Wound reopened after stitches removed: Symptoms, Risk Factors, Prevention & More

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Symptoms, Risk Factors, Prevention & More

Wound Dehiscence: Symptoms, Risk Factors, Prevention & More

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Medically reviewed by Stacy Sampson, D. O. — By Scott Frothingham — Updated on May 5, 2021

Wound dehiscence occurs when a surgical incision reopens either internally or externally. It’s also known simply as dehiscence.

Although this complication can occur after any surgery, it tends to happen most often following abdominal or cardiothoracic procedures. It’s commonly associated with a surgical site infection.

Dehiscence usually takes place within 3 to 10 days of surgery.

Dehiscence can be identified by the feeling of a sudden pulling pain. If you’re concerned about possible dehiscence, check how your wound is healing.

A clean wound will have minimal space between the edges of the wound and will commonly form a straight line. If your stitches, staples, or surgical glue have split apart, or if you see any holes forming in the wound, you’re experiencing dehiscence.

Other symptoms you may experience include:

bleeding
fever
redness
swelling

There are several preoperative and postoperative risk factors for dehiscence, including:

Obesity. Obesity slows the healing process because fat cells have less efficiency in blood flow and oxygenation compared to other tissues.
Malnutrition. Malnutrition can also slow healing due to a lack of the vitamins, proteins, and other nutrients needed for recovery. Hypoalbuminemia, a lack of the protein albumin, is associated with dehiscence.
Smoking. Smoking reduces oxygenation in the tissues that are necessary for quick healing.
Peripheral vascular, respiratory, and cardiovascular disorders. Peripheral vascular, respiratory, and cardiovascular disorders all affect oxygenation, as do anemia, diabetes mellitus, and hypertension.
Cancer. Surgery to treat cancers such as head and neck cancer or colorectal cancer may result in dehiscence.
Age. Adults over 65 years old are much more likely to have other conditions that slow the wound healing process.
Sex. Men are more likely than women to experience dehiscence in certain types of surgeries, including some abdominal surgeries.
Steroids. The use of steroid medications slows down wound healing.
Infection. Wounds with an infection will take longer to heal, which makes you more susceptible to dehiscence.
Surgeon inexperience. If your surgeon is less experienced, you may have a longer operating time, or sutures may not be applied properly. This can lead to wounds reopening.
Emergency surgery or re-exploration. Unexpected surgery or the surgeon going back into a previously operated area can lead to further unexpected complications. This includes the reopening of an original wound.
Strain from coughing, vomiting, or sneezing. If abdominal pressure increases unexpectedly, the force could be enough to reopen a wound.

It’s important to keep an eye on the healing progress of your wound, as any openings can lead to infection.

In addition, an opening could lead to evisceration, which is a much more severe condition that occurs when your wound reopens and your internal organs come out through the incision.

The best way to prevent dehiscence after your operation is to follow your doctor’s instructions and surgical recovery best practices. Some of these are:

Avoid lifting anything greater than 10 pounds, as this may increase pressure on the wound.
Be extremely cautious in the first 2 weeks of recovery. You should walk around in order to avoid blood clots or pneumonia, but in most cases you shouldn’t push yourself much more than this.
After 2 to 4 weeks, start slightly more rigorous physical activity at your own pace. If you start to feel pressure, consider taking 1 to 2 days of rest and trying again another time.
After about 1 month, start pushing yourself a little more, but make sure you’re listening to your body. If something really doesn’t feel right, stop.

The average time for an abdominal incision to fully heal is roughly 1 to 2 months. If you think your wound may be reopening, or if you notice any symptoms of dehiscence, contact your doctor or surgeon immediately.

You may also need to place yourself on bed rest and stop any activity or lifting. These may make the condition worse and may be the cause for reopening.

Although it may only be a small opening or one suture that’s broken, wound dehiscence can quickly escalate to infection or even evisceration. Call your surgeon if you notice any symptoms.

If you’re experiencing evisceration, immediately seek emergency medical attention. Don’t try on your own to push any organs back inside your body.

Last medically reviewed on May 5, 2021

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

A to Z: Wound dehiscence. (n.d.).
kidshealth.org/Nemours/en/parents/az-wound-dehiscence.html
Getting life back to normal after surgery. (2018).
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Ghiam MK, et al. (2018). Head and neck cancer patients: Rates, reasons, and risk factors for 30-day unplanned readmission.
pubmed.ncbi.nlm.nih.gov/29787349
Gould L, et al. (2015). Chronic wound repair and healing in older adults: Current status and future research.
ncbi.nlm.nih.gov/pmc/articles/PMC4582412
Sandy-Hodgetts K, et al. (2013). Determining risk factors for surgical wound dehiscence: A literature review.
onlinelibrary.wiley.com/doi/full/10.1111/iwj.12088
Shanmugam VK, et al. (2015). Postoperative wound dehiscence: Predictors and associations.
ncbi.nlm.nih.gov/pmc/articles/PMC4587566
Söderbäck H, et al. (2019). Incidence of wound dehiscence after colorectal cancer surgery: Results from a national population-based register for colorectal cancer.
link.springer.com/article/10.1007/s00384-019-03390-3

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

Current Version

May 5, 2021

Written By

Scott Frothingham

Edited By

Ashley Williams

Medically Reviewed By

Stacy Sampson, D.O.

Copy Edited By

Stassi Myer – CE

Dec 5, 2018

Written By

Scott Frothingham

Edited By

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Medically reviewed by Stacy Sampson, D.O. — By Scott Frothingham — Updated on May 5, 2021

Wound Dehiscence: Symptoms, Causes, Treatment Options

Written by WebMD Editorial Contributors

Medically Reviewed by Dan Brennan, MD on April 14, 2021

Signs of Wound Dehiscence
Causes of Wound Dehiscence
Complications of Wound Dehiscence
Treatment for Wound Dehiscence

Wound dehiscence is a surgery complication where the incision, a cut made during a surgical procedure, reopens. It is sometimes called wound breakdown, wound disruption, or wound separation.

‌Partial dehiscence means that the edges of an incision have pulled apart in one or more small areas. Complete dehiscence is when the entire cut reopens through all layers of skin and muscle.

‌Wound disruption is most common within 3 to 10 days after a surgery. Symptoms at the incision site start getting worse instead of better and may include:

Pain
Redness
Swelling
Bleeding
Drainage of other fluids

You may also have a fever. You or your doctor might be able to see broken stitches or a gap where the edge of the incision used to meet.

Wound healing involves three phases:

‌Inflammatory: The body rushes fluid and healing cells to the incision site, causing swelling, redness, and pain. The goal is to clear out dead cells and bacteria so that repair of the wound can begin.
Proliferative: Special cells called fibroblasts pull the edges of the wound together. The body makes new tissue to repair the cut.
Maturation: The new tissue gets stronger and less fragile.

Wound separation can happen at any phase and can be caused by one or more of the following.

Infection. ‌When a wound is infected, healing cannot move past the inflammatory phase. The body must focus on clearing bacteria from the area. Infection also limits the number of fibroblast cells that are able to move to the area. Any repair tissue that is able to develop will be weak and fragile.

Pressure on sutures. Vomiting, severe coughing, or heavy lifting can strain the stitches or staples used to hold the wound closed while it heals. If one or more of the sutures break, the incision may pull apart at that spot.‌

Poor suture technique. Wound disruption may be caused by stitches or staples that are improperly applied. Sometimes wound separation will occur when sutures are removed too early in the healing process.

Decreased blood flow. Good blood flow is important to move oxygen and healing cells to the wound and to clear away bacteria and dead cells. Anything that decreases blood flow puts you at a higher risk of wound breakdown. This includes smoking and conditions such as diabetes, obesity, and heart disease.

Even minor wound disruption needs to be treated right away to keep it from getting worse. An open wound is easily infected, and infection can lead to further separation.

Complete wound dehiscence is a medical emergency, as it can lead to evisceration, where internal organs protrude through the wound.

Call your doctor if you notice signs of wound breakdown. Possible treatment options include:

Pain management. ‌Your doctor may prescribe medication if you are in pain because of the wound disruption, dressing changes, or infection. They may tell you to use a different kind of dressing or explain how to care for the wound in a way that causes less pain.

Antibiotics. ‌If you have an infection or are at high risk of infection because of the open wound, your doctor may prescribe antibiotics. This is a kind of medicine that stops or slows the growth of the germs that cause infection.

Management of risk factors. ‌Your doctor will work with you to improve any risk factors that helped cause the wound separation. For instance, if you have diabetes, they will help you get your blood sugar levels under control. If the wound breakdown was caused by blood or pus collecting under the sutured area, the doctor can put in a small plastic tube to drain the fluid.

Removal of dead tissue. ‌Dead or damaged cells can keep the wound from healing properly and increase your risk of infection. Your doctor may give you a special kind of wound bandage to help the body remove dead cells. If there is a lot of dead tissue and the wound separation is deep, you may need further surgery to remove it.

Negative pressure wound therapy. Negative pressure wound therapy (NPWT) is used to treat wounds that are not healing well, especially if there is a lot of fluid draining from the wound. It can help prevent infection, increase blood flow, remove extra fluid, and encourage the growth of new tissue. The wound is covered with a special dressing that has a small opening. A tube is attached to this opening and hooked up to a pump. When the pump is turned on, it gently draws fluid and infection out of the wound.

Closure. The doctor may close the wound separation with new stitches, or they may allow it to heal as it is. If a wound disruption is deep or complete, you may need another surgery to repair the wound.

If you notice any of these symptoms, contact your doctor immediately.

Top Picks

Sutures came apart after tooth extraction: what to do

Contents of the article

Indications for suturing after tooth extraction
Pain after suturing the socket: pathology and norm
Types of suture materials in surgical dentistry
How long does it take to walk with stitches
Complications: what to look out for
How to prevent stitches coming apart after tooth extraction
Why did the stitches come apart after the removal of a wisdom tooth

Suturing after tooth extraction is a standard procedure. The doctor sutures the hole when indicated or at the request of the patient. Tightly fixed edges of the wound accelerate the healing process, relieve pain, and reduce the risk of complications. Immediately after the surgical operation, the dentist-surgeon explains the rules of hygiene – tells how to care for the hole, what to do if the seams open after tooth extraction.

Indications for suturing after tooth extraction

In oral surgery, it is customary to suture the socket of the removed unit if:

extraction of a wisdom tooth, removal of eights was carried out;
there is a risk of severe bleeding – according to the patient’s examinations or as a preventive measure;
extirpation of impacted and dystopic teeth was performed;
, the extraction was difficult – the crown part of the tooth was severely destroyed or the roots of the extracted unit were significantly curved.

All surgical removal operations, when the dentist cuts the gum and injures the jaw tissues, involve suturing the edges of the formed hole.

Also, the socket of the extracted tooth is sutured after the implant is placed in it. The procedure is carried out as part of a one-stage implantation with delayed prosthetics. The implantologist-surgeon combines two operations. After extracting the tooth and evaluating the state of the socket according to the control x-ray, the doctor implants a dental implant, which will subsequently become a support for a fixed dental crown. The operation is performed only after preliminary preparation, since the patient must undergo a complete examination and hardware diagnostics.

Pain after suturing the socket: pathology and norm

Pain in the sutures is normal. Injury to the gums due to a serious surgical intervention causes pain – especially in the first days.

The patient must understand that tooth extraction is damage to the ligaments that hold the tooth in the gum, rupture of nerve fibers and blood vessels. During the operation, the pain is blocked by an anesthetic, but after the anesthesia wears off, discomfort is observed at the suturing site.

The following sensations should not cause concern:

aching pain in the first 24 hours after removal;
slight tissue swelling in the area of operation
discomfort and slight soreness when opening the mouth;
short-term increase in body temperature.

In rare cases, after complex removal, the patient may experience chills, swelling of the face, purulent discharge, cough, nausea. These signs should not be ignored – it is better to immediately seek help from a specialist.

Types of suture materials in surgical dentistry

Dental clinics use different types of threads to fix the edges of the sockets during tooth extraction:

Synthetic, self-absorbable by hydrolysis reaction. These are hypoallergenic threads that guarantee reliable fixation of the wound edges for about a month.
Enzyme-based natural absorbable surgical suture. The stitches disappear in 10-100 days, and the thread segments are safely removed from the human body.
Synthetic regular threads. Made from silk, nylon, polyester. Require mechanical removal after complete healing of the hole.

How long does it take to walk with sutures

The patient’s actions depend on the type of suture material used by the doctor. If the doctor used a non-absorbable option, a control appointment is prescribed after 7-10 days. During the examination, the surgeon evaluates the healing rate, the condition of the wound. Makes a decision on the need to remove sutures.

The procedure is fast and atraumatic. The thread is cut into small segments and painlessly removed from the gum. In case of discomfort and worries of the patient, the doctor can use topical anesthesia.

Self-absorbable sutures fall apart on their own after approximately three weeks. The patient may not notice the disappearance of material from the wound. Especially if healing is going well, and the hole does not bother.

Complications: what to look out for

Even a sutured socket can become a source of problems or inflammation. The patient monitors the condition himself and should consult a doctor if any alarming symptoms appear:

Severe bleeding – for a day or more.
Incessant pain – throbbing, especially severe at night or while eating.
Edema – flux in the area of tooth extraction.
Redness is not only a change in the color of the gums, but also redness on the face in the projection of the removal zone.
Blood in saliva – in the first three days after surgery.
Increase in body temperature.

The listed symptoms indicate pathological processes and require urgent medical advice. After the examination, the doctor will prescribe treatment, decide on re-suturing.

How to prevent stitches coming apart after tooth extraction

To prevent the stitches from coming apart prematurely, the patient needs to follow a few simple rules. Among them:

Do not pry, touch or try to pull out the seams with your hands, toothpicks, improvised objects.
Avoid food intake for the first 2 hours after surgery, do not smoke for 3-24 hours.
Perform all mandatory oral hygiene procedures, while brushing your teeth with increased caution.
Refuse to eat hard, hot and cold foods in the first days after removal.
Replace rinsing with antiseptic baths, when the medicinal composition is kept in the mouth for 1-1.5 minutes and spit out.

Compliance with all recommendations guarantees rapid and successful healing. Ignoring advice can provoke infection of the wound, suppuration and divergence of sutures, and the development of an inflammatory process.

Why did the seams come apart after the removal of a wisdom tooth

Suture separation after dental surgery is due to many factors:

Development of periostitis, inflammation of the periosteum. The process is accompanied by an increase in the volume of tissues, the formation of pus under the seams, which leads to the divergence of the seams. Also, the patient is worried about severe pain, putrid smell and taste in the mouth. Periostitis requires mandatory treatment, taking antibiotics, which are prescribed by the attending physician after examining the patient.
Sloppy work of a doctor. Sometimes the seams diverge due to poor placement, so the operation to remove a tooth should be performed by an experienced dentist.
Violation of hygiene and doctor’s recommendations. Sudden movements when brushing your teeth, malnutrition, active training can cause sutures to separate and re-bleed.
Swelling of the hemostatic sponge. With severe bleeding and a significant increase in the volume of hemostatic, the sponge can rise above the level of the hole, partially damage the sutures.

In most cases, open sutures do not pose a threat to the patient’s dental health. But a surgeon’s consultation is required. The doctor assess the condition of the hole, the rate of healing. Re-suture the wound if necessary.

The risk of suture separation is minimal if the tooth extraction is performed by an experienced doctor in a good dental clinic. Special ratings help patients choose a doctor and a medical center. According to them, you can evaluate the professionalism, experience and knowledge of a dentist-surgeon – read reviews, compare comments. And also learn about the quality of services of a particular dentistry – prices, promotions, offers.

The materials posted on this page are for informational purposes and are intended for educational purposes. Site visitors should not use them as medical advice. Determining the diagnosis and choosing a treatment method remains the exclusive prerogative of your doctor! The company is not responsible for possible negative consequences resulting from the use of information posted on the site https://100zubov.ru/

Suture treatment after cat sterilization: doctor’s advice in Moscow

Published in
Castration and sterilization

Author
Mikhail Shelyakov

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The appearance of sutures awaits all animals that are operated on in the classical way.

Let us remind you that we practice minimally invasive sterilization methods, otherwise known as puncture operations. After such techniques, the seams are not superimposed, their processing and removal is not required.
Therefore, this material is more of an informational nature for owners choosing cavity techniques. We also note that with any methods of performing sterilizations, the uterus and ovaries are always removed by surgery. The choice of the operation technique is determined by the experience of the surgeon, the availability of clinic equipment and the preferences of the owner of the animal.

For an animal, postoperative recovery is a somewhat worrying period. But a lot depends on the owner, as soon as the animal recovers, gets on its feet, and returns to its usual way of life. Here, competent and timely processing of the seam after the sterilization of the cat is important.
The experience of doctors, sterile conditions, modern equipment play an important role in the operation. But complications often arise due to poor-quality care of the animal after surgery. Therefore, veterinarians are asked to strictly follow all the recommendations, to take good care of your pet, and he will soon get better.

The first two weeks after surgery are critical. At this point, the wound heals and needs to be monitored as much as possible. The treatment of the seam after the sterilization of the cat occurs daily. The damaged surface is treated with an antiseptic without alcohol. Control the cleanliness and dryness of the seam. The animal is isolated from the wound by putting on a collar, blanket.

Possible complications in a cat after sterilization in the suture area

Complications in the first few days after the operation are a normal situation:

incision bleeding;
refusal of food and toilet;
drowsiness, lethargy;
bumps have formed in the seam area;
high or low temperature.

Seek immediate medical attention if the suture does not look as it should and the animal has problems:

bleeding;
sore abdomen;
discharge of pus from a wound;
abnormal discharge from the loop;
divergence of seams;
has a high temperature for more than five days;
inadequate condition of the animal.

It happens that the animal licks the seam after sterilization, if the owner did not take care of the blanket in time or the cat tore it, chewed it. In this case, you should immediately go to the vet. There is a high risk of infection and inflammation.

Removal of sutures in a cat after sterilization

Stitches are removed at least 10 days after surgery. The maximum is 2 weeks. You should not delay too much with this: the wound heals and begins to itch a lot, plus the surgical threads grow into the skin and create additional discomfort.
Veterinarian removes stitches. At the same time, the seam after sterilization of the cat is completely healed, clean, dry, without redness, swelling, blood, dried crust. If the scar looks suspicious, the procedure is postponed, the animal is examined, examined and the causes of the protracted inflammatory process are found out. As a rule, wounds heal quickly and without complications.

Mikhail Shelyakov

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