Wound disruption
Theory
Wound disruption or dehiscence can occur within a few days or weeks post surgery. There are a number of factors that contribute to it.
Disruption exposes the underlying structures and therefore nearly always requires surgical correction.
Immediate management is aimed at stabilising the patient and notifying senior staff.
Immediate intern management
Attend patient and assess.
- ABC.
- Clinical assessment.
- Inspect wound.
- IV access IV fluids and basic blood tests.
- Nil orally.
- Reassure patient.
- Call surgical registrar and unit registrar.
If vital structures/bowel exposed
Cover exposed structure:
- Bowel – saline soaked sterile towel.
- Vital structure – saline soaked gauze.
|
Clinical features
History
- Basic patient information
- Nature of recent operation
- Events leading to wound disruption
- Past history
- ? Last meal
Examination
- Basic patient parameters
- Wound
- Nature and site
- Underlying/exposed structures
- Any discharge (colour, smell, and in particular blood stained fluid or fresh blood)
- Surrounding tissues
- Erythema, swelling, purpura
Abdominal wound dehiscence classically occurs from days five to ten and is heralded by serous wound discharge.
Predisposing factors
- Elderly
- Multiple medical problems
- Diabetes
- Cancer
- Malnourishment
- Immunosuppressants
- Smoker
- Poor technique
Causes
- Increasing tension deep to sutures – abdominal compartment syndrome
- Infection
- Wound necrosis
- Haematoma
- Sudden strains across wound eg. coughing, vomiting
Further definitive management
- Surgical consultation and review required
- Decision for re-intervention depends on exposed structures and cause for wound disruption
- Exposed bowel/vital structure
- Surgical intervention and repair
- Consider using tension sutures in abdominal wound dehiscence
- Gross infection wound/abscess
- May elect to leave wound exposed
- Pack and dress to allow healing by secondary intention
- Haematoma
- Evacuate
- Stop bleeding – direct/pack wound
Other considerations
- Try and correct predisposing factors:
- Optimise diabetic control
- ? Need immunosuppressants/steroids
- Pre-operative nutritional support/supplementation
- Smoking cessation
- Seriously consider indications for surgery
- A serous discharge from an abdominal wound should alert to the possibility of impending wound disruption
Back