Wound Dehiscence Part 1

This is the part one of the series in wound dehiscence posts. This part explains definition, incidence, mortality and causes of wound dehiscence.

Burst Abdomen (Wound Deshiscence)

What is it?

  • Also known as abdominal wound dehiscence, wound failure, wound disruption, evisceration and eventration. May be partial or complete.
  • Wound dehiscence before cutaneous healing is burst abdomen while dehiscence after cutaneous healing is incisional hernia.

  • The incidence varies in reported series of cases, but it is somewhere between 0.5 and 5%.
  • The incidence of wound dehiscence/burst abdomen varies from center to another worldwide. While it is recorded to be 1-3 % in most centers
  • Incidence of wound dehiscence before 1940 (>71000 incisions): 0.24-3.0%
  • Incidence of wound dehiscence between 1950 and 1984 (>320,000 incisions): 0.24 - 5.8%
  • Incidence of dehiscence between 1985-1996 (18,133 incisions): 1.2%

  • A consistently higher mortality was found in the patients who had burst than in the controls
  • 35% according to studies


Preoperative Factors:

  • (Chronic pulmonary disease) Cough present pre-operatively and post-operatively
  • Being treated with Corticosteroids
  • Ascites, Jaundice or Depletion of protein or vitamin C or uraemia
  • Obesity
  • Malignant Disease
  • Peritonitis
  • Haemoglobin < 11g/dl
  • Diabetes
  • Zinc Deficiency

Nature of Primary - Disease and Operation:

Main groups of operations after which burst abdomens occurred are
those on the Gastroduodenum (mainly for peptic ulcer) and Large Bowel

The Operation:

  • Most burst abdomens occur in Upper abdominal incisions and vertical incisions
  • Almost no burst abdomen occurred in Lower abdomen oblique or transverse incision according to few studies
  • The inclusion of too little rather than too much of tissue leads to trouble
  • Using Catgut 11% Dehiscence occurred in one study
  • Incisions greater than 18 cm
  • Emergency Operations carry more risk than elective

Post-Operative Complications:
  • Cough
  • Distention
  • Vomiting
  • Ascites
  • Hiccup
  • Wound Inflammation Infected wounds are significantly weaker than controls almost certainly due to decreased fibroblast concentration and activity
  • Pancreatic or intestinal digestion of the suture line from a fistula
  • Ileus
  • Radiation Therapy
  • Antineoplastic Therapy: Delay the treatment till 2-3 weeks
Download all 4 posts as a single file: Wound Deshiscence from Surgical Perspective

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