Wound dehiscence

Congenital deficiency of Factor Xlll is inherited as an autosomal recessive trait and is frequendy recognized at birth because of delayed persistent hemorrhage from the umbiUcus. In Factor Xlll-deficient people wound healing is defective and wound dehiscence is common. 

Petersson P, Montgomery A, Petersson U. Wound dehiscence outcome comparison for sutured and mesh reconstructed patients. Hernia 2014 18(5) 681-9. 

It is also important that the suture material is stable to radiation. This can occur when, following gynecologic cancer, a patient is prescribed abdominal radiation for palliative or curative therapy. The ionizing effect of the radiation may adversely affect suture strength, and may lead to wound dehiscence (Orr et al, 2004). The use of a knotted monofilament suture presents a high risk in such cases, since, if the suture breaks at one point, the entire length of the suture stitch is rendered ineffective in keeping the wound closed. Several small suture stitches may be used but this increases the time of operation and can lead to complications due to the presence of multiple knots. A barbed suture, however, can effectively eliminate both these risks. Since it anchors at multiple points, should the suture break it will still hold the wound tissue in closed apposition at the next barb. Secondly, since the suture stays inside the tissue there is less scar formation. 

Wound dehiscence can be due to mechanical stresses. When a foreign body (i.e., the port) is present, its contamination quickly leads to infection, which is very difficult to treat without device removal. Insufficient suture strength, improper suture techniques, improper choice of stitch, premature removal of sutures, or excessive tension of the suture line may all contribute to dehiscence (Lyon et al. 1999 Hunt and Zederfeldt 1990). 

The first distinctive type of presentation of CBS is in patients who develop wound dehiscence from prior radical neck dissection or flap mobilization, resulting in a visibly exposed carotid artery. In such a setting it is well recognized that the exposed artery will inevitably rupture if it is not promptly covered with well-vascularized, viable tissue (e.g. free pedicle flap, rotated musculocutaneous flap, etc.). For such a scenario, although rupture of the carotid artery has not occurred at this point in time, there... 

Several case studies have reported comeal epithelial changes and stromal melting in inflammation-related neovascularisation after topical or subconjxmctival application of bevacizumab. A case of recipient bed melt, wound dehiscence and limbal ischaemia corresponding to the injection area 3 weeks after penetrating keratoplasty and subconjunctival... 

Bhasin P, Gujar P, Bhasin P. A case of recipient bed melt and wound dehiscence after penetrating keratoplasty and subconjunctival ii ection of bevacizumab. Cornea 2012 31(ll) 1342-3. 

Sutures are foreign bodies, and althongh modem synthetic monofilament sutures are almost completely inert, braided and natural sutures can excite a significant inflammatory response. Bacteria can be difficnlt or impossible to eradicate once colonization of the suture or knot interstices has occurred. This can predispose the wound site to infection, with abscess and sinus formation, wound dehiscence, and incisional hernias. Sutures should be avoided or used with caution in the presence of established infection or severe contamination. 

Wound dehiscence Avoid in high tension wounds unless in conjunction with deep tension relieving sutures, surgical tapes, and immobilization... 

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