What is the recommended management for wound dehiscence following breast reduction surgery?

Management of Breast Wound Dehiscence Post Breast Reduction

For mild wound dehiscence following breast reduction surgery, initiate conservative management with saline wound cleansing, dry sterile dressing coverage, and close monitoring for infection, while considering negative pressure wound therapy (NPWT) for high-risk patients or wounds that fail to improve with standard care. 1, 2, 3

Initial Assessment and Conservative Management

Assess the wound systematically for:

• Depth and extent of separation 1
• Signs of infection including erythema, purulence, increased pain, or warmth 1
• Exposed tissue or underlying structures 1
• Patient risk factors: obesity, diabetes, smoking history, prior radiotherapy, neoadjuvant chemotherapy, or corticosteroid use 4

Immediate wound care protocol:

• Cleanse the wound with simple saline solution without additives, as additives provide no additional benefit 1
• Apply dry sterile gauze dressing to the dehiscence site—this is the easiest and most effective initial treatment that avoids unnecessary wound packing which causes pain without improving healing 5
• Keep the dressing undisturbed for minimum 48 hours unless leakage occurs 6, 1
• Do not use advanced dressings for primarily closed surgical wounds, as they show no benefit in preventing surgical site infection 6, 1

Infection Prevention and Monitoring

Monitor daily for infection development:

• Check for progressive erythema, purulent drainage, or systemic signs of infection 1, 5
• Consider biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) if infection is suspected 1
• Obtain wound cultures before initiating antibiotics if infection develops 1
• Implement strict hand hygiene and infection prevention protocols 1

Advanced Treatment Options

Consider NPWT for specific scenarios:

• High-risk patients (those with obesity, diabetes, smoking history, prior radiotherapy, or other comorbidities) may benefit from prophylactic or therapeutic NPWT application 4, 3
• Recent evidence shows NPWT significantly reduces wound dehiscence rates in breast surgery patients—in one randomized trial, only 2 of 25 patients treated with NPWT developed dehiscence compared to 9 of 26 with standard dressings (p=0.038) 7
• NPWT demonstrates accelerated granulation tissue formation and epithelialization rates in open wounds following breast reduction dehiscence 2
• Six of ten studies reviewing NPWT in breast surgery showed significant decreases in overall complications 3
• Apply NPWT immediately after identifying dehiscence, replace after 2-3 days, and continue for approximately 7 days 4

Alternative advanced therapy:

• Charged polystyrene microspheres (CPM)-soaked dressings applied daily may accelerate wound healing and epithelialization in dehiscence cases, though this requires further validation 2

Surgical Considerations

Indications for surgical consultation:

• Progressive wound separation despite conservative management 1
• Deep tissue involvement or exposed structures 1
• Signs of deep infection or abscess formation 1
• Vascular compromise or significant tissue necrosis 1

Wound closure technique considerations for future prevention:

• Subcuticular continuous sutures demonstrate lower superficial wound dehiscence rates compared to interrupted stitches (RR 0.08; 95% CI 0.02-0.35), though no difference exists in surgical site infection rates 6
• The continuous suture technique provides better wound edge approximation and seal against bacterial invasion 6

Common Pitfalls and Caveats

Avoid these management errors:

• Do not extend dressing change intervals unnecessarily—there is no evidence this reduces infection 6, 1
• Never pack the wound aggressively, as this increases pain without improving healing outcomes 5
• Do not use prophylactic drains for serous fluid, as evidence shows no benefit in most breast procedures 5
• Avoid needle aspiration of seromas or hematomas, as this introduces skin flora and significantly increases infection risk 8
• Be vigilant for early infection signs, as prompt intervention prevents progression to serious complications requiring implant removal or reoperation 1, 4

Expected Outcomes

Complication rates in breast reduction surgery:

• Baseline wound dehiscence rates range from 4% in recent systematic reviews 9
• With NPWT intervention, dehiscence rates can be reduced to near zero in high-risk populations 4
• Most mild dehiscence cases resolve with conservative management without requiring surgical intervention 5
• Infection rates average 3% and should be managed promptly to avoid delays in adjuvant therapy if applicable 9