Surgical wound dehiscence

Despite advances in preoperative care, the rate of surgical wound dehiscence has not decreased in recent years; 1%-3% of patients experience wound dehiscence. A nursing goal for the postoperative patient is always prevention of wound dehiscence. Recognition of risk factors is essential. For example, older males with ascites are at very high risk. Prevention of wound infection and mechanical stress on the incision are important. Management of dehisced wounds may include immediate surgery if bowel is protruding from the wound. If surgery is not needed, management is essentially the same as that of any other wound through maintenance of a moist wound environment, reduction of bioburden and pain, and promotion of granulation tissue. Mortality rates associated with dehiscence have been reported between 14% and 50% (Hanif et al., 2000; Waqar et al., 2005). One of the complications (morbidity) of dehisced wounds is an incisional hernia, which develops in an estimated 43% of patients (van't et al., 2004). Researchers followed 126 patients who had wound dehiscence repair for a mean of 37 months and found that 31% of the hernias were diagnosed more than 2 years postoperatively. Nurses need to ensure adequate nutrition and reduced tension on the abdomen, and implement measures to prevent incisional infections.