What are the causes and management of surgical wound dehiscence (swd)?

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Last updated: April 6, 2025 • View editorial policy

From the Guidelines

Surgical wound dehiscence should be managed based on the extent of dehiscence, with superficial cases treated with wound cleaning and dressing changes, and deeper cases requiring surgical consultation for possible reclosure or negative pressure wound therapy, as recommended by the most recent guidelines 1.

Management of Surgical Wound Dehiscence

The management of surgical wound dehiscence depends on the extent of dehiscence and the presence of infection.

  • For superficial dehiscence with no infection, the wound should be cleaned with normal saline or a mild antiseptic solution like chlorhexidine 0.05% twice daily, and a non-adherent dressing such as petroleum-impregnated gauze should be applied, with dressings changed daily.
  • For infected wounds, wound cultures should be obtained, and appropriate antibiotics should be administered, such as cephalexin 500mg four times daily for 7-10 days for mild infections, with consideration of more frequent dressing changes.
  • Deep or extensive dehiscence requires surgical consultation for possible reclosure or negative pressure wound therapy.

Prevention of Surgical Wound Dehiscence

To prevent surgical wound dehiscence, it is essential to:

  • Use antibiotic-coated sutures, which have been shown to reduce the rate of surgical site infections in emergency settings 1.
  • Avoid the use of retention sutures routinely, as there is currently no high-quality evidence to suggest that they decrease the incidence of wound dehiscence, although they may be considered in patients with high-risk conditions for incisional hernia and wound dehiscence.
  • Ensure proper wound care, including cleaning and dressing changes, and promote healing with nutritional support and vitamin C supplementation.

Risk Factors for Surgical Wound Dehiscence

Surgical wound dehiscence can occur due to various factors, including:

  • Infection
  • Poor surgical technique
  • Excessive wound tension
  • Malnutrition
  • Diabetes
  • Steroid use
  • Premature suture removal Patients should be aware of these risk factors and take steps to prevent them, such as avoiding activities that strain the wound and keeping the area clean and dry.

From the Research

Risk Factors for Surgical Wound Dehiscence

  • Obesity and wound infection are common risk factors associated with surgical wound dehiscence, particularly in abdominal surgery 2
  • There is a lack of reporting on variables associated with surgical wound dehiscence in other surgical domains, as well as a lack of risk assessment tools 2
  • The definition of surgical wound dehiscence is not clearly defined in the literature, making it challenging to identify at-risk patients 2

Prevention and Management of Surgical Wound Dehiscence

  • A skin-stretching wound closure system can be used to prevent and manage dehiscence of high-tension flap donor sites, promoting primary intention healing and good cosmetic outcomes 3
  • Negative pressure wound therapy (NPWT) may play a role in preventing or treating wound infections by increasing wound penetration of antibiotics 4
  • Antibiotic prophylaxis can reduce the incidence of surgical wound infection, with the choice of antibiotic depending on the nature of the operation 5, 6

Antibiotic Prophylaxis

  • Cefazolin is recommended for prophylaxis of postoperative infections in aseptic (clean) operations due to its excellent pharmacokinetics and activity against gram-positive pathogens 5
  • A cefotaxime-generation cephalosporin is the agent of choice for operations where violation of the digestive tract creates a contaminated field 5
  • The timing of antibiotic administration is critical, with the first dose given before the procedure and readministration at one to two half-lives of the antibiotic as needed 6

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.