What is the management for wound dehiscence after steri-strips removal?

Management of Wound Dehiscence After Steri-Strip Removal

When wound dehiscence occurs after steri-strip removal, immediate wound assessment and re-approximation with appropriate closure technique is required, prioritizing sutures over re-application of steri-strips or tissue adhesives alone, as sutures significantly reduce the risk of recurrent dehiscence.

Immediate Assessment and Risk Stratification

Upon discovering wound dehiscence after steri-strip removal, perform the following evaluation:

• Check for signs of infection: increasing pain, redness, swelling, warmth, purulent discharge, or foul odor 1
• Assess pain severity: pain disproportionate to the injury may indicate deeper complications such as infection or complete wound breakdown requiring urgent intervention 1
• Evaluate wound edges: determine if dehiscence is superficial (skin only) or involves deeper layers 2
• Look for systemic signs: fever, chills, or red streaks extending from the wound indicate need for immediate medical attention 1

Primary Management Strategy

For Clean, Non-Infected Dehiscence

Re-closure with sutures is the definitive approach, as evidence demonstrates sutures are significantly superior to tissue adhesives for preventing wound breakdown (RR 3.35; 95% CI 1.53-7.33) 3. The number needed to treat for an additional harmful outcome (dehiscence) with tissue adhesives versus sutures is 43 3.

• Use subcuticular continuous sutures when possible, as this technique reduces superficial wound dehiscence compared to interrupted stitches (RR 0.08; 95% CI 0.02 to 0.35) 4
• Preferred suture materials: 4-0 poliglecaprone or 4-0 polyglactin, which retain 50-75% of original tensile strength after 1 week in situ, providing extended wound support 4
• Do not rely on steri-strips alone for re-closure, as they do not reduce the incidence of surgical site infection or provide adequate tensile strength for dehisced wounds 4

For Infected or Contaminated Dehiscence

• Bedside wound debridement under local anesthesia is safe, effective, and well-tolerated, with similar success rates to conventional operating room revision under general anesthesia, while offering reduced costs and shorter antibiotic courses 5
• Surgical debridement in operating room remains appropriate for extensive dehiscence, systemically ill patients, or when bedside management fails 5
• Initiate appropriate antibiotic therapy based on wound culture results or empiric broad-spectrum coverage pending cultures 5

Post-Closure Care Protocol

Immediate Post-Repair Period (First 24-48 Hours)

• Keep wound completely dry to allow proper adhesion and initial healing 1
• Avoid submerging in water; brief showers may be acceptable after 24 hours only if the area can be kept dry 1
• Do not apply ointments, creams, or lotions over or near the closure site, as these can compromise healing 1

Duration of Wound Protection

• Facial wounds: maintain closure for 5-7 days due to excellent blood supply and rapid healing 1
• Trunk, arms, or legs: maintain closure for 10-14 days, with high-tension areas requiring the full 14 days 1

Activity Modifications

• Avoid activities that place tension on the wound or cause excessive sweating for at least the first week 1
• Elevate the injured body part if swollen to accelerate healing 1

Risk Factor Identification for Recurrent Dehiscence

The following factors significantly increase risk of wound dehiscence and warrant consideration of internal retention sutures or enhanced closure techniques:

• Metabolic factors: hypoalbuminemia, anemia, malnutrition 6
• Comorbidities: chronic lung disease 6
• Postoperative complications: vomiting, prolonged intestinal paralysis, repeated urinary retention, increased coughing 6
• Risk stratification: patients with three or more risk factors should receive internal retention sutures for primary closure 6

Common Pitfalls to Avoid

• Do not remove closure materials too early, as premature removal causes wound dehiscence due to inadequate tensile strength 1
• Do not re-apply steri-strips as the sole management for dehisced wounds, as they provide insufficient mechanical support 4
• Avoid excessive suture tension, as pressure necrosis from sutures is the primary cause of wound dehiscence; use measured tension (approximately 300g) rather than excessive tightening 7
• Do not delay seeking medical attention if infection signs develop, as early intervention prevents progression to systemic complications 1

Daily Monitoring Requirements

• Inspect wound daily for signs of infection, increasing separation, or drainage 1
• Monitor pain levels: increasing pain after the first 2-3 days suggests complications requiring medical evaluation 1
• Check for wound edge separation: early detection allows prompt intervention before complete dehiscence occurs 1