Management of Dehisced Wounds

Management of Dehisced WoundsThough some surgical wounds may seem to be healing normally, the edges of the wound may fail to join, which leads to a complication called wound dehiscence. While infection is the most common type of complication that can arise from this condition, another much more severe but rare condition called wound evisceration can occur, which is life-threatening. During this condition the edges of the wound separate and internal organs such as the gut will protrude from the wound. It could even progress to the bone if it remains untreated.

Proper wound assessment and comprehensive documentation with wound EMR helps in better management of dehisced wounds. Common risk factors include age, treated condition, poor nutrition, swelling caused by the trauma of the surgical procedure, obesity and other existing medical issues or even technical factors due to the type of closure used.

Common Wound Care Approaches

More likely to occur 6 to 7 days after surgery, the condition is often managed using a medical approach, such as sterile dressing application and wound monitoring. Possibility of infection is more in areas where dehiscence has occurred thus using a wound cleanser gently in conjunction with your normal treatment might be recommended. Management of dehisced wounds may include:

  • Daily wound care that includes examining, cleaning, and dressing
  • Use of antibiotics if an infection is present or possible

For infected wounds, it is crucial to remove pus, devitalized tissue, or accumulated fluid as well as giving the appropriate antibiotic therapy. Also, the wound should be irrigated to remove any purulent material. An appropriate dressing should be applied depending on the size and shape of the wound. Immediate surgery is recommended if the bowel is protruding from the wound. Surgery is done to remove contaminated and/or dead tissue, re-suture the wound and place a temporary or permanent piece of mesh to bridge the gap in the wound.

Clear Documentation Helps Faster Wound Healing

Assessment includes evaluating the condition of the wound and surrounding tissue for information about the healing process or presence of infection. It provides baseline information and enables the progress of wound healing to be monitored. The information gained from the assessment should be clearly documented to facilitate communication between the nurse, patient and care giver. Wound EMRs are helpful to structure the process of assessment and documentation. Wound specific templates in the software streamlines the documentation process and ensures easy and quick access.

Documentation should include details such as when the problem occurred, description of the appearance of the wound or eviscerated organ – amount, color, consistency and odor of any drainage, patient’s vital signs, response to the treatment and the practitioner’s actions, skin care provided and dressings applied.

Prevention Is Better Than Cure

Instead of treating complications in a surgery wound, it is far better for patients, nurses as well as physicians to take effective measures to reduce the chance of wound dehiscence. Patients should follow physician’s post-operative instructions carefully and minimize activities that may negatively impact the wound site. The patient should move carefully, and protect the wound site from anything that may cause friction or pull the skin around the site of the wound. Nurses should implement measures to prevent incision infections. They should maintain light pressure on the wound, while using wound dressing.