Pearls for Practice: Dilemmas of Dehiscence
Dehisced surgical wounds often create dilemmas for clinicians. Many factors can affect whether a surgical wound may dehisce. Some factors that determine wound closure success are nutrition, comorbidities, edema, smoking, and corticosteroid usage.
Before surgical site dehiscence, patients may develop symptoms such as fever, increased exudate, pain, erythema, or swelling. When a wound dehisces, the underlying causes must be identified. Infection is a suspected primary cause for dehiscence and needs to be assessed and treated locally or systemically as appropriate.
The presence of necrotic tissue in the wound bed also can play a role in dehiscence. The amount of necrotic tissue can determine if the patient needs to return to surgery or be treated more conservatively. The dehisced surgical wound tends to have increased serous or purulent exudate, which must be controlled to prevent other skin issues.
The role of nutrition in successful wound closure cannot be overemphasized. After surgery, a patient’s nutritional level can decrease significantly, requiring nutritional supplements to ensure protein/caloric needs are met.
As with any difficult case, treatment success can depend on a team approach. The roles of dietitians, nursing, and therapy are vital in assisting the physician to determine the appropriate course of action. Dehisced wounds pose many challenges to even the experienced practitioner but can be managed with the appropriate interventions and modifications to the patient’s care plan.
Pearls for Practice is made possible through the support of Ferris Mfg. Corp, Burr Ridge, IL (www.polymem.com). The opinions and statements of the clinicians providing Pearls for Practice are specific to the respective authors and are not necessarily those of Ferris Mfg. Corp., OWM, or HMP Communications.
This article was not subject to the Ostomy Wound Management peer-review process.