Abdominal Wound

dehiscence

DR.NAZMOON NAHAR
Honorary Medical Officer
Surgery unit III
 Definition
Wound dehiscence is partial or total disruption
of any or all layers of the operative wound.

Rupture of all layers of the abdominal wall and

extrusion of abdominal viscera is evisceration or
Burst abdomen.
occurs in 1 to 3% of abdominal procedure.

commonly occurs from the fifth to eighth post

operative day when the strength of the wound is at
its weakest.
What is happened after wound closure?
Within hours after a wound is closed, the wound
space is filled with an inflammatory exudate.

Epidermal cells at the edges of the wound begin to

to divide and migrate across the wound surface.

By 48 hours after closure, deeper structures are

completely sealed off from the external
environment.
 Risk factors
 Systemic risk factors

 Local risk factors

 Systemic risk factors
Age
Malnourishment
Diabetes
Obesity
Renal failure
Jaundice
Sepsis
Cancer
Patients on steroids
 Local risk factors
3 most important local factors predisposing to
wound dehiscence are:

Inadequate closure

Increased intraabdominal pressure

Deficient wound healing.

 Adequacy of closure
single most important factor
The fascial layers give strength to a closure, and
when fascia disrupts, the wound separates.
Most wound that dehisces do so Because the
sutures tear through the fascia and placed too
tightly that obstruct blood supply to the wound.
 Intra abdominal pressure
After most intraabdominal operations, some
degree of Ileus exists, which may increase pressure
by causing distention of the bowel.

Other factors contributing to increased abdominal

pressure are COPD, obesity,coughing.
 Deficient wound healing
Infection is an associated factors in more than half
of the wounds that rupture.

The presence of drains, seromas, and wound

hematomas also delay healing.
 Diagnosis
The first sign of wound dehiscence is discharge of
pinkish sero senguineous fluid from the wound.

In some cases, the patient often describes a

popping sensation associated with severe coughing
or retching.
 Management
Patients with dehiscence of a laparotomy wound
and evisceration should be returned to bed and
the wound covered with moist towels

With the patient under G\A, any exposed bowel or

omentum should be rinsed with lactated Ringer
solution containing antibiotics and returned to the
abdomen
 Management
The previous sutures should be removed and the
wound is reclosed with additional measures to
prevent recurrent dehiscence, such as full
thickness retention sutures of no 22 wire or heavy
nylon.

Wound dehiscence without evisceration is best

managed by prompt elective reclosure of the
incision.
 Management
If a partial disruption (ie, the skin is intact) is stable
and the patient is a poor operative risk, treatment
may be delayed and the resulting incisional hernia
accepted.

It is important in these patients that skin stitches not

be removed before the end of 2nd post operative week
and that the abdomen be wrapped with a binder to
prevent further enlargement of the fascial defect or
sudden disruption of the covering skin.
Precautions for avoiding wound dehiscence
• Prophylactic measures should be taken to avoid
wound dehiscence such as:
• Chronic cough should be treated adequately before
surgery.
• Blood sugar level should be at normal range in case of
diabetic patients.
• Correction of gross obesity decreases intra abdominal
pressure.
• Wound closure: The most reliable wound closure uses
a continuous technique at suture length(SL) and
wound length(WL) ratio should be 4:1. Wound
dehiscence will take place if the ratio becomes less
than 4:1.
• Sutures must be placed at least 1cm from the wound
edge and about 1 cm apart. Dehiscence is often the
result of using too few stitches and placing them too
close to the edge of the fascia.
 Ideally the care of the wound begins in the pre
operative period and ends only months later. The
patient must be prepared so that optimal conditions
exist when the wound is made. Surgical technique
must be clean, gentle, and skillful. Post operatively
wound care includes maintenance of nutrition, blood
volume and oxygenation. Although wound healing is
in many ways a local phenomenon, ideal care of the
wound is essentially ideal care of the patient.
THANK YOU