Managing Wound Dehiscence after Breast Reduction Surgery

Wound dehiscence and delayed wound healing are the most common and grievous complication following a breast reduction surgery. The patient who makes a considerable financial investment for their breast reduction surgery expects quick and aesthetically pleasing results. With this complication, they will have to deal with an open wound in their breast. For effectively managing wound dehiscence after breast reduction surgery, it requires proper wound assessment and accurate and comprehensive wound documentation via wound EMR. Let’s see this in detail.

What Is Wound Dehiscence? How Is It Complicated?

Wound dehiscence refers to the significant wound breakdown, which usually causes delay in wound healing (more than 2 weeks). In the most commonly used breast reduction surgery technique, the skin is typically removed in the Wise pattern. As a result, an inverted T scar develops in the inframammary fold. Dehiscence normally occurs in the convergence of the flaps in the inverted T skin scar where the tension on the skin flaps is typically the highest. The small areas of dehiscence along the flap edge are termed partial dehiscence (T-junction breakdown), which generally heal without complication. Dehiscence involving larger areas than the T-junction is called total dehiscence.

This condition is stressful for the patient and the surgeons:

  • Wound dehiscence is usually accompanied by psychological stress. Thus, you should consider a treatment modality that can precipitate wound healing in terms of both filling the depressed wound and expediting re-epithelialization.
  • Plastic surgeons encountering such complications are always seeking possible management options. Healing by secondary intention is ideal for partial dehiscence. Antibiotic preparations, moist wound dressing and conservative surgical debridement (of the small amounts of devitalized tissue) are the other useful modalities. Silver-hydrofiber dressing and the use of negative pressure therapy are effective options for acute open wounds. In the case of total dehiscence, further operative procedures may be required. However, the tension required for primarily closing the wound edges and a high recurrence rate of wound dehiscence makes a surgical intervention undesirable in this scenario.

Proper Wound Documentation with Specialty EMR

Wound dehiscence at the inverted T junction depends upon several factors and the most important among them are wound infection and tension of the wound edges. These factors interfere with normal wound healing and make the condition worse. Proper wound assessment and frequent monitoring are necessary to understand whether the wound is getting infected and what’s happening to the wound edges. This is possible only with wound documentation that records the wound details (size, appearance, type of wound and so on) and its seriousness from time to time. There are several risk factors for wound dehiscence, which includes smoking, increased resection weights, obesity and lengthened anesthetic times. This can be understood with the history and physical examination report and proper actions taken.

Being a vexing complication, it is very important to quickly provide treatment for wound dehiscence. Wound care facilities relying upon general EMR take much time for entering and accessing the wound details at times of need as the wound care professionals may search through several templates to choose the templates related wound care. This may cause delay in treatment and care while wound EMR comprised of only wound specific templates streamlines the documentation process and ensures easy and quick access. With a physician and nurse interface, the facilities can improve the communication among the wound care management team and provide the most suitable treatment modality for managing wound dehiscence swiftly.