What is the management for a dehiscence (wound separation) following suture removal?

Management of Wound Dehiscence Following Suture Removal

If wound dehiscence occurs after suture removal, immediately assess for infection signs and resuture the wound if the edges can be approximated, while considering the use of absorbable subcuticular sutures or adjunctive negative pressure therapy to prevent recurrence. 1, 2

Immediate Assessment

When dehiscence follows suture removal, perform a focused examination looking for:

• Signs of infection: erythema, warmth, purulent drainage, increased pain, or systemic signs (fever, elevated white blood cell count) 2
• Wound characteristics: depth of separation, ability to approximate edges, presence of tissue necrosis 1
• Timing context: dehiscence occurring within days of suture removal suggests premature removal or inadequate wound tensile strength 3

Primary Management Algorithm

For Clean, Non-Infected Dehiscence:

• Resuture the wound immediately if edges can be approximated without excessive tension 4
• Use interrupted sutures with 5-0 or 6-0 monofilament non-absorbable sutures (nylon or polypropylene) for facial wounds 1
• Consider layered closure starting with deeper layers if the dehiscence extends beyond superficial tissue 1
• Apply a bandage contact lens or protective dressing for specialized wounds (e.g., corneal procedures) 5

For Infected or Contaminated Dehiscence:

• Remove any remaining retained suture material immediately, as this significantly increases infection risk 2
• Obtain Gram stain and culture of any purulent drainage 2
• Initiate antibiotic therapy active against Staphylococcus aureus, including MRSA coverage if risk factors are present 2
• Perform incision and drainage if abscess formation is present around retained sutures; do not attempt needle aspiration 2
• Do not pack the wound after drainage, as this causes more pain without improving healing 2

Prevention of Recurrent Dehiscence

The key insight from high-quality evidence is that the type of suture material and timing of removal are critical factors:

• Absorbable subcuticular continuous sutures (4-0 poliglecaprone or polyglactin) reduce superficial wound dehiscence by 92% (RR 0.08; 95% CI 0.02 to 0.35) compared to non-absorbable interrupted sutures 3
• These absorbable sutures retain 50-75% of original tensile strength after 1 week, providing continued wound support after the critical early healing period 3
• Non-absorbable sutures should be removed at 5-7 days for facial wounds and 7-9 days for other locations to minimize scarring while ensuring adequate healing 1, 2

When Resuturing After Dehiscence:

• Strongly consider using absorbable subcuticular sutures instead of non-absorbable sutures to eliminate the need for future removal and reduce re-dehiscence risk 3
• Use continuous non-locking suturing techniques to distribute tension more evenly across the suture line, reducing tissue edema and necrosis risk 1
• Avoid overly tight sutures that can strangulate tissue and impair healing 1

Adjunctive Therapies for High-Risk Cases

For patients at high risk of recurrent dehiscence (wide excisions, friable tissue, elderly patients):

• Negative pressure wound therapy (e.g., Prevena™ system at -125 mmHg) can be applied directly over the resuture line for 7-8 days to hold edges together, remove exudates, and protect from contamination 6
• Triclosan-coated sutures significantly reduce surgical site infection prevalence compared to non-coated sutures 2
• Autologous micro-grafts may be considered for elderly patients with dehisced wounds, showing complete remission within 30 days in small case series 7

Post-Repair Management

• Keep wounds clean and dry for the first 24-48 hours 1
• For facial wounds, use chlorhexidine 0.12% rinses twice daily for lip lacerations to reduce bacterial load 1
• Monitor closely for infection signs: increasing pain, redness, swelling, or purulent discharge 1
• Pain disproportionate to injury severity may suggest deeper complications requiring urgent evaluation 1

Critical Pitfalls to Avoid

• Do not use adhesive steri-strips routinely after resuturing, as evidence shows no improvement in cosmetic outcomes or scar width when added to buried dermal sutures 1
• Do not leave any superficial or exposed suture material, as this significantly increases infection risk 2
• Do not remove sutures prematurely (before 5-7 days for facial wounds); the original dehiscence likely resulted from inadequate wound tensile strength at the time of removal 3, 1
• Do not attempt conservative management alone for significant dehiscence; resuturing is required for optimal outcomes 4