dehiscence

Patient Care. Patients most at risk for wound dehiscence are those who are obese, malnourished, or dehydrated or have abdominal distention, a malignancy, or multiple trauma to the abdomen. Infected wounds are also prone to dehiscence. Those patients who smoke or have a chronic cough are also at risk. Careful monitoring of patients with a predisposition to delayed healing is essential for prevention or mitigation of wound separation, especially between the fifth and twelfth postoperative days, when dehiscence most often occurs. In about half the cases of dehiscence there is a noticeable increase in serosanguineous drainage on the wound dressing before separation of the outer layers becomes apparent. Patients also may report the feeling that something has “given way” in the wound.

If evisceration has not occurred, the wound may be splinted with reinforced dressings, sterile towels, or a binder. This could prevent further separation and allow time to notify the surgeon. The patient should be instructed to lie quietly and, if it is an abdominal wound, to try to avoid increasing intra-abdominal pressure by coughing or straining in any way.

Should splinting an abdominal wound fail to prevent further separation and a spilling of the viscera through the opening, emergency surgery is imperative. Until the patient goes to surgery, the protruding intestines should be covered to prevent drying. Some authorities recommend that only dry sterile towels be used while others prefer covering the entire wound with a sterile towel moistened with povidone-iodine (Betadine). Warming the solution to body temperature can help avoid shock to the intestines, but is not necessary if there is not time to do this.