7 Coupled with this, an increased number of complex surgical procedures are being performed in elderly patients with multiple comorbidities – potentially increasing the rate of post-operative wound complications.įollowing hospital discharge, patients are often not seen at their respective hospitals or private consulting practices until 4–6 weeks later, and the burden of care during this period rests on GPs. 6 This is a matter of importance, as rising numbers of early patient discharges from hospitals following major procedures are occurring because the demand for hospital beds in Australia presently exceeds supply. 1 Subsequently, George Winter’s landmark publication in 1962 about moist wound healing 2 resulted in a vast array of wound dressings available on the market, often with considerable confusion about their appropriate use on acute and chronic wounds.Īlthough there are many published resources on the management of chronic wounds, 3–5 there is a lack of guidelines on the management of acute post-surgical wounds in the community by general practitioners (GPs), and ‘there is almost no research on wound care in the post-hospital setting’. Frequent dressing change is recommended to reduce the risk of infection, while allowing exposure to air to help the wound heal faster.The management of wounds has progressed significantly since Ambroise Paré’s famous words, ‘I dressed him and God healed him’. Finally, the patient's wound should be closely monitored to prevent dehiscence from reccurring. Next the wound must be closed properly with the appropriate surgical technique and sutures. Surgical debridement is typically performed to treat wound dehiscence by removing the dead or infected tissue to enable better healing of the wound. Antibiotics may be used to prevent any future infections if none were present, as woundĭehiscence increases the risk of wound infection. The antibiotic therapy used to treat the patient is considered, along with any ongoing infection that might have caused the dehiscence. A wound dehiscence is treated as a new wound, and takes into consideration the surgical history of the wound. Other factors - the risk is greater with smoking, obesity, premature post-surgery exercise, heavy lifting, recurrent vomiting, coughing or an improper diet that leads to constipation.Īll wound dehiscence cases are surgical emergencies that require immediate attention.The surgical procedure - the risk of dehiscence increases with over-tightening of sutures, poor suturing technique, inappropriate surgery site or suturing material.The patient's health status - the risk is higher in patients with a weak immune system, malnutrition or chronic medical illness.The two most important factors controlling the risk of wound dehiscence are: Pus and/or frothy drainage in infected woundsĮvery person who has a surgical wound has at risk of dehiscence, especially in the first two weeks after surgery, when the tissue is still weak and not completely healed.Signs and symptoms of wound dehiscence are clear and easy to identify by the patient and may present as one or more of the following: This can be seen in some cases of abdominal wound dehiscence. In complete wound dehiscence, all layers of the wound thickness are separated, revealing the underlying tissue and organs, which may protrude out of the separated wound. In partial dehiscence, only the superficial layers or part of the tissue layers reopen. There are two basic types of wound dehiscence, partial or complete, depending on the extent of separation. Secondary wound dehiscence can occur in patients with AIDS, renal disease, diabetes mellitus and those undergoing chemotherapy or radiotherapy. In some cases, wound dehiscence could be secondary to wound infection or poor healing as seen in patients with chronic diseases, malnutrition or weak immune systems. Wound dehiscence can also be caused by increased stress to the wound area as a result of strenuous exercise, heavy lifting, coughing, laughing, sneezing, vomiting or bearing down too hard with bowel movement. Wound dehiscence can be caused by poor surgical techniques such as improper suturing, over-tightened sutures or inappropriate type of sutures. However, when wound dehiscence occurs, the edges starts to separate and the wound reopens instead of healing closed as planned. Typically, the sutures or closures around wound edges should stay intact while new tissue, known as "granulation tissue," starts forming to help heal the wound. Wound dehiscence is one of the most common complications of surgical wounds, involving the breaking open of the surgical incision along the suture.
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