Wound Dehiscence and Evisceration

Wound dehiscence is partial or complete separation of previously approximated wound edges after closure. Superficial dehiscence involves the skin or subcutaneous tissue. Fascial dehiscence means that the deeper abdominal fascial closure has separated; this is far more dangerous because the fascia provides the abdominal wall’s load-bearing strength. Evisceration occurs when intra-abdominal contents protrude through a completely disrupted abdominal wound. It is a surgical emergency. The exposed bowel can become dry, contaminated, compressed, or ischemic, and the open abdominal defect can rapidly contribute to fluid loss, infection, and physiologic collapse. During early healing, newly deposited collagen has not yet produced the strength of mature scar tissue. The fascial closure is therefore vulnerable to two opposing problems: the tissue may not be strong enough, or mechanical forces may suddenly exceed the closure’s strength. Coughing, vomiting, straining, abdominal distention, and difficult pulmonary secretions increase intra-abdominal pressure. Infection, tissue ischemia, impaired perfusion, malnutrition or hypoalbuminemia, diabetes or poor glycemic control, smoking, obesity, corticosteroid exposure, anemia, pulmonary disease, and emergency surgery can weaken the repair or impair collagen formation. The skin may appear nearly closed...