SN5 SHORT NOTE 5M

Wound Dehiscence

General Surgery · Final Professional

What It Is

Wound dehiscence is the separation of the layers of a surgical wound before it has healed. When this happens to an abdominal wound and is complete, so that abdominal contents protrude, it is called a burst abdomen — a surgical emergency that classically occurs around the 5th to 10th postoperative day, when the wound is at its weakest (the initial clot has been removed but new collagen has not yet gained strength).

The Warning Sign — and WHY It Matters

CLINICAL PEARL

Clinical pearl: The classic herald of an impending burst abdomen is a sudden discharge of pink, serosanguinous ('salmon-coloured') fluid from the wound. Understanding it is important: this is peritoneal fluid leaking to the surface because the deep fascial and muscle layers have already given way, even though the skin sutures are still holding the wound superficially closed. In other words, the wound has burst on the inside before it looks open on the outside — so this discharge demands urgent action, not reassurance.

Causes

The causes are best grouped by timing.
Pre-operative (host) factors that weaken healing include malnutrition, anaemia, diabetes, obesity, malignancy, jaundice and steroids.
Operative factors are technical — poor suture technique, inappropriate suture material, or a badly placed incision.
Post-operative factors are those that stress the wound or impair healing — raised intra-abdominal pressure (persistent cough, abdominal distension, ileus, straining), wound infection, and haematoma.

Management

When a burst abdomen occurs, the steps follow common sense: reassure the patient (it is frightening), cover the wound and any protruding bowel with sterile gauze soaked in warm saline — this keeps the bowel moist and reduces contamination while awaiting theatre — resuscitate, and take the patient to the operating theatre for re-suture using a mass-closure technique with strong, deep (tension) sutures that take large bites of the full thickness of the abdominal wall. Any infection is treated and the predisposing factors are corrected.

Pink serosanguineous discharge precedes dehiscence by a day or two.

Factor group	Examples
Preoperative	Malnutrition, anaemia, jaundice, diabetes, steroids, malignancy
Operative	Poor closure technique, wrong suture, tight sutures
Postoperative	Cough, vomiting, distension, wound infection

KEY POINT

Key points TO remember

Dehiscence = wound layers separate before healing; burst abdomen = complete abdominal wound failure with viscera protrusion (day 5–10).
Pink serosanguinous discharge is the warning sign — deep layers have given way though skin still holds.
Causes: host (malnutrition, diabetes, malignancy), technique, and post-op raised intra-abdominal pressure/infection.
Cover with warm saline-soaked gauze, resuscitate, re-suture with mass closure/tension sutures.

EXAM TIP

Sources: Bailey & Love's Short Practice of Surgery; SRB's Manual of Surgery.

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