(1) Wound infection. Surgical wounds are assessed for possible
complications by inspection (sight and smell) and palpation for appearance, drainage, and
pain. The wound edges should be clean and well approximated with a crust along the
wound edges. If infection is present, the wound is slightly swollen, reddened, and feels
hot. Hand washing is the most frequently used medical aseptic practice and the single
most effective way to prevent the spread of microorganisms that cause wound infections.
(2) Dehiscence. Dehiscence is the separation of wound edges without the
protrusion of organs. An appreciable increase in serosanguineous fluid on the wound
dressing (usually between the 6th and 8th postoperative day) is a clue to impending
(3) Evisceration. Evisceration is the separation of wound edges with the
protrusion of organs through the incision. Wound disruption is often preceded by sudden
straining. The patient may feel that something "gave way."
b. If dehiscence is suspected or occurs, place the patient on complete bed rest in
a position that puts the least strain on the operative area and notify the surgeon. If
evisceration occurs, cover the wound area with sterile towels soaked in saline solution and
notify the surgeon immediately. These are both emergency situations that require prompt
c. Predisposing factors and causes of wound separation are:
(2) Malnutrition , particularly insufficient protein and vitamin C, which
interferes with the normal healing process.
Defective suturing or allergic reaction to the suture material.
Unusual strain on the wound from severe vomiting, coughing, or sneezing.
(5) Extreme obesity, an enlarged abdomen, or an abdomen weakened by
prior surgeries may also contribute to the occurrence of wound dehiscence and
8-20. WOUND CLOSURES AND HEALING
a. Any wound or injury results in repair to the damaged skin and underlying
structures. All wounds follow the same phases in healing, although differences occur in
the length of time required for each phase of the healing process and in the extent of
granulation tissue formed. Wounds heal by one of three processes: primary, secondary,
or tertiary intention.