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    Wound Dehiscence

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    Zurezki Yuana Yafie
    1. Wound dehiscence occurs when abdominal wall layers separate after surgery due to failure of the fascia to heal properly. Complete dehiscence involves separation of all layers while partial dehiscence involves some separation. 2. Incisional hernia is a late complication where the muscle and fascia separate but skin remains intact. It develops in 1% of uncomplicated cases but 10% with wound infection and 30% after dehiscence repair. 3. The risk of dehiscence can be reduced by using absorbable monofilament sutures with a wide bite and short stitch interval, along with retention sutures when needed for high-risk patients.

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    Wound Dehiscence

    Uploaded by

    Zurezki Yuana Yafie
    146 views52 pages
    1. Wound dehiscence occurs when abdominal wall layers separate after surgery due to failure of the fascia to heal properly. Complete dehiscence involves separation of all layers while partial dehiscence involves some separation. 2. Incisional hernia is a late complication where the muscle and fascia separate but skin remains intact. It develops in 1% of uncomplicated cases but 10% with wound infection and 30% after dehiscence repair. 3. The risk of dehiscence can be reduced by using absorbable monofilament sutures with a wide bite and short stitch interval, along with retention sutures when needed for high-risk patients.

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    1. Wound dehiscence occurs when abdominal wall layers separate after surgery due to failure of the fascia to heal properly. Complete dehiscence involves separation of all layers while partial dehiscence involves some separation. 2. Incisional hernia is a late complication where the muscle and fascia separate but skin remains intact. It develops in 1% of uncomplicated cases but 10% with wound infection and 30% after dehiscence repair. 3. The risk of dehiscence can be reduced by using absorbable monofilament sutures with a wide bite and short stitch interval, along with retention sutures when needed for high-risk patients.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    146 views52 pages

    Wound Dehiscence

    Uploaded by

    Zurezki Yuana Yafie
    1. Wound dehiscence occurs when abdominal wall layers separate after surgery due to failure of the fascia to heal properly. Complete dehiscence involves separation of all layers while partial dehiscence involves some separation. 2. Incisional hernia is a late complication where the muscle and fascia separate but skin remains intact. It develops in 1% of uncomplicated cases but 10% with wound infection and 30% after dehiscence repair. 3. The risk of dehiscence can be reduced by using absorbable monofilament sutures with a wide bite and short stitch interval, along with retention sutures when needed for high-risk patients.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 52

    Wound Dehiscence

    Fascial disruptionFailureofthe
    fasciatohealproperlycanleadto
    partialorcompletedehiscence.
    Completedehiscenceismarkedby
    separationofallabdominalwalllayers
    andmaybeaccompaniedby
    evisceration.Partialwounddehiscence
    withouteviscerationislesscritical,but
    stillaseriousproblem.Botharesurgical
    emergencies.
    Alatecomplicationoffascial
    disruptionisincisionalhernia.
    Incisionalherniarefersto
    separationofmuscleandfascia
    whileperitoneum,subcutaneous
    tissue,andskinremainintact.It
    canbecorrectedonanelective
    basis,unlessincarcerated
    Theincidenceoffascialdisruptionis1percent
    overalland0.4percentingynecologicsurgery.
    Bycomparison,incisionalherniadevelopsin
    approximately1percentofuncomplicated
    surgicalcases,10percentofpatientswith
    woundinfection,and30percentofpatients
    whounderwentrepairofdehiscence.More
    thanone-halfofherniasappearwithinsix
    monthsoftheoriginaloperation,
    approximatelythree-quartersarepresentby
    twoyears,and97percentarepresentbyfive
    years
    IncisionalfactorsTensiononan
    incisionisproportionaltoitslength.
    Herniationismorecommonwhenthe
    incisionisinexcessof18cm.Itwas
    thoughtthatlongitudinalincisionswere
    atgreaterriskofdehiscencethan
    transverseincisions.
    SutureThemaincausesofwound
    separationarefailureofsuturetoremain
    anchoredinthefascia,suturebreakage,knot
    failure,andexcessivestitchintervalwhich
    allowsprotrusionofviscera.Inupto95
    percentofabdominalwounddehiscences,the
    suturesandknotsareintact,butthesuture
    haspulledthroughthefascia.Thisisusually
    theresultoffascialnecrosisfromsutures
    beingplacedtooclosetotheedgeorundertoo
    muchtension
    Sincetissueisweak1cmfromthe
    incision,suturesshouldbeplaced
    morethan1cmfromthewound
    edgetoensurethatthetissueis
    strongenoughtoholdthesuture.
    Forcontinuousclosure,thetotal
    lengthofthesutureshouldbe
    approximatelyfourtimesthe
    lengthoftheincision.
    However,itisdifficulttomakelegitimate
    comparisonssincelongitudinalincisionsare
    morelikelytobeperformedincasesof
    hemorrhage,trauma,sepsis,multiorgan
    disease,previoussurgery,previousradiation
    therapy,andmalignancy.Randomizedtrials
    comparingparamedian,transverse,and
    midlineincisionsreportednosignificant
    differencesinthefrequencyofdehiscenceor
    herniationwhenconfoundingfactorswere
    considered
    Causes

    Infection at the wound


    Pressure on sutures
    Sutures too tight
    Injury to the wound area
    Weak tissue or muscle at the wound
    area
    Risk Factors

    Overweight
    High blood pressure
    Increasing age
    Poor nutrition
    Sex: female
    Diabetes
    Smoking
    Malignant growth
    Presence of prior scar at the incision
    site
    Surgical error
    Increased pressure within the abdomen
    due to: fluid accumulation (ascites);
    inflamed bowel; severe coughing,
    straining, or vomiting
    Long-term use of corticosteroid
    medications
    Other medical conditions, such as
    diabetes , kidney disease, cancer,
    immune problems, chemotherapy ,
    radiation therapy
    Incorrect suture technique used to close
    operative area
    Poor closure technique at the time of
    surgery
    Use of high-dose or long-term
    corticosteroids
    Severe vitamin C deficiency (scurvy)
    Symptoms

    Bleeding
    Pain
    Swelling
    Redness
    Fever
    Broken sutures
    Open wound
    Treatment

    Drug Therapy
    Antibiotic therapy
    Medical Treatment
    When appropriate, frequent changes in
    wound dressing to prevent infection
    When appropriate, wound exposure to air to
    accelerate healing and prevent infection, and
    allow growth of new tissue from below
    Surgical Intervention
    Surgical removal of contaminated, dead
    tissue
    Resuturing
    Placement of a temporary or permanent
    piece of mesh to bridge the gap in the
    wound
    Suturebreakageandknotfailure
    uncommoncausesofwoundseparation.
    Absorbablesuturematerialhasan
    increasedriskofdehiscenceandherniation
    becauseupto80percentoftensile
    strengthislostwithintwoweeks.Chromic
    catgutsutureclosure,whichisrapidly
    degraded,isassociatedwithan11percent
    dehiscencerate;therefore,catgutsuture
    shouldnotbeusedonthefascia,whether
    asalayeredormassclosure
    Polyglycolicacidandpolyglactin
    910,whicharedegradedmore
    slowly,givebetterresults,similar
    topermanentsuturesinhealthy
    patientswhohavenounusualrisk
    ofdehiscence.Inhigh-risk
    patients,polyglycolicacidand
    polyglactinareinferiortoa
    permanentsuture,suchasnylon
    Monofilamentsuturesshouldbe
    usedforclosureofmost
    longitudinalincisionsorif
    prolongedhealingisanticipated,
    suchasinaninfectedwound
    PreventionThemethodoffascial
    closureisacriticalaspectofincision
    closure,asthisprovidesthemajorityof
    woundstrengthduringhealing.Analysisof
    articlesrelatedtoabdominalfasciaclosure
    publishedfrom1966to2003includedfour
    meta-analysesthatwereusedtodraw
    conclusionsaboutoptimaltechniquefor
    closureofabdominalsurgicalwounds.
    Recommendationsincluded
    Useasimplerunningtechnique
    Use#1or#2delayedabsorbable
    monofilamentsuture
    Usemassclosuretoincorporateall
    layersoftheabdominalwall
    (exceptskin)
    Takewidetissuebites(1cm)
    Useashortstitchinterval(1cm)
    Useasuturelengthtowound
    lengthratioof4to1
    Usenonstrangulatingtensionon
    thesuture
    Theuseofretentionsuturesprovides
    themostsecureclosure,andisoften
    usedtoreinforceotherclosures.
    Retentionsutureswilldecreasethe
    numberofwounddehiscences,butnot
    eliminatethementirely.Retention
    suturesmaybeplaced2cmfromthe
    incisioninathroughandthrough,
    verticalmattress,verticalparallel,or
    doubleretentionfashion
    Permanentsutureof2-caliberor
    greatershouldbeusedandleftin
    placeforatleast21days.For
    patientsatriskforwound
    dehiscencearunningmass
    closure,Smead-Jonesclosureor
    theplacementofretentionsutures
    areallappropriateoptions

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