Looking down on your surgical wound and seeing it open up is one of the most disturbing and traumatic experiences a human can go through. You certainly had an expectation that your wound would heal. The experience is extremely frightening.
A dehiscence is a reopened wound that has come apart at the “seams.” The cause may be a wound infection, a wound injury, poor wound healing, or failure of the whatever material was used to close the wound (sutures, staples, etc).
The risk of dehiscence is usually with the first two weeks after surgery. A large wound dehiscence requires immediate attention should be reported to your surgeon as soon as possible. Abdominal wounds that dehisce can result in organs protruding from the abdomen. If that happens, place sterile dressings over the wound, do not strain, get help and call your surgeon. If your surgeon is not available, don’t hesitate to call 9-1-1. An ambulance has the proper sterile dressings available and can help you move while avoiding straining. Remember, you will be okay, as distressing as this is.
The edges of the wound that are separating may have redness or swelling, drainage or even tissue coming from the wound. Some risk factors for infection leading to dehiscence include abdominal surgery, exertion after surgery, diabetes, obesity, HIV infection and the presence of synthetic surgical mesh. Mesh is a factor because bacteria like to congregate near the surface of the implant.
Normal wounds heal from the outside in but dehisced wounds heal from the inside out and take much longer to heal—but they do heal eventually with good care. Treatment includes gauze packings, frequent dressing changes, and resting the area affected. Every other stitch might be removed to allow for better drainage. If drainage does not get out, it can create a tunnel through the affected area as it tries to surface and drain. (Surgeons often place rubber or plastic drains while the would is beginning to heal to help it find the surface.) Large wounds are packed with sterile dressing which is changed routinely, often by a wound care specialist or nurse. The wound may be cultured and antibiotics, tylenol or non steroidal anti-inflammatory medications may be prescribed. Occasionally, the wound is repaired surgically.
Dietary changes may be recommended in order to build up your body’s ability to fight infection and a physical therapist may visit to help you return to normal activities as soon as possible. The best thing you can do for your body is to take plenty of fluids and rest, giving it a chance to heal.
Peggy Day is working on a book to combine all these stories. This is an excerpt from Pelvis in Flames: Your Pelvic Mesh Owner’s Guide. Your input is welcome to help make Pelvis in Flames the book you need to read.
If you’d like to join an online support group and learn about erosion, partial removals, surgeons, or just find out that you are not alone, join my group, Surgical Mesh or check the list of support groups here.
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