Management of Dehisced Wound
Immediately irrigate the wound with copious sterile saline or clean tap water, reapproximate the skin edges without suturing, apply a non-adherent dressing, and monitor closely for infection over 24-48 hours. 1
Immediate Assessment and Initial Management
Do not resuture the wound immediately. 1 The critical first step is wound preparation:
- Irrigate copiously with sterile saline or clean tap water to remove debris and reduce bacterial burden 1
- Reapproximate skin edges using Steri-Strips or similar tension-free methods—avoid placing new sutures at this stage 1
- Apply non-adherent dressing to protect the wound while allowing drainage 1
- Avoid aggressive cleansing with antiseptics or antimicrobial dressings unless clear infection is present 1
Critical Infection Assessment (Within 24-48 Hours)
Monitor for specific signs that indicate infection requiring intervention 1:
- Fever >38.5°C (101.3°F) or heart rate >110 bpm 1
- Expanding erythema >5 cm around the wound margins 1
- Purulent discharge with foul odor (note: clear to yellowish serous fluid is normal and expected) 1
- Severe pain disproportionate to wound appearance 1
- Secondary signs including wound bridging, undermining, pocketing, or increased warmth 2
Common pitfall: Clear serous drainage without odor is normal wound healing—do not assume infection or start antibiotics 1. Only initiate antimicrobial therapy when clinical signs of infection are present 2.
Wound Closure Strategy
Plan for delayed primary closure or healing by secondary intention rather than immediate resuturing. 1
If Wound Remains Clean (No Infection):
- Delayed primary closure may be considered after 3-5 days if the wound shows early granulation tissue and no signs of infection 1
- Continue Steri-Strip approximation without tension 1
If Any Doubt About Closure Viability:
- Manage with secondary intention healing using dressing changes every 5-7 days 1
- Consider negative-pressure wound therapy (NPWT) for appropriate dressings to reduce fluid loss, limit microbial colonization, control pain, and accelerate re-epithelialization 2
- Once fascial closure is achieved in deeper wounds, incisional NPWT on the closed incision significantly reduces wound complications including re-dehiscence 2
Critical principle: Infected wounds should never be closed, and even clean dehisced wounds should be managed conservatively initially 1. Immediate resuturing of a wound that has already failed increases infection risk and causes further tissue trauma 1.
Ongoing Wound Management
Dressing Protocol:
- Change dressings every 5-7 days if no complications arise 1
- Use appropriate moisture-control dressings (hydrogels, hydrocolloids) to promote epithelialization 2
- Consider collagen matrix dressings to reduce protease activity and promote fibroblast proliferation 2
Biofilm Considerations:
- Suspect biofilm formation if the wound fails to heal despite adequate care, shows low-level chronic inflammation, increased exudate, or poor granulation 2
- Biofilm-based wound management with pH regulation (target pH 4-6) may be beneficial using stabilized hypochlorous acid 2
Follow-Up Protocol
- Examine within 24 hours of initial presentation to assess for infection 1
- Continue monitoring for signs of clinical deterioration, extension of dehiscence, or delayed healing 2
- If wound conversion occurs (progression to deeper defect) or local sepsis develops, consider surgical debridement followed by biosynthetic xenograft or allograft closure 2
When Antibiotics Are Indicated
Do not start empiric antibiotics without clear infection signs 1. Indiscriminate prophylactic antibiotics may increase colonization with resistant organisms and Candida 2. Only institute antimicrobial therapy when: