Background

Surgical wounds are defined as incisions that are made during a surgical procedure.¹ Typically, surgical wounds are named for the location in which they are made. Examples include abdominal surgical wounds, perineal surgical wounds, or midline (chest) surgical wounds. Alternatively, surgical wounds can be named by the procedure. Examples of this naming include left transmetatarsal amputation site, right below the knee amputation site, left lateral leg incision and drainage site, right great toe amputation site, or left total knee replacement surgical incision, to name a few.

Surgical wounds are typically closed with staples, sutures, or skin glue during the procedure; however, they may, at times, be left open due to infection or other findings during surgery.¹ Wound dehiscence is when part or all of the wound comes apart and typically occurs 5-8 days postoperatively.² Common risk factors for surgical wound dehiscence²:

• Diabetes
• Malnutrition or poor nutrition
• Smoking
• Obesity
• Ischemia
• Infection

Preventing Surgical Wound Dehiscence

Ideally, most wound care professionals may want to prevent surgical wound dehiscence before it occurs. If clinicians prevent dehiscence, the healing process and, subsequently, the patient's ability to return to normal daily activities is typically quicker. Some methods to prevent surgical wound dehiscence include supporting the abdomen when coughing, sneezing, or moving around/sitting up in bed, avoiding strain or pressure to the wound area (heavy lifting, exercise, coughing, constipation/straining with bowel movements), and maintaining a good diet and good oral intake to prevent dehydration. It is essential to practice good hygiene, keep the wound clean, dry, and intact, and follow the provider's specific instructions on wound care and any prescribed medications.¹

Treatment of Surgical Wound Dehiscence

Surgical wounds are typically defined as either closed or open wounds. As a reminder, closed wounds are usually secured with sutures, staples, or surgical glue. Closed surgical wounds are generally described as well approximated or not well approximated and may generally be left open to the air. Soap and potable water are okay for established wounds, and wound care professionals can let water gently run over the site and pat dry. No tub soaks, baths, or swimming should be attempted until the wound is healed, unless specifically instructed differently by the surgeon.¹ Open surgical wounds are left open intentionally postoperatively or as a result of post-operative wound dehiscence. Wound assessment and appearance are key factors when selecting an appropriate topical treatment, and should include the following¹:

• Wound measurements should be obtained (for a baseline and tracking healing). Wound measurements are recorded as length, by width, by depth, and an assessment for tunneling and undermining should be completed and recorded.
• Condition of periwound skin should be assessed and documented along with wound drainage (amount, color, odor).
• The presence or absence of necrotic tissue should also be noted, taking into account that this will help to guide the treatment choice.

Key points

Some key points of surgical wound dehiscence prevention and treatment are listed below:

• The best management strategy for surgical wound dehiscence is prevention.
• Wound assessment is important before selecting a topical treatment. Initial and ongoing assessment should take place.
• Determine if the wound is wet or dry; if the wound is wet/draining a lot, we want an absorptive therapy. Alternatively, if the wound is dry, we want to add moisture for moist wound healing.
• Be sure to protect your periwound skin (watch for maceration, medical adhesive-related skin injuries, moisture associated skin damage).
• Work with the interdisciplinary team and surgical team to determine the best treatment plan and follow-up, being sure to treat the whole patient and not just the hole in the patient.
• Keep it simple; use one product at a time when able to be able to see what is actually working versus what may not be.

Conclusion

The prevention of wound dehiscence and infection are fundamental principles to educate on in the perioperative period. Preventing complications postoperatively speeds up the timeline in which the patient is able to return to their usual day-to-day life. It is vital to take an interprofessional approach, involve the patient in the plan of care, follow standards of care and evidence based practices, and have initial and routine follow up. I will end with one of my favorite concepts; as always, we should be treating the whole patient and not just the hole in the patient.

References

1. Wound, Ostomy and Continence Nurses Society Core Curriculum: Wound Management. 2nd edition. Philadelphia, PA: Wolters Kluwer; 2022.
2. Rosen, R., & Biagio, M. May 2022. Wound dehiscence. National Library of Medicine.

About the Author

Holly is a board certified gerontological nurse and advanced practice wound, ostomy, and continence nurse specialist at VA Northeast Ohio Healthcare System in Cleveland, Ohio. She has a passion for education, teaching, and our veterans. Holly has been practicing in WOC nursing for approximately ten years. She has much experience with the long-term care population and chronic wounds as well as pressure injuries, diabetic ulcers, venous and arterial wounds, surgical wounds, radiation dermatitis, and wounds requiring advanced wound therapy for healing. Holly enjoys teaching new nurses about wound care and, most importantly, pressure injury prevention. She enjoys working with each patient to come up with an individualized plan of care based on their needs and overall medical situation. She values the importance of taking an interprofessional approach with wound care and prevention overall, and involves each member of the health care team as much as possible. She also values the significance of the support of leadership within her facility and the overall impact of great teamwork for positive outcomes.