Internal Vs. External Wound Dehiscence

Wounds that don't heal.

It can be very concerning when a wound does not appear to be healing, particularly post-surgery. Dehiscence is the separation of a surgical incision or premature rupture of a wound closure, and it can range in severity from being a nuisance to life-threatening. Dehiscence usually results from poor wound healing and is common in patients with diabetes and/or vascular disease (poor blood circulation), although it can happen to anyone. Wound dehiscence can be classified as external (outer tissues) or internal (inner tissues).

External Dehiscence

External dehiscence is more common and less serious than internal dehiscence. This type of tissue separation involves only the outer tissues, such as mucosa, skin, the cornea or subcutaneous tissues (just below the skin). It may result from irritation at a suture site or in combination with a deeper wound separation. By itself, external dehiscence may not require treatment unless there are complicating factors such as patient non-compliance (refusal to follow doctor's orders) or if the location of the wound predisposes it to infection. External dehiscence also is referred to as superficial wound dehiscence.

Internal Dehiscence

Internal dehiscence is a more serious post-surgical complication than external dehiscence. As the name implies, it involves the separation of internal tissues such as fascia, muscle, ligament or even an internal organ. Such wounds are at high risk for infection, and it is important for the patient to seek proper treatment to prevent this. All dehisced wounds are slower to heal than wounds that remain closed, so they may require several visits to the doctor or a wound treatment center. Home health care agencies also may be employed for in-home wound care for those patients who require it.

Who's at Risk?

What's your risk of wound dehiscence? question box image by Pete Linforth from Fotolia.com

Dehiscence can happen to anyone, but some patients are at higher risk. Non-compliant patients are at the top of that list. It is very important to follow wound care instructions regarding bandage changes and getting the incision site wet. Patients with underlying illnesses that interfere with healing--such as diabetes, peripheral vascular disease, and peripheral neuropathy--are also at risk. Medications, such as steroids or other immunosuppressives, also may interfere with healing.

Treatment

See your doctor for treatment. bandage image by lefebvre_jonathan from Fotolia.com

After sterilizing the area, your doctor will examine the wound carefully to determine the extent of the dehiscence and look for evidence of infection. If needed, he may numb the area and debride, or remove any undesired tissue. The area may be re-stitched. It usually is necessary to apply a bandage, and you should change it as the doctor directs. The doctor may prescribe pain medications or antibiotics. You may need to have regular follow-ups until the wound heals. Some cases may require skin grafting, wound-vac application or other interventions.

Prevention

Smoking interferes with wound healing. no smoking image by cate1966 from Fotolia.com

To prevent wound dehiscence, follow your doctor's post-surgical directions. Keep the incision and surrounding skin clean, changing bandages only as directed. While the incision heals, avoid activities that put stress on the area or could result in pulling the stitches. Avoid smoking and caffeine, as both can decrease blood flow to the incision site. Wash your hands regularly to help you avoid contaminating the wound. If you have questions about your health status, contact your physician directly.

References

• MedlinePlus: Surgical wound care
• ICD-9 Codes: Internal vs. External dehiscence
• Mayo Clinic: Steroids
• Wheeless Orthopedic: Surgical wound care
• NYU Langone Medical Center: Wound Dehiscence - Prevention

Resources

• PubMed: Smoking and wound healing