Wound Care: Fascial Dehiscence

Definitions

• Fascial Dehiscence: Separation of Fascial Tissue from a Surgical Incision
  • Risk of Evisceration
• Evisceration: Extrusion of Bowel Through Fascia/Skin

Risk Factors

• Deep Infection – Strongest Risk Factor
• Patient Factors:
  • Male Sex
  • COPD
  • Postoperative Coughing
  • Ascites
  • Anemia
  • Emergency Surgery
  • Wound Infection
  • Malignancy
  • Obesity
  • Malnutrition
  • Sepsis
  • Steroids
• Technical Factors:
  • Tension
  • Long Incisions
  • Poor Suture Placement
  • *No Difference Between Paramedian, Transverse or Midline Incisions

Presentation

• “Popping” Sensation Followed by Profuse Serosanguinous Fluid Drainage
• Incisional Bulge
• Timing: 4-14 Days Postoperatively; Average 8 Days

Diagnosis

• Dx: Clinical; US/CT if Unclear
• Do NOT Open at Bedside – Risk Evisceration

Treatment

• Surgical Repair