What is it called when a surgical site opens?

October 1, 2025 •

5 min read

Wound dehiscence, the technical term for when a surgical incision reopens, occurs in approximately 0.5%–3.4% of abdominopelvic surgeries and is a serious complication requiring immediate medical attention. It is crucial to understand this condition, as it can be a significant setback in a patient's recovery and, in severe cases, can lead to life-threatening complications. This article will explore what is it called when a surgical site opens, delving into the factors that contribute to this phenomenon, its signs, and what steps you and your medical team will take to manage it.

Quick Summary

A surgical site opening is called wound dehiscence, a complication where the edges of a closed incision separate. This can happen due to infection, mechanical stress, or underlying health issues. A more severe complication is evisceration, where internal organs protrude through the wound. Urgent medical care is required for both.

Key Points

Wound Dehiscence Defined: The separation of a surgical incision after it has been closed, occurring when wound edges pull apart due to compromised healing or stress.
Evisceration is an Emergency: Evisceration is a severe complication of dehiscence where internal organs protrude through the wound, requiring immediate emergency surgery.
Risk Factors Vary: Factors like obesity, diabetes, malnutrition, smoking, and infection can increase the risk of dehiscence.
Symptoms Require Immediate Action: A popping sensation, visible gapping, increased pain, foul-smelling drainage, or fever are key signs of dehiscence that require contacting a doctor.
Treatment Depends on Severity: Treatment can range from local wound care and negative pressure therapy for minor cases to emergency surgery for severe dehiscence or evisceration.
Prevention is Key: Following post-operative care instructions, supporting the wound during physical strain, and managing underlying health issues are crucial preventive measures.
Healing by Secondary Intention: For less severe cases, the wound may be allowed to heal naturally from the inside out, a slower but often effective process.

What is Wound Dehiscence?

When a surgical site opens, the medical term is wound dehiscence. This event signifies a breakdown in the healing process where the closed edges of a surgical incision, which were previously held together with stitches or staples, pull apart. Dehiscence can be partial, affecting only the superficial layers of the skin, or complete, involving all tissue layers down to the muscle. It is a complication that most frequently occurs within the first two weeks following a surgical procedure, when the wound is still fragile and has not yet achieved its full tensile strength.

The crucial distinction: Dehiscence vs. Evisceration

While dehiscence is the separation of a surgical wound, a more critical and life-threatening condition is evisceration. Evisceration is a severe form of dehiscence, most commonly associated with abdominal surgeries, where internal organs or other tissues protrude through the open wound. This is a medical emergency that requires immediate surgical intervention to prevent infection, dehydration, and tissue damage. For a patient experiencing evisceration, covering the protruding organs with a sterile, saline-moistened dressing while awaiting emergency care is a critical first-aid step.

Causes and risk factors of wound dehiscence

Wound dehiscence can be triggered by a combination of factors related to the patient's health, the surgical procedure, and postoperative care. Understanding these contributing elements is essential for prevention.

Patient-related risk factors

Obesity: Excessive body weight can place increased tension on a surgical incision, especially in the abdominal area, making it more prone to separation.
Diabetes: Poorly controlled blood sugar levels can impair the body's ability to heal wounds effectively by affecting white blood cell function and blood flow.
Malnutrition: Inadequate protein, vitamin C, and zinc levels can delay healing, as these nutrients are vital for collagen synthesis and tissue repair.
Smoking: Nicotine constricts blood vessels, reducing blood flow and oxygen supply to the healing tissue, which slows down the process.
Advanced Age: Older patients may have a slower tissue repair mechanism, increasing their risk.
Chronic Corticosteroid Use: Long-term use of corticosteroids can weaken tissue and suppress the immune response.
Connective Tissue Disorders: Genetic conditions like Ehlers-Danlos syndrome can cause poor wound healing due to defects in collagen production.

Procedural and mechanical factors

Wound Infection: Infection is a leading cause of dehiscence, as bacteria can break down the wound's healing tissue and suture materials.
Mechanical Stress: Any activity that puts strain or tension on the wound, such as heavy lifting, excessive coughing, straining during bowel movements, or severe vomiting, can cause sutures to break.
Surgical Technique: Inadequate or improper suturing technique, inappropriate suture material, or applying too much tension when closing the wound can increase the risk of the incision separating.
Hematoma or Seroma: A large collection of blood (hematoma) or fluid (seroma) under the incision can place pressure on the wound, hindering healing and potentially causing it to open.

Signs and symptoms to watch for

Recognizing the early signs of dehiscence is crucial for timely intervention and preventing more serious complications. You should contact your surgeon or healthcare provider immediately if you experience any of the following:

A sudden 'popping' or 'ripping' sensation in the wound.
Visible separation or gapping of the wound edges.
A significant increase in pain, redness, or swelling around the incision.
Drainage from the wound that is different from the normal, clear to pink fluid. This can include cloudy, yellow, green, or foul-smelling pus.
Bleeding from the incision site.
Fever or chills, which can indicate an infection.
Broken or loose stitches or staples.

Comparison of wound dehiscence types

This table outlines the key differences between superficial and complete wound dehiscence.


Feature	Superficial Dehiscence	Complete Dehiscence	Evisceration (Severe Dehiscence)
Depth of Separation	Only the outer skin and superficial tissue layers separate.	All tissue layers of the wound separate, including muscle.	Complete wound separation with protrusion of internal organs.
Risk Level	Generally less severe, with a lower risk of systemic complications.	More serious, with higher risks of infection and delayed healing.	Life-threatening medical emergency requiring urgent surgery.
Treatment	Local wound care, including regular dressing changes, sometimes with negative pressure wound therapy (NPWT).	Typically requires surgical debridement and re-closure in the operating room.	Immediate emergency surgery to return organs to the abdominal cavity and close the wound.
Symptoms	Visible gapping of skin, increased drainage.	Visible gapping of skin and muscle tissue, potential for infection.	Visible protrusion of internal organs, severe pain, potentially shock.

Treatment and management

The treatment for dehiscence depends on the severity and underlying cause. It is a critical component of post-surgical recovery and should be managed under the strict guidance of a healthcare professional.

For less severe cases

Local Wound Care: The wound may be left to heal naturally from the bottom up, a process known as healing by secondary intention. This involves regular cleaning and applying specific types of dressings.
Negative Pressure Wound Therapy (NPWT): Also known as a wound VAC, this therapy uses a vacuum pump to pull fluid from the wound and promote tissue growth. It is highly effective for managing larger or more complex superficial dehiscence.
Antibiotics: If an infection is present, your doctor will prescribe antibiotics to clear the infection and aid the healing process.

For severe cases (including evisceration)

Emergency Surgery: Complete dehiscence, especially with evisceration, is a surgical emergency. The patient will be taken back to the operating room for debridement of dead or infected tissue and surgical re-closure of the wound.
Protection of Organs: In cases of evisceration, the protruding organs will be covered with a sterile, saline-moistened dressing to keep them moist and protected from infection before emergency surgery.

Prevention strategies for patients

Taking proactive steps can significantly reduce the risk of wound dehiscence and promote healthy healing after surgery. A patient's active participation in their recovery is paramount.

Follow Postoperative Instructions: Adhere strictly to your surgeon's guidelines regarding wound care, activity limitations, and medication schedules.
Support the Incision: When coughing, sneezing, or laughing, gently place a pillow or your hands over the incision to provide support and minimize strain. This technique is known as splinting.
Avoid Heavy Lifting: Do not lift heavy objects or engage in strenuous exercise for at least 6-8 weeks, or as advised by your doctor.
Manage Underlying Health Conditions: Effectively manage conditions like diabetes to ensure stable blood sugar levels that support healing.
Prioritize Nutrition: A balanced diet rich in protein, vitamins, and minerals provides the building blocks your body needs for tissue repair.
Quit Smoking: Cessation of smoking is one of the most effective ways to improve wound healing and overall health.
Watch for Warning Signs: Stay vigilant for any symptoms of infection or separation and report them to your healthcare provider immediately.

Conclusion

What is it called when a surgical site opens is a question with a clear and serious answer: wound dehiscence. While it is a relatively uncommon complication, it represents a significant risk to a patient's recovery. The more severe form, evisceration, is a life-threatening emergency. Both conditions stem from a failure of the healing process due to various patient-specific and procedural factors. By being aware of the causes and risk factors, recognizing the warning signs, and meticulously following postoperative care instructions, patients can play an active role in preventing this complication. Prompt medical attention is essential for effective treatment and to get back on the path to a full recovery.

Authoritative Link

For more detailed information on surgical wound complications, consult the National Institutes of Health (NIH) resource on wound dehiscence and evisceration: NCBI Bookshelf: Wound Dehiscence

Frequently Asked Questions

Wound dehiscence typically occurs in the early postoperative period, most often between five and eight days after surgery, when the wound is still fragile.

If you notice your surgical incision has opened, you should contact your surgeon or healthcare provider immediately. For a severe opening with organ protrusion (evisceration), call 911 or go to the emergency room immediately.

Minor superficial dehiscence may be managed with careful at-home care under a doctor's guidance, involving cleaning and dressing changes. However, all cases should be evaluated by a healthcare professional to determine the severity and the correct course of action.

To prevent dehiscence, follow all postoperative instructions, avoid straining and heavy lifting, support your incision with a pillow when coughing or sneezing, and adhere to a healthy diet and lifestyle, including quitting smoking.

While a surgical wound infection is a common cause of dehiscence, it is not the only cause. Other factors such as mechanical stress, poor nutrition, underlying health conditions like diabetes, and technical issues with sutures can also lead to the complication.

A large dehisced wound often requires professional medical treatment, which may include surgical debridement (removal of dead tissue), antibiotics, and potentially Negative Pressure Wound Therapy (NPWT) or a repeat surgery for re-closure.

Dehiscence is the separation of wound edges, while evisceration is the more severe complication where internal organs protrude through the wound following dehiscence. Evisceration is a medical emergency.