Wound Dehiscence

AnthonyTheEmt

AnthonyTheEmt

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Has anyone ever heard this term before? I picked up a pt last night who recently had abd surgery to remove part of his cancerous colon, and had his surgical site reopen when he was at home doing stuff. The RN used this term "dehiscence wound". I have never heard this before, and didn't realize how serious it is. I dont have a lot of experience and am still learning, but part of me thinks I shouldve known better. Has anyone else ever had one, and other than driving fast, what did you do?
 
Yes. It's like an eviscerated bowel. I had a patient, who was at a skilled nursing facility and had recent abdominal surgery, have his wound dehisce. Not a pretty sight. I covered it with a moist dressing, started a line, covered him with a blanket and drove fast. He expired later that night. MODS secondary to sepsis.
 
Yep, I've heard of it. Don't feel bad that you hadn't; you'll pick up tons of verbage and lingo as you trudge along and gain experience. :) Was there a drain placed?
 
It isn't that big of a deal. In n7's case the patient likely died due to sepsis and not a dehiscence (hell in light of the sepsis it was probably a good thing as it would provide an avenue for drainage). We saw it frequently in obese patients, just a quick take back to throw some retention sutures, then re-close the layers. Pre-hospital not a lot to do if it is just an isolated open wound.
 
This guy had a rather large incision and his guys were basically outside.
 
AnthonyTheEmt said:
Has anyone ever heard this term before? I picked up a pt last night who recently had abd surgery to remove part of his cancerous colon, and had his surgical site reopen when he was at home doing stuff. The RN used this term "dehiscence wound". I have never heard this before, and didn't realize how serious it is. I dont have a lot of experience and am still learning, but part of me thinks I shouldve known better. Has anyone else ever had one, and other than driving fast, what did you do?
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I have treated them on multiple occasions. You have to remargin and close the wound. It is a surgery thing. Not much for EMS.
 
Veneficus said:
I have treated them on multiple occasions. You have to remargin and close the wound. It is a surgery thing. Not much for EMS.
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How do you pronounce the word?
 
Dwindlin said:
It isn't that big of a deal. In n7's case the patient likely died due to sepsis and not a dehiscence (hell in light of the sepsis it was probably a good thing as it would provide an avenue for drainage). We saw it frequently in obese patients, just a quick take back to throw some retention sutures, then re-close the layers. Pre-hospital not a lot to do if it is just an isolated open wound.
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From a quality of care level it is a big deal. Wound dehiscence is one of the quality indicators that CMS uses. As a result increased numbers of them generally reflects inadequate care, in their eyes (aka an area where improvement is needed) as they are considered somewhat preventable.


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and de-hiss-ence is the way I always heard it pronounced when I worked in patient safety.
 
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Dehiscence is a generic term for the re-opening of a healing wound, but especially one which has been addressed and closed by medical personnel.

The issues with a bowel resection dehiscence are with the bowel itself (did the anastamosis dehisce? Then it's an open intestine leaking whatever out), or was it the abdominal wall (and you can have a few payers to dehisce there, but you wouldn't know an inner one had dehisced until/unless external signs were there such as herniation, bruising, hematoma, or signs of hidden infection). Oh, yes, and pain.
 
mycrofft said:
Dehiscence is a generic term for the re-opening of a healing wound, but especially one which has been addressed and closed by medical personnel
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Anthony, I think that (above) is the main information you were looking for. The wound won't heal in the preferred way (referred to as "primary intention") if the edges aren't closed together and can lead to complications.
 
All it means is that a surgical wound that was held together by stiches or staples came apart. It doesn't necessarily mean anything major is going to happen like guts hanging out (though that could happen), it just refers to the actual sugcal incision not being together to heal and close up,
 
AnthonyM83 said:
Anthony, I think that (above) is the main information you were looking for. The wound won't heal in the preferred way (referred to as "primary intention") if the edges aren't closed together and can lead to complications.
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A "secondary intention" is when you encourage wound healing by combatig infection and bandaging to encouage the formation of granular then scar tissue to fill the wound up and grow together, and trying to avoid just getting a thin tissue paper-like epithelialization roofing it over and letting the anaerobes play underneath.

Dehiscences can be tricky and the are NO fun for the patient.
 
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