Help! My Surgical Incision Is Opening!

What To Do If Your Surgical Wound Is Opening

Bracing an incision, supporting an incision, dehiscence and evisceration after surgery
Bracing an Incision After Surgery.

It can be quite alarming to have your incision start to open after having a surgical procedure.  That doesn't mean it is an emergency, but an incision that begins to open shouldn't be ignored.  

The opening of a wound varies from minor, such as a suture coming loose or a very small area of the incision starting to pull apart to a major issue where the entire incision opens and the tissue below the incision is visible or even starting to come out through the incision.

 

In all cases, you should be keeping a close eye on your incision, even if there are no areas that have come open you should be inspecting it daily for signs of infection and to make sure it is healing steadily. 

Dehiscence After Surgery

When a surgical incision starts to open, a problem called dehiscence, you need to closely monitor your incision for worsening of the condition.  If one of your sutures has come loose or the glue strips holding your incision have fallen off, this is not typically concerning.   If the incision starts to gape open, leaving space between the sides of the incision, you should notify your surgeon.  

You want to tell your surgeon about it because even small openings, such as a suture pulling free and causing a small gap, allows foreign material like bacteria inside of the wound. This increases the chances of your wound becoming infected and your wound opening further.

 

A small opening may not require medical attention, but your surgeon should be the judge of whether or not you should be seen in the office.  A small opening may require the placement of an additional staple, or sticky bandages called "steri-strips" to support the incision while it heals.  

Your surgeon will know the particular details of your medical history, how the surgery was performed, and the potential complications that you face.

 This information, combined with the appearance of your wound, will help to dictate the treatment that you will require.

If your wound has just started to open, with only a small portion of the incision spreading apart, cover it with a clean bandage and call your surgeon. If it is wide open, cover it, call your surgeon and plan to be seen by either your surgeon or an emergency room physician right away.

Evisceration After Surgery

In rare circumstances, the opening of a wound can become very serious or even life threatening by  completely opening and eviscerating.  Evisceration means that the incision opens wide and the internal organs, particularly the intestines, begin to protrude outside of the body through the open incision. In some rare cases, the intestines will begin to fall out of the abdominal cavity through the incision.

If your wound has opened completely (enough to see internal organs or tissues) or you have tissues bulging out of the wound, cover the area with moist sterile bandages.  If you do not have bandages, moist clean linens, such as a clean pillow case, should be used to cover the area while activating the emergency response system (911).  

In these severe cases, surgery may be required to stabilize the incision.

 At the very least, the emergency room will notify your surgeon and potentially repair the incision. 

How to Prevent Wound Opening After Surgery

Inspecting your incision daily during wound care will help you spot any issues before they become severe.  Look at your incision.  Does it have drainage that looks suspicious? Does it look better than it did the week before? Does your incision look red or angry instead of steadily getting better each day?  If your incision is not healing in a slow and steady manner, you will need to address it with the staff at your surgeon's office, or your surgeon.

Bracing your wound can help prevent your incision from opening after surgery.

 Plan to brace your wound when coughing, sneezing, rising from a seated position and even when having a bowel movement.  

If you are straining to have a bowel movement, consider using a stool softener or a gentle laxative to decrease how hard you need to push. Increasing your water intake may also be helpful in preventing constipation.

A Word From Verywell:

Incision care isn't as challenging as you might think.  Take a good look at your incision daily, it should appear to be getting a little better each day or so. Keep your incision clean but don't scrub it or abuse it with harsh cleansers.  Treat it like a baby's bottom.  If the incision appears to be getting worse or starting to open, let the surgeon's office know and they can guide you in what your next step should be.

Sources:

Perioperative Nursing Care. Nursing Fundamentals http://www.brooksidepress.org/Products/Nursing_Fundamentals_II/lesson_8_Section_4.htm