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What Causes Surgical Wound Dehiscence?

According to the National Center for Biotechnology Information (NCBI), postoperative wound dehiscence—in which surgical sites that have been sutured, stapled, or glued together following a procedure come apart—results in nearly 10% of post-operative surgery deaths, almost 10 days of extra hospitalization, and approximately $40,000 in costs. 

The separation of the incision following a surgical procedure can be partial, resulting in superficial layers or a small number of tissue layers being reopened. Worse, it can result in complete dehiscence, with all layers being separated and organs being exposed or protruding through incision openings. 

With this knowledge and these statistics in mind, it’s important for physicians and their patients to understand what leads to surgical wound dehiscence.

Six Factors Leading to Wound Dehiscence

Sometimes, wound dehiscence happens due to improper suturing on the part of the physician. Improper suturing could be caused by these six factors.

1. Using an Inappropriate Knot

Knots maintain the appropriate tension on a wound which is vital when it comes to proper healing and reducing the chances of wound dehiscence. Physicians applying sutures need to understand which knot is most appropriate for any given surgery. These include the basic square knot, the one- and two-hand tie, the instrument tie, the simple interrupted stitch, and the vertical mattress stitch. You can learn more about these methods with the Boston University School of Medicine Surgery.

2. Tying Knots Too Loose or Too Tight

A loose knot can result in a suture to lose tension and slip open. They can also easily snag on something during a patient’s daily activities, causing a break that results in wound dehiscence. If a suture is not held under the proper tension through a correctly tied knot, healing abilities will be compromised; this could not only lead to wound dehiscence, but also excessive scarring and discomfort. On the other hand, an incision could be placed under too much tension, causing it to break open and potentially cutting tissue in the process.  

3. Using an Inappropriate Suturing Material

There are a variety of materials used for suturing, and each has its time and place. For example, multifilament materials, which are braided or twisted to increase the friction rate may be necessary for one surgery, while monofilament materials, which consist of only one strand of fiber and reduce friction rates, may be acceptable for another. The use of synthetic polymeric monofilament sutures can also pose a problem; these materials have “memory,” returning to their original shape over time instead of lying flat, which is important for many surgical procedures.

Using absorbable versus non-absorbable sutures should also be a consideration. Absorbable materials, which dissolve naturally into the body over time, can be a bit unpredictable in the breakdown time; when used on surface wounds, they could dissipate earlier than expected resulting in a tear or opening.

4. Improper Placement of Sutures

Oftentimes, wound dehiscence occurs because sutures have been placed too close to the wound edges. These wound edges may experience inflammation, swelling, increased blood supply, and reduced collagen structure, all of which make them vulnerable to coming apart. In addition, dead tissue that can no longer support the suturing within these edges could also lead to the suture coming apart. 

5. Early Removal of Sutures

If sutures are removed too soon or allowed to remain too long, complications may occur. Removing them too soon—before the tissues beneath have had time to bond—the wound could reopen, damaging new material that was beginning to form and allowing bacteria access to the site. Of course, it’s important not to leave the sutures in for too long as well; this can cause excessive scarring. 

6. Suturing when Foreign Objects Are Present

Proper cleansing of a wound before suturing is critical. If any foreign objects, such as wood or metal splinters, shards of glass, bone fragments, gravel, hair, or even cloth fibers are left in before the wound is closed, they could cause bleeding, inflammation, and infection, leading to wound dehiscence. 

Other Reasons for Wound Dehiscence

While we’ve highlighted some reasons wound dehiscence may occur due to the choices of a physician, it’s important to understand that wound dehiscence can occur due to the health or the actions of the patient. They may put too much stress on an incision site through exercise, breaking apart a properly sutured incision; they may have a weakened immune system due to diabetes, cancer, or HIV/AIDS, leading to dehiscence; or it’s possible that a fit of coughing or a bout of laughter could even cause the break. For more, read our story Ten Ways to Keep Your Surgical Wound From Opening.

A Way to Prevent Wound Dehiscence

Many factors can contribute to wound dehiscence, but with suturing being one of the causes, doesn’t it make sense to look for an alternative wound closure method?

Now you have one: BandGrip. The latest development in wound closure technology, BandGrip Micro-Anchor Skin Closures are a quick, intuitive, and minimally-invasive closure option for surgeons. Resembling a typical adhesive bandage, BandGrip’s patented micro-anchors grip the skin tightly and hold wound edges together to facilitate a secure closure offering many advantages:

  • Faster and easier application versus sutures and staples
  • Eliminates the risk of needlestick injuries
  • Can be applied by a nurse or physician’s assistant
  • Results in less scarring than sutures or staples
  • Supports better mobility due to its smooth, water-resistant surface
  • Ability to be tiled for larger wounds or incisions
  • Does not require a return visit for removal, saving surgeon’s time

Want to see BandGrip in action? View the video below.

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