emergency medical care should be sought by activating EMS, 911 or reporting to the nearest emergency medical facility.

    Next, cover the opening and organs with the cleanest sheet or bandage material you have, after wetting it thoroughly. If you have been bandaging your wound, you should have the supplies to cover the tissue with sterile bandages. The fabric/bandage needs to be moist, to prevent it from adhering to tissue. If you have sterile saline, use it to saturate the bandage or towel. If not, bottled or tap water can be used.

    If you do not have bandage materials, a clean towel or sheet can be used.

    UNDER NO CIRCUMSTANCES should you attempt to push the organs back into the abdominal cavity. If the worst case scenario has happened and loops of intestines have pushed out of the incision, gather them in the wet sheet or bandage and keep the patient calm and seated or lying down.

    5

    How to Prevent Dehiscence and Evisceration

    Bracing – When doing any activity that increases abdominal pressure (sneezing, coughing, vomiting, laughing, bearing down for a bowel movement) hold pressure over your incision using your hands or a pillow. This can both prevent dehiscence and minimize pain during activity.

    Prevent Constipation – Constipation is common after surgery, and straining to have a bowel movement puts unnecessary stress on your incision. Prevent constipation with proper nutrition after surgery, or if you are already constipated, ask your surgeon for medication to help.

    Proper Incision Care – Proper incision care will not only speed healing, but it helps prevent infection, which can weaken the incision and increase the chances of dehiscence.

    Prevent coughing and sneezing – If you’ve had surgery and your allergies are acting up or you have a cough, be proactive about keeping sneezing and coughing to a minimum. Repetitive coughing and sneezing can slowly weaken your incision, which can slow healing and (in some cases) lead to dehiscence.

    Avoid Lifting – If your doctor says you are not allowed to lift anything heavier than 5 pounds for 2 weeks after surgery, he isn’t kidding. Lifting objects can place stress on your incision that can cause it to open.

    A Word From VeryWell:

    After surgery wound dehiscence is typically minor, with a small area of the wound opening or gaping slightly. If the area is small, it is typically an inconvenience, a minor disruption in an otherwise normal recovery. Evisceration is far rarer, but more serious when it happens, and cannot be ignored. Prevention, with incision bracing and not ignoring a serious cough as well as refraining from heavy lifting, is key.

    Most incisions heal well after surgery with minimal issues. Dehiscence can be a minor problem or it can turn into a serious issue that requires emergency surgery to correct. Prevention is key, and paying close attention to the healing of your incision is key to prompt treatment.

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    Home British & World English dehiscence

    Definition of dehiscence in English:

    dehiscence

    noun

    mass nountechnical

    • The splitting or bursting open of a pod or wound.

      ‘a hard, dry seed is shed from the plant after dehiscence of the mature fruit’
      count noun ‘two implants failed due to wound dehiscences in the post-operative period’

    Origin

    Early 19th century: from dehisce + -ence.

    Pronunciation

    dehiscence

    /diːˈhɪs(ə)ns/

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    What Is Wound Dehiscence?

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    Submitted by WoundSource Editors on March 8th, 2016
    Keywords: 
    Wound Care , Wound Treatments , Wound Care 101 , Surgical Wounds
    Blog Category: 
    Wound Care 101 , Wound Types
    wound dihescence on abdomen

    Wound dehiscence is a distressing but common occurrence among patients who have received sutures. The condition involves the wound opening up either partially or completely along the sutures – basically, the wound reopens to create a new wound.

    Causes of Wound Dehiscence

    Wound dehiscence is always a risk. The patient’s health, the amount of physical activity impacting the wound site, the wound location, and the physician’s skill all increase or decrease the chances of wound dehiscence . However, everyone is at risk of this condition, no matter how healthy the person may be.

    Wound dehiscence can be accidental or done intentionally. If a sutured wound becomes infected, for example, physicians may have to surgically reopen the wound to debride the wound of infected tissue; this is a form of dehiscence.

    However, most cases of wound dehiscence are accidental. This can be due to excessive pulling or pressure causes the two sides of the wound to separate, or because the suturing work was not done well and stitches have broken. Sutures that are located over joints or on parts of the body with increased movement can break if the joints bend and stretch the surrounding wound tissue too much.

    The suture site can also suffer as a side effect of an underlying health condition that affects the immune system or healing ability. For example, AIDS and diabetes can both increase the chances of wound dehiscence.

    How to Tell if a Wound is Dehisced

    A dehisced wound can appear fully open – the tissue underneath is visible – or it can be partial, where just the top portion of the skin has torn open. The wound could be red around the wound margins, have drainage, or it could be bleeding or seeping, where only a thin trickle of blood is coming out. The wound will likely be painful and may become increasingly so. The wound might also look moist well after the sutures have been added. Some wound tissue may appear to be necrotic.

    Patients should also be aware that even if the wound looks like it is healing properly, if any of the stitches are broken, that could be a sign the wound either has minor dehiscence or is about to dehisce.

    How to Treat a Dehisced Wound

    Much of the treatment for a dehisced wound is similar to the treatment for a new wound: any infection must be treated with antibiotics, dead tissue must be removed (possibly debrided), and the wound needs interventions to support closure. If a clear cause why the wound dehisced can be established, these factors must be addressed.

    For example, if the original sutures were not done properly, the new ones need to be done well. If the wound dehiscence was due to the sutures being located right over a joint like the elbow, the joint needs to be immobilized as much as possible. If the wound dehiscence is due to an immune or healing issue, then the wound needs to be monitored more closely to ensure any new signs of dehiscence are identified before the wound actually reopens.

    Preventing Wound Dehiscence

    To prevent wound dehiscence, the patient must follow all post-suture instructions carefully, particularly any instructions regarding when the wound site can get wet. The patient must move carefully and protect the wound site from anything that could cause friction or pull the skin around wound site. Patients should report any redness or new pain, or pain that doesn’t get better, as soon as possible so that a physician can verify whether or not the wound is still healing properly. The patient also has to take care not to tense muscles excessively, such as when the patient lifts a heavy object. Wound dehiscence can occur suddenly, and it important for patients to follow physician instructions carefully and minimize activities that may potentially impact the wound site until wound is well on its way to healing completely.

    Image Credit: Medetec ( www.medetec.co.uk )

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    Surgical Wounds

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