How to assess a surgical wound dehiscence

➔ First, you should conduct a holistic patient assessment:

• Look into medical/surgical history
• Assess current health, lifestyle, medication, pain, psychosocial status
• Understand what led up to dehiscence – coughing, vomiting, trauma, purulent drainage, infection, etc.



For more information on how to conduct a holistic patient assessment, look to The Wound Care Pathway.

➔ Next assess the dehiscence, by using a validated assessment tool like the Triangle of Wound Assessment:

• Measure length, depth and appearance 
• Check for undermining, tunnelling, exposure of medical material 
• Check for oedema, warmth, pain 
• Assess wound exudate
• Check for signs of infection – purulent exudate indicates infection is present

Grading system

➔ Categorize the surgical wound dehisence (SWD) according to the WUWHS grading system from 1 / 1a, to 4 / 4a.¹

How to diagnose surgical wound dehiscence

➔ First you should diagnose the severity of the dehisced surgical wound by grading it from 1/1a-4/4a.


➔ Then assess for signs of infection. You should check for infection by looking for: 


• Pain, tenderness or oedema 

• Purulent discharge 
• Local temperature changes and/or fever

How to develop a treatment and care plan

➔ Always develop a holistic care plan that involves the patient in both development and implementation. Review patient expectations and outcomes and potential limitations.



➔ Let your treatment plan be determined by the severity of the dehiscence and the absence or prevalence of infection. If infection is already present you should treat the wound as a priority.



➔ Make sure you take all factors into account as you plan: 


• Prevention of infection and deterioration 
• Infection treatment 

• Management of risk factors of systemic infection 

• Frequency of dressing changes, cleansing and debridement 

• Maintenance of body temperature and adequate oxygenation 
• Pain management – well controlled pain
• Nutrition 
• Post-Operative Care 

• Surveillance and reporting

How to manage surgical wound dehiscence

➔ First, prepare the wound bed by cleansing and debriding the wound to remove debris and necrotic or indolent tissue



➔ You should use every dressing change to assess the wound again. Use a validated assessment tool to conduct a formal reassessment on a regular basis until wound is fully healed

• Reduction of wound size is a key indicator of healing 

• If wound is infected monitor signs and symptoms based on IWII Infection Continuum & Management Guide. 

• After the wound bed preparation, some wounds can be sutured for the second time to heal, if this is being considered, refer back to surgeon



➔ Consider using NPWT for highly exudating wounds and for wound dehiscences, that are categorized as grades 3 & 4. As healing progresses, step down from advanced therapies (i.e. when exudate decreases or wound improves consider stepping down from NPWT to standard dressing).



For more information about managing infection, consult: Ten top tips: managing surgical site infections.

How to choose dressing and additional therapy

➔ To provide an optimal healing environment, choose a dressing that is appropriate for the level of exudate, size of wound and skin type. The dressing type may need to be changed as healing progresses, or if there is no progress in the wound over a two-week period. 



➔ Make sure the dressing is able to conform to the wound bed – it should leave no gap between dressing and wound bed in order to effectively manage exudate, moisture and bacterial balance.

➔ Only choose dressings that are atraumatic upon removal. You should be able to easily remove it intact, and not cause further damage to the wound bed or periwound skin. 



➔ If you suspect infection use a dressing with antimicrobial properties.

How to monitor progression

➔ You should conduct reassessments at time intervals that are appropriate for the severity of wound.



➔ As part of your holistic care plan involve your patient in monitoring and managing the surgical wound dehiscence.
Your patient education should include: 


• How to detect signs and symptoms of infection 
• Reducing risk factors – how to avoid putting additional stress on the incision
• Advice about activity levels
• Scar tissue management and cosmetic implications/effects 
• Instruction to contact HCP if symptoms occur or patient deteriorates



➔ Monitor for signs of oedema and manage swelling 



➔ Assess vascular status if the dehiscence is on lower extremities.



➔ Consider a re-evaluation near end of the process to confirm healing and to evaluate scarring. Excess scar tissue can reduce mobility, delay return to normal activities and the visible aspect may affect the psychosocial wellbeing of the patient.^2-4

When to refer or contact a specialist

• If organs, implants and/or bone is visible – make immediate referral back to surgeon.
• If systemic infection is suspected refer to specialist.

• If abscesses, large seromas or large haematomas are detected refer to specialist.

• If ischemia is suspected in a leg wound, refer for vascular assessment.