Why do surgical wounds fail

Complete dehiscence, however, will present as all layers being separated with underlying tissue and organs being exposed and sometimes protruding through the wound opening. Other symptoms of dehiscence include visibly broken sutures before the wound has healed completely, as well as renewed pain, bleeding and drainage from the surgical wound site. Wound dehiscence can be caused by a problem with suturing. This can range from the wrong type of suture to overly-tight sutures, or simply error on the part of the clinician.

Forces acting upon the wound area, like a cough, sneeze or the patient exerting a muscle by lifting a heavy object or having a bowel movement, can also cause dehiscence. Dehiscence can also be caused by infections or poor wound healing. Patients who have weakened immune systems such as those with AIDS or renal disease or who are malnourished are at risk for this along with patients undergoing chemo- or radiotherapy.

Pressure or trauma can also contribute to dehiscence of a surgical wound. A normal, healing surgical incision should be treated according to post-operative instructions, maintaining good hygiene and using an appropriate dressing.

Avoid unnecessary strain on the wound site. For a dehisced wound, a patient should return for medical care immediately. This may include debridement , antibiotic therapy and resuturing or use of another type of wound closure device.

Following this treatment, the wound will need to be monitored extremely closely for signs of recurring dehiscence. An overview of surgical site infections: aetiology, incidence and risk factors. World Wide Wounds. Accessed on March 30, McDonagh V. Management of a dehisced surgical wound in an older patient. Knots maintain the appropriate tension on a wound which is vital when it comes to proper healing and reducing the chances of wound dehiscence.

Physicians applying sutures need to understand which knot is most appropriate for any given surgery. These include the basic square knot, the one- and two-hand tie, the instrument tie, the simple interrupted stitch, and the vertical mattress stitch.

A loose knot can result in a suture to lose tension and slip open. If a suture is not held under the proper tension through a correctly tied knot, healing abilities will be compromised; this could not only lead to wound dehiscence, but also excessive scarring and discomfort. On the other hand, an incision could be placed under too much tension, causing it to break open and potentially cutting tissue in the process.

There are a variety of materials used for suturing, and each has its time and place. For example, multifilament materials, which are braided or twisted to increase the friction rate may be necessary for one surgery, while monofilament materials, which consist of only one strand of fiber and reduce friction rates, may be acceptable for another.

Using absorbable versus non-absorbable sutures should also be a consideration. Absorbable materials, which dissolve naturally into the body over time, can be a bit unpredictable in the breakdown time; when used on surface wounds, they could dissipate earlier than expected resulting in a tear or opening.

Oftentimes, wound dehiscence occurs because sutures have been placed too close to the wound edges. They monitor wounds for signs of infection or other complications. Your doctor will examine the wound and review your symptoms. Complications usually occur within 30 days. Report any symptoms to your doctor or care provider. Non-healing surgical wounds are closely monitored at every step. Learn more about our doctors and care team who diagnose and treat non-healing surgical wounds.