Dehiscence is the unintended separation of the edges of a closed wound, a process also known as wound separation. While it can occur in any type of closed wound, it is most frequently discussed as a complication following a surgical procedure. This failure of the incision line exposes underlying tissues and creates a pathway for infection. The integrity of the wound closure is most vulnerable immediately following the operation, making prompt identification and management crucial for recovery.
Understanding Surgical Wound Dehiscence
Surgical wound dehiscence is the separation of previously approximated wound edges resulting from a failure of proper healing. This complication typically occurs within five to eight days after surgery, when the wound is fragile and lacks sufficient tensile strength. The condition is classified into two main types based on the tissue layers involved.
Partial, or superficial, dehiscence involves only the outer layers of the skin (epidermis and dermis), with deeper layers remaining intact. Complete dehiscence involves the separation of all layers of the incision, including the deep fascial closure. The most severe form is evisceration, a surgical emergency where internal organs, often the intestines, protrude through the open wound, requiring immediate surgical intervention.
Factors That Increase Separation Risk
The risk of surgical incision failure is influenced by systemic patient health issues and local factors affecting the wound. Systemic conditions impair the body’s natural healing process. These include chronic conditions such as diabetes, which compromises blood flow and increases infection risk, and obesity, where fat tissue has less efficient blood supply. Poor nutrition or hypoproteinemia (low protein levels) also hinder the body’s ability to synthesize new tissue and collagen for repair. Smoking reduces oxygen delivery to tissues due to vasoconstrictive effects, slowing healing, and long-term use of certain medications, such as corticosteroids, can impair the generation of new tissue and blood vessels.
Local and post-operative factors place mechanical stress on the newly closed wound. Activities that abruptly increase intra-abdominal pressure, such as excessive coughing, straining during a bowel movement, or severe vomiting, can physically tear the fragile closure. A surgical site infection is also a major factor, as the associated inflammation and tissue destruction decrease the wound’s tensile strength.
Recognizing the Physical Signs
The initial sign of dehiscence is often a sudden feeling of “pulling” or “popping” within the incision, signaling the tearing of the suture line. This sensation may be accompanied by an increase in pain disproportionate to typical post-operative discomfort. Visual inspection reveals the separation of the skin edges, where the incision line no longer meets neatly.
A particularly concerning symptom is a sudden gush of fluid from the wound. This discharge is often serosanguineous, meaning it is thin, pink, and blood-tinged. While some drainage is normal, a sudden increase indicates that deeper layers may have failed. If the separation is severe, underlying tissues may become visible through the opening. In cases of evisceration, parts of the abdominal organs, such as loops of bowel, may be seen protruding from the wound.
Immediate Steps and Medical Treatment
If wound separation is suspected, the patient must remain calm and avoid activities that strain the incision, such as sitting up or coughing forcefully. The healthcare provider or emergency services should be contacted immediately, especially if evisceration is suspected. The patient should be placed in a low-Fowler’s position (head slightly elevated, knees bent) to reduce tension on the abdominal area.
For visible separation, the wound must be covered immediately with a clean, non-adherent dressing. If evisceration is present, a sterile dressing moistened with saline is used to protect the exposed tissue. Patients must never attempt to push any protruding organs back into the body. Superficial separations are managed conservatively, allowing the wound to heal secondarily with regular wound care, including frequent dressing changes or specialized vacuum-assisted closure devices. Complete dehiscence or evisceration requires immediate surgical repair in the operating room, involving the closure of the deep fascial layers with strong sutures to restore structural integrity.