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Post-operative wound dehiscence

Definition:
  • Partial or complete separation of the layers of a surgical wound.
Etiology:
  • Increased intra-abdominal pressure (e.g., coughing, vomiting).
  • Mechanical stress on the wound.
  • Surgical factors (e.g., tension on the wound, inappropriate suture material or technique).
  • Infection at the wound site.
  • Malnutrition.
  • Steroid use.
  • Radiation therapy.
  • Underlying diseases (e.g., diabetes, vascular disorders).
  • Smoking.
Clinical Features:
  • Discharge of serosanguinous fluid from the wound.
  • Visible separation of wound edges.
  • Underlying tissues/organs may become exposed.
  • Pain or discomfort around the wound site.
  • Signs of infection (redness, warmth, swelling, purulent discharge).
Management:
  • Protect the wound to prevent further separation and contamination.
  • If minor, secondary healing may be sufficient with dressings and wound care.
  • Significant dehiscence may require surgical intervention (e.g., wound closure, debridement).
  • Systemic antibiotics if there’s evidence of infection.
  • Nutritional support to promote wound healing.
  • Manage underlying conditions that may impede healing (e.g., hyperglycemia in diabetics).
Prevention:
  • Meticulous surgical technique.
  • Use appropriate sutures and closure techniques.
  • Address and manage risk factors pre-operatively (e.g., improving nutritional status, optimizing blood glucose levels).
  • Post-operative wound care and education (e.g., advising patients to avoid activities that increase intra-abdominal pressure).
  • Early mobilisation post-surgery can help reduce the risk.
  • Proper post-operative pain management (to minimise coughing due to pain).
Complications:
  • Infection.
  • Evisceration (protrusion of internal organs, typically intestines, through the wound).
  • Formation of wound abscess or fistula.
  • Prolonged wound healing.
  • Scarring.
  • Increased hospital stay and associated costs.

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