Surgical Wound Dehiscence and Evisceration
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.
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.2
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.2 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.
Always report dehiscence to your surgeon. 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.
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.2 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.3 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.”
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).3 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.
Emergency Treatment If Your Incision Eviscerates
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.2 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.
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.
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.