Causes and management of surgical wound dehiscence

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Dehiscence of the wound after abdominal surgery is a serious complication that continues to plague the surgeon and threaten the patient. Dehiscence is the disruption or breakdown of a wound.1, 2 It may range in magnitude from a failure of the deeper portions of the abdominal incision to unite, unrecognized in the postoperative course but resulting later in an incisional hernia, to the dramatic “burst abdomen” or evisceration in which dehiscence of the wound occurs suddenly and is accompanied by protrusion of abdominal contents, usually bowel, through the disrupted wound.

Significant wound dehiscence occurs in approximately 1% of all laparotomies.1–8 The incidence of wound disruption is correspondingly greater in a series of patients with various predisposing factors. For example, a recent report9 stated that there was 7% wound disruption (21 of 291) in patients who underwent laparotomy for carcinoma. At the other extreme, in one author’s (S.O.H.) experience there has been no incidence of significant disruption in a McBurney-type, muscle-splitting incision where the very nature of the incision effectively prevents such an occurrence.10

A number of factors influence the healing of a wound. Since we do not know how to accelerate the healing of wounds, it is more pragmatic to deal with those factors that may interfere with proper healing of the wound and hence predispose toward dehiscence. Factors can be divided into three groups: (1) systemic, such as severe anemia; (2) local, such as infection, or the technique followed in making and suturing the surgical incision; and (3) postoperative, . . .



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