Wound Dehiscence

Wound dehiscence is partial or complete separation of the edges of a surgical incision. It occurs when the force pulling the wound apart exceeds the strength of the healing tissue holding it together. Healing normally progresses through hemostasis, inflammation, proliferation, and remodelling. During proliferation, fibroblasts deposit collagen and new blood vessels support the developing tissue. This collagen is initially weak. Infection, poor perfusion, hyperglycemia, inadequate nutrition, and smoking can disrupt collagen production or damage the developing matrix. Coughing, vomiting, straining, or increased abdominal pressure can then pull apart an incision that has not gained enough tensile strength. A superficial dehiscence involves skin or subcutaneous tissue. A fascial dehiscence is deeper and more dangerous because the abdominal wall has lost its structural support. Evisceration occurs when abdominal organs protrude through a dehisced incision. It is a surgical emergency because exposed bowel can become dry, contaminated, injured, or ischemic.