Surgical wound dehiscence (SWD) is defined as the rupturing of opposed or sutured margins following a surgical procedure There is two types of surgical wound dehiscence – partial and full thickness dehiscence.
Dehiscence can occur up to and including day 30 postoperatively. Did you know that most wound dehiscence occurs 4–14 days following surgery?
Wounds Failing to Heal Common Factors
Failure of the wound to heal may be due to a number of factors which commonly include:
- patient-related factors, for example, cardiovascular disease
- mechanical reasons of suture breakage or knots slipping
- infection or dehiscence
- radiotherapy or chemotherapy
- Patients may be more at risk of wound dehiscence if they have these risk factors:
Age: over 65 years old,
- Signs of systemic and local infection
- Previous surgery in the same anatomical area
Intraoperative risk factors can include emergency admissions, the classification of surgery e.g.clean, clean-contaminated or dirty, the duration of procedure and intraoperative warming practices
- Postoperative factors that can increase the risk of wound dehiscence can include raised intra-abdominal pressure, e.g. excessive
coughing, recurrent vomiting and constipation
What are the signs and symptoms that there is disruption to the normal healing process?
- Opposed sutured margins open or separated at any point along the incision site
- Broken sutures (non-healed opposing margins)
- Redness at the incision site
- Pain at the incision site
- Exudate from the incision site
Key Wound Characteristics to Document!
As Nurses, we understand the importance of accuracy with recording a wound assessment. A wound assessment should incorporate at a minimum the following:
- Anatomical Location
- Tissue involvement/characteristics
- Exudate type/amount
- Presence of odour,
- Pain assessment
- Type of dehiscence – partial or full thickness
Remember to assess and document signs of wound infection which can include dull wound tissue, slough, failure of the wound to decrease in size, hypergranulation , increased exudate, erythema, increased pain or unexplained pain, malodour and the increased temperature of the periwound tissue.
Goal of Care – Prep Wound Bed for Closure
The critical goal of care is the preparation of the wound bed for re closure.The strategies to be completed include completing a wound bed assessment to confirm any signs of infection and necrosis. The use of the T I M E process (Tissue, Infection/
Inflammation, Moisture, Edge can facilitate a focused assessment of the wound bed.The appropriate use of antibiotics, surgical debridement and the removal of drains, sutures and staples along with surgical debridement may need to also occur.
‘Following the removal of necrotic tissue, superficial dehiscence can be closed by secondary intention. For large and deep wound
dehiscence, NPWT and a return to theatre for closure may be indicated.’
Nurses play a critical role in supporting the early identification of wounds which are at risk by completing accurate and timely assessments and communicating with relevant health professionals.
We have created a good info sheet that you can download which identifies key reminders regarding wound dehiscence.
Download it and pop it up in your workplace as a reminder!
The Nurses for Nurses Network provides great information and CPD on an array of nursing topics including wound care in a range of easy learning ways including webinars and quizzes on the latest information that Nurses need to know – remember the Nurses for Nurses Network was created by Australian Nurses for Nurses! www.nursesfornurses.com.au