Wound dehiscence - Meaning, Evisceration, after Suture Removal, Treatment

Wound Dehiscence:

• What is Wound Dehiscence?
• Meaning
• Evisceration
• After Suture Removal
• Treatment

What is Wound Dehiscence?

Wound dehiscence is a postoperative complication in which a surgical incision partially or completely reopens after it has been closed. This occurs when the integrity of the wound is compromised due to factors such as infection, poor healing, excessive tension, or premature suture removal. Dehiscence can involve only the superficial skin layers or extend deeper into muscle and fascia.

Patients may notice increased drainage, redness, swelling, or a visible gap in the incision. In severe cases, deeper tissues may be exposed, requiring emergency intervention. Early identification and proper management are crucial for preventing complications such as infection or evisceration.

Meaning

The term dehiscence means “to split open.” In surgical contexts, it refers to the reopening of a wound that was previously closed with sutures, staples, or adhesive. This reopening can be mild—affecting only the surface—or severe, involving deep layers and posing serious risks.

Wound dehiscence indicates that the healing process has been disrupted. Common reasons include excessive strain on the incision (coughing, lifting, straining), infection, compromised blood supply, obesity, diabetes, malnutrition, or steroid use. Understanding the meaning helps clinicians identify risk factors early to prevent wound failure.

Evisceration

Evisceration is the most severe form of wound dehiscence. It occurs when abdominal organs—usually the intestines—protrude through a reopened surgical incision. This is a medical emergency requiring immediate intervention. Patients may present with sudden pain, visible organs, or fluid leakage.

Emergency management includes covering the exposed organs with sterile, moist dressings, avoiding pressure, and preparing the patient for urgent surgery. Evisceration typically results from deep fascial dehiscence and is more likely in patients with infection, increased abdominal pressure, or disrupted sutures.

After Suture Removal

Wound dehiscence can occur after suture removal if the incision has not fully healed or if excessive tension was placed on the wound edges. Removing sutures too early or in high-tension areas such as the abdomen or joints can increase the risk. Patients may notice the incision starting to separate or reopen gradually.

Signs include drainage, widening of the incision, and discomfort. Healthcare providers often mitigate this risk by removing sutures in stages, using adhesive strips for support, or advising patients to avoid strain or overactivity during early healing. Proper follow-up is essential to detect early signs of separation.

Treatment

Treatment of wound dehiscence depends on its severity:

• Superficial dehiscence: Usually managed conservatively with cleaning, dressing changes, and allowing the wound to heal by secondary intention. Sometimes negative pressure wound therapy (NPWT) is used.
• Partial dehiscence: May require re-suturing if the wound edges can be approximated and no infection is present.
• Deep dehiscence with evisceration: Emergency surgery is required to re-close the fascia and protect internal organs.

Broad-spectrum antibiotics may be needed if infection is suspected. Patients should be monitored closely, and contributing factors like uncontrolled diabetes, malnutrition, or excessive strain should be addressed to promote proper healing.