What is the difference between wound dehiscence and wound evisceration?
What is wound dehiscence?
Wound dehiscence is the separation of wound edges at the suture line. A healthy, healing wound should be well-approximated, meaning that the edges meet neatly and are held closely together by sutures, staples or another method of closure. A wound is at the greatest risk of dehiscence in the first 6-8 days after surgery, when the wound is still fresh and very fragile. In all cases dehiscence should be reported to the surgeon.
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What causes wound dehiscence?
1. A sudden increase in abdominal pressure. This is due to coughing, sneezing, vomiting, bearing down to have a bowel movement or lifting a heavy object, causes an abdominal wound to open.
2. Infection. The infection delays healing and can also weaken the newly formed tissue as the body works to close the incision.
3. Malnutrition. A patient who is malnourished or unable to eat may not be able to heal their wound quickly.
4. Obesity. Obese patients are more likely to have problems with wound closure and healing, as the wound has more difficulty closing and the healed incision must be stronger to support the additional weight of the fatty tissue.
What is wound evisceration?
Wound evisceration is the protusion of the internal organs (usually abdominal) through an incision. Evisceration is a rare but severe surgical complication, it is an emergency and should be treated immediately.
What to do if evisceration occurs at home?
1. Call 911 or go to the nearest hospital.
2. Cover the opening and organs with cleanest WET sheet or bandage to prevent it from adhering to tissue and also prevent infection. Sterile saline should be used but if not, bottled or tap water is used.
3. Calm down and seat low or lie down to prevent abdominal tension.
Section for Nurses:
WOUND DEHISCENCE
Assessment:
-Increased drainage.
-Opened wound edges.
-Appearance of underlying tissues through the wound.
Interventions:
-Place the patient in a low-fowler's position with the knees bent to prevent abdominal tension on an abdominal suture line.
-Notify the physician.
-Prevent wound infection through strict asepsis.
-Administer antiemetics as prescribed to prevent vomiting and further strain on the abdominal incision.
-Instruct the patient to splint the abdominal incision when coughing.
WOUND EVISCERATION
Assessment:
-Discharge of serosanguineous fluid from a previously dry wound.
-The appearance of loops of bowel or other abdominal contents through the wound.
-Patient reports feeling a popping sensation after coughing or turning.
Interventions:
-Place the patient in a low Fowler's position with the knees bent to prevent abdominal tension.
-Cover the wound with a sterile normal saline dressing.
-Notify the physician.
-Prevent wound infection through strict asepsis.
-Administer antiemetics as prescribed to prevent vomiting and further strain on the abdominal incision.
-Instruct the patient to splint the abdominal incision when coughing.
-Monitor signs and symptoms of shock.
References:
Saunders Comprehensive review for the NCLEX-RN examination
http://surgery.about.com/od/aftersurgery/ss/DehiscenceEvisc.htm
