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.

Incidence:

• 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%

Mortality:

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

Causes:

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