Facial Dehiscence: Definition and Clinical Context
Facial dehiscence refers to the spontaneous or traumatic separation of a surgical wound or incision on the face, representing a postoperative complication where the wound edges pull apart before complete healing has occurred. 1
Clinical Definition and Mechanism
Facial dehiscence is a type of surgical wound dehiscence that specifically affects facial surgical sites, occurring when wound closure fails and the incision reopens. 2 This complication involves the breakdown of the surgical repair, with separation of tissue layers that were previously approximated during closure. 1
The condition represents a failure of wound healing where the mechanical integrity of the closure is compromised before adequate tissue strength has developed. 2
Risk Factors for Facial Dehiscence
Patient-Related Risk Factors
- Smoking significantly increases the risk of wound dehiscence, with an odds ratio of 16 according to studies of maxillofacial procedures. 1
- Diabetes mellitus is associated with increased wound complications including dehiscence due to impaired wound healing and increased infection risk. 1
- Previous wound healing issues predispose patients to recurrent dehiscence problems. 1
- Prolonged corticosteroid use weakens tissue integrity and impairs healing, particularly relevant in patients who have undergone procedures like corneal transplantation. 3
- Advanced age correlates with higher dehiscence risk due to decreased tissue elasticity and healing capacity. 3
Surgical and Technical Factors
- Excessive wound tension during closure is a primary mechanical cause of dehiscence, particularly in primary layered closures compared to flap reconstructions. 4
- Inadequate surgical technique including improper suture placement or premature suture removal can precipitate wound separation. 3, 4
- Infection at the surgical site compromises wound integrity and increases dehiscence risk. 1, 5
- Poor wound care in the postoperative period, including inadequate debridement or moisture management. 5
Timing and Presentation
- Facial dehiscence typically occurs within the first 2-3 weeks postoperatively, with the highest risk period being the first 2 weeks after suture removal when continuous sutures are used. 3
- In maxillofacial sinus procedures, few patients experience wound dehiscence within the first 2 weeks postoperatively. 1
- Spontaneous dehiscence can occur from minor activities such as coughing, yawning, or falling without direct facial trauma. 3
Clinical Significance and Management
Recognition and Monitoring
Patients should be monitored closely during the first 2-3 weeks postoperatively for signs of wound separation, including visible gap formation, drainage, or loss of wound approximation. 3 Early recognition facilitates prompt intervention to preserve optimal outcomes. 3
Treatment Approach
- Superficial incisional dehiscences that have been opened can usually be managed without antibiotics unless systemic inflammatory response criteria are present. 1
- Dehiscences with systemic signs (hypotension, oliguria, decreased mental alertness) or in immunocompromised patients require empiric broad-spectrum antibiotic treatment. 1
- Surgical re-closure may be necessary to preserve functional and aesthetic outcomes, particularly when intervention occurs early. 3
- Wounds should be drained, irrigated, and if needed, opened and debrided when fascial disruption is suspected. 1
Prevention Strategies
- Smoking cessation for at least 4 weeks preoperatively significantly reduces dehiscence risk. 1
- Optimal glycemic control in diabetic patients minimizes wound complications. 1
- Use of suspension sutures in facial reconstruction can prevent distortion of free margins and reduce tension-related dehiscence, though they do not prevent scar spreading. 4
- Appropriate timing of suture removal with careful patient selection, avoiding premature removal in high-risk patients. 3