Best Treatment for Wound Dehiscence and How to Prevent it?
 |
| Best treatment for wound dehiscence and how to prevent it? Photo by Alexander Grey: |
Best treatment of wound dehiscence is a topic of great interest as wound dehiscence is one of the main complications that people face after a surgery.
Depending on the site of the surgery and the severity,
treatment of wound dehiscence differs but the distress people undergo remains
almost the same.
What is Wound Dehiscence?
Wound dehiscence occurs as a complication when you receive sutures from a surgery. The wound edges may reopen partially or fully due to the defects in the wound healing mechanism making a new wound.
Ultimate result
is that wound will take a lot of time to heal causing you unnecessary trouble.
Usually, you will notice this within one week after surgery
as during this time, the wound healing process is still in early stages.
There are two main aspects of wound dehiscence.
Superficial
wound dehiscence is when the most superficial layers of wound edges are
separated whereas Full thickness dehiscence is when the underlying deep
layers are also involved and separated completely.
In full thickness dehiscence, if the wound is situated on a cavity as in the abdomen, this can open a pathway from the inside of the cavity to the outside as well. If so, there is a risk of internal organs coming out of this pathway. This is Evisceration.
Evisceration is a very dangerous consequence of wound dehiscence that needs urgent proper treatment.
Tensile Strength
During the first few days of the skin wound, the tensile strength of the wound is minimal. But as the collagen tissue forms, the wound tissue will increase its tensile strength over time.
Thus, wound dehiscence is
more likely during the first few days of the wound.
Causes and Risk Factors of Wound Dehiscence
Causes and Risk factors related to the Patient
Age
Increasing age is a risk factor for wound dehiscence.
Malnutrition
If you have any nutritional deficiency like anemia,
hypoalbuminemia, vitamin deficiencies etc. it will result in poor wound healing
that will in turn can cause wound dehiscence. Most importantly, vitamin c
deficiency, zinc deficiency, protein deficiency can reduce wound healing.
Similarly, if you are obese, it may exert undue pressure while coughing, sneezing, etc. on abdominal wounds leading to wound dehiscence.
Presence of an Infection
Infected wounds will not heal due to the effect of bacteria making the wound and surrounding area inflamed. Thus, infection will lead to wound dehiscence. So, it is very important to adhere to proper nursing care after a surgery to prevent wound infection.
Smoking
Smoking will cause your blood vessels to constrict so you
will have poor blood supply to the affected area. This will cause poor wound
healing making you susceptible for wound dehiscence.
Diabetes
Presence of other comorbidities like diabetes can cause poor
wound healing since it reduces the quality of your blood vessel walls which
results in poor blood supply to the wound.
Steroid Use
If you are using long term steroids, that will have a
negative impact on wound healing. Thus, you will have a high risk of having
wound dehiscence.
Emergency surgery or Re-exploration
If you have undergone a surgery in the same region
previously, re-exploration of the wound may increase the risk of wound
dehiscence later. Likewise, if it is an emergency surgery, there is a high risk
too.
Causes and Risk factors related to the Physician
The Experience and the proper technique of the surgeon
Needless to say, your surgeon has a great role in preventing wound dehiscence.
In the hands of a good experienced surgeon with proper
surgical techniques, you are safe while poor surgical technique is a great risk
factor.
Usually, they will suture the wound with the best suture material with proper techniques.
Exerting minimum adequate pressure on sutures
is important as excess tension will reduce the blood flow to the surrounding
tissues causing dehiscence.
Symptoms of Wound Dehiscence
When you observe the wound, you will see that sutures are
not in place. Similarly, a few sutures may be loose and you will see the edges
of the wound is separated.
There will be a bad smell from the wound and also, the
surrounding area of the wound may have redress and soreness.
Sometimes, you will notice a bulging of the wound surroundings. Moreover, a clear fluid or blood-stained fluid can come out of these separated edges. In some occasions, this may be normal, but if pus comes through that opening, that means some infection is going on and you need to take urgent treatments to combat the infection.
In wound dehiscence comorbid with wound infection, you may
have fever, pain and redness in the wound, generalized body weakness, etc.
Depending on the severity, you will see pus coming out of the wound defect as
well.
On the other hand, if the wound is on the abdominal wall,
you may see parts of bowel come out of this opening if it is due to
evisceration. You need urgent treatment if this happens.
Diagnosis
When your doctor sees and observe these things, he will
diagnose that you are having wound dehiscence or evisceration.
However, if any infection persists, he will take a swab from
the wound that contains the fluid coming out of the wound and send for culture.
This culture report will tell what kind of bacteria in the wound and he can
treat you accordingly.
Treatment for Wound Dehiscence
Deep dehiscence is a surgical emergency as this can lead to
evisceration. In this case, patient is taken to the operating theater and the
defect will be closed. If you see any evidence of evisceration, cover the bowel
with saline soaked sterile gauze and rush to the emergency unit.
In this case, your doctor will prescribe broad spectrum antibiotics and good pain relief medications.
Proper nursing interventions can treat superficial wound dehiscence. This include washing out the wound with normal saline and applying sterile gauze dressings. Depending on the healing of the wound, you need to repeat these nursing interventions.
This is the wound healing by Secondary Intension. This may take a several weeks depending on the size and the area of the wound. In this kind of situations, doctors suture the wound as a Secondary Closure. In secondary closure, wound heals faster so you need to visit your doctor less frequently.
Similarly, there is a technique called Vacuum Assisted
Closure where doctors apply negative pressure wound therapy to heal the
wound quicker than the other methods.
How to Prevent Wound Dehiscence?
To prevent wound dehiscence, it is very important you adhere to the post-operative instructions of your doctors. Visit your doctor or wound care nurse as they recommend for wound dressing and observations.
Do not lift heavy weights for about three months until the wound tissue regains some of its tensile strength.
However, depending on the operation and the region of the wound, this period may vary. Take your doctor’s advice in this regard. Research say that a wound will regain 80% of its original tensile strength in about 2 years after a surgery.
Sometimes doctors say, do not lift a weight no more than a weight of a cup of a tea, after abdominal operation. Although it’s a little dramatical, it gives the idea that you should take it pretty seriously to prevent wound dehiscence.
You can do your normal day to day activities with less straining. If you happen to get a cough or constipation, etc. you should consult your doctor and take necessary treatments for that.
That is because if you strain too much, this increased intraabdominal pressure can lead to wound dehiscence in any abdominal surgery.
Furthermore, in an abdominal surgery, you can use abdominal binders to reduce the pressure on your sutures from the straining. This will prevent wound dehiscence.
Take a nutritious diet. Ensure a balanced diet having all the nutrients in adequate amounts in your daily dietary intake. This will ensure faster wound healing. Similarly, your doctors will improve your nutritional status well before the surgery in elective scenarios.
On the other hand, in an elective surgery, your doctors will optimise your nutritional status which is optimum for wound healing.
And also, they will direct you to specific physiological and physical rehabilitation programs to reduce the risk of wound dehiscence in the incision site.
Related Reading Material - BestAbdominal Exercises Post Hernia Surgery: A Safe Recovery Guide
Stop smoking.
Make Sure your other co-morbidities are well taken cere of. If you have diabetes, take medicine properly and control your sugar levels. Because good sugar control will prevent infections at the same time improve wound healing preventing wound dehiscence.
In conclusion,
To sum up, wound dehiscence is a complication that occurs following a surgery when you receive sutures. This is a result of poor wound healing.
In the case of evisceration, it is a surgical emergency that needs emergency operation while repeated wound dressing can manage superficial dehiscence.
Taking proper preventive measures
at the right time can prevent this condition.
Good luck! 🥰
From Dr. Pasindu
Stay happy stay healthy 🥰
Do you like What
you just read?
Share it with your friends and loved ones too!
Follow our FACEBOOK
page for more articles like this!
Comments
Post a Comment