From the Guidelines
For wound dehiscence with steri strips, the most effective treatment is to remove any remaining strips, clean the wound gently, and apply a thin layer of antibiotic ointment, with consideration of reapplying steri strips or seeking medical attention for suturing if necessary, as supported by the general principles of wound care 1. The management of wound dehiscence involves several key steps to promote healing and prevent infection.
- Remove any remaining steri strips to assess the wound and prevent further irritation.
- Clean the wound gently with sterile saline or mild soap and water to remove any debris or bacteria.
- Apply a thin layer of antibiotic ointment like bacitracin or Neosporin to prevent infection.
- For small dehiscence (less than 2cm), new steri strips can be reapplied after cleaning, placing them perpendicular to the wound with 1/8 inch spacing between strips.
- For larger dehiscence, seek medical attention as suturing may be necessary. The use of negative-pressure wound therapy (NPWT) has been shown to be effective in reducing surgical site infections (SSI) and wound dehiscence in certain cases, as demonstrated by a meta-analysis 1. However, the application of NPWT should be considered on a case-by-case basis, taking into account the size and location of the wound, as well as the patient's overall health status. It is also important to cover the wound with a non-adherent dressing like Telfa and change it daily or when soiled, and to monitor for signs of infection including increasing redness, warmth, swelling, purulent discharge, or fever. Wound dehiscence occurs when healing tissue separates before complete healing, often due to excessive tension, infection, poor nutrition, or underlying health conditions that impair healing, and most small dehiscence wounds will heal by secondary intention if kept clean and protected, though they may result in a wider scar than wounds that heal primarily 1.
From the Research
Treatment for Wound Dehiscence
- Wound dehiscence is a serious complication that can occur after a wound is closed with Steri-Strips (adhesive skin closures) 2.
- There is limited research on the treatment of wound dehiscence specifically in wounds closed with Steri-Strips.
- However, studies suggest that negative pressure wound therapy (NPWT) can be an effective treatment for wound dehiscence, including cases with fat liquefaction and large skin necrosis 3.
- NPWT has been shown to promote wound healing and reduce the risk of complications, such as infection and amputation 4, 3.
Wound Closure Methods
- Steri-Strips are a type of wound closure method that can be used for skin closures after orthopedic surgeries 2.
- Compared to skin staples, Steri-Strips may have improved safety, comfort, cosmesis, and cost-effectiveness 2.
- However, Steri-Strips may detach from the skin during the postoperative period, and blisters may develop around the surgical incision 2.
Infection Prevention
- Topical antibiotics, such as bacitracin zinc and neomycin sulfate, can be used to prevent infections in uncomplicated soft-tissue wounds repaired in the ED 5.
- The use of topical antibiotics has been shown to result in significantly lower infection rates compared to a petrolatum control 5.
- However, the effectiveness of topical antibiotics in preventing infections in wounds closed with Steri-Strips is not well established.