Wound Dehiscence

The Concept

Wound dehiscence is the partial or complete separation of the layers of a surgical wound. When an abdominal wound disrupts completely and the abdominal contents protrude, it is called a 'burst abdomen' — a dramatic and serious complication, typically occurring around the fifth to tenth postoperative day.

Herald Sign & Causes

A characteristic warning sign is the discharge of serosanguinous ('pink', salmon-coloured) fluid from the wound a day or two before it bursts. The causes combine patient factors — malnutrition, obesity, diabetes, steroids, malignancy, jaundice, old age, and raised intra-abdominal pressure (chronic cough, distension) — and local factors (wound infection), together with technical factors (poor closure technique).

Management

A burst abdomen is a surgical emergency: the exposed viscera are covered with sterile saline-soaked gauze, the patient is reassured and given analgesia, IV fluids and antibiotics, and arrangements are made to return to theatre for resuturing (a mass closure of the abdominal wall). Even after successful repair, these patients are at increased risk of a later incisional hernia.

Prevention & the Role of Mass Closure

Because a burst abdomen is serious, prevention is emphasised, and it centres on sound closure and patient optimisation. A mass closure technique (taking large bites of the whole musculo-aponeurotic layer with a suture length at least four times the wound length) distributes tension and reduces dehiscence, as does preventing wound infection and optimising the patient (nutrition, diabetic control, treating a chronic cough). When dehiscence does occur, prompt recognition of the herald pink discharge and urgent resuturing give the best outcome and reduce the later incisional-hernia burden.

The Bottom Line

Wound dehiscence, and its extreme form the burst abdomen, is heralded by a serosanguinous discharge around day 5–10 and is an emergency requiring saline-gauze cover and urgent resuturing, with infection and poor closure the key causes.

A Note on Partial VS Complete Dehiscence

It is useful to distinguish the degrees of dehiscence. A partial (incomplete) dehiscence separates the superficial layers while the deep musculo-aponeurotic layer holds, so the viscera remain covered — this may present later as an incisional hernia. A complete dehiscence disrupts all layers, producing the burst abdomen with protruding viscera that is the emergency. Recognising that a superficial breakdown, though less dramatic, still signals a weak repair helps anticipate the later hernia and informs follow-up.

Pink serous discharge is the herald sign, days before dehiscence.

• Wound dehiscence = separation of the layers of a surgical wound; 'burst abdomen' = complete disruption with protrusion of viscera (usually day 5–10).
• Herald sign: serosanguinous ('pink'/salmon) discharge before it bursts.
• Causes: patient factors (malnutrition, obesity, diabetes, steroids, malignancy, jaundice, raised intra-abdominal pressure) + infection + poor technique.
• Emergency: cover viscera with saline-soaked gauze, IV fluids/analgesia/antibiotics, urgent return to theatre for resuturing (mass closure); later incisional hernia risk.