WARNING – GROSS PICTURE BELOW
You probably know what this is, but can you spell it? What are risk factors for it? And how do you manage it?
Think about it for a minute and then scroll down for the answer.
Answer: Wound dehiscence with evisceration (the bulge from the wound at the 1:00-2:00 position is bowel)
A good nursing article about wound dehiscence is here.
The following are excerpts about wound dehiscence taken from Sabiston’s Textbook of Surgery, 18th ed.
Wound dehiscence occurs in approximately 1% to 3% of patients who undergo an abdominal operation – usually 7 to 10 days postop.
It may be related to technical errors in placing sutures too close to the edge, too far apart, or under too much tension.
A deep wound infection is one of the most common causes of localized wound separation.
Many factors contribute to wound dehiscence including technical errors in fascial closure, emergency surgery, advanced age, wound infection, obesity, chronic steroid use, previous wound dehiscence, malnutrition, radiation therapy, and other systemic diseases such as diabetes or renal failure.
Dehiscence may occur without warning. Evisceration, such as in this case, makes the diagnosis obvious. Serosanguinous drainage precedes wound dehisence in 25% of patients. Probing the wound with a sterile, cotton-tipped applicator or gloved finger may also detect the dehiscence.
Treatment depends on the extent of fascial separation and the presence of evisceration or significant intra-abdominal contamination (intestinal leak, peritonitis). A small dehiscence may be managed by packing the wound with saline-moistened gauze and using an abdominal binder. If evisceration occurs, cover the intestines with a sterile, saline-moistened towel and contact the surgeon immediately. The patient will require urgent surgical closure of the wound.
Management of wound dehiscence may involve placing absorbable mesh, skin grafts, and/or flaps to reconstruct the abdominal wall.
Wound vacuums remove interstitial fluid, lessen bowel edema, decrease wound size, reduce bacterial colonization, increase perfusion, and improve healing. Successful closure of the fascia can be achieved in 85% of cases of abdominal wound dehiscence.