One of the most common wound complications after surgery is dehiscence. It’s possible for a glued, sutured or stapled incision to come open in some areas. And in some cases, the entire incision line can rip apart. No matter how small or large the problem is, wound dehiscence can be frightening and alarming for the patient.
Fortunately, dehiscence is not always an emergency. You can get back on the path to recovery by taking care of the wound at home. However, if the wound is too deep, you’d need repair surgery. And while this wound complication is not always preventable, there are some things that you should do to reduce its likelihood. This way, you won’t risk bad scarring and can recover quickly.
What Is Wound Dehiscence?
Wound dehiscence refers to the partial or complete reopening of the surgical wound. It is a risk of any surgery with incisions, but it is more common in abdominal and cardiothoracic procedures. The risk of this complication can increase due to the following factors:
- Obesity (BMI more than 30)
- Smoking
- HIV/AIDS
- Diabetes
- Heart disease
- Longer surgery duration/anaesthesia for an extended period of time
- Being older than 65
- Poor nutrition
As far as plastic surgeries are concerned, this most commonly affects patients who have a tummy tuck, breast reduction and breast lift. Several researches show that there’s a 10% risk of wound dehiscence following breast reduction and uplift.
A small study published in Plastic Surgery International reported a 16% risk of wound reopening after a tummy tuck. Even though wound reopening is not that common, it remains a risk.
Keep in mind that wound reopening can delay healing by more than 2 weeks, and it usually occurs a week or so following the surgery. So, most patients are in the early stages of recovery when they experience this complication.
Stages of Wound Healing
While wound dehiscence can delay recovery by a few weeks, keep in mind that wound healing, in general, takes about 2 years. It has 4 main stages, which are as follows:
- Homeostasis – This stage lasts for a few minutes and starts immediately after the injury to the skin. In this phase, the goal is to stop the wound from bleeding.
- Inflammatory – This stage usually lasts for 4-6 days and involves the removal of debris and bacteria. You can experience swelling, warmth, pain, and redness as a result of it, but it’s a part of the healing process.
- Proliferative – This stage usually lasts for 3 weeks. In this stage, special cells help in the rebuilding of damaged skin tissue. You will start noticing the formation of a scar in this phase.
- Maturation – This stage can last for almost 2 years. During this, the wound is essentially strengthened through the production of collagen. If all goes well, the scar tissue will get paler and flatter with time. As much as 80% of the original strength of the skin is restored in this phase.
Keep in mind that these phases of healing can be disrupted by the risk factors mentioned above. Usually, wound dehiscence occurs during the inflammatory and proliferative phases. So, you need to be very careful during the early stages of recovery.
What Causes Wound Reopening After Plastic Surgery?
Different reasons can lead to wound opening after plastic surgery. It may be due to one or more of the following:
Wound Tension
One of the most common causes of wound dehiscence is tension on the wound. For instance, in an inverted “T” breast reduction, there’s a vertical incision line extending from the bottom of the areola. This connects with a horizontal incision in the breast crease, forming an inverted T.
This “T junction,” essentially the connecting point between the two incisions, is under the most tension. And this is the area along the incision lines that most commonly ends up reopening. Keep in mind that since the blood flow to this area is reduced, the T junction is also slow to heal. This makes this area vulnerable to other risks, which can lead to wound dehiscence.
Tension on a surgical wound can also result from improper wound closure. It’s not just about stapling, stitching, or glueing the wound; the surgeon has to take the depth of the wound, its location, and the patient’s medical history into consideration. If the stitches are too weak or haven’t been done properly, the wound will come undone.
Pressure Injury
A wound that is under excessive pressure is also prone to dehiscence. And this also happens quite frequently (and easily). It can happen if you:
- Cough/Sneeze (hard)
- Vomit
- Gag
- Engage in strenuous physical activity
- Life heavy weights (including children)
- Strain due to constipation (pain medication and anaesthesia can cause this)
While these you may be able to avoid, sometimes, there is internal pressure on the wound. For instance, if you have excessive swelling, infection (abscess), seroma, or hematoma, the pressure can pull on the edges of the wounds and open them up.
For these reasons, you need to make sure that you follow your surgeon’s aftercare instructions. Keep your activity level to a minimum, keep the surgical area elevated or use ice packs (if your surgeon says so) to reduce swelling. Also, you can ask your doctor if you can take laxatives in the early weeks of recovery to resolve constipation.
Excess Removal Of Skin
When performing breast reduction, uplift or tummy tuck, the surgeon has to remove excess skin so the patient can get their desired aesthetic results. However, if the surgeon is inexperienced and ends up removing too much skin, wound closure would become difficult.
And even when the wound is closed, it will be under a lot of tension. This can also increase the risk of wound dehiscence after plastic surgery. So, the choice of the surgeon also matters when it comes to reducing the risk of this complication. Your surgeon needs to be slightly conservative in their approach so the wound can be closed easily.
Infection
Infection of the surgical site may cause wound dehiscence. An infection essentially disrupts the process of healing since the body has to now clear up the bacteria from the wound site.
Keep in mind that there are special cells called fibroblasts, which are critical to wound healing. They repair the damaged tissue by producing collagen.
However, when infection occurs, fibroblasts aren’t able to do their job. Additionally, the bacteria itself releases certain chemicals that delay wound healing. The swelling due to infection can further increase the risk of the wound reopening.
Premature Removal Of Stitches
Sutures can be absorbable and non-absorbable. If the non-absorbable stitches are removed too early, it also increases the risk of wound dehiscence after plastic surgery.
That’s because the wound is still quite weak, and even if the slightest pressure is applied to it, it will have no support, and it will come open. Removing the stitches too early can also increase the risk of infection, which is why your surgeon has to be careful about this.
What Are the Signs of Wound Dehiscence Following Cosmetic Surgery?
When the surgical wound reopens, you’ll feel it ripping or tearing open. The edges of the wound will be apart from each other, and you will be able to see the tissue underneath. Other than that, you may also experience:
- Bleeding
- Pain
- Fluid discharge
- Redness
If this happens, you need to be on the lookout for any signs of infection (which can be similar to signs of inflammation but that’s part of the recovery process). Surgical site infection can cause:
- Fever
- Tenderness
- Warmth
- Swelling
- Yellow pus discharge
- Pain
- Malodour
If something’s not right, you will experience a delay in healing. Therefore, it’s important to get in touch with your surgeon as soon as possible.
How Do You Treat Wound Dehiscence After Plastic Surgery?
Depending on the cause of the wound reopening, your surgeon may recommend the following:
Secondary Intention Healing
You should know that there are primarily two types of healing: primary and secondary. “Primary” is when the wound is closed with the help of sutures. And “secondary” is when the wound is allowed to heal on its own, without the need for any stitches.
If your wound has reopened after plastic surgery, your surgeon may advise you to let it heal by what’s known as “secondary intention”. In this, the wound will close back up on its own. However, you will have to do dressing changes for about 1.5 months or more (depending on the depth and size of the wound and its location).
You may have to change the wound dressing more than once a day. However, if it gets wet or dirty, make sure to change it immediately. And when doing so, make sure to:
- Wash your hands thoroughly with mild, unscented soap and warm water.
- Wear protective gloves.
- Clean the wound with iodine to get rid of dirt and bacteria (ask your surgeon about washing the wound with soap and water as it may cause irritation).
- Pat (not rub) the area dry with sterile gauze.
- Cover the incision line with clean gauze.
If the wound is bleeding, you can apply direct pressure on it. You should then change the dressing. However, if the bleeding doesn’t stop, you should get in touch with your doctor immediately.
Under no circumstance should you try to pick at the wound. It is possible for bacteria in your nails and fingertips to cause infection and bad scarring. Just keep changing the dressing properly, and your wound will start to heal in a few weeks.
Antibiotics
These may be needed to deal with the infection or prevent it after the wound has reopened. You may have to take antibiotics (some need IV antibiotics before they can take pills) and use antimicrobial wound dressings. The latter will essentially release antimicrobial agents (silver, iodine, cadexomer, or PHMB) into the wound so that any bacteria can be killed.
The dressings are available as gels, sheets, solutions, foams and creams. But keep in mind, do not use them unless your surgeon advises so. It’s important to get treatment as soon as possible. It may be necessary for the surgeon to debride the wound if the infection is too severe.
Negative Pressure Wound Therapy (NPWT)
NPWT consists of a special wound dressing or bandage that’s connected to a vacuum pump and a canister. Fluid and pus will be sucked out of the wound, allowing it to heal.
Your surgeon may recommend negative pressure wound therapy (NPWT) to increase the speed of healing. If you notice small rips in the wound due to the accumulation of fluid in the surgical area, this treatment can help you. However, again, do not use this device unless advised by your surgeon.
How To Prevent Wound Dehiscence After Cosmetic Surgery?
Your surgeon will advise you on how to prevent this potential wound complication. You can greatly reduce its likelihood by doing the following:
Wear Your Support Garment
In case of breast surgery, you’ll be provided with a surgical bra. And for any abdominal surgery like a tummy tuck or liposuction, a compression garment is given by the clinic.
These garments will provide much-needed support to the surgical area and reduce tension on the wound. Not just that, but they’ll also help with swelling, which is why you need to wear them for as long as instructed by your surgeon.
Don’t Pick At Stitches
It’s important that you do not touch, rub, or scratch your stitches. That will only disrupt the healing process, and you’ll also be increasing the risk of infection. Your stitches will be dissolved or removed in a matter of a few weeks, so be patient (never try removing your stitches by yourself).
Your surgeon may apply skin tape. It’s there to provide support to your wound (so it’s not under tension). So, make sure it stays in place for as long as instructed by your doctor.
Keep the Surgical Area Clean
Make sure that the surgical area is clean at all times. If the dressing has gotten dirty, you should change it immediately (with clean hands). Otherwise, you may end up with an infection, which can lead to wound dehiscence.
Also, take a shower, not a bath, 2 days after the surgery, and when you do so, do not remove the steri-strip bandages along the incisions. Once you’re done, make sure to pat them dry.
Limit Your Movement
After any surgery, you need to rest. If you move around too much or pull on the wound too much, even the stitches are going to give away. Sweating can also cause infection, which can do the same.
So, wait till your surgeon gives you the go-ahead. And until then, avoid exercising or moving around too much to prevent the wound from reopening.
Conclusion
It can be quite frightening to experience wound dehiscence. It isn’t always a concern, however. Many times, patients are able to heal through “secondary intention.” You need to keep changing the wound dressing, and your wound will naturally heal in a few weeks.
But you must be very careful if your wound reopens, even in small areas, so that it does not become more serious. If you end up with an infection, it can result in bad scarring. Just make sure to find an experienced, board-certified surgeon. And after the surgery, follow all the aftercare instructions for a successful recovery.
