Wound Dehiscence: Symptoms, Types, Causes and Treatment

Wound dehiscence is a potentially serious complication where a surgical or traumatic wound reopens along its sutured line. This breakdown of the wound can lead to delayed healing, infection, and in severe cases, life-threatening complications. Understanding the signs, types, causes, and modern management of wound dehiscence is crucial for both patients and healthcare professionals to ensure timely intervention and optimal outcomes.

Symptoms of Wound Dehiscence

Wound dehiscence often presents with distinctive symptoms that may vary depending on the wound’s location, depth, and underlying causes. Early recognition of these symptoms is essential for prompt management and prevention of further complications.

Symptom	Description	Frequency/Context	Source(s)
Wound Opening	Visible separation of wound edges	Most common, in both abdominal and perineal wounds	1, 5
Discharge	Purulent or serous fluid leaking	Frequently seen, may indicate infection	1, 2, 5
Pain	Localized pain around the wound	Common, sometimes with discharge	1, 5
Redness/Swelling	Inflammation at wound site	May accompany infection or stress	5, 6
Tissue Exposure	Internal tissues/organs visible	Severe cases, especially abdominal	7, 11
Delayed Healing	Slow or absent wound closure	Chronic or complicated wounds	1, 9

Table 1: Key Symptoms of Wound Dehiscence

Wound Opening and Tissue Separation

The hallmark symptom of dehiscence is the physical separation of wound edges. This can manifest as a small gap or, in severe cases, complete opening exposing deeper tissues or even organs, particularly in abdominal wounds (“burst abdomen”) 5 7 11. In obstetric wounds, such as perineal tears after childbirth, the separation is often complete and may require re-suturing 1.

Discharge and Signs of Infection

Purulent (pus-like) or serous (clear/yellow) discharge is a frequent sign of wound dehiscence and often indicates infection. In some studies, up to 22% of dehisced wounds had purulent discharge, and many patients reported both discharge and pain 1. Redness, swelling, and warmth around the wound are other indicators of infection or inflammation 5 6.

Pain and Local Discomfort

Pain is a common symptom, particularly when associated with infection or tissue stress. Persistent or increasing pain at the wound site should always prompt further evaluation 1 5.

Delayed Healing and Chronic Symptoms

Some wounds may not fully separate but instead fail to heal, remaining open for weeks. Chronic non-healing wounds can lead to granulation tissue, scar formation, and sinus tract development 1 9.

Types of Wound Dehiscence

Wound dehiscence can be classified based on the depth, location, and the extent of tissue separation. Knowing the types helps guide appropriate intervention and risk assessment.

Type	Description	Typical Location	Source(s)
Superficial	Involves only skin and subcutaneous tissue	Any surgical wound	1, 5
Partial	Some, but not all, layers separate	Surgical incisions	5, 11
Complete (Total)	All layers open; possible organ exposure	Abdominal wounds	7, 11
Fascial	Involves the fascia, sometimes muscle	Abdominal, orthopedic	2, 6, 11
Perineal	Dehiscence after obstetric procedures	Perineum (vaginal/obstetric)	1, 4

Table 2: Common Types of Wound Dehiscence

Superficial vs. Deep Dehiscence

• Superficial dehiscence affects only the skin and subcutaneous tissue. While less dangerous, it can still be uncomfortable and delay healing 5.
• Partial dehiscence occurs when only some layers of the wound separate. These cases may not expose internal organs but can progress if not treated 5 11.
• Complete dehiscence (or evisceration) involves all layers of the wound opening, sometimes allowing internal organs to protrude. This is a surgical emergency, most often seen in abdominal cases 7 11.

Fascial Dehiscence and Burst Abdomen

Fascial dehiscence specifically refers to the separation of the deeper connective tissue (fascia) that holds muscles and organs in place. This is most commonly seen in abdominal surgeries and is associated with high morbidity and mortality. When the wound opens entirely, exposing bowels or viscera, it’s known as a “burst abdomen” 2 6 7 11.

Perineal and Other Site-Specific Types

Perineal wound dehiscence is frequently observed after obstetric procedures such as episiotomies or repairs for perineal tears. These wounds can separate completely and often require secondary suturing 1 4.

Causes of Wound Dehiscence

Wound dehiscence is multifactorial, often resulting from a combination of patient-related and technical factors. Understanding these causes is key to prevention and management.

Cause	Mechanism/Explanation	Level of Impact	Source(s)
Infection	Delays healing, weakens wound	Major, common	2, 5, 6
Pressure Necrosis	Suture tension cuts through tissue	Primary technical cause	3
Poor Surgical Technique	Inadequate closure or suture technique	Significant	3, 5, 6
Older Age	Reduced tissue healing capacity	High-risk group	2, 5, 6
Malnutrition/Hypoproteinemia	Impaired collagen synthesis	Major systemic factor	2, 6
Emergency Surgery	Less optimal conditions, higher infection risk	Increased risk	5, 6
Comorbidities (e.g., diabetes, uremia, malignancy, steroid use, hypertension)	Impaired healing processes	Contribute to risk	2, 5, 6
Mechanical Stress	Coughing, vomiting, increased intra-abdominal pressure	Frequently implicated	5, 6

Table 3: Major Causes of Wound Dehiscence

Infection

Infection is a leading cause of wound dehiscence. Bacterial contamination delays healing by destroying newly formed tissue and weakening the wound’s structural integrity. Both superficial and deep infections can contribute, and the presence of discharge or redness is often an early warning sign 2 5 6.

Pressure Necrosis and Suture Technique

Pressure necrosis from overly tight sutures is a critical technical factor. Excessive tension causes tissue to die and break down, undermining the wound’s ability to stay closed. Proper suture technique—using wide bites, appropriate spacing, and measured tension—can dramatically reduce risk 3.

Patient-Related Risk Factors

• Older age: Patients over 65 have a higher risk of dehiscence due to decreased tissue elasticity and slower healing 2 5 6.
• Nutritional status: Hypoproteinemia (low protein) and malnutrition impair the body’s ability to synthesize collagen, essential for wound strength 2 6.
• Comorbid conditions: Chronic diseases (e.g., diabetes, uremia, malignancy), steroid use, hypertension, and systemic infections all raise the risk by compromising healing 2 5 6.

Surgical and Postoperative Factors

• Emergency surgeries are associated with higher risk due to less meticulous technique and increased contamination 5 6.
• Mechanical stress on the wound (from coughing, vomiting, or physical strain) further jeopardizes wound integrity 5 6.
• Improper aseptic precautions and poor surgical technique also contribute significantly 5 6.

Cumulative Risk

Studies show that the risk increases with the number of contributing factors; patients with more than eight risk factors had universal dehiscence, and those with more than ten risk factors had 100% mortality 2.

Treatment of Wound Dehiscence

Timely and effective treatment is essential to restore wound integrity, prevent infection, and minimize complications. Management strategies vary depending on the type and severity of dehiscence.

Treatment	Approach/Technique	Outcomes/Benefits	Source(s)
Early Re-suturing	Prompt surgical closure	Faster healing, fewer complications	1, 5
Conservative Management	Dressings, wound care, observation	Used for superficial/minor cases	1, 7
Vacuum-Assisted Closure (VAC/NPWT)	Negative pressure therapy	Promotes healing, reduces infection	7, 8, 10
Synthetic Mesh Repair	Mesh reinforcement of wound	Lowers hernia rates, stable closure	11
Autologous Micro-Grafts	Application of patient’s own cells	Accelerates healing, promising for chronic wounds	9
Secondary Intention Healing	Allowing wound to heal naturally	Option when closure not possible	7, 9

Table 4: Main Treatment Approaches for Wound Dehiscence

Early Re-suturing and Surgical Closure

Early re-suturing is often recommended for complete or significant wound separations, especially in perineal or abdominal wounds. Prompt closure leads to faster healing, fewer follow-up visits, and minimal complications compared to delayed or conservative treatments. In a 13-year review, nearly half of patients healed within four weeks after early re-suturing 1 5.

Conservative Management

Not all dehiscences require immediate surgical intervention. Superficial separations may be managed with local wound care, dressings, and monitoring, particularly if infection is controlled and the wound is small 1 7.

Negative Pressure Wound Therapy (NPWT/VAC)

Negative pressure wound therapy (NPWT), also known as vacuum-assisted closure (VAC), has revolutionized the management of dehisced wounds, especially in high-risk or non-healing cases. NPWT accelerates granulation tissue formation, reduces infection rates, and can decrease the length of hospital stay. Meta-analyses confirm its efficacy in both open and closed surgical wounds, with significant reductions in infection and dehiscence rates 7 8 10.

Mesh Reinforcement and Fascial Closure

In large or fascial dehiscences—particularly of the abdominal wall—the use of synthetic mesh is increasingly favored. Mesh repair offers a lower rate of incisional hernia compared to primary suture closure, with similar infection rates. This is especially important in patients at high risk of recurrence 11.

Advanced and Emerging Therapies

• Autologous micro-grafts: Harvesting and applying the patient’s own progenitor cells to the wound can expedite healing in chronic or recalcitrant cases. Early results are promising, with wounds closing within a month of treatment 9.
• Secondary intention healing: In some cases, especially where infection or tissue loss is extensive, the wound may be left open to heal naturally over time, sometimes aided by skin grafts or flaps 7 9.

Complications and Follow-Up

Complications such as skin dehiscence, granuloma, scar tissue, pain, or sinus formation may occur but are typically manageable with conservative or minor surgical interventions. Most patients require only a few outpatient follow-ups post-intervention 1.

Conclusion

Wound dehiscence is a multifaceted complication that requires vigilance, prompt recognition, and a tailored management approach to ensure optimal patient outcomes. By understanding its symptoms, types, causes, and treatments, healthcare professionals can minimize risks and improve healing trajectories.

Main Points to Remember:

• Recognize Early Signs: Look for wound separation, discharge, pain, and delayed healing.
• Know the Types: Superficial, partial, complete (with possible organ exposure), fascial, and site-specific (e.g., perineal) dehiscence each require different approaches.
• Identify Causes: Infection, pressure necrosis, poor nutrition, comorbidities, and technical factors are central contributors.
• Act Promptly: Early re-suturing, NPWT, mesh reinforcement, and innovative therapies like micro-grafts are effective, with management tailored to wound severity and patient risk factors.
• Prevent Complications: Address underlying risk factors, use correct surgical techniques, and ensure proper postoperative care to reduce incidence and improve outcomes.

Being proactive and informed about wound dehiscence can make a significant difference in patient recovery and overall well-being.