What Is Surgical Wound Dehiscence?

When an Incision Reopens

Dehiscence is a surgical complication where the edges of a wound no longer meet. It's also known as wound separation. Unlike a healthy, healing injury, dehiscence prevents a wound from closing neatly, and the edges cannot be held together by sutures, staples, or another method of closure.

In rare instances, a wound that doesn't close properly can result in evisceration, which is when internal organs (most often organs in the abdomen), push out through the wound.

This article explains how and why wound separation happens, possible complications, ways to prevent it, and treatment options.

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This video has been medically reviewed by Anju Goel, MD, MPH.

Dehiscence Definition

During an operation, your surgeon makes an incision or cut. Depending on the type of surgery, this can be a fraction of an inch or spread across several inches.

As the cut heals, the wound fills in with new tissue, called "granulation" or "granulating tissue." If stress or other factors cause the edges of a wound to separate before the new skin has time to strengthen, the wound won't close. The granulating tissue will tear open or won't come together at all.

A wound is at the greatest risk of dehiscence in the first two weeks after surgery when the skin is still very fragile.

Wound Dehiscence Causes

When the edges of a wound separate, it's usually because of problems with sutures or staples that are supposed to hold the skin together. Issues that come up can include:

  • Post-surgery stress on the wound, which can include something as ordinary as a cough or sneeze
  • Certain types of sutures that may dissolve too soon and lead the incision to open
  • The type of closing procedure used, which may not have been effective for the incision

While the type of suture material—sutures, staples, or surgical glue—and surgical technique may cause separation, those factors are less important than a person's pre-existing health issues.

Underlying Health Issues

Your risk of wound dehiscence increases if you have certain types of medical conditions.

  • Malnourishment: Proper nutrition is necessary to support healing and ensure new skin is strong enough to withstand normal stress.
  • Infection: Bacteria in the incision increases the chances of dehiscence. An infection delays healing and weakens newly formed tissue, making it more likely that your wound won't close.
  • Obesity: The inflammation period of healing may last significantly longer in people with obesity. Also, in these cases, sutures or other material used to close a wound must be stronger to support the additional weight of the fatty tissue.

Dehiscence Symptoms

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Dehisced wound

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Wound dehiscence most commonly occurs six to eight days after surgery.

Signs and symptoms of dehiscence can include:

  • Pain
  • Increased bleeding
  • Increased drainage
  • Swelling
  • Redness
  • Broken sutures
  • Fever

With dehiscence, the wound is completely or partially open so you can see the raw tissue underneath. Often, the skin around the edges is red and inflamed. Pus or other liquid may be draining from the opening along with blood.

Evisceration of a Surgical Wound

Evisceration is a rare but severe surgical complication where the surgical incision opens (dehiscence) and the abdominal organs then protrude or come out of the incision (evisceration). Evisceration is an emergency and should be treated as such.

Evisceration can range from the less severe, with the organs visible and slightly extending outside of the incision to very severe. For instance, intestines may spill out of an abdominal incision.

Treatment for Dehiscence and Evisceration

Minor dehiscence may be managed at home under a healthcare provider's care, but serious wound separations will require immediate medical attention.

Managing Dehiscence

Although rates of dehiscence are low, once it occurs, the possibility of further complications or death is high. Thus, any break in a post-surgical incision should be reported to your surgeon.

Bacteria can get into the wound through even a very small opening, putting you at risk for infection. In addition, about 20% to 45% of cases of dehiscence become evisceration. Your risk of death is much higher once an evisceration develops.

While waiting to see your healthcare provider, continue to cover your incision with a clean bandage (if you were originally instructed to have the wound covered).

Treating Evisceration

Evisceration is always a medical emergency. If you see tissue or organs protruding from a surgical wound, call 911 or go to the nearest hospital emergency room.

It's important to keep the wound moist. To care for it on your way to seek medical attention or while waiting for EMS, cover the opening and organs with a moist, sterile bandage or sheet.

Evisceration Warning

Do not, under any circumstances, try to push organs or tissue back into the wound.

Prevention

In high-risk situations or special circumstances, surgeons may use an advanced technique to close a wound. Known as a "pie-crust" incision, this method makes a number of small cuts in the surrounding skin similar to the holes in a pie crust. The multiple cuts are perpendicular to the wound line. They allow the skin to come together more easily and heal better with less scarring.

Regardless of the method used to close the wound, it's important to take steps to reduce the chances of dehiscence or evisceration. Some techniques you can use include:

  • Practice bracing: When doing any activity that puts stress on the wound (sneezing, coughing, vomiting, laughing, bearing down for a bowel movement) apply pressure over your incision using your hands or a pillow. This can both prevent wound dehiscence and minimize pain during activity.
  • Prevent constipation: Constipation is common after abdominal surgery, which is when dehiscence is most likely to occur. Straining to have a bowel movement can open the incision. Prevent constipation with proper nutrition after surgery, or if you're already constipated, ask your surgeon for medication to help.
  • Care for your incision: Proper incision care will not only speed healing, but it helps prevent infection, which can weaken the incision and increase the chances of dehiscence.
  • Prevent coughing and sneezing: If your allergies are acting up or you have a cough, be proactive about keeping sneezing and coughing to a minimum. Repetitive coughing and sneezing can weaken your incision, which can slow healing and (in some cases) lead to wound dehiscence.
  • Avoid lifting: If your healthcare provider says you're not allowed to lift anything heavier than 5 pounds for two weeks after surgery, take the advice seriously. Again, the strain can cause the wound to open.

Protein and Wound Healing

Eating a diet rich in lean protein before surgery and during recovery may help promote healthy healing so you can avoid dehiscence. Proteins are the building blocks for tissue growth, cell renewal, and cell repair, so they're essential during healing.

Summary

After surgery, incisions may not heal properly. When the surgical cut fails to close or reopens, it's called a dehiscence wound. You can avoid this problem by taking it easy, eating properly, and following guidelines for wound care.

If the wound separates significantly, your internal organs and tissue could push out of the incision. This is known as evisceration. Get to an emergency room immediately if this happens.

Poor nutrition, obesity, and infections can increase the risk of complications related to healing. You can lower your risk by eating well and avoiding certain types of physical activities.

A Word From Verywell

Most wound dehiscence is minor, with a small area of the wound opening or gaping slightly. If the area is small, you can typically manage it by following your surgeon's instructions.

Evisceration is far rarer, but it's more serious when it happens and cannot be ignored.  Recovery from surgery can test your patience, but following all the recommendations of your healthcare provider will help you to fully heal sooner and avoid long-term complications.

Frequently Asked Questions

  • What does wound dehiscence look like?

    A wound can appear partially open in small sections or fully open with the tissues beneath it fully visible. You may see redness along the edges, drainage, or blood.

  • Is wound dehiscence an emergency?

    It is a complication that needs prompt treatment, including repair before it becomes a potentially life-threatening medical emergency. You may also need medications to prevent or treat an infection.

  • How long does it take for a dehisced wound to heal?

    It depends on the size of the wound, its location, and the level of repair needed. In some cases, it may take about three months to fully heal, particularly if there was an infection.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Jennifer Whitlock, RN, MSN, FN
Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.