Wound Dehiscence and Evisceration

Wound dehiscence is separation of the edges of a surgical incision after closure. Partial dehiscence may involve gaping of superficial layers while deeper tissues remain intact. Complete dehiscence with protrusion of abdominal viscera is evisceration, a surgical emergency. Most dehiscences occur between postoperative days 4 and 14. The incision is still mechanically weak during this period: collagen tensile strength remains less than 10% of that of uninjured tissue. A cough, episode of vomiting, or strained movement can generate enough force to separate tissue that has not yet developed adequate strength. Evisceration may be preceded by sudden serosanguineous drainage, a sensation that the incision has “given way,” or visible widening of the wound. Once organs are visible, the priority changes from protecting a vulnerable incision to protecting exposed tissue and obtaining immediate operative help.